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    Anesthesia and Sedation Forms

    Note: If you are applying under a conscious sedation or general anesthesia certificate, you must also apply under the pediatric sedation endorsement if you will be administering sedation to pediatric patients ages 8 years or younger.

    Pediatric Sedation Endorsement Application Form

    Allied Sedation Monitoring Certification Application Form

    Conscious Sedation Application Form

    Conscious Sedation Re-certification Form

    General Anesthesia Application Form

    General Anesthesia Re-certification Form

    Sedation Contractor INITIAL-RENEWAL Form

    Adverse Reaction Form

    Inspection Checklists

    CS Inspection Checklist and Self-evaluation Form

    CSS Inspection Checklist and Self-evaluation Form

    GA Inspection Checklist and Self-evaluation Form

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    Board of Dentistry
    335 Randolph Ave Suite 250, St. Paul, MN  55102
    Phone: 612.617.2250   Toll Free:  888.240.4762   Fax: 651-797-1373
    MN Relay Service for Hearing Impaired: 800.627.3529
    dental.board@state.mn.us

    Language Line Translation Services Now Available (612) 617-2250

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    Affirmative Action

    The State of Minnesota is an equal opportunity employer. Equal opportunity means that an applicant or employee cannot be treated unfairly because of personal characteristics that are protected under the law. Protected characteristics include: race, color, national origin, religion, creed, sex, marital status, familial status, sexual orientation, age, disability, status with regard to public assistance, and membership or activity in a local human rights organization.

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