The standard form shall be in triplicate and be distributed as follows:
- (1) The original shall be kept by the person named on the form;
- (2) The first copy shall be maintained by the physician, physician assistant, or nurse practitioner signing the form; and
- (3) The second copy shall be mailed to the department by the physician, physician assistant, or nurse practitioner signing the form.
Source: 32 SDR 38, effective September 5, 2005; 41 SDR 218, effective July 1, 2015.
General Authority: SDCL 34-12F-3.
Law Implemented: SDCL 34-12F-3.
Prior versions effective: 2005-09-05.