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To fill out this document, start by entering your personal information including your name, profession, and license details. Next, provide your address and contact information accurately. Finally, complete the answer sheet and evaluation section before submission.

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How to fill out the Nitrous Oxide Sedation Basic Review Course?

  1. 1

    Enter your personal information in the designated fields.

  2. 2

    Provide accurate details about your profession and license.

  3. 3

    Complete the answer sheet based on course materials.

  4. 4

    Fill out the evaluation section thoughtfully.

  5. 5

    Prepare the document for submission by checking for errors.

Who needs the Nitrous Oxide Sedation Basic Review Course?

  1. 1

    Dental professionals looking to fulfill continuing education requirements.

  2. 2

    Registered dental hygienists seeking additional certification.

  3. 3

    Dentists who wish to enhance their skills in sedation techniques.

  4. 4

    Dental assistants involved in sedation procedures during treatments.

  5. 5

    Healthcare educators aiming to provide updated training to students.

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What are the instructions for submitting this form?

To submit this form, you may choose to fax it to 518.514.1103 or email it to CESupport@dentallearning.com. Alternatively, you can send the completed form via postal mail to ADL, PO Box 14585, Albany, NY 12212. Ensure that your submission is completed within the designated timeframe for successful credit approval.

What are the important dates for this form in 2024 and 2025?

The important dates for this form include the publication date in January 2017, the revised date in February 2020, and the expiration date in February 2023, impacting when courses must be completed.

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What is the purpose of this form?

This form serves multiple purposes, primarily to ensure participants in the Nitrous Oxide Sedation course can document their progress and feedback. It aids in the evaluation of the course's effectiveness and identifies areas for improvement. Additionally, it facilitates communication between participants and the Academy of Dental Learning regarding their experiences.

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Tell me about this form and its components and fields line-by-line.

This form includes various fields to capture essential information from participants of the Nitrous Oxide Sedation course.
fields
  • 1. Name: Enter your full name.
  • 2. Profession: Specify your job role in the dental field.
  • 3. License State: Indicate the state where your dental license is active.
  • 4. License Number: Provide your official license number.
  • 5. Expiration Date: State the expiration date of your license.
  • 6. Address: Fill in your current address.
  • 7. City: Enter your city.
  • 8. State: Specify your state.
  • 9. Zip Code: Input your postal zip code.
  • 10. Telephone: Provide your contact telephone number.
  • 11. Fax: Enter your fax number if applicable.
  • 12. E-mail: Submit your email address.

What happens if I fail to submit this form?

Failure to submit this form may result in loss of continuing education credit for the course. It is essential to ensure that all required sections are completed accurately before submission. Not submitting may delay your certification process.

  • Incomplete Information: Missing essential details can lead to processing delays.
  • Submission Past Deadline: Submitting the form after the expiration date will invalidate the course.
  • Payment Issues: Failure to provide valid payment information may result in course cancellation.

How do I know when to use this form?

This form should be used when you have completed the Nitrous Oxide Sedation course and need to document your learning. It is also used to provide feedback about the course content and your experience. Any dental professional wishing to receive continuing education credit must submit this form.
fields
  • 1. Course Completion: To verify you have completed the course and to record your achievements.
  • 2. Feedback Submission: To provide the Academy with valuable insights and evaluations.
  • 3. Certification Request: To request certification indicating your successful completion of the course.

Frequently Asked Question

How do I edit this PDF?

To edit this PDF, upload the document to PrintFriendly and use our editing tools to modify the text and fields.

Can I fill out the document online?

Yes, you can fill out the document directly online using PrintFriendly's PDF editor.

What is the refund policy?

If you're not satisfied with the course materials, you may return them within 15 days for a full refund excluding shipping.

How do I submit the completed form?

You can submit the completed form via email, fax, or postal mail to the provided addresses.

Is there a deadline for submissions?

Please refer to the expiration date mentioned in the document for submission deadlines.

Who can benefit from this course?

Dental professionals, including dentists and hygienists, will find this course beneficial for their continuing education.

What is ADA CERP?

ADA CERP is a service that provides resources for identifying quality dental education providers.

Can I save my edits?

Currently, users can edit and download PDFs, but saving directly on the site is not available.

Are there any prerequisites for this course?

There are no prerequisites, but it is recommended for professionals in the dental field.

Where can I find more information about the course?

More information is available on the Academy's website, including course content and FAQs.

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Nitrous Oxide Sedation Basic Review Course

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