Sports physicals, parking permits, Medicaid prior authorization, WIC and school meal statements, MOST, medical cannabis and hunting permits from South Dakota agencies.
South Dakota's clinician forms are spread across a dozen programs, and the busiest for most practices are the school sports physical and the disabled parking permit. The SDHSAA Preparticipation Physical Exam Form sits in the association's annual Physical Exams & Sports Concussions packet. The Department of Revenue's Form 1305 covers permanent and temporary parking permits and disabled person plates. South Dakota Medicaid uses numbered prior authorization forms, PA-100 for general services and PA-101 for DME and nutrition. This hub lists 16 forms.
A few things work differently here. Workers' compensation has no state-prescribed physician report; the one physician form is Form 112, the finger amputation hand diagram. Form 1305 is a web form that must be printed and taken to the county treasurer. Medicaid prior authorization requests are faxed or emailed with medical records, and South Dakota Medicaid is fee-for-service, with no managed care plans. Medical cannabis certifications are entered only in the state portal. 3 forms here have a Spanish version, including the sports physical and the MOST.
DOL-LM-112Records the exact point of finger amputation on a hand diagram so the insurer can compute the scheduled loss under SDCL 62-4-6.
Physician certifies a walking-limiting physical disability (200-foot rule, assistive device, oxygen, lung/heart condition, arthritic/neurological/orthopedic limitation) for a permanent or temporary (up to 12 months) portable parking permit or disabled person plates.
General South Dakota Medicaid prior authorization request for medical services, submitted with supporting medical records.
Requests South Dakota Medicaid prior authorization for durable medical equipment and nutrition products.
Requests prior authorization of private duty nursing or extended home health aide services, submitted with a physician-signed plan of care.
Ordering provider requests South Dakota Medicaid prior authorization for genetic testing.
Record of the physical examination and recommendation for participation, in the annual SDHSAA participation packet that also covers concussion and cardiac information.
Physician release allowing a wrestler with a skin lesion to compete.
Meal modification request covering school meals and CACFP/SFSP agencies; Part B box A (disability affecting a major life activity) requires a recognized medical authority's statement.
Medical documentation required by 7 CFR 246.10(d) for WIC to issue exempt infant formula, WIC-eligible nutritionals or non-contract formula, and to modify WIC foods, for a participant with a qualifying medical condition.
Portable medical order for patients with terminal illness covering CPR, scope of treatment and nutrition.
Registered practitioner certifies that a patient has a debilitating medical condition, triggering the patient's emailed application link for a registry card.
Provider report of a reportable communicable disease to the South Dakota Department of Health.
Physician verification of a temporary or permanent ambulatory condition so the hunter can get a 4-year (or temporary) permit to shoot from a parked motor vehicle.
Physician or chiropractor statement that the applicant cannot use a conventional bow (30 lb draw) due to loss of use of an arm or wheelchair use, for a crossbow or draw-lock permit.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
A Doctor of Medicine, Doctor of Osteopathy, Doctor of Chiropractic, licensed physician assistant or licensed nurse practitioner. The clinician completes the Preparticipation Physical Exam Form page of the annual packet, which also covers concussion and cardiac information, and it goes back to the school. Local school boards decide whether exams are annual, biennial or triennial, and exams done after April 1 count for the next year. A Spanish version is available.
With Form 1305, the Disabled Person Parking Permits and License Plates Application. A licensed physician completes the medical certification on page 2: walking limited to 200 feet, an assistive device, oxygen, a lung or heart condition, or an arthritic, neurological or orthopedic limitation. Blindness alone does not qualify. The patient prints the web form and takes it to the county treasurer. Permits cost nothing. Permanent permits renew every 5 years without a new certification; temporary renewals need one.
PA-100 for general medical services, PA-101 for durable medical equipment and nutrition products, PA-104 for private duty nursing and extended home health, with the physician-signed plan of care attached, and PA-106 for genetic testing. The Department of Social Services, Division of Medical Services, reviews them. Send them by fax or email with the supporting medical records. On the PA-101 every field is required, and the DME provider completes it with the prescriber's order and records.
In the Medical Cannabis Patient/Caregiver/Practitioner Portal; there is no paper form. A physician, PA or APRN with authority to prescribe, registered with the program, certifies that the patient has a debilitating medical condition. The patient then receives an emailed link to apply for a registry card. Practitioners licensed in South Dakota, or in a nonresident patient's home state, can certify. Cards are renewed annually.