South Dakota Administrative Rules
Title 20 - PUBLIC SAFETY
Article 20:47 - PHYSICIANS AND SURGEONS
Chapter 20:47:03 - Licensure
Section 20:47:03:03 - General application requirements

(1) Submit an affidavit, with a photograph of the applicant attached, attesting to the applicant's qualifications as required by the provisions of SDCL chapter 36-4 and this article;

(2) Submit a certificate of good moral character signed by two persons holding a license or certificate from this board, a similar board in another state, the District of Columbia, the National Board of Medical Examiners, or the National Board of Osteopathic Physicians and Surgeons, who are not at the time of making the certificate under any charge or accusation which would be grounds for cancellation, suspension, or revocation of their license. The persons shall verify that they are personally acquainted with the applicant and know of the applicant's moral character;

(3) List all states in which the applicant is or has been licensed to practice medicine and state if such a license has ever been canceled, suspended, or revoked or if proceedings have ever been instituted against the applicant for cancellation, suspension, or revocation;

(4) State all places where the applicant has previously practiced medicine and give the time of the practice;

(5) State whether the applicant has ever been convicted of any criminal offense, exclusive of misdemeanor traffic violations, or if any prosecution against the applicant in any court for a felony or a crime involving moral turpitude is pending;

(6) State whether the applicant has ever been denied a license to practice in another state;

(7) State whether the applicant is currently suffering from any condition for which they are not being appropriately treated that impairs their ability to practice medicine in a competent, ethical, and professional manner;

(8) State whether the applicant has ever appeared or been requested to appear before any licensing board concerning any violation of law or regulation of any state, district, territory, or province of the United States or Canada;

(9) State whether the applicant has ever had hospital staff privileges revoked, suspended, reduced, or otherwise restricted;

(10) Give the history of the applicant's medical schooling, including dates and places, diplomas earned, and average grade received;

(11) If the applicant completed graduate medical education training after July 1, 1987, submit a certificate showing that the applicant has successfully completed a program of graduate medical education of at least two years through a hospital approved by the board. The records of the graduate medical education program must establish the degree of proficiency of the applicant's performance. Applicants who completed graduate medical education before July 1, 1987, must submit a certificate of internship or residency showing that the applicant has served not less than one year as an intern or resident in a hospital approved by the board or its equivalent;

(12) List all dates and places where the applicant has previously taken the Federation Licensing Examination or United States Medical Licensing Examination;

(13) State whether the applicant has ever been terminated, asked to resign, or resigned or otherwise not completed any postgraduate or residency training program;

(14) State whether the applicant has ever been subject to proceedings by a professional society to revoke, reduce, or restrict membership;

(15) State whether the applicant has ever been notified of a complaint by a medical facility, professional society or association, or any licensing agency;

(16) State whether the applicant has ever settled a civil damages action, by the payment of money or otherwise, or had a civil judgment rendered against the applicant involving medical malpractice or the practice of medicine.