Prior to the establishment of an independent practice, an RDHAP shall provide to the board documentation of an existing relationship with at least one dentist for referral, consultation, and emergency services, on the form entitled: Documentation of RDHAP Relationship with Dentist, (rev. 5/99), which is hereby incorporated by reference. The dentist's license shall be current, active and not under discipline by the board. Any change shall be reported to the Board in writing, within 30 days following such change.