21 NCAC 16Q .0102         APPLICATION FOR GENERAL ANESTHESIA OR SEDATION PERMIT, PERMIT RENEWAL, AND PERMIT REINSTATEMENT

(a)  An applicant for a general anesthesia or sedation permit shall be licensed and in good standing with the Board.

(b)  All permit applications shall be made on the forms furnished by the Board at www.ncdentalboard.org and shall include:

(1)           the full name;

(2)           the mailing address;

(3)           the North Carolina dental license number;

(4)           a telephone number; and

(5)           an email address.

(c)  In addition to the information in Paragraph (b) of this Rule, all applications for a general anesthesia, moderate conscious sedation, moderate pediatric conscious sedation, or minimal conscious sedation permit shall include:

(1)           the addresses of all dental offices where the applicant intends to use general anesthesia or sedation;

(2)           dental education, including dental school name, dates attended, degree received, and any other dental post-graduate education or specialty degrees received;

(3)           a resume or curriculum vitae;

(4)           the names of and copies of unexpired BLS certifications for any auxiliaries that will assist the applicant with general anesthesia or sedation;

(5)           a statement disclosing and explaining any instances of patient mortality or morbidity in connection with applicant's prior use of general anesthesia or sedation; and

(6)           documentation of the required qualifications for the permit for which the applicant is applying, as set out in Rule .0201, .0301, .0404, or .0504 of this Subchapter.

(d)  In addition to the information in Paragraph (b) of this Rule, all applications for an itinerant permit shall include:

(1)           North Carolina general anesthesia or sedation permit number; and

(2)           a statement of compliance with the requirements for the itinerant permit for which the applicant is applying, as set out in Rule .0206, .0304, or .0406 of this Subchapter.

(e)  All applications for renewal of a general anesthesia or sedation permit shall be submitted electronically through the Board's website, www.ncdentalboard.org, and shall include:

(1)           the full name;

(2)           the permit number and expiration date;

(3)           the addresses of all dental offices where the permit holder uses general anesthesia or sedation; and

(4)           a statement disclosing and explaining any instances of patient mortality or morbidity in connection with use of general anesthesia or sedation that occurred during the calendar year preceding the application and that were not previously disclosed to the Board.

(f)  All applications for reinstatement of a general anesthesia or sedation permit shall be made on forms furnished by the Board at www.ncdentalboard.org and shall include:

(1)           the full name;

(2)           the permit number and date of issuance;

(3)           the mailing address;

(4)           the North Carolina dental license number;

(5)           the addresses of all dental offices where the applicant intends to use general anesthesia or sedation; and

(6)           a statement disclosing and explaining any instances of patient mortality or morbidity in connection with use of general anesthesia or sedation that occurred during the calendar year preceding the application.

(g)  Any permit obtained through fraud or by any false representation shall be revoked.

History Note:        Authority G.S. 90-28; 90-30.1;

Eff. August 1, 2021.