SECTION .0500 – LICENSURE BY CREDENTIALS
21 NCAC 16C .0501 DENTAL HYGIENE LICENSURE BY
CREDENTIALS
(a) An applicant for a dental hygiene license by
credentials shall submit to the Board:
(1) a completed, notarized application form
provided by the Board;
(2) the nonrefundable licensure by credentials
fee;
(3) an affidavit from the applicant stating for
the two years immediately preceding the application:
(A) the dates that and locations where the applicant has
practiced dental hygiene;
(B) that the applicant has provided at least 2000 hours
of clinical care directly to patients; and
(C) that the applicant has continuously held an active,
unrestricted dental hygiene license issued by another U.S. state or any U.S.
territory.
(4) a statement disclosing and explaining any
disciplinary actions, investigations, malpractice claims, state or federal
agency complaints, judgments, settlements, or criminal charges;
(5) a statement disclosing and explaining
periods within the last 10 years of any voluntary or involuntary commitment to
a hospital or treatment facility, observation, assessment, or treatment for
substance abuse, with verification demonstrating that the applicant has
complied with all provisions and terms of any county or state drug treatment
program, or impaired dental hygiene or other impaired professionals program;
and
(6) a copy of a current CPR certificate.
(b) In addition to the requirements of Paragraph (a) of
this Rule, an applicant for a dental hygiene license by credentials shall
arrange for and ensure the submission to the Board office the following
documents as a package, with each document in an unopened envelope sealed by
the entity involved:
(1) official transcripts certifying that the
applicant graduated from a dental hygiene program accredited by the Commission
on Dental Accreditation of the American Dental Association;
(2) if the applicant is or has ever been
employed as a dental hygienist by or under contract with a federal agency, a
letter certifying the applicant's current status and disciplinary history from
each federal agency where the applicant is or has been employed or under
contract;
(3) a certificate of the applicant's licensure
status from the regulatory authority or other occupational or professional
regulatory authority and a full, fair and accurate disclosure of all
disciplinary actions taken or investigations pending, from all licensing
jurisdictions where the applicant holds or has ever held a dental hygiene
license or other occupational or professional license;
(4) a report from the National Practitioner
Databank;
(5) a report of any pending or final
malpractice actions against the applicant verified by the malpractice insurance
carrier covering the applicant. The applicant shall submit a letter of
coverage history from all current and all previous malpractice insurance
carriers covering the applicant;
(6) the applicant's passing score on the
National Board Dental Hygiene Examination administered by the Joint Commission
on National Dental Examinations; and
(7) the applicant's passing score on the
licensure examination conducted by a regional testing agency or independent
state licensure examination that is substantially equivalent to the clinical
licensure examination required in North Carolina as set out in Rule .0303 of
this Subchapter.
(c) All information required shall be completed and
received by the Board office as a complete package with the initial application
and application fee. Incomplete applications shall be returned to the
applicant.
(d) All applicants shall submit to the Board a signed
release form, completed Fingerprint Record Card, and other form(s) required to
perform a criminal history check at the time of the application. The forms are
available from the Board office.
(e) An applicant for dental hygiene licensure by
credentials shall pass written examinations and, if deemed necessary based on
the applicant's history, a clinical simulation examination administered by the
Board. If the applicant fails the written examinations, the applicant may
retake the examination two additional times during a one year period, as
required by Rule .0311 of this Subchapter. Applicants who fail the clinical
examination or who do not pass the written examination after three attempts
within one year may not reapply for licensure by credentials.
(f) Should the applicant reapply for licensure by
credentials, an additional licensure by credentials fee shall be required at
the time of reapplication.
(g) Any license obtained through fraud or by any false
representation shall be void ab initio and of no effect.
History Note: Authority G.S. 90-223; 90-224.1; 90-229;
Temporary Adoption Eff. January 1, 2003;
Eff. January 1, 2004;
Recodified from Rule .0401 Eff. June 1, 2006;
Amended Eff. September 1, 2014; February 1, 2010.