Section .0500 – Licensure By Credentials

Link to law: 21 - occupational licensing boards and commissions/chapter 16 - dental examiners/subchapter c/21 ncac 16c .0501.html
Published: 2015

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(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


(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.


(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;


(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


(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


(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


(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.