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Section .0600 – Limited Volunteer Dental License


Published: 2015

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SECTION .0600 – LIMITED VOLUNTEER DENTAL LICENSE

 

21 NCAC 16B .0601          LIMITED VOLUNTEER DENTAL LICENSE

(a)  An applicant for a limited volunteer dental license

shall submit to the Board:

(1)           a completed, notarized application form

provided by the Board;

(2)           the non-refundable limited volunteer dental

licensure fee;

(3)           an affidavit from the applicant stating:

(A)          for the five years immediately preceding

application, the dates that and locations where the applicant has practiced

dentistry;

(B)          that the applicant has provided at least 1,000 hours

per year of clinical care directly to patients for at least five years, not

including post graduate training, residency programs or an internship; and

(C)          that the applicant has provided at least 500 hours

of clinical care directly to patients within the last five years, not including

post graduate training, residency programs or an internship;

(4)           a statement disclosing and explaining periods

within the last 10 years of any voluntary or involuntary commitment to a

hospital or treatment facility, of observation, assessment, or treatment for

substance abuse, with verification from the applicable program demonstrating

that the applicant has complied with all provisions and terms of any county or

state drug treatment program, or impaired dentists or other impaired

professionals program; and

(5)           a copy of a current CPR certification card.

(b)  In addition to the requirements of Paragraph (a) of

this Rule, an applicant for a limited volunteer dental license 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 verifying that the

applicant graduated from a dental school accredited by the Commission on Dental

Accreditation of the American Dental Association;

(2)           a certificate of the applicant's licensure

status from the dental regulatory authority or other occupational or

professional regulatory authority and, if applicable, of the applicant's

authorization to treat veterans or personnel enlisted in the United States

armed services, and information regarding all disciplinary actions taken or

investigations pending, from all licensing jurisdictions where the applicant

holds or has ever held a dental license or other occupational or professional

license;

(3)           a report from the National Practitioner

Databank;

(4)           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;

(5)           the applicant's passing score on the Dental

National Board Part I and Part II written examination administered by the Joint

Commission on National Dental Examinations; and

(6)           the applicant's passing score on a

licensure examination in general dentistry substantially equivalent to the

clinical licensure examination required in North Carolina as set out in Rule .0303

of this Subchapter, conducted by a regional testing agency or a state licensing

board.

(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 such other form(s)

required to perform a criminal history check at the time of the application.  The

forms are available at the Board.

(e)  An applicant for limited volunteer dental license must pass

written examinations as set out in G.S. 90-37.1 and, if deemed necessary by the

Board based on the applicant's history, a clinical simulation examination

administered by the Board. An applicant who fails the written exam may retake

it two additional times during a one year period. The applicant shall wait a

minimum of 72 hours before attempting to retake a written examination.  Applicants

who fail the clinical examination or who do not pass the written examination

after three attempts in one year may not reapply for a limited volunteer dental

license.

(f)  Should the applicant reapply for a limited volunteer

dental license, an additional limited volunteer dental license fee shall be

required.

(g)  Any license obtained through fraud or by any false

representation shall be void ab initio and of no effect.

(h)  The license may be renewed on an annual basis provided

that the licensee provides documentation that he or she has practiced a minimum

of 100 hours, completed continuing education requirements as required in

Subchapter 16R of these Rules and has current CPR certification.

 

History Note:        Authority G.S. 90-28; 90-37.1;

Temporary Adoption Eff. January 1, 2003;

Eff. January 1, 2004;

Recodified from 21 NCAC 16B .0501 Eff. March 1, 2006;

Amended Eff. September 1, 2014.