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.