21 NCAC 16B .0801. TEMPORARY VOLUNTEER DENTAL PERMIT

(a)  An applicant for a Temporary Volunteer Dental License shall submit to the Board:

(1)           A completed, notarized application form provided by the Board, with a photograph of the applicant taken within six months of the application date attached;

(2)           A statement from all jurisdictions in which the applicant is now or has ever been licensed, disclosing the applicant's disciplinary history and current status of the applicant's license;

(3)           A statement signed by a N.C. licensed dentist agreeing to provide supervision or direction to the temporary volunteer dentist, stating where, during the effective period of the permit such supervision or direction will occur, and affirming that no fee or monetary compensation of any kind will be paid to the applicant for dental services performed; and

(4)           A statement signed by the applicant stating where the applicant will practice, the type of facility where the practice will occur, the duration of the practice, the name of the supervising dentist, and affirming that no fee will be charged or accepted.  The applicant shall update the information within five days of any changes in the practice location or facility.

(b)  All information required must be completed and received in the Board office as a complete package at least two weeks prior to the issuance of the license.  Incomplete applications shall be returned to the applicant.

(c)  To renew the Temporary Volunteer Dental License the licensee shall submit the information required in Subparagraphs (a)(2) – (4) of this Rule, along with an affidavit stating that the information on the original application is correct and requires no update or correction.

(d)  All required information shall be completed and received in the Board office as a complete package at least two weeks prior to the renewal of the license.  Incomplete applications shall be returned to the applicant.  The applicant shall report any changes to submitted information within five days of when the licensee knew or should have known of the changes.

 

History Note:        Authority G.S. 90-29; 90-37.2;

Eff. February 1, 2008;

Amended Eff. September 1, 2014.