North Carolina Administrative Code › Title 21 - OCCUPATIONAL LICENSING BOARDS AND COMMISSIONS › Chapter 16 - DENTAL EXAMINERS › Subchapter C - LICENSURE DENTAL HYGIENISTS › Section .0600 - REINSTATEMENT OF DENTAL HYGIENE LICENSE › Section 16C .0601 - APPLICATION FOR REINSTATEMENT AND PROOF OF COMPETENCY

Current through Register Vol. 39, No. 2, July 15, 2024
(a)
				  Any person desiring to practice dental hygiene in North Carolina whose North
				  Carolina dental hygiene license has been revoked, suspended, retired, or
				  expired shall submit to the Board an application for reinstatement. All
				  applications for reinstatement of a dental hygiene license shall be made on the
				  forms furnished by the Board at www.ncdentalboard.org and shall include:
(1) original dental hygiene license number
				  and date of issuance;
(2) full
				  name;
(3) street address as of the
				  date of the application;
(4)
				  telephone number;
(5) email
				  address;
(6) citizenship or
				  immigration status, with verifying documentation;
(7) a statement disclosing and explaining the
				  nature, facts, and disposition of any matter where the applicant has ever:
(A) been summoned to court or before a
				  magistrate for the violation of any law or ordinance or for the commission of
				  any felony or misdemeanor;
(B) been
				  arrested for the violation of any law or ordinance or for the commission of any
				  felony or misdemeanor;
(C) been
				  taken into custody for the violation of any law or ordinance or for the
				  commission of any felony or misdemeanor;
(D) been indicted for the violation of any
				  law or ordinance or for the commission of any felony or misdemeanor;
(E) been convicted or tried for the violation
				  of any law or ordinance or for the commission of any felony or
				  misdemeanor;
(F) been charged with
				  the violation of any law or ordinance or for the commission of any felony or
				  misdemeanor; or
(G) pleaded guilty
				  to the violation of any law or ordinance or for the commission of any felony or
				  misdemeanor;
(8) whether
				  the applicant is under investigation as of the date of the application or has
				  ever been investigated by the Board or any other licensing board;
(9) whether the applicant has ever had a
				  civil lawsuit related to the practice of dental hygiene settled;
(10) all dental hygiene licenses from other
				  jurisdictions ever held by the applicant, including dates of
				  licensure;
(11) a statement
				  disclosing all the applicant's dental hygiene practices, including:
(A) the dates during which the applicant was
				  employed as a dental hygienist;
(B)
				  the name and address of each employer; and
(C) the reason for the termination of each
				  employment;
(12) a
				  statement disclosing and explaining any current condition or impairment,
				  including substance abuse, alcohol abuse, or a mental, emotional, or nervous
				  disorder or condition, that in any way affects the ability to practice dental
				  hygiene. For purposes of this Rule, "current" means recently enough that the
				  condition or impairment may affect the applicant's ability to function as a
				  dental hygienist as set out in
				  G.S.
				  90-229(a)(4) and (13). If
				  the applicant contends that the condition or impairment is reduced or
				  ameliorated because the applicant is receiving ongoing treatment or
				  participating in a monitoring or support program, the applicant may provide
				  information regarding the treatment or program, and may include any
				  verification demonstrating that the applicant has complied with all provisions
				  and terms of any drug treatment program, or impaired dental hygienists or other
				  impaired professionals program;
(13) two letters of character reference from
				  non-family members;
(14) a copy of
				  a National Practitioner Data Bank report concerning the applicant that was
				  obtained within six months prior to the date the report is submitted to the
				  Board;
(15) documentation of the
				  applicant's completion of continuing education courses, as set out in
				  21 NCAC
				  16I, in amounts equal to the number of hours
				  required for renewal of a dental hygiene license; and
(16) a copy of an unexpired CPR
				  certificate.