SUBCHAPTER 16C - LICENSURE EXAMINATION: DENTAL HYGIENIST
SECTION .0400 – LICENSURE BY CREDENTIALS
21 NCAC 16C .0401 DENTAL HYGIENE LICENSURE BY CREDENTIALS
(a) An applicant for a dental hygiene license by credentials shall submit to the Board:
(1) a completed, notarized application, on a form provided by the Board;
(2) the licensure by credentials fee;
(3) verification that the applicant has successfully completed with a passing score the National Board Dental Hygiene Examination
administered by the Joint Commission on National Dental Examinations;
(4) verification that the applicant has successfully completed with a passing score, 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;
(5) verification that the applicant holds a valid, current and unrestricted dental hygiene license issued by a state, U.S. territory or the
District of Columbia;
(6) verification that the applicant has been subject to a state, U.S. territory, or federal dental regulatory authority during the two years
immediately preceding the application;
(7) verification of all dental hygiene or professional licenses held;
(8) an affidavit from the applicant stating for the two years immediately preceding application:
A. the dates that and locations where the applicant has practiced dental hygiene; and
B. that the applicant has been in continuous active clinical practice averaging at least 1000 hours per year in clinical direct
patient care, during the two years immediately preceding application;
(9) a statement disclosing and explaining any disciplinary actions, investigations, malpractice claims, patient complaints or state or
federal agency complaints, judgments, settlements, or criminal charges;
(10) if applicable, a statement disclosing and explaining periods within the last 10 years of 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; and
(11) verification that the applicant holds a current certification in cardiopulmonary resuscitation.
(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 officially sealed envelope
from the entity involved:
(12) (1) official transcripts and a certificate from the dean verifying that the applicant has graduated from a dental hygiene program
accredited by the Commission on Dental Accreditation of the American Dental Association;
(13) (2) if the applicant is or has ever been employed as a dentist or dental hygienist by or under contract with a federal agency,
verification of the applicant's current status and disciplinary history from each federal agency where the applicant is or has
been
employed or under contract;
(14) (3) if the applicant is or has ever been a member of a state dental society or dental hygiene association, verification of the
applicant's current status and disciplinary history from each state dental society or dental hygiene association in which the
applicant is or has been a member;
(15) (4) verification of the applicant's licensure status and complete information regarding any disciplinary action taken or
investigation pending, from all licensing jurisdictions where the applicant holds or has ever held a dental hygiene license or other
professional license;
(16) (5) a report from the National Practitioner Databank, if applicable; and
(17) (6) a report of any pending or final malpractice actions against the applicant and verified by the applicant's malpractice insurance
carrier along with all documents and records. The applicant must request a verification of coverage history from his or her
current and all previous malpractice insurance carriers.
(c) 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.
(d) An applicant for dental hygiene licensure by credentials must successfully complete written examinations and, if deemed necessary by the
Board based on the applicant's history, a clinical simulation examination administered by the Board. If the applicant fails any of the
examinations, the applicant may retake the examination failed two additional times during a one year period.
(e) All information required must be completed and received by the Board office as a complete package with the initial application and
application fee. If all of the information is not received as a complete package, the application shall be returned to the applicant. Should the
applicant reapply for licensure by credentials, an additional licensure by credentials fee shall be required.
(f) 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; Temporary Adoption Eff. January 1, 2003.