Section 828 IAC 1-3-1.5 - Licensure to practice dental hygiene by endorsement; credentialsAuthority: IC 4-1-8-1; IC 25-13-1-5; IC 25-14-1-13
Affected: IC 25-13-1-7; IC 25-13-1-17
Sec. 1.5.
(a) Persons seeking licensure to practice dental hygiene by endorsement shall do the following:(1) File an application on a form supplied by the board.(2) Submit the fees required by 828 IAC 0.5-2-4.(b) The applicant for a license shall provide the following:(1) Where the name on any document differs from the applicant's name, one (1) of the following: (A) A notarized or certified copy of a marriage certificate.(B) Legal proof of a name change.(2) Two (2) recent passport-type photographs of the applicant, taken within eight (8) weeks before filing of the application.(3) An original transcript of the applicant's dental hygiene education, including the following:(A) The degree or degrees conferred.(B) The date each degree was conferred.(4) If the applicant has been convicted of a criminal offense, excluding minor traffic violations, the applicant shall submit a notarized statement detailing all criminal offenses, excluding minor traffic violations, for which the applicant has been convicted. This notarized statement must include the following: (A) The offense of which the applicant was convicted.(B) The court in which the applicant was convicted.(C) The cause number under which the applicant was convicted.(D) The penalty imposed by the court.(5) An applicant who is now, or has been, licensed to practice any health profession in another state must submit verification of license status. This information must be sent by the state that issued the license directly to the Indiana board.(6) The applicant shall submit the following: (A) A self-query form completed by the following:(i) The National Practitioner Data Bank (NPDB).(ii) The Healthcare Integrity and Protection Data Bank (HIPDB) data bank.(B) Proof of completion of at least fourteen (14) hours of continuing dental hygiene education taken within the previous two (2) years. No more than two (2) hours of training in basic life support shall count toward this requirement.(7) All information on the application shall be submitted under oath or affirmation, subject to the penalties for perjury.(8) The applicant shall submit the following proof that the applicant: (A) Satisfactorily completed the following: (i) The National Board Dental Hygiene Examination provided by the Joint Commission on Dental Examinations.(ii) A national, regional, or state clinical licensing examination in any other state having and maintaining a standard of examination for licensure and laws regulating the practice of dental hygiene within that state or province that is substantially equivalent to the examination and licensing requirements of Indiana.(B) Has been engaged in the active practice of dental hygiene for not less than two (2) years out of the five (5) years immediately preceding the submission of the application.(9) The applicant shall submit the following: (A) Written statements from at least three (3) practicing dentists verifying the applicant's active, moral, and ethical practice of dental hygiene. The statements must: (ii) have been written not more than eight (8) weeks before the submission of the application.(B) Proof that the applicant is currently certified in basic life support.(c) An applicant who has previously failed an examination for licensure administered by the board is not eligible to apply for a license by endorsement until the applicant: (1) has passed all portions of the examination in which he or she failed; or(2) provides the board with proof that additional training has been received in the subjects of the failure.(d) All applicants must submit the applicant's United States Social Security number in order to be eligible for licensure.State Board of Dentistry; 828 IAC 1-3-1.5; filed Sep 27, 2002, 2:38 p.m.: 26 IR 374; filed Mar 23, 2006, 10:15 a.m.: 29 IR 2544; readopted filed Nov 9, 2012, 11:21 a.m.: 20121205-IR-828120384RFAReadopted filed 11/29/2018, 10:35 a.m.: 20181226-IR-828180401RFA