Section Den 301.03 - Application for Dental Hygienist License Registration and Renewal(a) Each applicant for registration and renewal of a license to practice dental hygiene in the state of New Hampshire shall provide the following on the hygienist "Application for Registration and License Renewal" form, effective April 2017 and available on the board's website: (1) Applicant's mailing address if changed;(3) Applicant's dental hygienist license number;(4) Whether applicant's hygienist license is active or inactive;(5) The original date of dental hygienist licensure;(6) Whether the applicant has practiced in the current biennium;(7) A listing of other states where the applicant holds a dental hygienist license, if any;(8) Applicant's primary residence and telephone number;(9) Name of practice, address and telephone number of each practice employing the applicant, and primary email address either business or personal;(10) Whether the applicant: a.Has ever been convicted of any felony, misdemeanor, or driving under the influence of alcohol or drugs which has not been annulled;b.Has ever been convicted of the illegal practice of dental hygiene;c.Has ever been denied dental hygienist licensure;d.Currently has or ever has had any professional license subjected by any professional licensing body in any jurisdiction or state to any investigation, sanction, or disciplinary action, including but not limited to revocation, suspension, probation or stayed probation, limitation or restriction, fine, reprimand, denied renewal, voluntary or involuntary relinquishment, or required submission to care, counseling, supervision, or further education;e.Has ever been or is currently named as a party in any malpractice or professional liability claim or lawsuit or has any pending; orf.Has any physical, mental or other condition or addiction to alcohol, narcotics or other mind altering drugs that may impair an ability to practice dental hygiene;(11) Whether the applicant practices under public health supervision, pursuant to Den 302.02, and the name of the program; (12) Whether the applicant administers local anesthesia for dental patients in New Hampshire, and if yes, whether the applicant received a certificate of local anesthesia qualification;(13) Whether the applicant has completed 20 hours of continuing education within 2 years immediately preceding the application; (14) Whether the applicant, if he or she is an Expanded Function Dental Auxiliary (EFDA) pursuant to Den 302.07(b)(6), has completed 10 CEU's in this biennium in restorative dentistry; and (15) Whether the applicant's BLS-HCP training is current. (b) The form shall be completed and attested to by the applicant and filed with the board. Deceptive or false statements, knowingly made by the applicant shall result in denial of license. By signing the form, the applicant shall waive any confidentiality regarding disclosure to the board from any other jurisdiction about any pending complaints or action being taken against the applicant's license to practice dental hygiene and consents to a criminal background check.(c) If the answer to (a) (13) is 'no', then a 30-day extension period for late registration shall be available to complete the requirement.(d) Pursuant to Den 301.08, there shall be a fee for late biennial registration. The form used shall be the same as the regular renewal form.(f) Pursuant to RSA 126-A:5, XVIII-a.(a) and RSA 317-A:12-a, hygienists shall complete, as part of their renewal application, the New Hampshire division of public health service's health professions survey issued by the state office of rural health and primary care, department of health and human services, pursuant to He-C 801.(g) The board shall provide hygienists with the opportunity to opt out of the survey. Written notice of the opt-out opportunity shall be provided with the renewal application. The opt out form shall be available on the NH state office of rural health and primary care website at https://www.dhhs.nh.gov/dphs/bchs/rhpc/data-center.htm.(h) Hygienists choosing to opt-out of the survey shall complete and submit the "New Hampshire Health Professions Survey Opt-Out Form," revised June 2020, to the state office of rural health and primary care, department of health and human services, via one of the following: (i) Information contained in the opt-out forms shall be kept confidential in the same accord with the survey form results, pursuant to RSA 126-A:5XVIII-a(c).N.H. Admin. Code § Den 301.03
Amended byVolume XXXIV Number 46, Filed November 13, 2014, Proposed by #10689, Effective 10/7/2014, Expires10/7/2024.Amended by Volume XXXV Number 23, Filed June 11, 2014 , Proposed by #10824, Effective 5/6/2015, Expires5/6/2025.Amended by Volume XXXVI Number 01, Filed January 7, 2016, Proposed by #10991, Effective 12/9/2015, Expires 12/9/2025.Amended by Volume XXXVII Number 50, Filed December 14, 2017, Proposed by #12428, Effective 12/6/2017, Expires 12/6/2027.Amended by Volume XL Number 46, Filed November 12, 2020, Proposed by #13116, Effective 10/9/2020, Expires 10/9/2030