17 CAR § 115-1805 – Permit requirements

(a) Complete required application forms provided by the Arkansas State Board of Dental Examiners.
(b) Pay fee of five thousand dollars ($5,000) as set by Arkansas Code § 17-82-602.
(c) The operator must be a dentist licensed in Arkansas.
(d) List all dentists and dental hygienists who will be providing care in the mobile dental facility complete with their:
1. (1) Name;
2. (2) Address;
3. (3) Telephone number; and
4. (4) License number.
(e) The official business address (not a post office box) where patient records including radiographs are maintained and available for inspection and copying upon request by the board.
(f) Communication device available twenty-four (24) hours per day, seven (7) days per week and capable of both making and receiving calls as well as the ability to contact emergency services, i.e., ambulance, police, fire stations, etc.
(g) Written procedure for emergency follow-up care for patients treated in the mobile dental facility, which must include:
1. (1) Arrangements for treatment in a dental facility that is permanently established in the area where services are provided (fifty-mile radius); or
2. (2) A statement that follow-up care will be provided:
  1. (A) Through the mobile dental facility;
  2. (B) At the operator’s established dental practice location in this state; or
  3. (C) At any other established dental practice in this state that agrees to accept the patient.
(h)
1. (1) List of dentists who have agreed to provide follow-up care as indicated in subdivision (g)(2)(C) of this section.
2. (2) A signed statement from each dentist agreeing to provide follow-up care must be provided with the application.
(i) Evidence of radiographic equipment registration and inspection by the Department of Health.
(j)
1. (1) Signed statement that all required physical equipment is present and functioning properly.
2. (2) A checklist of these items will be a part of the application.
(k) Copy of the driver’s license of any person who will be driving the mobile dental facility.
(l) Proof of general liability insurance from a licensed insurance carrier for at least one million dollars ($1,000,000).
(m) Name of established nonmobile dental facility with which the mobile facility is associated.
(n) Be inspected by the board or the board’s designee prior to the start of operation.