1. (a) Applications for permits described in Den 304.03 shall be processed in accordance with Plc 304.06 through Plc 304.10.

2. (b) Applicants shall submit documents and fees as described below for the type of permit being applied for:

   1. (1) For a facility permit the applicant shall:

      1. a. Complete and submit an application required by Den 304.05(c)(1);
      2. b. Pay the applicable fees required by Plc 1002.11; and
      3. c. Have successfully completed the on-site facility inspection performed by a qualified consultant, as defined in Den 304.01(m), and required by Den 304.04(a)(3);

   2. (2) For a facility hosting permit, the applicant shall:

      1. a. Complete and submit the application required by Den 304.05(c)(1);
      2. b. Pay the applicable fees required by Plc 1002.11; and
      3. c. Have successfully completed the on-site facility evaluation performed by a qualified consultant, as defined in Den 304.01(m), and required by Den 304.04(b)(2);

   3. (3) For a general anesthesia, deep sedation, and moderate sedation permit, the applicant shall:

      1. a. Complete and submit the application required by Den 304.05(c)(2);
      2. b. Pay the applicable fees required by Plc 1002.11;

      3. c. Submit one of the following:

         1. 1. Evidence of completion of an advanced training in anesthesiology and related academic subjects beyond the undergraduate dental school level in a training program as described in Part III C. of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists”, revised 2016, as specified in Appendix II; or
         2. 2. Evidence of completion of an advanced dental education program in either dental anesthesiology or oral and maxillofacial surgery as described in the CODA requirements for each advanced program;
      4. d. Submit proof of current ACLS and PALS certification; and
      5. e. Have successfully completed the simulated emergency management evaluation performed by a qualified consultant, as defined in Den 304.01(m), and required by Den 304.04(c)(4);

   4. (4) For a moderate sedation only permit, the applicant shall:

      1. a. Complete and submit an application required by Den 304.05(c)(2);
      2. b. Pay the applicable fees required by Plc 1002.11;
      3. c. Submit evidence of meeting the requirements as described in Part III B. of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists” revised 2016, as specified in Appendix II;
      4. d. Submit proof of current ACLS certification; and
      5. e. Have successfully completed the simulated emergency management evaluation performed by a qualified consultant, as defined in Den 304.01(m), and required by Den 304.04(d)(4);

   5. (5) For a moderate sedation with pediatric qualification permit, the applicant shall:

      1. a. Complete and submit an application required by Den 304.05(c)(2);
      2. b. Pay the applicable fees as required by Plc 1002.11;
      3. c. Submit evidence of meeting the requirements as described in Part III B. of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists” revised 2016, as specified in Appendix II;
      4. d. Submit proof of current ACLS certification, PALS certification, or both consistent with the age demographic of the patients being treated;
      5. e. Have successfully completed the simulated emergency management evaluation performed by a qualified consultant, as defined in Den 304.01(m), and required by Den 304.04(e)(1); and
      6. f. Submit to the OPLC a letter of verification, certificate of completion, or official transcript demonstrating successful completion of the educational objectives as described in Part V of the American Dental Association “Guidelines for Teaching Pediatric Pain Control and Sedation to Dentists and Dental Students” approved 2021, as specified in Appendix II; or

   6. (6) For a pediatric minimal sedation permit, the applicant shall:

      1. a. Complete and submit an application required by Den 304.05(c)(2);
      2. b. Pay the applicable fees as required by Plc 1002.11;
      3. c. Submit evidence of meeting the requirements as described in Part III A. of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists”, revised 2016, as specified in Appendix II; and
      4. d. Submit to the OPLC a letter of verification, certificate of completion, or official transcript demonstrating successful completion of the educational objectives for inhalation and enteral minimal sedation training as described in Part IV of the American Dental Association “Guidelines for Teaching Pediatric Pain Control and Sedation to Dentists and Dental Students” approved 2021, including training in airway management and patient rescue from moderate sedation.

3. (c) Applications for permits shall include:

   1. (1) The “Application for Facility or Facility Hosting Permit” requiring the following information:

      1. a. Check which of the following is being applied for:

         1. 1. Facility permit; or
         2. 2. Facility hosting permit;
      2. b. Dental practice name;
      3. c. Hosting dentist’s or qualified dentist’s full legal name;
      4. d. List the name(s) of all qualified providers administering general anesthesia, deep sedation, or moderate sedation at the facility including their NH license type(s) and number(s);
      5. e. Facility physical address;
      6. f. Facility mailing address;
      7. g. Facility primary e-mail address;
      8. h. Facility phone number;
      9. i. Answer yes or no to the question “Is either general anesthesia, deep sedation, or moderate sedation administered at this facility?”; and
      10. j. Answer yes or no to the question “Is moderate sedation only administered at this facility?”;

   2. (2) The “Application for Permit to Administer General Anesthesia, Deep Sedation, and Moderate Sedation, Moderate Sedation Only, Moderate Sedation with Pediatric Qualification, or Pediatric Minimal Sedation” requiring the following information:

      1. a. Check the type of permit being applied for from the following list:

         1. 1. General anesthesia, deep sedation, and moderate sedation;
         2. 2. Moderate sedation;
         3. 3. Moderate sedation with pediatric qualification; or
         4. 4. Pediatric minimal sedation;
      2. b. Name of applicant;
      3. c. Applicant’s license type;
      4. d. Applicant’s license number;
      5. e. Applicant’s home mailing address;
      6. f. Applicant’s primary e-mail address:
      7. g. Applicant’s home or cell phone number;

      8. h. The following information for each facility where the dentist intends to provide services;

         1. 1. Facility name;
         2. 2. Facility’s physical address;
         3. 3. Facility’s permit type, if applicable;
         4. 4. Facility’s permit number, if applicable; and
         5. 5. If facility application has been submitted to obtain a permit, the date of submission;

      9. i. If applying for a general anesthesia, deep sedation, and moderate sedation permit complete the following:

         1. 1. Check one of the following:

            1. (i) “I am applying for this permit based on completion of advanced training in anesthesiology and related academic subjects beyond the undergraduate dental school level in a training program as described in Part III C. of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists”, revised 2016, as specified in Appendix II”; or
            2. (ii) “I am applying for this permit based on completion of an advanced dental education program in either dental anesthesiology or oral and maxillofacial surgery as described in the CODA requirements for each advanced program”;

      10. j. Answer yes or no to the following certificate(s) held by the applicant and if yes, provide the expiration date:

          1. 1. Basic life support for healthcare providers (BLS-HCP);
          2. 2. Advanced cardiovascular life support (ACLS); and
          3. 3. Pediatric advanced life support (PALS);

      11. k. List each clinical staff member(s) involved in patient care and include the following for each:

          1. 1. Name and job title;
          2. 2. Whether the individual has completed BLS-HCP;
          3. 3. Date BLS-HCP initial certification received or date renewed and date of expiration;
          4. 4. Whether the individual has completed ACLS;
          5. 5. Date ACLS initial certification received or date renewed and date of expiration;
          6. 6. Whether the individual has completed PALS; and
          7. 7. Date PALS initial certification received or date renewed and date of expiration;

      12. l. If applying for a moderate sedation only permit or a moderate sedation permit with pediatric qualification, complete the following:

          1. 1. Answer yes or no to the question “I am applying for this permit based on evidence of meeting the requirements as described in Part III B. of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists” revised 2016, as specified in Appendix II”; and
          2. 2. Answer yes or no to the question “I have successfully completed the educational objectives as described in Part V of the American Dental Association “Guidelines for Teaching Pediatric Pain Control and Sedation to Dentists and Dental Students” approved 2021, as specified in Appendix II; and

      13. m. If applying for a pediatric minimal sedation permit, complete the following:

          1. 1. Answer yes or no to the question “I am applying for this permit based on evidence of meeting the requirements as described in Part III A. of the American Dental Association “Guidelines for the Use of Sedation and General Anesthesia by Dentists”, revised 2016, as specified in Appendix II; and
          2. 2. Answer yes or no to the question “I have successfully completed the educational objectives for inhalation and enteral minimal sedation training as described in Part IV of the American Dental Association “Guidelines for Teaching Pediatric Pain Control and Sedation to Dentists and Dental Students” approved 2021, as specified in Appendix II, including training in airway management and patient rescue from moderate sedation”; and

   3. (3) Each applicant shall sign and date the application described in (1) or (2) above below the following attestation:

      “I am not under investigation by any professional licensing board and my credentials have not been suspended or revoked by any professional licensing board. The information and documentation provided are true, complete, and not misleading to the best of my knowledge and belief, I understand that providing false or misleading information constitutes grounds for denial, suspension, or revocation of a license, and that knowingly providing false material information constitutes a misdemeanor under RSA 641:3 relative to falsification in official matters.”

Source. #14246, eff 8-3-25, EXPIRES: 8-3-35