Get Or Moderate Sedation Permit Application Form 2020-2025

This guide provides step-by-step instructions for completing the OR Moderate Sedation Permit Application Form online. Filling out this form correctly ensures adherence to state regulations for administering sedation and anesthesia.

Follow the steps to successfully complete your application form.

1. Begin by selecting the 'Get Form' button to access the OR Moderate Sedation Permit Application Form. This will allow you to open the document in a suitable application for editing.
2. Complete the identification section by entering your name, Oregon License Number, and mailing and business addresses. Ensure all provided information is accurate and clearly legible.
3. Choose the type of sedation permit you are applying for by checking the appropriate box: 'Enteral Moderate Sedation' or 'Parenteral Moderate Sedation'.
4. In the training section, detail and submit evidence of formal training in moderate sedation. Include course titles, dates, hours of clinical and classroom training, and sponsoring institutions. Attach copies of certifications like Basic Life Support (BLS) if applicable.
5. For the preoperative evaluation section, respond to questions concerning patient evaluation, vital signs monitoring, ASA status, and patient instructions. Ensure clear and complete answers.
6. In the operative section, describe the sedation procedure. Provide information on the drugs administered, dosages, monitoring methods, and emergency preparedness protocols.
7. In the postoperative section, convey your recovery monitoring plan, discharge criteria, and attach copies of the postoperative instructions provided to the patient.
8. Complete the emergency section by detailing your emergency protocols, training related to anesthesia emergencies, and necessary equipment maintained for emergencies.
9. Review all sections of the application carefully, checking for completeness and clarity to avoid potential rejection due to missing information.
10. Upon final review, save your changes, and then download the completed application form. You may opt to print or share it as needed before mailing it and the fee to the Oregon Board of Dentistry.

Ensure you have all necessary documents and submit your application for the OR Moderate Sedation Permit online today.