Get Or Moderate Sedation Permit Application Form 2017-2025

The OR Moderate Sedation Permit Application Form is an essential document for dental practitioners seeking approval to administer moderate sedation. This guide provides clear, step-by-step instructions for completing the application online, ensuring a smooth submission process.

Follow the steps to complete your application effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Start by checking the appropriate box for the type of sedation you are applying for, specifically either Enteral Moderate Sedation or Parenteral Moderate Sedation.
3. Provide your name and Oregon License Number in the designated fields to confirm your identity as a licensed practitioner.
4. Fill in your mailing address and business contact information accurately to ensure proper communication regarding your application.
5. In the training section, detail your formal training in moderate sedation by listing courses, documenting hours, and providing the sponsoring institutions.
6. Complete sections regarding preoperative evaluations, operative procedures, postoperative recovery care, and emergency protocols by responding to each question comprehensively.
7. Attach required documentation, such as proof of your training and certification in Healthcare Provider BLS/CPR level to the application.
8. Review your application meticulously to ensure all questions are answered and required documents are included to avoid automatic rejection.
9. Sign and date the application at the bottom, signifying that you understand the information provided and that it is accurate.
10. Finally, save changes, download the completed form, print it out, and mail it along with the appropriate fee to the Oregon Board of Dentistry.

Complete your OR Moderate Sedation Permit Application Form online today to ensure compliance and enhance your practice.