California Code of Regulations
Title 16 - Professional and Vocational Regulations
Division 10 - Dental Board of California
Chapter 2 - Dentists
Article 5 - General Anesthesia and Moderate Sedation
Section 1043.8.1 - Application for Pediatric Endorsement

Universal Citation: 16 CA Code of Regs 1043.8.1

Current through Register 2024 Notice Reg. No. 12, March 22, 2024

(a) For the purposes of Sections 1646.2(c) and 1646.9 of the Code, submission of a completed application to the Board for a pediatric endorsement for a general anesthesia permit shall include the following information and documents:

(1) Name, mailing address or address of record, physical address, dental or medical license number, and applicant's general anesthesia permit number, if any;

(2) A certificate of completion or other documentary evidence showing completion of a residency training program as required by Section 1646.2 of the Code for a dental licensee or Section 1646.9 of the Code for a physician or surgeon licensee;

(3) A completed Form PE-1 (New 05/2021) "Documentation of Deep Sedation and General Anesthesia or Moderate Sedation Cases for Pediatric Endorsement," which is hereby incorporated by reference;

(4) A certificate or other documentary evidence of current certification in Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) as provided by the American Red Cross (ARC), the American Heart Association (AHA), or the American Safety and Health Institute (ASHI);

(5) An application fee as set forth in Section 1021; and,

(6) A certification by the applicant, under penalty of perjury, that the information on the application is true and correct.

(b) For the purpose of Section 1647.3(d) of the Code, submission of a completed application to the Board for a pediatric endorsement for a moderate sedation permit for patients under thirteen (13) years of age shall include the following information and documents:

(1) Name, mailing address or address of record, physical address, dental license number, and applicant's moderate sedation permit number, if any;

(2) A certificate of completion or other documentary evidence showing completion of a residency training program as required by Section 1647.3 of the Code;

(3) A completed Form PE-1 (New 05/2021);

(4) A certificate or other documentary evidence of current certification in Pediatric Advanced Life Support (PALS) as provided by the American Red Cross (ARC), the American Heart Association (AHA), or the American Safety and Health Institute (ASHI);

(5) An application fee as set forth in Section 1021; and,

(6) A certification by the applicant, under penalty of perjury, that the information on the application is true and correct.

(c) Upon request by the Board in any investigation of the information provided on Form PE-1 (New 05/2021), applicants shall also provide documentation or patient records for each deep sedation and general anesthesia or moderate sedation pediatric case listed on Form PE-1, including preoperative evaluation, medical history, monitoring of vital signs throughout the procedure, and condition at discharge.

(d) Applicants shall submit legible copies of the information required by this section with pediatric patient identifying information redacted.

1. New section filed 8-16-2022; operative 8-16-2022 pursuant to Government Code section 11343.4(b)(3) (Register 2022, No. 33).

Note: Authority cited: Section 1614, Business and Professions Code. Reference: Sections 27, 108, 1611.5, 1646.1, 1646.2, 1647.2, 1647.3 and 1646.9, Business and Professions Code.

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