Current through Register Vol. 48, No. 12, March 22, 2024
a) A person seeking a Temporary Permit for
Free Dental Care pursuant to Section
19.2 of the Act shall file an
application on forms provided by the Division, that includes:
1) Certification of licensure in the original
jurisdiction and from any jurisdiction where the applicant has been practicing
for at least one year, stating:
A) The time
during which the applicant was licensed in that jurisdiction, including the
date of the original issuance of the license; and
B) Whether the files of the jurisdiction
contain any record of any disciplinary action taken or pending;
2) Certification of graduation
from a course of instruction in a dental school that meets the minimum
education standards of the Division specified in Section
1220.140;
3) Certification of licensure in another
jurisdiction in which the applicant is currently licensed, stating, if
applicable:
A) The time during which the
applicant was licensed in that jurisdiction, including the date of original
issuance of the license;
B) A
description of the licensure examination in that jurisdiction; and
C) Whether the file on the applicant contains
a record of any disciplinary actions taken or pending;
4) Certification of a collaborative agreement
with an Illinois licensed dentist, including the name and license number of the
Illinois licensed collaborating dentist;
5) Certification of formal invitation to
perform dental care by a charitable organization or a formal invitation to
study or receive training on specific dental or clinical subjects or techniques
by a licensed CE sponsor approved by the Department; and
6) The fee as required under Section
1220.415.
b) A continuing education sponsor seeking a
license to provide live patient continuing education clinical training courses
pursuant to Section 19.2(a-5) of the Act shall file an application on forms
provided by the Division, that includes:
1)
Proof of a valid Illinois CE Sponsor License in good standing;
2) Proof that the continuing education course
provides services, without compensation, that will improve the welfare of
Illinois residents who are eligible for Medicaid or who are uninsured and whose
household income is not greater than 200% of the federal poverty
level;
3) A plan of follow-up care
and training models;
4) Any and all
documentation to be signed by the patients, including but not limited to
waivers, consent forms, and releases;
5) Information related to the facilities
being utilized, staffing plans, and emergency plans;
6) The process by which patients will be
contacted before, during, and after treatment;
7) The intended population that will be
receiving treatment in the specific continuing education course;
8) Proof of valid malpractice insurance for
the approved continuing education sponsor that extends coverage to clinical
staff, trainees, and out-of-state permit holders;
9) A valid written collaborative agreement
between the temporary visiting dentists holding a permit pursuant to Section
19.2 of the Act and the Illinois
licensed dentist co-treating patients under this Section; and
10) A fee as required under
1220.415.
c) The written
collaborative agreement shall be made available upon request. The application
to the Department shall include the name and Illinois license number of the
collaborating dentist, as well as the name, license number, and licensure
jurisdiction of the visiting dentist. The Department may disapprove a
collaborating dentist if the Department believes a collaborating dentist is not
appropriate based on previous disciplinary history or inability to properly
serve as a collaborating dentist.
d) The Temporary Training License will be
valid for no longer than 5 consecutive clinical days within 6 months from the
date of issuance and may be restored no more than one time within 5 years of
the initial license's issuance.