Form 08-4172 - Procedure For Obtaining A Permit To Administer Parenteral Sedation - Alaska Department Of Commerce And Economic Development

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State of Alaska
Department of Commerce and Economic Development
Division of Occupational Licensing
Board of Dental Examiners
333 Willoughby Avenue, 9th Floor
P.O. Box 110806
Juneau, Alaska 99811-0806
(907) 465-2542
E-mail: License@commerce.state.ak.us
PROCEDURE FOR OBTAINING A PERMIT TO ADMINISTER PARENTERAL SEDATION
A dentist may not administer parenteral sedation without a permit issued by the Alaska Board of
Dental Examiners. A parenteral sedation permit is renewed biennially in conjunction with the renewal
of the permittee's license to practice dentistry in the State of Alaska.
The following documents must be on file before your application will be reviewed for a permit to
administer parenteral sedation:
1. Completed, signed, and notarized application.
2. Course verification form, course description and/or outline from the college or university
where you received your training in administering parenteral sedation; or
proof of practice in which you have administered parenteral sedation on an outpatient basis
within the State of Alaska at least during the three years immediately preceding April 13,
1991.
3. Certification of Equipment, Facilities and Staff.
4. Certified copy of current cardiopulmonary resuscitation card.
5. Application fee of $50.00 (nonrefundable).
6. Permit fee of $100.00.
08-4172 (Rev. 7/98)

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