2013 DENTAL RAD TECH REINSTATEMENT APP. FORM - REV. 12-12-12

MARYLAND STATE BOARD OF DENTAL EXAMINERS
GUIDELINES FOR REINSTATEMENT OF EXPIRED 2013
DENTAL RADIATION TECHNOLOGIST CERTIFICATE
The Panel may not procedure a documentation program until each supply or need is met and each papers is obtained.
Please make sure that your program is finish before it is presented.
Reinstatement of Terminated 2013 Oral Rays Technologist Certification
An personal having an expired certification to exercise dental radiation technological innovation may make an application
for restoration if the applicant:
(1) Finishes a Elephone Q verbal radiation technological innovation restoration application; and
(2) Provides evidence of finishing 8 time of dental training from Board-approved programs,
4 time of which shall be in radiology and therefore a 2-hour Board-approved course on infection
management and;
(3) Provides one (1) picture that is between 2x2-inches and 3x3-inches with the essential notarized
affidavit. Note that the picture will be fitted to your certification. The picture must fulfill the following
guidelines: taken within the last 2 decades to mirror your present appearance; front side opinion of complete
experience
from top of locks to shoulders; a innos D6000 organic expression; no hat or go protecting that obscures the
hair
or hair line, unless used everyday for spiritual purposes; no eyewear, headsets, wi-fi hands-
100 % free gadgets or identical items; no people or disruptions in the picture. Images duplicated or
electronically examined from driver’s permits or other formal records are not appropriate. In
inclusion, poor selling device or cell cellphone photos are not appropriate. “Passport”
photos are appropriate. Undesirable photos will be came back and may wait the issuance of your
certification.
(4) Provides a notarized declaration from their monitoring dentist(s) showing whether they have
used dental radiation technological innovation, which is the positioning or visibility of dental radiographs, on
or after Apr 2, 2013, and if yes, the dates; and
(5) Is effective the Panel a Elephone Q documentation restoration fee of $118.00.
To make an application for restoration of documentation, you must publish the Application for Reinstatement of
Terminated 2013 Oral Rays Technologist Certificate and include the following with your application:
A $118 non-refundable fee.
Proof of finishing 8 time of training, such as at least 4 time in radiology and a innos D6000 2-hour Board-approved
course on disease management. The course(s) must have been finished within 1 season previous the time frame of your
program for restoration.
A notarized declaration from your monitoring dentist(s) whether you have used dental radiation technological
innovation, which is the positioning or visibility of dental radiographs, on or after Apr 2, 2013, and if yes , the schedules.
A notarized picture. See specifications detailed above.