N.J. Admin. Code § 13:30-4.3

Current through Register Vol. 56, No. 21, November 4, 2024

Section 13:30-4.3 - Documents submitted with application for permit

(a) The following information and materials shall accompany the application for a dental clinic permit:

1. A floor plan of the clinic (to scale) setting forth:

i. Operatories;

ii. Recovery rooms;

iii. Reception room or rooms;

iv. Rest-room facilities;

v. Laboratory facilities;

vi. Storage-room facilities; and

vii. Record room;

2. A list of all personnel connected with the clinic setting forth:

i. The name, home address and license number of the director;

ii. The name, home address and license number of each dentist;

iii. The name, home address and license number of each dental hygienist;

iv. The name and home address of each dental assistant;

v. The name and home address of each dental technician;

vi. The names, titles and home addresses of all other personnel;

vii. If the clinic is to be operated by a public corporation, the names and addresses of all directors and officers of the corporation;

viii. If the clinic is to be operated by a closed corporation, the names and addresses of all directors, officers and stockholders of the corporation;

ix. If the clinic is to be operated by an entity other than a public or closed corporation, the names and addresses of all persons having any responsibility with respect to the maintenance, operation, or establishment of the clinic in either a professional or business capacity; and

x. Information concerning whether any person listed in the clinic application pursuant to (a)2 above has been convicted of a crime, including the dates of the conviction and a description of the nature of the conviction or whether any criminal charges are pending;

3. A copy of all contracts involving the clinic including:

i. A list of services to which eligible persons are entitled;

ii. A copy of the contract between the owner of the clinic and the dental director;

iii. A copy of the contract between the owner of the clinic and the dentists;

iv. A copy of the contract between the owner of the clinic and the dental hygienists and all other personnel;

v. If the dental director engages the services of dentists and dental hygienists and other personnel, a copy of such contracts;

vi. If the dentists are to be remunerated on a fee for service basis, a copy of the fee schedule; and

4. A proposed budget for the operation of the clinic and a financial statement of the applicant.

(b) All contracts specified in (a)3 above shall be filed with the New Jersey State Board of Dentistry and no change shall be made to such contracts without prior Board approval.

N.J. Admin. Code § 13:30-4.3

Amended by R.2000 d.147, effective 4/3/2000.
See: 32 New Jersey Register 215(a), 32 New Jersey Register 1221(a).
Rewrote the section.