234 CMR, § 4.16 - Reinstatement of a License Which Has Been Revoked, Surrendered or Suspended
(1) A licensee
whose license has been revoked, surrendered or suspended shall petition the B
oard for reinstatement of the license as provided in a consent agreement or B
oard final decision and order. If not otherwise specified by consent agreement
or Board order, the licensee shall petition the Board for license reinstatement
by the following procedure:
(a) Licensee shall
submit a petition for reinstatement which sets forth in detail the background
of the complaint and disciplinary action taken and the reasons why the license
should be reinstated and shall also include:
1. Documentation acceptable to the Board of
completion of the conditions of any consent agreement or final decision and
order issued by the Board;
2. A
detailed summary of the licensee's activities during the revocation, suspension
or surrender including, but not limited to, the licensee's professional
conduct, remedial actions and academic and other continuing education
pursuits;
3. Documentation
acceptable to the Board of completion of CEU requirements at
234 CMR
8.00: Continuing Education and any
CEUs required by a consent agreement or Board order;
4. An outline of projected professional plans
for the 24 month period following reinstatement;
5. If requested by the Board, statements from
at least three persons attesting to the character or health of the applicant as
well as the applicant's work and professional history since the date of
revocation, suspension or surrender and the basis of the affiant's
knowledge;
6. Upon the Board's
request, a licensee shall undergo assessment by a qualified medical,
psychiatric or psychological professional, acceptable to the Board, and
authorize the evaluating provider to release the assessment to the Board to
determine the licensee's ability to practice dentistry, dental hygiene or
dental assisting in a safe and competent manner; and
7. An affidavit, signed under pains and
penalties of perjury, attesting to the licensee's compliance with all laws of
the Commonwealth relating to the payment of state taxes pursuant to M.G.L. c.
62C, § 49A, child support pursuant to M.G.L. c. 119A, § 16(a), to the
completion of all continuing education requirements pursuant to
234 CMR
8.00: Continuing Education, and to
the truthfulness of all statements contained in the licensee's petition for
reinstatement.
(2) If requested by the Board, the applicant,
any supervisor, and treating health practitioner may be required to personally
appear before the Board or a subcommittee of its members.
(3) Unless the Board orders otherwise, a
licensee shall not petition the Board for reinstatement sooner than two months
preceding the expiration of the period of revocation, suspension or
surrender.
Notes
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