Sedation Permit for Pediatric Moderate Sedation Renewal

A pediatric moderate permit is a qualification added to the license therefore it is renewed at the same time the dental license is renewed. If you no longer wish to maintain your permit, please submit a request to Voluntary Relinquish the permit to mqa.dentistry@flhealth.gov.

Applicants for initial licensure must use a Livescan service provider to submit a set of fingerprints to the Florida Department of Law Enforcement (FDLE) for the purpose of conducting a search for any Florida and national criminal history records that may pertain to applicant. The results of the search will be returned to the Care Provider Background Screening Clearinghouse and made available to the Department for consideration during the licensure process. The fingerprints submitted by the applicant will be retained by FDLE and the Clearinghouse. All costs for conducting a criminal history background screening are borne by the applicant.

It is important to use the correct Originating Agency Identification (ORI) when submitting fingerprints. If you do not provide an ORI number or if you provide an incorrect ORI number to the service provider, the board office will not receive your fingerprint results, so it is extremely important to use the correct ORI when having your fingerprints scanned.

Applicants can use any FDLE approved Livescan service provider to submit their fingerprints. The applicant is fully responsible for selecting the service provider and ensuring the results are reported to the Department.  If you are applying for initial licensure after December 15, 2012, You must print this form and take it with you to a Livescan service provider. For more information, FAQs, and a list of all approved Livescan service providers please visit the Department’s website at: FLHealthSource.gov/Background-Screening.