Application For Anesthesia Permit
Applicants will need to download all of the following documents listed below to apply for a Dental Anesthesia Permit:
Application For Permit To Administer Anesthesia & Sedation For Dentists
Information and Instruction Sheet
Indiana State Board of Dentistry Statute and Administrative Rules.
A compilation from the Indiana Code and Administrative Code. The Indiana State Board of Dentistry Compilation from the Indiana Code and Indiana Administrative Code is available to Download:
Microsoft Word Version
Adobe PDF Version
Indiana Professional Licensing Agency Statute.
A compilation of the statutes governing professions regulated by the boards and commissions under the Indiana Professional Licensing Agency is available to Download:
Microsoft Word Version
Adobe PDF Version
TO ADD ADDITIONAL OFFICES AND/OR HOSPITALS
If wish to add an additional office and/or hospital where you intend to administer general anesthesia, deep sedation, or light parenteral conscious sedation you will be required to submit the following:
- A written request for an additional office and/or hospital with the dentist name, additional location, license and permit number.
- A new Emergency Equipment Affidavit. (A sample affidavit is located on page 4 of the Application for Anesthesia Permit.)
- A fee of $25.00 for each additional office and/or hospital
If you have any questions regarding adding an additional office and/or hospital where you intend to administer general anesthesia, deep sedation, or light parenteral conscious sedation, please contact our office by calling (317) 234-2054 or by email at pla8@pla.in.gov.
