Anesthesia Privileges and Applications

The following is required to be mailed to the TSBDE:

1. Anesthesia Permit Application.
2. Pay required fee. 
3. Copy of current Basic Life Support CPR card and PALS or ACLS certification.
   1. Nitrous Oxide/Oxygen Inhalation Sedation – Basic Life Support only
   2. Level 1: Minimal Sedation – Basic Life Support 
   3. Sedation Level 2, 3 & 4 – Basic Life Support and ACLS or PALS if treating adults and children 13 years of age or older (Note: PALS is required if treating children under the age of 13 years old).
4. Proof of completion of a qualifying course and case management experience.  Training and case management experience is found on each application. SeeTSBDE Rules and Regulations, Chapter 110 and/or the application for specific training requirements.
5. National Practitioner Data Bank (NPDB) Self-Query.  All applicants are required to complete a self-query of the NPDB.  The report results must remain in the original sealed envelope and be attached to your application to TSBDE.   NPDB self-query reports are valid for 60 days.  NPDB charges a minimal fee to furnish this information. If you are applying for more than one level of sedation, in one mailing, you may submit one NPDB Self-Query Report which will apply towards all levels of sedation.  If you are applying for sedation privileges on separate dates you must submit a NPDB Self-Query report with each anesthesia permit application.  You can contact the NPDB at Post Office Box 10832, Chantilly, VA 22021, telephone number (800) 767-6732, or website  http://www.npdb.hrsa.gov/pract/howToGetStarted.jsp. 

Anesthesia Applications:

Nitrous Oxide and Level 1 Permit Application

Level 2, Level 3, or Level 4 Permit Application