Become a Fellow Certificate of Excellence in Dental Office Anesthesia – SPDOS Society of Physicians in Dental Office Sedation

Application for Certificate of Excellence

The SPDOS offers qualified physicians a CERTIFICATE OF EXCELLENCE in DENTAL OFFICE ANESTHESIA to attest to the physician’s qualifications and experience. Receiving this certification is an invaluable way to promulgate your expertise and skills. To apply, please complete the application below and submit a one-time payment of $100.

To be a fellow in the SPDOS, the following criteria must be satisfied:

Board certification in Anesthesiology

Clean disciplinary record

No major malpractice claims involving sentinel events(death, brain injury, etc)

Has satisfied their State's Dental Board requirements for providing dental office anesthesia

Proof of 100 dental office cases involving deep sedation/GA in the past year (includes both adult and pediatric cases).

Name*

E-mail Address*

Are you Board Certified in Anesthesiology?*

Have you ever been disciplined by your state medical board or any other regulatory agency?*

Have you had any major malpractice claims involving patient death, brain injury, paralysis, or loss of major body function?*

Have you satisfied your state’s Dental Board requirements for providing dental office anesthesia?*

Are you currently under investigation by any regulatory agency?*

Are you ACLS certified?*

Have you administered at least 100 cases of deep sedation or general anesthesia in dental/oral surgery offices in the last 12 months? (Please exclude any dental procedures done in a hospital or surgery center).*

Are you PALS certified?

Have you administered at least 100 cases of deep sedation or general anesthesia in dental/oral surgery offices in the last 12 months for children 8 years old or younger? (Please exclude any dental procedures done in a hospital or surgery center).*

With my electronic signature I verify that the above responses are true and correct to the best of my knowledge.*

Only fill in if you are not human

Application for Certificate of Excellence

To be a fellow in the SPDOS, the following criteria must be satisfied:

Board certification in Anesthesiology

Clean disciplinary record

No major malpractice claims involving sentinel events(death, brain injury, etc)

Has satisfied their State's Dental Board requirements for providing dental office anesthesia

Proof of 100 dental office cases involving deep sedation/GA in the past year (includes both adult and pediatric cases).

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