Ala. Admin. Code ch. 540-X-3 | Alabama Administrative Code Chapter 540-X-3 — Certificate of Qualification

540 Alabama Board of Medical Examiners

Ala. Admin. Code r. 540-X-3-.01 General Requirements That Apply To All Applicants For A Certificate Of Qualification

All applicants for a certificate of qualification shall satisfy the requirements of Rules 540-X-3-.01 to 540-X-3-.10, inclusive, complete the Federation of State Medical Boards (FSMB) on-1ine Uniform Application, and submit to FSMB the Sixty-Dollar ($60.00) Uniform Application fee, or the fee in effect at the time of the application published by FSMB. This fee is not refundable once payment is received by the Board.

History

Author: Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; Act No. 93-148.
Filed May 20, 1993 for publication. See also Notice of Intended Action dated May 20, 1993 repealing existing Chapter 3. Amended: July 21, 1993; effective August 25, 1993. Amended: Filed July 26, 1999; effective August 30, 1999. Amended: Filed October 15, 2008; effective November 19, 2008. Amended: Published May 29, 2020; effective July 13, 2020. Amended: Published December 30, 2021; effective February 13, 2022.

Ala. Admin. Code r. 540-X-3-.02 Medical Education Requirement

(1) All applicants for a certificate of qualification shall present a diploma or evidence of graduation from any of the following institutions:

(a) A college of medicine or school of medicine accredited by the Liaison Committee on Medical Education.

(b) A college of osteopathy accredited by the Commission on Osteopathic College Accreditation.

(c) A college of medicine or school of medicine not accredited by the Liaison Committee on Medical Education which is approved by the Board of Medical Examiners and whose graduates are eligible for examination by the Education Commission for Foreign Medical Graduates (ECFMG) for its certificate. The Education Commission for Foreign Medical Graduates (ECFMG) and its sponsoring organizations define a “graduate of a foreign medical school” as a physician whose basic medical degree or qualification was conferred by a medical school located outside the United States, Canada, and Puerto Rico. The medical school must be listed, at the time of an World Directory of Medical applicant’s graduation, in the Schools published by the World Health Organization or in the International Medical Education Directory published by the Foundation for Advancement of International Medical Education and Research.

(2) The Board, within its discretion, may withhold approval of any college of medicine designated in (1)(c) above which:

(a) Has had its accreditation withdrawn by a national or regional accreditation organization; or

(b) Has had its authorization, certification, or licensure revoked or withdrawn by a national or regional governmental supervisory agency; or

(c) Has been denied approval or has had its approval withdrawn by any national, state, or territorial licensing jurisdiction based upon an evaluation of the college of medicine or upon a finding of misconduct by the college; or

(d) Has engaged in fraudulent, criminal, or other practices which are inconsistent with quality medical education.

A college of medicine which allows graduation from its medical school program, issues diplomas, or confers medical degrees based on course work offered via the Internet or online programs, and which is deemed by the Board to be a college of medicine which engages in practices which are inconsistent with quality medical education, will not be an approved college of medicine for the purpose of fulfilling the medical education requirement of Code of Ala. 1975, §34-24-70 and this rule.

(3) Documentation submitted through the Federation Credentials Verification Service (FCVS) may be accepted to demonstrate compliance with subparagraphs (1)(a), (1)(b) and (1)(c) above.

(4) If the diploma of the applicant is based in any part upon clinical rotations, clerkships or training which was completed at hospitals which are not located within the same country where the medical school is principally located or where the director of the clinical rotation, clerkship or training is not directly responsible to the administration of the medical school, the applicant shall have the director of the clinical rotation, clerkship or training at the hospital where the clinical rotation, clerkship or training was undertaken send an original letter to the Board outlining the dates of the training, the exact type of training completed and an evaluation of the applicant's performance in the clinical rotation, clerkship or training undertaken.

(5) In the event that the Alabama Board of Medical Examiners shall, after careful consideration, determine that there exists substantial credible evidence to indicate that a college of medicine or a college of osteopathy located outside of the United States may have issued or is issuing diplomas to individuals who have not in fact acquired such diploma by actual attendance at and participation in a residency program of medical instruction and clinical rotations then in such event the Board may require that an applicant holding a diploma from such college submit the following additional documentation in conjunction with his or her application:

(a) That the applicant document to the satisfaction of the Board actual attendance in residence at all portions of the program of medical instruction designed to be taken in residence on the premises of the college of medicine or college of osteopathy issuing the diploma.

(b) That the applicant document to the satisfaction of the Board actual attendance and participation in clinical programs of instruction, or clinical rotations at a hospital facility actually affiliated with the college of medicine or college of osteopathy and offered as a part of the overall program of medical education.

(c) The foregoing requirements shall apply to applicants for a certificate of qualification by endorsement under Code of Ala. 1975, §34-24-73, or by examination under Code of Ala. 1975, §34-24-70, or for limited licensure under Code of Ala. 1975, §34-24-75.

(d) The Board shall publish and maintain a list of any colleges of medicine or colleges of osteopathy which it determines to be within the scope of this rule.

(e) The documentation which the Board of Medical Examiners will deem to be acceptable for the purposes of this rule shall include, but is not limited to, passport data showing entry to and exit from the country in which the college of medicine or college of osteopathy is located; other travel or immigration documents issued by the United States Government, or the government of the country in which the college of medicine or college of osteopathy is located reflecting residence in that country; the sworn and notarized certification of the department or division director of any clinical program affiliated with the college of medicine or college of osteopathy attesting to the attendance and residency of the applicant; or any other impartial documents as would be considered trustworthy by a reasonably prudent person in the conduct of his most important affairs. Failure of the applicant to document actual attendance as specified above will result in a denial of the application for certificate of qualification. The requirements set forth in this rule shall be in addition to all of the other requirements set forth in the rules and regulations of the State Board of Medical Examiners.

(6) The following Colleges of Medicine or Schools of Medicine are not approved by the Board for applicants for certificates of qualification pursuant to the authority of Code of Ala. 1975, §34-24-70(a)(1)c. and Rule 540-X-3-.02(2):

(a) Universidad Tecnoglica de Santiago, Dominican Republic (UTESA)

(b) Universidad Eugenio Maria de Hostos, Dominican Republic (UNIREMHOS)

(d) University of Health Sciences Antigua, St. Johns (Antigua), Dominican Republic

(7) Graduates of the following colleges of medicine or schools of medicine are required to submit the additional documentation required by Rule 540-X-3-.02(5)(a) through (d) in conjunction with an application for a certificate of qualification:

(a) Kigezi International School of Medicine, Uganda, Africa

(b) Universidad Centro de Estudios Tecnologicos, Dominican Republic (CETEC)

(d) Universidad Centro de Investigacion Formacion Asesona Social, Dominican Republic (CIFAS)

(e) Spartan University (A.K.A. St. Lucia Health Sciences University), Dominican Republic

(f) Universidad Autonoma de Ciudad Juarez, Mexico

(g) Universidad Mexico American Del Norte, Mexico

History

Author: Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53 and Act No. 93-148.
Filed May 20, 1993 for publication. See also Notice of Intended Action dated May 20, 1993 repealing existing Chapter 3. Approved/Adopted: July 21, 1993. Effective Date: August 25, 1993. Amended: Filed May 20, 1996; effective June 25, 1996. Amended: Filed May 20, 1997; effective June 24, 1997. Amended: Filed November 20, 1997; effective December 25, 1997. Amended: Filed July 26, 1999; effective August 30, 1999. Amended: Filed January 20, 2000; effective February 24, 2000. Amended: Filed October 17, 2003; effective November 21, 2003. Amended: Filed June 23, 2006; effective July 28, 2006. Amended: Filed June 22, 2007; effective July 27, 2007. Amended: Filed December 13, 2007; effective January 17, 2008. Amended: Filed September 17, 2009; effective October 22, 2009. Amended: Filed January 19, 2012; effective February 23, 2012. Amended: Filed March 15, 2017; effective April 23, 2017. Amended: Published December 30, 2021; effective February 13, 2022.

Ala. Admin. Code r. 540-X-3-.03 Post-Graduate Education Requirement

(1) Applicants for a certificate of qualification who graduated from a college of medicine accredited by the Liaison Committee on Medical Education or a college of osteopathy accredited by the Commission on Osteopathic College Accreditation shall present evidence satisfactory to the Board that the applicant has completed one (1) year of post-graduate or residency training in any of the following programs:

(a) A program accredited by the Accreditation Council for Graduate Medical Education.

(b) A program accredited by the American Osteopathic Association.

(d) A program accredited by the College of Family Physicians of Canada.

(e) Documentation submitted through the Federation Credentials Verification Service (FCVS) may be accepted to demonstrate compliance with subparagraphs (a), (b), (c), and (d) above.

(2) Applicants for a certificate of qualification who graduated from a college of medicine not accredited by the Liaison Committee on Medical Education or a college of osteopathy not accredited by the Commission on Osteopathic College Accreditation shall present evidence satisfactory to the Board that the applicant has completed two (2) years of post-graduate or residency training in any of the following programs:

(a) A program accredited by the Accreditation Council for Graduate Medical Education.

(b) A program accredited by the Commission on Osteopathic College Accreditation.

(d) A program accredited by the College of Family Physicians of Canada.

(e) Documentation submitted through the Federation Credentials Verification Service (FCVS) may be accepted to demonstrate compliance with subparagraphs (a), (b), (c), and (d) above.

(3) The terms “has completed one (1) year of post-graduate or residency training” and “has completed two (2) years of post-graduate or residency training” shall mean that the applicant has successfully completed or met the program’s established criteria, standards or requirements which are necessary for promotion to the next level of post-graduate training or that the applicant has successfully completed or met the program’s established criteria, standards or requirements which are necessary for completion of the program.

(4) Merely accumulating twelve (12) months of post-graduate or residency training or twenty-four (24) months of post-graduate or residency training shall not be evidence satisfactory to the Board that the applicant has fulfilled the post-graduate education requirement necessary for qualifying for the issuance of a certificate of qualification for a license to practice medicine in Alabama.

History

Author: Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; Act No. 93-148.
Filed May 20, 1993 for publication. See also Notice of Intended Action dated May 20, 1993 repealing existing Chapter 3. Amended: July 21, 1993; effective August 25, 1993. Amended: Filed November 20, 1997; effective December 25, 1997. Amended: Filed August 23, 1999; effective August 30, 1999. Amended: Filed August 22, 2002; effective September 26, 2002. Amended: Filed March 11, 2010; effective April 15, 2010. Amended: Published December 30, 2021; effective February 13, 2022. Amended: Published October 31, 2023; effective December 15, 2023.

Ala. Admin. Code r. 540-X-3-.04 Examination Requirements

(1) Applicants for a certificate of qualification shall achieve a passing score on one of the licensure examinations listed below:

(a) The United States Medical Licensing Examination (USMLE).

Applicants who are not dual degree candidates as specified in subparagraph (1)(a)3. below, shall have achieved a passing score on Step 3 in not more than three administrations. These applicants shall have passed Steps 1, 2 and 3 within a seven-year period. The time period for completion of Steps 1, 2 and 3 begins when the applicant initially passes his or her first Step. The Board shall not accept scores from a re-examination of a previously passed Step of the USMLE. The seven-year period is determined on a calendar year to calendar year basis. These applicants shall not have attempted to pass Steps 1, 2 and 3 a combined total of more than ten (10) times.
Applicants who are not dual degree candidates as specified in subparagraph (1)(a)3. below and who are currently board certified by one or more of the specialty boards recognized by the American Board of Medical Specialties or the American Osteopathic Association shall not be required to pass Steps 1, 2 and 3 within the seven-year period specified in subparagraph (1)(a)1. above; however, these applicants shall be limited to a combined total of ten (10) attempts to pass Steps 1, 2 and 3 as set forth in subparagraph (1)(a)1.
Applicants who are dual degree candidates as defined in these rules shall have achieved a passing score on Step 3 in not more than three administrations, and shall have completed Steps 1, 2 and 3 within a ten (10)-year period, except that the Board may approve, within its discretion and at the request of the applicant, a longer period not to exceed 15 years. The time period for completion of Steps 1, 2, and 3 begins when the applicant initially passes his or her first step. The time period for completion is determined on a calendar year to calendar year basis. The Board shall not accept scores from a re-examination of a previously passed step of the USMLE.
For purposes of the United States Medical Licensing Examination, dual degree candidates are defined as the following:

(i) The applicant is pursuing the M. D. or D. O. degree and the Ph.D. degree in an institution or program accredited by the LCME and a regional university accrediting body; and

(ii) The applicant is a student in good standing, enrolled in the institution or program; and

(iii) The Ph.D. studies are in a field of biological sciences tested in the USMLE Step 1 content, including, but not limited to anatomy, biochemistry, physiology, microbiology, pharmacology, pathology, genetics, neuroscience and molecular biology.

If an applicant fails to achieve a passing score on Step 3 in three administrations, the Board may approve one additional attempt to pass Step 3 after demonstration by the applicant of additional education, experience, or training acceptable to the Board.

(b) The Comprehensive Osteopathic Medical Licensing Examination or its predecessor examination administered by the National Board of Osteopathic Medical Examiners.

(d) If the examination was completed before January 1, 2000, applicants, by endorsement, who are licensed in another state, the District of Columbia, a territory of the United States, or a province of Canada are eligible for licensure upon proof of a passing score on one of the following examinations:

The Federation Licensing Examination.
The National Board of Medical Examiners Examination.

(e) The Board has established that the successful completion of certain combinations of the Federation Licensing Examination, National Board of Medical Examiners Examination and/or United States Medical Licensing Examinations, which are listed herein, are acceptable through January 1, 2000, in satisfaction of the examination requirement for a certificate of qualification. Those combinations and the passing score for each examination component are as follows:

NBME Part 1 (passing score=75) or USMLE Step 1 (passing score=75); plus NBME Part 11 (passing score=75) or USMLE Step 2 (passing score=75); plus NBME Part III (passing score=75) or USMLE Step 3 (passing score=75); or
FLEX Component 1 (passing score=75); plus USMLE Step 3 (passing score=75); or
NBME Part 1 (passing score=75 or USMLE Step 1 (passing score=75); plus NBME Part 11 (passing score=75) or USMLE Step 2 (passing score=75); plus FLEX Component 2 (passing score=75).

(f) Documentation submitted through the Federation Credentials Verification Service (FCVS) may be accepted to demonstrate compliance with the requirements of this rule.

History

Author: Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; Act No. 93-148.
Filed May 20, 1993 for publication. See also Notice of Intended Action dated May 20, 1993 repealing existing Chapter 3. Amended: July 21, 1993; effective August 25, 1993. Amended: Filed August 21, 1997; effective September 25, 1997. Amended: Filed November 20, 1997; effective December 25, 1997. Amended: Filed July 26, 1999; effective August 30, 1999. Amended: Filed March 22, 2002; effective April 26, 2002. Amended: Filed October 17, 2002; effective November 21, 2002. Amended: Filed March 21, 2003; effective April 25, 2003. Amended: Filed December 17, 2005; effective January 21, 2005. Amended: Filed September 23, 2005; effective October 28, 2005. Amended: Filed October 15, 2008; effective November 19, 2008. Amended: Filed October 22, 2009; effective November 26, 2009. Amended: Published December 30, 2021; effective February 13, 2022.

Ala. Admin. Code r. 540-X-3-.05 Criminal History Background Check

(1) Beginning October 1, 2008, all applicants for a certificate of qualification or certification of eligibility for any expedited license shall submit to a criminal history background check by the Board by providing fingerprints and executing a criminal history information release using forms provided by the Board.

(a) Each applicant shall submit a complete set of fingerprints, either inked cards or electronically, properly executed by a law enforcement agency or an individual properly trained in fingerprinting techniques.

(2) Fingerprints provided by each applicant shall be submitted by the Board to the Alabama State Bureau of Investigation (SBI), which is responsible for forwarding the fingerprints to the Federal Bureau of Investigation (FBI) for a national criminal history record check.

(3) The applicant shall pay directly to the Board, or its designee, all costs associated with the background check required by this rule.

(4) Information received by the Board pursuant to a criminal history background check shall be confidential and shall not be a public record, except that such information received by and relied upon by the Board in denying the issuance of a certificate of qualification for a license to practice medicine in Alabama, or relied upon in denying the issuance of, or certification of eligibility for any expedited license may be disclosed as may be necessary to support the denial.

History

Author: Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; Act No. 08-397.
New Rule: Filed October 15, 2008; effective November 19, 2008. Amended: Published December 30, 2021; effective February 13, 2022. Amended: Published October 31, 2023; effective December 15, 2023.

Ala. Admin. Code r. 540-X-3-.06 Education Council For Foreign Medical Graduates

(ECFMG) Certification Requirement {#sec-540-x-3-.06 omnilex-key=us-al-regs-official--chapter-540-x-3--540-X-3-.06}

(1) All applicants who graduated from a college of medicine not accredited by the Liaison Committee of Medical Education or the American Osteopathic Association shall achieve certification given by the Education Council for Foreign Medical Graduates or shall achieve a Fifth Pathway Certification and pass the examination administered by the Education Council For Foreign Medical Graduates. For the purposes of this rule, Fifth Pathway Certification and passage of the examination administered by the Education Council For Foreign Medical Graduates is hereby deemed equivalent to certification given by the Education Council For Foreign Medical Graduates. Proof of certification or passage of the examination must be sent directly from the Education Council for Foreign Medical Graduates to the Alabama State Board of Medical Examiners. Proof of Fifth Pathway Certification must be sent directly from the certifying agency to the Alabama State Board of Medical Examiners.

(2) Documentation submitted through the Federation Credentials Verification Service (FCVS) may be accepted to demonstrate compliance with the requirements of this rule.

History

Author: Wendell R. Morgan, Patricia E. Shaner, Attorneys for the Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; Act No. 93-148.
Filed May 20, 1993 for publication. See also Notice of Intended Action dated May 20, 1993 repealing existing Chapter 3. Amended: July 21, 1993; effective August 25, 1993. Amended: Filed March 20, 1995; effective April 24, 1995. Amended: Filed November 20, 1997; effective December 25, 1997. Amended: Filed July 26, 1999; effective August 30, 1999. Amended (Rule Number Only): Filed October 15, 2008; effective November 19, 2008.
Editor's note: Rule 05 was renumbered to .06 as per certification filed October 15, 2008; effective November 19, 2008.

Ala. Admin. Code r. 540-X-3-.07 Additional Requirements For Examination For Certain Applicants

(1) The SPEX shall be administered at dates and times to be established by the Examination Board of the Federation of State Medical Boards of the United States, Inc. pursuant to policies and procedures established by the Federation of State Medical Boards of the United States, Inc.

(2) SPEX Eligibility:

(a) The following individuals are eligible to take the Special Purpose Examination in Alabama:

Applicants who are applying for licensure in Alabama who are required to take the examination under another provision of this section.
Individuals required to take the examination pursuant to an order or directive of the State Board of Medical Examiners or the Medical Licensure Commission.

(b) All applicants for a certificate of qualification who are required to achieve a passing score on the SPEX shall have achieved a passing score in not more than three (3) administrations. Applicants who have not achieved a passing score within three (3) administrations shall no longer be eligible to take the SPEX.

(c) Individuals required to take the SPEX pursuant to a Board order or directive shall have achieved a passing score in not more than three (3) administrations, and those individuals who have not achieved a passing score within three (3) administrations shall no longer be eligible to take the SPEX.

(3) Endorsement applicants who are required to take the SPEX and who choose to take the SPEX through a licensing jurisdiction other than the State of Alabama must have proof of passage of the SPEX sent directly from the Federation of State Medical Boards of the United States, Inc. to the Alabama Board of Medical Examiners. Applicants may request that a certified transcript of their SPEX score be forwarded by the Federation of State Medical Boards of the United States, Inc. to the Alabama Board of Medical Examiners. An application will not be deemed complete until such proof of passage of the SPEX is received by the Alabama State Board of Medical Examiners.

(4) Documentation submitted through the Federation Credentials Verification Service (FCVS) may be accepted to demonstrate compliance with the requirements of this rule.

History

Author: Wendell R. Morgan, Patricia E. Shaner, Attorneys for the Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; Act No. 93-148.
Filed May 20, 1993 for publication. See also Notice of Intended Action dated May 20, 1993 repealing existing Chapter 3. Approved/Adopted: New Rule: Filed: July 21, 1993; effective August 25, 1993. Amended: Filed July 21, 1995; effective August 25, 1995. Amended: Filed November 20, 1997; effective December 25, 1997. Amended: Filed July 26, 1999; effective August 30, 1999. Amended: Filed November 13, 2007; effective December 18, 2007. Amended (Rule Number Only): Filed October 15, 2008; effective November 19, 2008. Amended: Published December 30, 2021; effective February 13, 2022. Amended: Published October 31, 2023; effective December 15, 2023.
Editor's note: Rule 06 was renumbered to .07 as per certification filed October 15, 2008; effective November 19, 2008.

Ala. Admin. Code r. 540-X-3-.08 Interview Requirements

The Board may, within its discretion, require that an applicant attend a personal interview with the Credentials Committee of the Board or, at its direction, a representative of the Board in the following circumstances:

(a) When the applicant's answer to any question on the application is incomplete or requires additional explanation;

(b) When the Board is in receipt of any information from any source concerning the applicant that would require additional information or explanation;

History

Author: Wendell R. Morgan, Patricia E. Shaner, Attorneys for the Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; Act No. 93-148.
Filed May 20, 1993 for publication. See also Notice of Intended Action dated May 20, 1993 repealing existing Chapter 3. Approved/Adopted: New Rule Filed: July 21, 1993; effective August 25, 1993. Amended (Rule Number Only): Filed October 15, 2008; effective November 19, 2008.
Editor's note: Rule 07 was renumbered to .08 as per certification filed October 15, 2008; effective November 19, 2008.

Ala. Admin. Code r. 540-X-3-.09 Fees Payable For Applicants For Certificates Of Qualification For Licensure To Practice Medicine In Alabama

(1) All applicants for a certificate of qualification whether by examination, endorsement, or without examination (limited license) shall submit an application fee in the amount of One Hundred and Seventy-five ($175.00) Dollars.

(2) Beginning October 1, 2008, all applicants for a certificate of qualification for a full license to practice medicine shall pay a criminal history background check fee of Sixty-five Dollars ($65.00)

(3) All applicants for a certificate of qualification for a full license to practice medicine shall submit the Sixty-Dollar ($60.00) application fee, or the fee in effect at the time of the application published by the Federation of State Medical Boards (FSMB), to FSMB.

(4) In addition to the application fee stated above, those applicants for a certificate of qualification by examination (USMLE) and/or those applicants for a certificate of qualification who are required by these rules to take and pass the SPEX examination shall submit examination fees according to the following schedule:

(a) Those applicants for a certificate of qualification by USMLE examination shall pay an examination fee which shall include the following:

That fee which, pursuant to an Official Notice from the United States Medical Licensing Examination, is in effect at the time the application for a certificate of qualification by examination is filed with the Alabama Board of Medical Examiners.
A fee for administration cost to be set on an annual basis. All Official Notices regarding USMLE fees and any administration fee shall be kept on file in the office of the Executive Director of the Alabama State Board of Medical Examiners.

(b) Those applicants who are required to take and pass the SPEX examination and who choose to sit for the SPEX in the State of Alabama shall pay that fee which, pursuant to an Official Notice from the Federation of State Medical Boards of the United States, is in effect at the time the application to take the SPEX is filed with the Alabama Board of Medical Examiners. All Official Notices regarding SPEX fees from the Federation of State Medical Boards of the United States shall be kept on file in the office of the Executive Director of the Alabama State Board of Medical Examiners.

History

Author: Wendell R. Morgan, Patricia E. Shaner, Attorneys for the Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; Act No. 93-148.
Filed May 20, 1993 for publication. See also Notice of Intended Action dated May 20, 1993 repealing existing Chapter 3. Amended: July 21, 1993; effective August 25, 1993. Amended: Filed July 21, 1995; effective August 25, 1995. Amended: Filed October 15, 2008; effective November 19, 2008. Amended: Filed January 21, 2016; effective March 6, 2016. Amended: Published May 29, 2020; effective July 13, 2020.
Editor's note: Rule 08 was renumbered to .09 as per certification filed October 15, 2008; effective November 19, 2008.

Ala. Admin. Code r. 540-X-3-.10 Policy Of The Board Of Medical Examiners For Referral Of Applications For A Certificate Of Qualification Which Reflect Treatment Or Aftercare For Chemical Dependency And Substance Abuse Or Psychiatric Illness To The Alabama Physicians Health Program For Evaluation And Recommendation To The Board Of Medical Examiners

(1) The Contract between the Alabama Board of Medical Examiners and the Medical Association of the State of Alabama, Physicians Health Program (PHP) permits the Board to refer physicians with a history of treatment for chemical dependency and substance abuse to the Alabama PHP for evaluation and a recommendation back to the Board of Medical Examiners. It is the Board's policy that staff for the Board of Medical Examiners will refer to the Medical Director of the PHP the names of any applicants for a certificate of qualification who has disclosed in his or her application a history of addiction to alcohol or drugs and/or treatment, monitoring or aftercare for chemical dependency and substance abuse or psychiatric illness preceding the date of application. Referral will be accomplished under the following steps:

(a) A notice to applicants will be included in the package of application forms sent to a prospective applicant informing them of the Board's policy on referral to the PHP for evaluation. The notice will be in the following form: NOTICE: ALL PROSPECTIVE APPLICANTS ARE HEREBY NOTIFIED THAT IT IS THE POLICY OF THE ALABAMA BOARD OF MEDICAL EXAMINERS TO REFER ANY APPLICANT WHO HAS BEEN ADDICTED TO THE USE OF ALCOHOL OR CONTROLLED SUBSTANCES AND/OR WHO HAS RECEIVED ANY TREATMENT, MONITORING OR AFTERCARE FOR CHEMICAL DEPENDENCY OR SUBSTANCE ABUSE OR PSYCHIATRIC ILLNESS WITHIN TWO (2) YEARS PRECEDING THE DATE OF THE APPLICATION TO THE PHYSICIANS HEALTH PROGRAM FOR EVALUATION BY THE PHP AND A RECOMMENDATION TO THE BOARD OF MEDICAL EXAMINERS ON THE LICENSE APPLICATION. AS A PART OF THE APPLICATION PROCESS, APPLICANTS WILL BE EXPECTED TO COOPERATE FULLY WITH REQUESTS FOR INFORMATION AND/OR EVALUATIONS WHICH MAY BE RECOMMENDED BY THE MEDICAL DIRECTOR OF THE PHYSICIANS HEALTH PROGRAM IN CONSULTATION WITH THE BOARD'S PHYSICIAN MONITORING COORDINATOR. AN APPLICATION SHALL NOT BE DEEMED TO BE COMPLETE AND SHALL NOT BE PLACED ON THE AGENDA OF THE BOARD OF MEDICAL EXAMINERS UNTIL THE BOARD HAS RECEIVED A RECOMMENDATION FROM THE PHYSICIANS HEALTH PROGRAM. THIS POLICY APPLIES TO APPLICANTS FOR A CERTIFICATE OF QUALIFICATION BY ENDORSEMENT OR BY EXAMINATION OR WITHOUT EXAMINATION (LIMITED LICENSE).

(b) Upon receipt of an application for a certificate of qualification by examination or by endorsement or without examination (limited license) the staff of the Alabama Board of Medical Examiners will immediately provide a copy of the application and any accompanying materials submitted by the applicant to the Medical Director of the Physicians Health Program. Referral to the PHP will not be delayed pending receipt of other elements of the application such as verifications of medical school and residency qualifications, license verifications in other states and tests results.

(c) Upon receipt of a referral for evaluation and recommendation from the Board of Medical Examiners, the Medical Director of the PHP will cause an evaluation and examination to be made of the information available and will determine what, if any, further information and/or evaluations are required in order for the PHP to make a recommendation to the Board of Medical Examiners on the application for a certificate of qualification. The Medical Director is authorized to communicate directly with the applicant to secure any additional information which may be required by the PHP in order to complete the evaluation. In the event that the Medical Director is unable to obtain the necessary information or in the event that the applicant is uncooperative with the PHP by failing or refusing to comply with the requests for information and/or evaluation, then in such event the Medical Director will notify the staff of the Board of Medical Examiners who will in turn notify the applicant in writing that his or her application will not be further considered by the Board unless and until a recommendation is received from the PHP.

(d) Upon completion of an evaluation, the Medical Director of the PHP will provide the staff of the Board of Medical Examiners a written recommendation stating whether in the opinion of the Medical Director the applicant can practice medicine with reasonable safety to patients and will specify any restrictions which he recommends should be placed on the applicants certificate of qualification.

(e) The Board of Medical Examiners' staff will provide a copy of the recommendation of the Medical Director to the applicant. If the Medical Director has recommended any restrictions on the certificate of qualification, the Board of Medical Examiners' Legal Department will prepare the necessary voluntary restriction and/or agreement as appropriate.

(f) When the other elements of the application have been received and the application is considered complete, the Board of Medical Examiners' staff will have the option to schedule the applicant for an interview with the Credentials Committee in accordance with the Committee's directive. The application will then be processed in the regular course of business.

(g) In any circumstances not specifically outlined by this Policy, the Executive Director and the Board of Medical Examiners' staff shall seek and obtain guidance from the Chairman of the Credentials Committee.

History

Author: Wendell R. Morgan, Patricia E. Shaner, Attorneys for the Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; Act No. 93-148.
Filed May 20, 1993 for publication. See also Notice of Intended Action dated May 20, 1993 repealing existing Chapter 3. Amended: July 21, 1993; effective August 25, 1993. Amended: Filed July 26, 1999; effective August 30, 1999. Amended: Filed September 20, 2001; effective October 25, 2001. Amended (Rule Number Only): Filed October 15, 2008; effective November 19, 2008.
Editor's note: Rule 09 was renumbered to .10 as per certification filed October 15, 2008; effective November 19, 2008.

Ala. Admin. Code r. 540-X-3-.11 Application Forms Required For A Certificate Of Qualification (Repealed 3/17/23)

Application Forms Required For A Certificate Of Qualification (Repealed 3/17/23)

History

Author: Wendell R. Morgan, Patricia E. Shaner, Attorneys for the Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; Act No. 93-148.
Filed May 20, 1993 for publication. See also Notice of Intended Action dated May 20, 1993 repealing existing Chapter 3. Amended: July 21, 1993; effective August 25, 1993. Amended: September 15, 1993. Filed for Publication: September 20, 1993. Amended: Filed November 17, 1993; Effective: December 22, 1993. Amended: Filed December 17, 1997; effective January 21, 1998. Amended: Filed October 15, 2008; effective November 19, 2008. Amended: Published May 29, 2020; effective July 13, 2020. Repealed: Published January 31, 2023; effective March 17, 2023.
Editor's note: Rule 10 was renumbered to .11 as per certification filed October 15, 2008; effective November 19, 2008.

Ala. Admin. Code r. 540-X-3-.12 Applicants For Certificate Of Qualification By Endorsement

(1) The State Board of Medical Examiners may issue a certificate of qualification by endorsement on behalf of a person who presents evidence satisfactory to the Board of successful completion of one of the following:

(a) The Federation Licensing Examination.

(b) The National Board of Medical Examiners Examination.

(d) The United States Medical Licensing Examination.

(e) The Licensing Medical Council of Canada Examination.

(f) Any other examination which is currently approved or which may later be approved by the Board of Medical Examiners and which examines in the following branches of medical learning: general medicine, surgery, obstetrics, gynecology, preventive medicine, jurisprudence, and any other branches as the Board may require. The Board of Medical Examiners does not approve the Florida State Board Examination given prior to June 1979, and the Board of Medical Examiners does not approve the Puerto Board Examinations given prior to the FLEX and the NBME being used as licensing examinations in Puerto Rico.

(2) Endorsement applicants who are required to take the SPEX must submit an endorsement application and a Federation of State Medical Boards of the United States, Inc. application for SPEX.

(3) Applicants requesting licensure by the FLEX, NBME, NBOME, USMLE, or LMCC examination shall request and cause the respective agency to furnish the Alabama Board of Medical Examiners an official transcript of the applicant's scores on or before the deadline for application.

(4) An applicant holding a limited license who qualifies for certification by the Board within one year from the end of the month when the limited license was issued, shall have the application fee waived.

(5) Beginning January 1, 2000, the following requirements shall apply:

(a) Applicants by endorsement who completed any one of the licensing examinations listed in Rule 540-X-3-.04(1) prior to January 1, 2000, are eligible for licensure upon proof of a passing score of such examination.

(b) Applicants by endorsement whose licensing examination was completed after January 1, 2000, shall achieve a passing score, as determined by the Board of Medical Examiners, on the United States Medical Licensing Examination or the National Board of Osteopathic Examiners Examination or its successor examination.

(6) Documentation submitted through the Federation Credentials Verification Service (FCVS) may be accepted to demonstrate compliance with the requirements of this rule.

History

Author: Wendell R. Morgan, Patricia E. Shaner, Attorneys for the Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; Act No. 93-148.
Filed May 20, 1993 for publication. See also Notice of Intended Action dated May 20, 1993 repealing existing Chapter 3. Amended: July 21, 1993; effective August 25, 1993. Amended: September 15, 1993. Filed for publication: September 20, 1993. Amended: Filed November 17, 1993; effective December 22, 1993. Amended: Filed July 21, 1995; effective August 25, 1995. Amended: Filed November 20, 1997; effective December 25, 1997. Amended: Filed July 26, 1999; effective August 30, 1999. Amended (Rule Number Only): Filed October 15, 2008; effective November 19, 2008.
Editor's note: Rule 11 was renumbered to .12 as per certification filed October 15, 2008; effective November 19, 2008.

Ala. Admin. Code r. 540-X-3-.13 Requirements For Applicants For A Certificate Of Qualification By Examination To Be Administered By The Board

(1) Requirements relating to the administration of Step 3 of the United States Medical Licensing Examination by the Board:

(a) The Board will administer USMLE Step 3 to applicants for a certificate of qualification who are applying for initial licensure in the State of Alabama and who meet all qualifications for administration of Step 3 of the USMLE. The Board will not administer the examination to physicians other than qualified applicants for licensure in Alabama.

(b) To be eligible to sit for USMLE Step 3, an applicant must have obtained the M.D. or D.O. degree, as provided in Rule 540-X-3-.02.

An applicant who graduated from a college of medicine accredited by the Liaison Committee on Medical Education of the American Medical Association or a college of osteopathy accredited by the American Osteopathic Association must either be currently enrolled in a post-graduate/residency training program or have completed one (1) year of post-graduate/residency training, as provided in Rule 540-X-3-.03(1).
An applicant who graduated from a college of medicine not accredited by the Liaison Committee on Medical Education of the American Medical Association or a college of osteopathy not accredited by the American Osteopathic Association must either have completed two (2) years of post-graduate/ residency training and be currently enrolled in the third year of post-graduate/residency training or have completed three (3) years of post-graduate/residency training, as provided in Rule 540-X-3-.03(2).

(d) To be eligible to sit for USMLE Step 3, an applicant must:

Have successfully completed both USMLE Steps 1 and 2; or
Have successfully completed combinations of FLEX components, NBME parts and/or USMLE Steps, as established in Rule 540-X-3-.04(4).

(e) To be eligible to sit for USMLE Step 3, an applicant must otherwise possess the qualifications for licensure as a physician in Alabama.

(f) An examinee who fails USMLE Step 3 may be re-examined at any subsequent examination upon payment of the required fee and submission of any required applications.

(g) A failure of any USMLE Step, regardless of the jurisdiction in which the examination was administered, shall be considered a failure of that step for purposes of Alabama licensure.

(h) Examination scores will be reported using a two-digit scaled score. A score of 75 or better on each Step (1, 2 or 3) shall constitute a passing score on that Step. Rounding up of scores shall not be allowed.

(i) Each USMLE Step must be passed individually in order to successfully complete the USMLE examination. Individual Step scores shall not be averaged to complete an overall score.

(j) Step 3 of the USMLE will be administered as designated by the USMLE program.

History

Author: Wendell R. Morgan, Patricia E. Shaner, Attorneys for the Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; Act No. 93-148.
Filed May 20, 1993 for publication. See also Notice of Intended Action dated 5/20/93 repealing existing Chapter 3. Amended: July 21, 1993; effective August 25, 1993. Amended: September 15, 1993. Filed for publication: September 20, 1993. Amended: Filed November 17, 1993; effective December 22, 1993. Amended: Filed July 21, 1995; effective August 25, 1995. Amended: Filed December 17, 1997; effective January 21, 1998. Amended: Filed July 26, 1999; effective August 30, 1999. Amended: Filed March 22, 2002; effective April 26, 2002. Amended: Filed October 17, 2003; effective November 21, 2003. Amended: Filed October 15, 2008; effective November 19, 2008.
Editor's note: Rule 12 was renumbered to .13 as per certification filed October 15, 2008; effective November 19, 2008.

Ala. Admin. Code r. 540-X-3-.14 Administrative Requirements For Examination By The Board

(1) Each applicant shall pay an examination fee as established by the Board for each administration of the required examination. The examination fee is not returnable to an unsuccessful applicant.

(2) Examinations administered by the Board may be given in Montgomery or at any other location in the state determined by the Board on those dates and at those times as set by the Board.

(3) Applicants who are required to take the Special Purpose Examination or the United States Medical Licensing Examination administered by the Board shall, in addition to the other requirements of this section, be eligible to sit for and take the examination under the rules established by the organization which created the examination.

(4) The Board may enter into personal service contracts with individuals, firms, or corporations for the administration of any examination required by this section.

(5) The Board shall keep complete records of all examinations conducted, giving the name, age, residence, college, date of graduation of the applicant examined, and the results of the examination. These records shall be open to public inspection.

(6) Applicants will be expected to conduct themselves in a professional manner during all phases of the examination. Any applicant whose conduct is deemed to be unprofessional by a representative of the Alabama Board of Medical Examiners will be dismissed from the examination, provided however, that the applicant shall be allowed to take the examination at a future test date. For the purpose of this rule unprofessional conduct shall include, but shall not be limited to, the following types of conduct or behavior:

(a) Appearing for the examination while intoxicated or under the influence of drugs or both;

(b) The use of profanity or abusive language during the course of the examination;

(d) Any and all actions on the part of applicant and/or examinees, or by others when solicited by an applicant and/or examinee, that subvert or attempt to subvert the examination process, including but are not limited to, the following: seeking and/or obtaining access to examination materials prior to the examination; falsification of information on application or registration of information on application or registration forms; impersonation of an examinee or engaging a proxy to take the examination; copying answers from another examinee; allowing answers to be copied; possessing unauthorized materials during an examination, altering or misrepresenting examination scores; theft or other unauthorized possession of examination materials; memorizing and reproducing test items and any unauthorized reproduction by any means and/or dissemination of copyrighted examinations materials.

History

Author: Wendell R. Morgan, Patricia E. Shaner, Attorneys for the Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; Act No. 93-148.
Filed May 20, 1993 for publication. See also Notice of Intended Action dated May 20, 1993 repealing existing Chapter 3. Amended: July 21, 1993; effective August 25, 1993. Amended: Filed July 21, 1995; effective August 25, 1995. Amended: Filed July 26, 1999; effective August 30, 1999. Amended (Rule Number Only): Filed October 15, 2008; effective November 19, 2008.
Editor's note: Rule 13 was renumbered to .14 as per certification filed October 15, 2008; effective November 19, 2008.

Ala. Admin. Code r. 540-X-3-.15 Provisional Approval For Certificate Of Qualification

(1) Provisional approval for the issuance of a certificate of qualification may be given by the Board based on the following:

(a) An applicant has met all of the requirements of Code of Ala. 1975, §34-24-70 and Board of Medical Examiners Rules, Chapter 540-X-3, necessary for the issuance of a certificate of qualification, except that the Board has not received satisfactory evidence that the applicant has successfully completed the post graduate or residency training requirement; and

(b) There are no grounds for denial of a certificate of qualification by the Board pursuant to Code of Ala. 1975, §34-24-70(d).

(2) Upon receipt by the Board of acceptable documentation from the post graduate or residency training program certifying that the applicant has successfully completed the post graduate training requirement necessary for the issuance of a certificate of qualification, the Board shall issue the certificate of qualification.

History

Author: Alabama Board of Medical Examiners. '
Authority: Code of Ala. 1975, 34-24-53, Act No. 93-148.
New Rule: Filed May 16, 2013; effective June 20, 2013.

Ala. Admin. Code r. 540-X-3-.16 Certificate Of Qualification Issued Without Examination (Limited License)

(1) Certificates of qualification without examination may, within the discretion of the Board, be issued for a period of up to one year to the following applicants:

(a) Individuals enrolled in an American Medical Association approved residency training program;

(b) Individuals enrolled in residency training programs in LCME accredited schools or Colleges of Medicine in Alabama approved by the Board as set forth in Section 540-X-3-.16.

(c) Visiting professors, subject to a time limit specified by the Board, and distinguished professors at medical colleges, and specialty professors at medical colleges,

(d) Physicians employed full-time at a state penal institution or a state mental institution.

(e) Physicians employed full-time at any other state institution approved by the Board.

(2) The Board may issue a certificate of qualification without examination to practice medicine to the Medical Licensure Commission when the below listed requirements have been met.

(a) Graduates of medical schools accredited by the LCME or schools of osteopathy accredited by the American Osteopathic Association must comply with the following:

Applicant must have received a diploma from a college of medicine or osteopathy approved by the Board;
Applicant must have served or be serving a one-year internship (residency) approved by the American Medical Association or by the Board;
Applicant must submit a letter from the Dean, Chief Medical Officer, or Program Director certifying applicant's training or employment at that institution;
Applicant must submit the application fee as set by Rule No. 540-X-3-.09;
Applicant must submit completed application with required certification and attachments.

(b) Graduates of medical schools not accredited by the LCME must comply with the following:

Applicant must have received a diploma from a college of medicine or osteopathy and be eligible for examination by the Education Commission for Foreign Medical Graduates (ECFMG) for its certificate. The Educational Commission for Foreign Medical Graduates (ECFMG) and its sponsoring organizations define a “graduate of a foreign medical school” as a physician whose basic medical digress or qualification was conferred by a medical school located outside of the United States, Canada, and Puerto Rico. The medical school must be listed at the time of an applicant’s graduation World Directory of Medical Schoolsin the by the World Health Organization.
Applicant must have served or be serving one year of internship (residency) approved by the American Medical Association or the Board.
Applicant must be certified by the ECFMG unless the applicant has received his medical training from a primarily English-speaking medical school. For the purposes of this rule, Fifth Pathway Certification and passage of the examination administered by the Education Council For Foreign Medical Graduates is hereby deemed equivalent to certification given by the Education Council For Foreign Medical Graduates. The Board may, within its discretion, waive the requirement of ECFMG certification for an applicant for distinguished professor or an applicant for specialty professor. The Board may, within its discretion, require that the applicant meet with the Credentials Committee of the Board.
Applicant must submit application fee as set by Rule 540-X-3-.07.
Applicant must submit completed application with required certification and attachments.

(3) The Board may, within its discretion, require that an applicant attend a personal interview with the Credentials Committee of the Broad or, at its direction, a representative of the Board in the following circumstances:

(a) When the applicant's answer to any question on the application is incomplete or requires additional explanation;

(b) When the Board is in receipt of any information from any source concerning the applicant that would require additional information or explanation;

(4) Any physician granted a limited license by this Board prior to December 31, 1969, which license has been renewed each year, shall be entitled to the annual renewal of such limited license, upon proper application, any other rule, regulation or policy notwithstanding; unless and until such limited license is revoked or suspended in accordance with §§34-24-360 and 34-24-361, Code of Ala. 1975, and these rules.

(5) For an applicant pursuant to Code of Ala. 1975, §34-24-75(b) who is a physician employed full-time at a state penal institution or a state mental institution, the following applies:

(a) Applicants qualify for a certificate of qualification without examination in circumstances which are the following:

The applicant does not qualify to take a licensing examination listed in Ala. Code §34-24-70(a)(3); or
The applicant has not met the additional requirements for examination for certain applicants stated in Code of Ala. 1975, §34-24-70(a)(6)a.; or
The applicant has achieved a passing score on Step 1 and on Step 2 and on Step 3 of the USMLE, but the applicant did not complete Steps 1, 2 and 3 within a seven (7) year period; or
The applicant has achieved a passing score on Step 3 of the USMLE, but the applicant achieved the passing score in more than three administrations.

(b) An applicant does not qualify for a certificate of qualification without examination if the applicant is eligible to meet the examination requirements stated in Code of Ala. 1975, §34-24-70(a)(3).

(6) Physicians employed full-time at regional mental health programs and facilities created pursuant to Code of Ala. 1975, §§22-51-1 through 22-51-14 are deemed to be employed full-time at state mental institutions and are subject to the requirements of paragraph (5) of this rule for the purposes of certificates of qualification issued without examination.

History

Author: Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; Act No. 93-148.
Filed May 20, 1993 for publication. See also Notice of Intended Action dated 5/20/93 repealing existing Chapter 3. Amended: July 21, 1993; effective August 25, 1993. Amended: September 15, 1993. Filed for publication: September 20, 1993. Amended: Filed November 17, 1993; effective December 22, 1993. Amended: Filed March 20, 1995; effective April 24, 1995. Amended: Filed August 21, 1996; effective September 26, 1996. Amended: Filed July 26, 1999; effective August 30, 1999. Amended: Filed May 19, 2006; effective June 23, 2006. Amended: Filed March 22, 2007; effective April 26, 2007. Amended: Filed September 20, 2007; effective October 25, 2007. Amended: Filed October 15, 2008; effective November 19, 2008. Amended: Filed November 18, 2009; effective December 23, 2009. Amended: Filed April 16, 2019; effective May 31, 2019.
Editor's note: Rule 14 was renumbered to .15 as per certification filed October 15, 2008; effective November 19, 2008. Rule .15 was renumbered to .16 as per certification filed May 16, 2013; effective June 20, 2013.

Ala. Admin. Code r. 540-X-3-.17 Training Programs Approved By The Board - Certificate Of Qualification Issued Without Examination

(Limited License) {#sec-540-x-3-.17 omnilex-key=us-al-regs-official--chapter-540-x-3--540-X-3-.17}

(a) For purposes of issuing a certificate of qualification without examination (limited license) to an applicant under rule 540-X-3-.15(1)(b), the Alabama Board of Medical Examiners may approve training programs not accredited by the Accreditation Council for Graduate Medical Education (ACGME) in schools or Colleges of Medicine accredited by the Liaison Committee on Medical Education (LCME) in Alabama that meet the following criteria:

(1) Enroll individuals holding the degree of Doctor of Medicine or equivalent degree from the individual’s country of origin;

(2) have a structured curricula;

(3) require a licensed physician preceptor for each individual enrolled in the program; and

(4) Have a formal evaluation process.

(b) In the initial application for a certificate of qualification without examination, the Dean of the College of Medicine shall certify and present written documentation demonstrating that the training program meets the criteria in this section and shall set forth the duration of the training program, which shall be subject to the approval of the Board at their discretion, but which shall normally not exceed a period of twenty-four months.

(c) A training program approved by the Board under Rule 540-X-3-.16 does not qualify as a post graduate or residency training program for the purpose of Rule 540-X-3-.03.

History

Author: Wendell R. Morgan, Attorney for the Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; Act No. 93-148.
New Rule: Filed August 21, 1996; effective September 26, 1996. Amended: Filed October 15, 2008; effective November 19, 2008.
Editor's note: The old Rule 540-X-3-.15 has been renumbered Rule 540-X-3-.16 as of the certification filed August 21, 1996. Previous rule 15 was renumbered to .16 as per certification filed October 15, 2008; effective November 19, 2008. Rule .16 was renumbered to .17 as per certification filed May 16, 2013; effective June 20, 2013.

Ala. Admin. Code r. 540-X-3-.18 Renewal Of Certificate Of Qualification Without Examination (Limited License)

Physicians must apply to the Board to renew their limited certificate of qualification by January 1 of each year. The Board shall have full discretion to accept or reject the application for renewal. Physicians must pay a renewal fee of $15.00, or as is otherwise set by law.

History

Author: Wendell R. Morgan, Patricia E. Shaner, Attorneys for the Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; Act No. 93-148.
Filed May 20, 1993 for publication. See also Notice of Intended Action dated May 20, 1993 repealing existing Chapter 3. Amended: July 21, 1993; effective August 25, 1993. Amended (Rule Number Only): Filed October 15, 2008; effective November 19, 2008.
Editor's note: Rule 540-X-3-.16 was previously numbered Rule 540-X-3-.15 as of the certification filed August 21, 1996. Previous rule 16 was renumbered to .17 as per certification filed October 15, 2008; effective November 19, 2008. Rule .17 was renumbered to .18 as per certification filed May 16, 2013; effective June 20, 2013.

Ala. Admin. Code r. 540-X-3-.19 Grounds For Denial Of A Certificate Of Qualification

The Board may deny an application for a certificate of qualification on any of the following grounds:

(1) Failure of the applicant to achieve a passing score on any examination according to statutory and regulatory requirements.

(2) Failure of the applicant to complete the application form as specified by the Board or to provide additional information requested by the Board in connection with the application, including failure to provide information to or submit to an evaluation recommended by the Alabama Physician Wellness Committee, or its designee.

(3) A finding that the applicant has submitted or caused to be submitted false, misleading, or untruthful information to the Board in connection with an application for a certificate of qualification.

(4) Failure to appear before the Board or a committee of the Board if formally requested to appear in connection with an application for a certificate of qualification.

(5) A finding by the Board that the applicant has committed any of the acts or offenses constituting grounds to discipline the licensee to practice medicine in this state pursuant to, but not limited to, Sections 16-47-128, 34-24-360, and 34-24-57.

(6) Failure of the applicant to comply with any of the requirements or rules for the issuance of a certificate of qualification.

History

Author: Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; Act No. 07-402.
Filed May 20, 1993 for publication. See also Notice of Intended Action dated May 20, 1993 repealing existing Chapter 3. Amended: July 21, 1993; effective August 25, 1993. Amended: Filed November 13, 2007; effective December 18, 2007. Amended (Rule Number Only): Filed October 15, 2008; effective November 19, 2008. Amended: Published December 30, 2021; effective February 13, 2022.
Editor's note: Rule 540-X-3-.19 was previously numbered Rule 540-X-3-.18 as of the certification filed August 21, 1996. Rule 540-X-3-.19 was renumbered to 540-X-3-.17 as per certification filed November 13, 2007. Previous rule 17 was renumbered to .18 as per certification filed October 15, 2008; effective November 19, 2008. Rule .18 was renumbered to .19 as per certification filed May 16, 2013; effective June 20, 2013.

Ala. Admin. Code r. 540-X-3-.19.1 Denial Of Application For Certificate Of Qualification – Hearing

(1) If, after examination of the application for a certificate of qualification to practice medicine and after consideration of any information developed by the Board pursuant to an investigation into the qualifications of the physician to practice medicine, the Board determines that there is probable cause to believe there exist grounds upon which the application for a certificate of qualification may be denied, the Board shall take the following actions:

(a) Defer final decision on the application for certificate of qualification; and

(b) Notify the applicant of the grounds for possible denial of the application for a certificate of qualification and the procedure for obtaining a hearing before the Board.

(2) If requested by the applicant within the time frame specified by the Board, a hearing shall be set before the Board on the application for a certificate of qualification.

(3) If the applicant, after being notified of the grounds for denial, fails to request a hearing within the time frame specified by the Board, the applicant will be deemed to have waived his or her right to a hearing, and the certificate of qualification shall be denied.

(4) All hearings under this rule shall be conducted in accordance with the Alabama Administrative Procedure Act, Code of Ala. 1975, §§41-22-1 et seq.

History

Author: Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §§34-24-53, 34-24-53.1, 34-24-70.
New Rule: Published October 29, 2021; effective December 13, 2021.

Ala. Admin. Code r. 540-X-3-.20 Non-Disciplinary Citation With Administrative Charge

(1) When the Board has determined that a ground for denial of an application for a certificate of qualification exists based upon the submission of false, misleading or untruthful information to the Board in connection with the application, the Board, in its discretion, may allow an applicant to submit a written request that a non-disciplinary citation with administrative charge be assessed against the applicant in lieu of a decision by the Board to deny the application.

(2) The Board may grant, if deemed appropriate, the request for an assessment of the citation with administrative charge and issue a certificate of qualification to the applicant.

(3) The written request to be submitted by the applicant shall be on a form approved by the Board and signed by the applicant.

(4) Submission of a written request form to the Board shall be accompanied by payment to the Board of the administrative charge in an amount determined by the Board which shall not exceed Ten Thousand Dollars ($10,000).

(5) Payment of the administrative charge shall be made to the Board prior to the issuance of a certificate of qualification.

(6) Upon receipt of a properly executed request form and payment of the administrative charge, the Board may issue the non-disciplinary citation and the certificate of qualification.

(7) The administrative charge is not refundable once payment is received by the Board.

(8) The imposition of a non-disciplinary citation with administrative charge is considered pubic information and is not considered a disciplinary action against the applicant, a restriction against the certificate of qualification or an adverse encumbrance against the certificate of qualification.

History

Author: Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; Act No. 07-402.
Filed May 20, 1993 for publication. See also Notice of Intended Action dated May 20, 1993 repealing existing Chapter 3. Amended: July 21, 1993; effective August 25, 1993. Repealed and New Rule: Filed November 13, 2007; effective December 18, 2007. Amended (Rule Number Only): Filed October 15, 2008; effective November 19, 2008. Amended: Published December 30, 2021; effective February 13, 2022.
Editor's note: Rule 540-X-3-.18 was previously numbered Rule 540-X-3-.17 as of the certification filed August 21, 1996. Previous rule 18 was renumbered to .19 as per certification filed October 15, 2008; effective November 19, 2008. Rule .19 was renumbered to .20 as per certification filed May 16, 2013; effective June 20, 2013.

Ala. Admin. Code r. 540-X-3-.21 Appeal From Denial Of Application For Certificate Of Qualification

An applicant may appeal the decision of the Board denying an application for a certificate of qualification or an application for reinstatement of a certificate of qualification or an application for removal of voluntary restrictions on a certificate of qualification to the Medical Licensure Commission of the State of Alabama. An appeal from a denial of an application for an initial certificate of qualification shall be governed by Rule 540-X-5-.08. An appeal from a denial of an application for reinstatement of a certificate of qualification or an application for removal of a voluntary restriction on a certificate of qualification shall be governed by Rule 540-X-5-.07

History

Author: Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53; 34-24-330, 34-24-361(g)
Filed May 20, 1993 for publication. See also Notice of Intended Action dated May 20, 1993 repealing existing Chapter 3. Amended: July 21, 1993; effective August 25, 1993. Amended (Changed Rule Number Only): Filed November 13, 2007; effective December 18, 2007. Amended: Filed August 21, 2008; effective September 25, 2008. Amended: Filed October 15, 2008; effective November 19, 2008.
Editor's note: Rule 540-X-3-.17 was previously numbered Rule 540-X-3-.16 as of the certification filed August 21, 1996. Rule 540-X-3-.17 was renumbered to 540-X-3-.19 as per certification filed November 13, 2007. Previous rule 19 was renumbered to .20 as per certification filed October 15, 2008; effective November 19, 2008. Rule .20 was renumbered to .21 as per certification filed May 16, 2013; effective June 20, 2013.

Ala. Admin. Code r. 540-X-3-.22 Outgoing Reciprocity

Physicians and osteopaths receiving their original license to practice medicine in the State of Alabama, who seek licensure in another state or district may apply to the Board for certification of their licensure by way of outgoing reciprocity at a cost of $10.00, or as is otherwise set by law.

History

Author: Wendell R. Morgan and Patricia E. Shaner, Attorneys for the Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53 and Act No. 93-148.
Filed May 20, 1993 for publication. See also Notice of Intended Action dated May 20, 1993 repealing existing Chapter 3. Amended: July 21, 1993; effective August 25, 1993. Amended (Rule Number Only): Filed October 15, 2008; effective November 19, 2008.
Editor's note: Rule 540-X-3-.20 was previously numbered Rule 540-X-3-.19 as of the certification filed August 21, 1996. Previous rule 20 was renumbered to .21 as per certification filed October 15, 2008; effective November 19, 2008. Rule .21 was renumbered to .22 as per certification filed May 16, 2013; effective June 20, 2013.

Ala. Admin. Code r. 540-X-3-.23 Withdrawal Of Application For Certificate Of Qualification And Certificate Of Qualification

(1) An applicant for a certificate of qualification shall have six (6) months from the date the initial signed application form is received by the Board to complete the application, except that an applicant for a certificate of qualification who is required to pass an examination as part of the application process shall have twelve (12) months from the date the initial signed application form is received to complete the application. After the expiration of the deadline for completing an application established in the preceding sentence, an incomplete application shall be withdrawn by the Board.

(2) A certificate of qualification issued by the Board shall be withdrawn by the Board after a period of six (6) months from the date of issuance unless the applicant has filed an application for a license to practice medicine with the Medical Licensure Commission of Alabama and paid the required fee.

(3) If either an application for a certificate of qualification or a certificate of qualification is withdrawn by the Board, the applicant, to reapply, shall submit a new application form including a new application fee.

History

Author: Wendell R. Morgan, Patricia E. Shaner, Attorneys for the Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-53 and Act No. 99-103.
New Rule: Filed July 26, 1999; effective August 30, 1999. Amended (Rule Number Only): Filed October 15, 2008; effective November 19, 2008.
Editor's note: Previous rule 21 was renumbered to .22 as per certification filed October 15, 2008; effective November 19, 2008. Rule .22 was renumbered to .23 as per certification filed May 16, 2013; effective June 20, 2013.

Ala. Admin. Code r. 540-X-3-.24 Certificate And Limited License Under Retired Senior Volunteer Program

(1) The State Board of Medical Examiners, at its discretion and subject to these rules, may issue a certificate of qualification on behalf of physicians meeting the requirements for participation in the Retired Senior Volunteer Program. The Retired Senior Volunteer Program (RSVP) is created for the purpose of permitting doctors of medicine and doctors of osteopathy who are fully retired from the active practice of medicine to obtain a limited license without cost which would permit the provision of outpatient health care services at established free clinics operated pursuant to the Volunteer Medical Professional Act, §6-5-660, et seq.

(2) Physicians having certificates issued under this section must limit their practice to the confines of an established free medical clinic, as that term is defined in Ala. Code § 6-5-662, or other non profit organizations or facilities located in Alabama which are approved by the board and which provide outpatient medical care for individuals unable to pay for the care.

(3) Certificates issued under this section and licenses based thereon shall state on their faces that the certificates are issued under the RSVP and are subject to restrictions.

(4) Any physician on whose behalf a certificate of qualification is issued under this section shall be subject to having his or her license suspended or revoked by the Medical Licensure Commission for the same causes or reasons and in the same manner as provided by law in the case of other physicians.

(5) Certificates of qualification issued under this section shall expire annually. Physicians may apply to the board for renewal of their certificate, but the board shall have full discretion to accept or reject the application for renewal.

(6) A physician is eligible to receive a certificate of qualification issued under this rule if the following qualifications are met:

(a) The applicant currently has or has had a full and unrestricted license to practice medicine in the State of Alabama or in any other state of the United States or the District of Columbia, which license is or was at the time of expiration unrestricted and in good standing with no pending disciplinary actions or investigations at the time of expiration.

(b) The applicant certifies, on a form prescribed by the board, that he or she is fully retired from the active practice of medicine.

(c) The applicant is in good health and is not currently undergoing treatment for a physical or mental condition which would impair the individual's ability to practice medicine with reasonable skill and safety to patients.

(d) The applicant certifies, on a form prescribed by the board, that he or she intends to limit his or her medical practice to the provision of outpatient services at an established free medical clinic as that term is defined in Ala. Code § 6-5-662 or other nonprofit organization or facility that has been approved by the board and that furnishes outpatient medical care to patients unable to pay for the care.

(e) The applicant certifies, on a form prescribed by the board, that his or her license to practice medicine in any state or the District of Columbia has never been revoked, suspended, placed on probation, or otherwise subject to disciplinary action and that the applicant has not had his or her hospital medical staff privileges revoked, suspended, curtailed, limited, or surrendered while under investigation.

(f) The applicant acknowledges, on a form prescribed by the board, that he or she is subject to the continuing medical education requirements for physicians as specified in the rules of the State Board of Medical Examiners.

(g) The applicant furnishes a certification of the employment arrangements or agreement with the qualified clinic or nonprofit organization.

(h) A certificate of qualification issued under this rule shall be issued at no cost to the applicant.

History

Author: Alabama State Board of Medical Examiners
Authority: §§34-24-75.1; 34-24-53; 6-5-660 et seq
New Rule: Filed January 21, 2005; effective February 25, 2005. Amended (Rule Number Only): Filed October 15, 2008; effective November 19, 2008. Amended: Filed October 20, 2016; effective December 4, 2016. Amended: Published September 30, 2025; effective November 14, 2025.
Editor's note: Previous rule 22 was renumbered to .23 as per certification filed October 15, 2008; effective November 19, 2008. Rule .23 was renumbered to .24 as per certification filed May 16, 2013; effective June 20, 2013.

Ala. Admin. Code r. 540-X-3-.25 Expedited Certificate Of Qualification For Military Members And Spouses

(1) The intent of this rule is to provide for the expedited issuance of a certificate of qualification to military service members and the spouses of military service members who are relocated to and stationed in Alabama and who are also qualified physicians.

(2) The board, at its discretion and pursuant to this rule, may issue a temporary certificate of qualification by endorsement to a physician applicant who is relocated to or stationed in this state under official military orders and who satisfies any of the following:

(a) Is an active duty, reserve, or transitioning member of the United States Armed Forces, including the National Guard;

(b) Is the spouse of an active duty, reserve, or transitioning member of the United States Armed Forces, including the National Guard; or

(3) For the purposes of this rule, a transitioning service member is a member of the United States Armed Forces, including the National Guard, on active duty status or on separation leave who is within 24 months of retirement or 12 months of separation.

(4) A physician must satisfy the requirements of paragraph (2) by providing the following:

(a) The active or reserve service member’s official military orders;

(b) The transitioning service member’s DD Form 214 or NGB Form 22; or

(c) The deceased service member’s DD Form 214 or NGB Form 22 and death certificate if the physician is the spouse of a service member; and

(d) A marriage certificate substantiating marriage to the service member if the physician is the spouse of a service member.

(5) A physician may receive a temporary certificate of qualification issued under paragraph (2) if he or she satisfies the requirements of paragraph (2) to the satisfaction of the board, and presents evidence satisfactory to the board of all of the following:

(a) Possession of a full and unrestricted license to practice medicine issued by the appropriate medical licensing board of another state, the District of Columbia, a territory of the United States, or a province of Canada;

(b) Graduation from a medical school accredited by the Liaison Committee on Medical Education or the Commission on Osteopathic College Accreditation, or a medical school listed on the International Medical Education Directory or its equivalent;

(c) Pursuant to Ala. Code §34-24-70(a)(3) and these rules, passage of each component of the United States Medical Licensing Examination (USMLE) or the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA), the Licentiate of the Medical Council of Canada Examination, or any of their predecessor examinations accepted by the applicant’s licensing board as an equivalent examination for licensure purposes;

(d) Successful completion of graduate medical education approved by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association;

(e) Has never been convicted, received adjudication, community supervision, or deferred disposition of any felony offense or any crime related to fraud, violence, sexual violations, or the practice of medicine;

(f) Has never had his or her medical license subjected to discipline by a licensing agency in any state, federal, or foreign jurisdiction, excluding any action related to the non-payment of fees related to a license;

(g) Has never had a controlled substance license or permit suspended or revoked by a state or the United States Drug Enforcement Administration;

(h) Is not currently under investigation by a licensing agency or law enforcement authority in any state, federal, or foreign jurisdiction; and

(i) Is a United States citizen, a national of the United States, or an alien lawfully present in the United States.

(6) A physician who is issued a temporary certificate of qualification under this rule shall apply for a certificate of qualification pursuant to 540-x-3.12 within 12 months after the issuance of a temporary certificate of qualification.

(a) A temporary certificate of qualification issued under these rules shall expire 12 months after the date of issuance if an application for a certificate of qualification pursuant to 540-X-3.12 has not been received by the board.

(b) A physician who is issued a temporary certificate of qualification under this rule may apply for an Alabama Controlled Substances Certificate pursuant to Chapter 540-X-4 of these rules.

(c) Applicants for a temporary certificate of qualification under this rule shall not be required to pay the initial application fee.

(d) A temporary certificate of qualification may be issued by the Executive Director of the State Board of Medical Examiners, or his or her designee, upon his or her satisfaction and certification of the requirements set forth in this rule.

(e) The temporary certificate of qualification shall clearly indicate that it is a temporary certificate for military service members or their spouses.

History

Author: Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §§34-24-53, 34-24-70, 34-24-70.1, 34-24-73(b); Alabama Acts No. 2021-100.
New Rule: Published August 31, 2021; effective October 15, 2021.

Ala. Admin. Code r. 540-X-3-Appendix-A Application For Certificate Of Qualification To Practice Medicine In Alabama

Under Alabama law, this document is a public record and will be provided upon request.

Application is made via the Federation of State Medical Boards’ Uniform Application (https://web.archive.org/web/20220621041332/https://www.fsmb.org/uniform-application/). Required demographic information: Please DO NOT provide contact information for office managers, assistants, or license assistance companies.

Name in full (First, Middle, Last, M.D./D.O.) Alternate name(s) used Address (Street, City, State, Zip) Email address Place of birth Date of birth Social Security Number (Pursuant to Ala. Code § 30-3-194, it is mandatory that we request and that you provide your social security number (SSN) on this application. The uses of your SSN are limited to the purpose of administering the state child support program and intra-agency for identification purposes. If your SSN is not provided, your application is not complete and no license will be issued) Sex Telephone (H or C) Telephone (W)

Provide a brief description and the location of your intended medical practice in the State of Alabama. Required background information: If your answer is “yes,” please provide a detailed explanation in the space provided. Legal:

Have you ever been arrested for, cited for, charged with, or convicted of any crime, offense, or violation of any law, felony, or misdemeanor, including, but not limited to, offenses related to the practice of medicine, state or federal controlled substances laws, or driving under the influence (DUI)? *This question excludes minor traffic violations such as speeding and parking tickets but includes felony and misdemeanor criminal matters that have been dismissed, expunged, sealed, subject to a diversion or deferred prosecution program, or otherwise set aside.

2 Have you ever been arrested for, cited for, charged with, or convicted of any sex offender laws or required to register as a sex offender for any reason?

Have you ever had a judgment rendered against you or action settled relating to an action for injury, damages, or wrongful death for breach of the standard of care in the performance of your professional service (“malpractice”)?
To your knowledge, as of the date of this application, are you the subject of an investigation or proposed action by any law enforcement agency?

Administrative/Regulatory:

Have you ever had any Drug Enforcement Administration registration and/or state controlled substances registration denied, voluntarily surrendered while under investigation, or subject to any discipline, including, but not limited to revocation, suspension, probation, restriction, conditions, reprimand, or fine?
Have you ever been denied a license to practice medicine in any state or jurisdiction or has your application for a license to practice medicine been withdrawn under threat of denial?
Has your certificate of qualification or license to practice medicine in any state or jurisdiction ever been subject to any discipline, including but not limited to revocation, suspension, probation, restrictions, conditions, reprimand, or fine?
Have your staff privileges at any hospital or health care facility ever been revoked, suspended, curtailed, limited, or placed under conditions restricting your practice?
To your knowledge, as of the date of this application, are you the subject of an investigation or proposed action by any federal agency, any licensing board/agency, or any hospital or health care facility?

Fitness to Practice:

Are you currently suffering from any condition that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical, and professional manner?
Within the past five years, have you raised the issue of any physical or psychiatric health disorder as a defense, mitigation, or explanation for your actions during any administrative or judicial proceeding or investigation; any inquiry or other proceeding; or any proposed termination by an educational institution; employer; government agency; professional organization; or licensing authority?
The Board recognizes that licensees encounter potentially impairing health conditions just as their patients and other health care providers do, including psychiatric or physical illnesses which may impact cognition, as well as substance use disorders. The Board expects its licensees to address their health concerns, both mental and physical, in a timely manner to ensure patient safety. Licensees should seek appropriate medical care and should limit their medical practice when appropriate and as needed. The Board encourages licensees to utilize the services of the Alabama Professionals Health Program, a physician advocacy organization dedicated to improving the health and wellness of medical professionals in a confidential manner. The failure to adequately address a health condition, where the licensee is unable to practice medicine with reasonable skill and safety to patients, can result in the Board taking action against the license to practice medicine.

I have read and understand the statements above.

[Applicant Attestation]

Education/Training/Experience:

As of the date of this application, has it been more than two years since the last time you were actively engaged in clinical practice or direct patient care?
Has your medical education, training, or medical practice been interrupted or suspended, or have you ceased to engage in direct patient care, for a period longer than 60 days for any reason other than a vacation or for the birth or adoption of a child?
Have you ever been placed on academic or disciplinary probation by, or been required to remediate any portion of, a medical school or postgraduate program?
Were limitations or special requirements imposed on you because of questions of academic, clinical, or disciplinary problems, or any other reason during your medical education or postgraduate training, such as repeating a class or classes or taking time off from school to study for an examination?
Have you ever been disciplined for unprofessional conduct/behavior reasons by a medical school or postgraduate program?
Pre-Medical education: List all schools attended, undergraduate and post-graduate education other than medical school, dates attended, and degree conferred.
Medical School: List all medical schools attended, dates, and complete addresses of institutions. Do not list post-graduate medical education training.

20 Post-Graduate medical education training: List all post-graduate medical education training since graduation from medical school, dates, and complete addresses of institutions. Do not list practice experience.

Activities following medical school and training: List all practice experience since completion of your formal training, providing dates, institutions/hospitals, and complete addresses.
Original full license (if applicable): Provide name of state/territory, date issued, license number, and examination taken. Has this license been the subject of any disciplinary action? If yes, please provide summary and supporting documentation.
List all states where you have been licensed to practice medicine. List all licenses including training or educational licenses.
List all hospital privileges: List all hospitals where you have held staff privileges of any type, providing dates, hospital names, and complete addresses.

Specialty/Examinations

Specialty (if applicable): (choose from list)
Specialty board certification: Are you CURRENTLY certified by one of the specialty boards approved by the American Board of Medical Specialties or the American Osteopathic Association? If yes, have your specialty board send verification to the Board.
Have you been certified or re-certified within the past ten years by one of the specialty boards approved by the American Board of Medical Specialties or the American Osteopathic Association?
Have you successfully completed a written licensing examination within the last ten years (e.g., USMLE, NBOME, SPEX)?

Release I, [name prints here], certify that all of the information supplied in the foregoing application is true and correct to the best of my knowledge, that the photograph submitted is a true likeness of myself and was taken within sixty days prior to the date of this application. I acknowledge that any false or untrue statement or representation made in this application may result in the denial of this application or the revocation of my license to practice medicine and criminal prosecution to the fullest extent of the law. I further consent to and authorize the release of this application and any information submitted with it or information collected by the Alabama Board of Medical Examiners in connection with this application, including derogatory information, to any person or organization having a legitimate need for the information, and I release the Alabama Board of Medical Examiners from all liability for the release of this information. I further consent to and authorize the release of information, including derogatory information, which may be in the possession of other individuals or organizations to the Alabama Board of Medical Examiners, and I release this individual or organization from any liability for the release of information.

Applicant’s signature Photograph

Under Alabama law, this document is a public record and will be provided upon request.

History

Author: Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §34-24-70.
Filed November 9, 1982. Repealed and new rule adopted in lieu thereof: Filed November 25, 1985. Amended: Filed May 22, 1989. Repealed and Replaced: Filed December 17, 1997; effective January 21, 1998. Amended: Filed July 26, 1999; effective August 30, 1999. Amended: Filed August 18, 2006; effective September 22, 2006. Amended: Filed December 13, 2007; effective January 17, 2008. Amended: Filed October 22, 2009; effective November 26, 2009. Amended: Filed May 16, 2013; effective June 20, 2013. Amended: Filed July 22, 2013; effective August 26, 2013. Amended: Filed March 20, 2014; effective April 24, 2014. Repealed and New Rule: Filed February 27, 2018; effective April 14, 2018. Amended: Filed August 22, 2018; effective October 6, 2018. Amended: Filed April 16, 2019; effective May 31, 2019. Amended: Published February 28, 2020; effective April 13, 2020. Repealed and New Rule: Published December 30, 2022; effective February 13, 2023. Repealed and New Rule: Published March 31, 2025; effective May 15, 2025.

Ala. Admin. Code r. 540-X-3-Appendix-B Application For A Limited Certificate Of Qualification

Under Alabama law, this document is a public record and will be provided upon request.

Application is made through the school, program, or institution.

Required demographic information:

Name in full (First, Middle, Last, M.D./D.O.)

Alternate name(s) used

Address (Street, City, State, Zip)

Email address

Place of birth

Date of birth

Social Security Number (Pursuant to Ala. Code § 30-3-194, it is mandatory that we request and that you provide your social security number (SSN) on this application. The uses of your SSN are limited to the purpose of administering the state child support program and intra-agency for identification purposes. If your SSN is not provided, your application is not complete and no license will be issued)

Sex

Telephone (H or C)

Telephone (W)

Name of Institution

Type of license (check one): Resident Fellow Distinguished Professor Specialty Professor Visiting Professor State Institution

Required background information:

If your answer is “yes,” please provide a detailed explanation in the space provided.

Legal:

Have you ever been arrested for, cited for, charged with, or convicted of any crime, offense, or violation of any law, felony, or misdemeanor, including, but not limited to, offenses related to the practice of medicine or state or federal controlled substances laws, or driving under the influence (DUI)?

*This question excludes minor traffic violations such as speeding and parking tickets but includes felony and misdemeanor criminal matters that have been dismissed, expunged, sealed, subject to a diversion or deferred prosecution program, or otherwise set aside.

2 Have you ever been arrested for, cited for, charged with, or convicted of any sex offender laws or required to register as a sex offender for any reason?

Have you ever had a judgment rendered against you or action settled relating to an action for injury, damages, or wrongful death for breach of the standard of care in the performance of your professional service (“malpractice”)?
To your knowledge, as of the date of this application, are you the subject of an investigation or proposed action by any law enforcement agency?

Administrative/Regulatory:

Have you ever had any Drug Enforcement Administration registration and/or state controlled substances registration denied, voluntarily surrendered while under investigation, or subject to any discipline, including, but not limited to revocation, suspension, probation, restriction, conditions, reprimand, or fine?
Have you ever been denied a license to practice medicine in any state or jurisdiction or has your application for a license to practice medicine been withdrawn under threat of denial?
Has your certificate of qualification or license to practice medicine in any state or jurisdiction ever been subject to any discipline, including but not limited to revocation, suspension, probation, restrictions, conditions, reprimand, or fine?
Have your staff privileges at any hospital or health care facility ever been revoked, suspended, curtailed, limited, or placed under conditions restricting your practice?
To your knowledge, as of the date of this application, are you the subject of an investigation or proposed action by any federal agency, any licensing board/agency, or any hospital or health care facility?

Fitness to Practice:

Are you currently suffering from any condition that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical, and professional manner?
Within the past five years, have you raised the issue of any physical or psychiatric health disorder as a defense, mitigation, or explanation for your actions during any administrative or judicial proceeding or investigation; any inquiry or other proceeding; or any proposed termination by an educational institution; employer; government agency; professional organization; or licensing authority?
The Board recognizes that licensees encounter potentially impairing health conditions just as their patients and other health care providers do, including psychiatric or physical illnesses which may impact cognition, as well as substance use disorders. The Board expects its licensees to address their health concerns, both mental and physical, in a timely manner to ensure patient safety. Licensees should seek appropriate medical care and should limit their medical practice when appropriate and as needed. The Board encourages licensees to utilize the services of the Alabama Professionals Health Program, a physician advocacy organization dedicated to improving the health and wellness of medical professionals in a confidential manner. The failure to adequately address a health condition, where the licensee is unable to practice medicine with reasonable skill and safety to patients, can result in the Board taking action against the license to practice medicine.

I have read and understand the statements above.

[Applicant Attestation]

Education/Training/Experience:

As of the date of this application, has it been more than two years since the last time you were actively engaged in clinical practice or direct patient care?
Has your medical education, training, or medical practice been interrupted or suspended, or have you ceased to engage in direct patient care, for a period longer than 60 days for any reason other than a vacation or for the birth or adoption of a child?

If yes, please provide a brief explanation.

Have you ever been placed on academic or disciplinary probation by, or been required to remediate any portion of, a medical school or postgraduate program?
Were limitations or special requirements imposed on you because of questions of academic, clinical, or disciplinary problems, or any other reason during your medical education or postgraduate training, such as repeating a class or classes or taking time off from school to study for an examination?
Have you ever been disciplined for unprofessional conduct/behavior reasons by a medical school or postgraduate program?
Pre-Medical education: List all schools attended, undergraduate and post-graduate work other than medical school, dates attended, and degree conferred.
Medical School: List all medical schools attended, dates, and complete addresses of institutions. Do not list post-graduate medical education training.

Activities following medical school and training: List all practice experience since completion of your formal training, providing dates, institutions/hospitals, and complete addresses.
Have you successfully completed a written licensing examination?

If yes, please choose: ABMS or AOA board certification exam; USMLE; COMLEX; Other

Release

I, [name prints here], certify that all of the information supplied in the foregoing application is true and correct to the best of my knowledge, that the photograph submitted is a true likeness of myself and was taken within sixty days prior to the date of this application. I acknowledge that any false or untrue statement or representation made in this application may result in the denial of this application or the revocation of my license to practice medicine and criminal prosecution to the fullest extent of the law. I further consent to and authorize the release of this application and any information submitted with it or information collected by the Alabama Board of Medical Examiners in connection with this application, including derogatory information, to any person or organization having a legitimate need for the information, and I release the Alabama Board of Medical Examiners from all liability for the release of this information. I further consent to and authorize the release of information, including derogatory information, which may be in the possession of other individuals or organizations to the Alabama Board of Medical Examiners, and I release this individual or organization from any liability for the release of information.

Applicant’s signature

Attach or Upload Photograph

I understand and agree that by typing my name, I am providing an electronic signature that has the same legal effect as a written signature pursuant to Ala. Code §§ 8-1A-2 and 8-1A-7. I attest that the foregoing information has been provided by me and is true and correct to the best of my knowledge, information and belief.

Date

Applicant’s typed name

Certification of Institution: This is to certify that the aforementioned individual is making application for a limited certificate of qualification at this institution.

Date

Name of Dean-School of Medicine, Director-Residency Training Program, Warden/Medical Director

Print application, attach a recent photograph of yourself, have Dean-Medical School, Director-Residency Training Program, or Warden/Medical Director sign, and return original to the Alabama Board of Medical Examiners.

History

Author: Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §§34-24-70, 34-24-73, and 34-24-75.
Amended: Filed July 26, 1999; effective August 30, 1999. Amended: Filed February 17, 2012; effective March 23, 2012. Amended: Filed July 22, 2013; effective August 26, 2013. Amended: Filed March 20, 2014; effective April 24, 2014. Repealed and New Rule: Filed February 27, 2018; effective April 14, 2018. Amended: Filed February 20, 2019; effective April 7, 2019. Amended: Published February 28, 2020; effective April 13, 2020. Repealed and New Rule: Published December 30, 2022; effective February 13, 2023. Repealed and New Rule: Published March 31, 2025; effective May 15, 2025.
Editor's note: Appendix B, Application for Certificate to Practice Medicine through Examination, was repealed and Appendix C was renamed Appendix B per certification filed February 27, 2018; effective April 14, 2018.

Ala. Admin. Code r. 540-X-3-Appendix-C Application For A Certificate Of Qualification Under The Retired Senior Volunteer Physician Program (RSVP)

Under Alabama law, this document is a public record and will be provided upon request.

Required demographic information:

Name in full (First, Middle, Last, M.D./D.O.)

Alternate name(s) used

Address (Street, City, State, Zip)

Email address

Place of birth

Date of birth

Sex

Telephone (H or C)

Telephone (W)

Required background information:

If your answer is “yes,” please provide a detailed explanation in the space provided.

Legal:

Have you ever been arrested for, cited for, charged with, or convicted of any crime, offense, or violation of any law, felony, or misdemeanor, including, but not limited to, offenses related to the practice of medicine or state or federal controlled substances laws, or driving under the influence (DUI)?

Have you ever been arrested for, cited for, charged with, or convicted of any sex offender laws or required to register as a sex offender for any reason?
Have you ever had a judgment rendered against you or action settled relating to an action for injury, damages, or wrongful death for breach of the standard of care in the performance of your professional service (“malpractice”)?
To your knowledge, as of the date of this application, are you the subject of an investigation or proposed action by any law enforcement agency?

Administrative/Regulatory:

Have you ever had any Drug Enforcement Administration registration and/or state controlled substances registration denied, voluntarily surrendered while under investigation, or subject to any discipline, including, but not limited to revocation, suspension, probation, restriction, conditions, reprimand, or fine?
Have you ever been denied a license to practice medicine in any state or jurisdiction or has your application for a license to practice medicine been withdrawn under threat of denial?
Has your certificate of qualification or license to practice medicine in any state or jurisdiction ever been subject to any discipline, including but not limited to revocation, suspension, probation, restrictions, conditions, reprimand, or fine?
Have your staff privileges at any hospital or health care facility ever been revoked, suspended, curtailed, limited, or placed under conditions restricting your practice?
To your knowledge, as of the date of this application, are you the subject of an investigation or proposed action by any federal agency, any licensing board/agency, or any hospital or health care facility?

Fitness to Practice:

Are you currently suffering from any condition that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical, and professional manner?
Within the past five years, have you raised the issue of any physical or psychiatric health disorder as a defense, mitigation, or explanation for your actions during any administrative or judicial proceeding or investigation; any inquiry or other proceeding; or any proposed termination by an educational institution; employer; government agency; professional organization; or licensing authority?
The Board recognizes that licensees encounter potentially impairing health conditions just as their patients and other health care providers do, including psychiatric or physical illnesses which may impact cognition, as well as substance use disorders. The Board expects its licensees to address their health concerns, both mental and physical, in a timely manner to ensure patient safety. Licensees should seek appropriate medical care and should limit their medical practice when appropriate and as needed. The Board encourages licensees to utilize the services of the Alabama Professionals Health Program, a physician advocacy organization dedicated to improving the health and wellness of medical professionals in a confidential manner. The failure to adequately address a health condition, where the licensee is unable to practice medicine with reasonable skill and safety to patients, can result in the Board taking action against the license to practice medicine.

I have read and understand the statements above.

[Applicant Attestation]

Education/Training/Experience:

As of the date of this application, has it been more than two years since the last time you were actively engaged in clinical practice or direct patient care?
Has your medical education, training, or medical practice been interrupted or suspended, or have you ceased to engage in direct patient care, for a period longer than 60 days for any reason other than a vacation or for the birth or adoption of a child?
Have you ever been placed on academic or disciplinary probation by, or been required to remediate any portion of, a medical school or postgraduate program?
Were limitations or special requirements imposed on you because of questions of academic, clinical, or disciplinary problems, or any other reason during your medical education or postgraduate training, such as repeating a class or classes or taking time off from school to study for an examination?
Have you ever been disciplined for unprofessional conduct/behavior reasons by a medical school or postgraduate program?
Pre-Medical education: List all schools attended, undergraduate and post-graduate work other than medical school, dates attended, and degree conferred.
Medical School: List all medical schools attended, dates, and complete addresses of institutions. Do not list post-graduate medical education training.
Post-Graduate medical education training: List all post-graduate medical education training since graduation from medical school, dates, and complete addresses of institutions. Do not list practice experience.

Certification:

I hereby certify that I am now or was licensed to practice medicine in the states of [list states], that my license to practice medicine in each of the states indicated is now or was on the date of expiration unrestricted and in good standing and that there are no currently pending disciplinary actions or investigations concerning my license in any of the states listed above. I further certify that my license to practice medicine in the states listed above has never been revoked, suspended, placed on probation, or otherwise subject to disciplinary action and that I have not had my hospital medical staff privileges revoked, suspended, curtailed, limited, or surrendered while under investigation.
I certify that I am fully retired from the active practice of medicine; however, I wish to volunteer my services as a physician in a free medical clinic located in [city], Alabama.
I understand and acknowledge that issuance of a certificate of qualification and license to practice medicine under the Retired Senior Volunteer Physician Program requires that I comply with the continuing medical education requirement for physicians as specified in the rules of the Alabama Board of Medical Examiners.

Release:

I, [name prints here], certify that all of the information supplied in the submitted application is true and correct to the best of my knowledge, that the photograph submitted is a true likeness of myself and was taken within sixty days prior to the date of this application. I acknowledge that any false or untrue statement or representation made in this application may result in the denial of this application or revocation of my license to practice medicine and criminal prosecution to the fullest extent of the law.

I further consent to and authorize the release of this application and any information submitted with it or information collected by the Alabama Board of Medical Examiners in connection with this application, including derogatory information, to any person or organization having a legitimate need for the information, and I release the Alabama Board of Medical Examiners from all liability for the release of this information. I further consent to and authorize the release of information, including derogatory information, which may be in the possession of other individuals or organizations to the Alabama Board of Medical Examiners, and I release this individual or organization from any liability for the release of information.

Applicant’s typed name

Print or upload signed affidavit and release, attach color picture if not uploaded, and return original to the Alabama Board of Medical Examiners.

(Letterhead)

CERTIFICATION OF FREE CLINIC

DATE:_____________________

TO: State Board of Medical Examiners

This is to certify that ______________________________, M.D./D.O. has agreed to perform voluntary professional services at ________________________(Clinic Name), located at ___________________, Alabama, which is an established free medical clinic operating under the provisions of Ala. Code §6-5-662* that provides outpatient medical care to patients unable to pay for it.

Clinic or Facility Administrator

Address

Telephone

Facsimile

*Or other nonprofit organization or facility located in Alabama which is approved by the Board and which provides outpatient medical care to individuals unable to pay for the care. A copy of the Board's approval must be attached.

History

Author: Board of Medical Examiners
Authority: Code of Ala. 1975, §§34-24-70, 34-24-73, 34-24-75.
Repealed: Filed December 17, 1997; effective January 21, 1998. New Appendix: Filed January 21, 2005; effective February 25, 2005. Amended: Filed February 17, 2012; effective March 23, 2012. Amended: Filed July 22, 2013; effective August 26, 2013. Amended: Filed March 20, 2014; effective April 24, 2014. Amended: Filed October 20, 2016; effective December 4, 2014. Repealed and New Rule: Filed February 27, 2018; effective April 14, 2018. Amended: Filed November 1, 2018; effective December 16, 2018. Amended: Published February 28, 2020; effective April 13, 2020. Repealed and New Rule: Published December 30, 2022; effective February 13, 2023. Repealed and New Rule: Published March 31, 2025; effective May 15, 2025. Amended: Published September 30, 2025; effective November 14, 2025.
Editor's note: Appendix C was renamed Appendix B, and Appendix E was renamed Appendix C per certification filed February 27, 2018; effective April 14, 2018.

Ala. Admin. Code r. 540-X-3-Appendix-D Retired Senior Volunteer Program Certificate Of Qualification Renewal Application

Under Alabama law, this document is a public record and will be provided upon request

Ala. Code § 34-24-75.1 requires that all physicians holding limited licenses under the retired senior volunteer program apply for renewal of the certificate of qualification prior to renewal of the license. Once the application has been completed, please return it to the qualified clinic or nonprofit organization to obtain certification.

Required demographic information:

Full name

Alternate name

Name of qualified clinic or nonprofit organization

License number

Date issued

Required background information:

If your answer is “yes,” please provide a detailed explanation in the space provided.

Legal:

Have you ever been arrested for, cited for, charged with, or convicted of any crime, offense, or violation of any law, felony, or misdemeanor, including, but not limited to, offenses related to the practice of medicine or state or federal controlled substances laws, or driving under the influence (DUI)?

Have you ever been arrested for, cited for, charged with, or convicted of any sex offender laws or required to register as a sex offender for any reason?
Have you ever had a judgment rendered against you or action settled relating to an action for injury, damages, or wrongful death for breach of the standard of care in the performance of your professional service (“malpractice”)?
To your knowledge, as of the date of this application, are you the subject of an investigation or proposed action by any law enforcement agency?

Administrative/Regulatory:

Have you ever had any Drug Enforcement Administration registration and/or state controlled substances registration denied, voluntarily surrendered while under investigation, or subject to any discipline, including, but not limited to revocation, suspension, probation, restriction, conditions, reprimand, or fine?
Have you ever been denied a license to practice medicine in any state or jurisdiction or has your application for a license to practice medicine been withdrawn under threat of denial?
Has your certificate of qualification or license to practice medicine in any state or jurisdiction ever been subject to any discipline, including but not limited to revocation, suspension, probation, restrictions, conditions, reprimand, or fine?
Have your staff privileges at any hospital or health care facility ever been revoked, suspended, curtailed, limited, or placed under conditions restricting your practice?
To your knowledge, as of the date of this application, are you the subject of an investigation or proposed action by any federal agency, any licensing board/agency, or any hospital or health care facility?

Fitness to Practice:

Are you currently suffering from any condition that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical, and professional manner?
Within the past five years, have you raised the issue of any physical or psychiatric health disorder as a defense, mitigation, or explanation for your actions during any administrative or judicial proceeding or investigation; any inquiry or other proceeding; or any proposed termination by an educational institution; employer; government agency; professional organization; or licensing authority?
The Board recognizes that licensees encounter potentially impairing health conditions just as their patients and other health care providers do, including psychiatric or physical illnesses which may impact cognition, as well as substance use disorders. The Board expects its licensees to address their health concerns, both mental and physical, in a timely manner to ensure patient safety. Licensees should seek appropriate medical care and should limit their medical practice when appropriate and as needed. The Board encourages licensees to utilize the services of the Alabama Professionals Health Program, a physician advocacy organization dedicated to improving the health and wellness of medical professionals in a confidential manner. The failure to adequately address a health condition, where the licensee is unable to practice medicine with reasonable skill and safety to patients, can result in the Board taking action against the license to practice medicine.

I have read and understand the statements above.

[Applicant Attestation]

Education/Training/Experience:

As of the date of this application, has it been more than two years since the last time you were actively engaged in clinical practice or direct patient care?
Has your medical education, training, or medical practice been interrupted or suspended, or have you ceased to engage in direct patient care, for a period longer than 60 days for any reason other than a vacation or for the birth or adoption of a child?

Date

Applicant’s typed name

Certification of qualified clinic or nonprofit organization

I understand and agree that by typing my name, I am providing an electronic signature that has the same legal effect as a written signature pursuant to Ala. Code §§ 8-1A-2 and 8-1A-7. I attest that the foregoing information is true and correct to the best of my knowledge, information and belief.

Date

Clinic or Facility Administrator’s typed name

History

Author: Board of Medical Examiners
Authority: Code of Ala. 1975, §§34-24-70, 34-24-73, 34-24-75.
Repealed: Filed December 17, 1997; effective January 21, 1998. New: Filed December 15, 2005; effective January 19, 2006. Amended: Filed February 17, 2012; effective March 23, 2012. Amended: Filed March 20, 2014; effective April 24, 2014. Repealed and New Rule: Filed February 27, 2018; effective April 14, 2018. Amended: Published February 28, 2020; effective April 13, 2020. Amended: Published December 30, 2022; effective February 13, 2023. Repealed and New Rule: Published March 31, 2025; effective May 15, 2025.
Editor's note: Appendix D, Certification of Established Free Medical Clinic, was repealed and Appendix F was renamed Appendix D per certification filed February 27, 2018; effective April 14, 2018.

Ala. Admin. Code r. 540-X-3-Appendix-E Limited Certificate Of Qualification Renewal Application

Limited Certificate of Qualification Renewal Application

Under Alabama law, this document is a public record and will be provided upon request.

If you meet the qualifications for a full medical license, you do not qualify for a limited license.

Section 34-24-75, Code of Alabama 1975, as amended, requires that all physicians holding a limited license apply to the Board of Medical Examiners for the renewal of their certificate of qualification prior to renewal of the license. Once the application has been completed, return it to the institution for the certification of the Dean, Program Director, Chief Medical Officer, or authorized State Institution individual.

Required demographic information:

Name in Full

Alternate name(s) used

Name of Institution

Home address

Telephone number (H/C)

Email address

License Number

Date Issued

Type of Limited License: (Please Choose One):

Resident

For yes, number of years in current residency program

Fellow

For yes, number of years in current fellowship program

Specialty Professor

For yes, number of years in current teaching position

Distinguished Professor

For yes, number of years in current teaching position

Visiting Professor

For yes, number of years in current teaching position

State Institution

For yes, number of years in current position

Required program/institution information

Do you limit your practice to the confines of the program/institution?

If the answer is no, please explain.

If applicable, list each United States Licensing Examination (USMLE) Steps you have passed and the date passed.

USMLE Step 1 _________________________

USMLE Step 2 _________________________

USMLE Step 3 _________________________

Required background information:

If your answer is “yes,” please provide a detailed explanation in the space provided.

Legal:

Have you ever been arrested for, cited for, charged with, or convicted of any crime, offense, or violation of any law, felony, or misdemeanor, including, but not limited to, offenses related to the practice of medicine or state or federal controlled substances laws or driving under the influence (DUI)?

2 Have you ever been arrested for, cited for, charged with, or convicted of any sex offender laws or required to register as a sex offender for any reason?

Have you ever had a judgment rendered against you or action settled relating to an action for injury, damages, or wrongful death for breach of the standard of care in the performance of your professional service (“malpractice”)?
To your knowledge, as of the date of this application, are you the subject of an investigation or proposed action by any law enforcement agency?

Administrative/Regulatory:

Have you ever had any Drug Enforcement Administration registration and/or state controlled substances registration denied, voluntarily surrendered while under investigation, or subject to any discipline, including, but not limited to revocation, suspension, probation, restriction, conditions, reprimand, or fine?
Have you ever been denied a license to practice medicine in any state or jurisdiction or has your application for a license to practice medicine been withdrawn under threat of denial?
Has your certificate of qualification or license to practice medicine in any state or jurisdiction ever been subject to any discipline, including but not limited to revocation, suspension, probation, restrictions, conditions, reprimand, or fine?
Have your staff privileges at any hospital or health care facility ever been revoked, suspended, curtailed, limited, or placed under conditions restricting your practice?
To your knowledge, as of the date of this application, are you the subject of an investigation or proposed action by any federal agency, any licensing board/agency, or any hospital or health care facility?

Fitness to Practice:

Are you currently suffering from any condition that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical, and professional manner?
Within the past five years, have you raised the issue of any physical or psychiatric health disorder as a defense, mitigation, or explanation for your actions during any administrative or judicial proceeding or investigation; any inquiry or other proceeding; or any proposed termination by an educational institution; employer; government agency; professional organization; or licensing authority?
The Board recognizes that licensees encounter potentially impairing health conditions just as their patients and other health care providers do, including psychiatric or physical illnesses which may impact cognition, as well as substance use disorders. The Board expects its licensees to address their health concerns, both mental and physical, in a timely manner to ensure patient safety. Licensees should seek appropriate medical care and should limit their medical practice when appropriate and as needed. The Board encourages licensees to utilize the services of the Alabama Professionals Health Program, a physician advocacy organization dedicated to improving the health and wellness of medical professionals in a confidential manner. The failure to adequately address a health condition, where the licensee is unable to practice medicine with reasonable skill and safety to patients, can result in the Board taking action against the license to practice medicine.

Date

Applicant’s typed name

Date

Typed Name of Dean, Program Director, Chief Medical Officer, Warden, Medical Director

Name of Program or State Institution

History

Author: Board of Medical Examiners
Authority: Code of Ala. 1975, §§34-24-53.1, 34-24-70.
Amended: Filed October 21, 2010; effective November 25, 2010. Amended: Filed February 17, 2012; effective March 23, 2012. Amended: Filed March 20, 2014; effective April 24, 2014. Repealed and New Rule: Filed August 17, 2017; effective October 1, 2017. Repealed and New Rule: Filed February 27, 2018; effective April 14, 2018. Amended: Filed February 20, 2019; effective April 7, 2019. Amended: Published February 28, 2020; effective April 13, 2020. Repealed and New Rule: Published December 30, 2022; effective February 13, 2023. Repealed and New Rule: Published March 31, 2025; effective May 15, 2025.
Editor's note: Appendix E was renamed Appendix C, and Appendix G was renamed Appendix E per certification filed February 27, 2018; effective April 14, 2018.

Ala. Admin. Code r. 540-X-3-Appendix-F Application For Reinstatement Of Certificate Of Qualification

Application for Reinstatement of Certificate of Qualification

Under Alabama law, this document is a public record and will be provided upon request.

Required demographic information:

Name in full (First, Middle, Last, M.D./D.O.)

Alternate name(s) used

Address (Street, City, State, Zip)

Email address

Place of birth

Date of birth

Sex

Telephone (H or C)

Telephone (W)

Date of revocation/suspension/surrender of certificate of qualification

Reasons for revocation/suspension/voluntary surrender of certificate or license (please give detailed reasons)

Provide a brief description and the location of your intended medical practice in the State of Alabama.

Required background information:

If your answer is “yes,” please provide a detailed explanation in the space provided.

Legal:

Have you ever been arrested for, cited for, charged with, or convicted of any crime, offense, or violation of any law, felony, or misdemeanor, including, but not limited to, offenses related to the practice of medicine or state or federal controlled substances laws, or driving under the influence (DUI)?

2 Have you ever been arrested for, cited for, charged with, or convicted of any sex offender laws or required to register as a sex offender for any reason?

Have you ever had a judgment rendered against you or action settled relating to an action for injury, damages, or wrongful death for breach of the standard of care in the performance of your professional service (“malpractice”)?
To your knowledge, as of the date of this application, are you the subject of an investigation or proposed action by any law enforcement agency?

Administrative/Regulatory:

Have you ever had any Drug Enforcement Administration registration and/or state controlled substances registration denied, voluntarily surrendered while under investigation, or subject to any discipline, including, but not limited to revocation, suspension, probation, restriction, conditions, reprimand, or fine?
Have you ever been denied a license to practice medicine in any state or jurisdiction or has your application for a license to practice medicine been withdrawn under threat of denial?
Has your certificate of qualification or license to practice medicine in any state or jurisdiction ever been subject to any discipline, including but not limited to revocation, suspension, probation, restrictions, conditions, reprimand, or fine?
Have your staff privileges at any hospital or health care facility ever been revoked, suspended, curtailed, limited, or placed under conditions restricting your practice?
To your knowledge, as of the date of this application, are you the subject of an investigation or proposed action by any federal agency, any licensing board/agency, or any hospital or health care facility?

Fitness to Practice:

Are you currently suffering from any condition that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical, and professional manner?
Within the past five years, have you raised the issue of any physical or psychiatric health disorder as a defense, mitigation, or explanation for your actions during any administrative or judicial proceeding or investigation; any inquiry or other proceeding; or any proposed termination by an educational institution; employer; government agency; professional organization; or licensing authority?
The Board recognizes that licensees encounter potentially impairing health conditions just as their patients and other health care providers do, including psychiatric or physical illnesses which may impact cognition, as well as substance use disorders. The Board expects its licensees to address their health concerns, both mental and physical, in a timely manner to ensure patient safety. Licensees should seek appropriate medical care and should limit their medical practice when appropriate and as needed. The Board encourages licensees to utilize the services of the Alabama Professionals Health Program, a physician advocacy organization dedicated to improving the health and wellness of medical professionals in a confidential manner. The failure to adequately address a health condition, where the licensee is unable to practice medicine with reasonable skill and safety to patients, can result in the Board taking action against the license to practice medicine.

I have read and understand the statements above.

[Applicant Attestation]

Education/Training/Experience:

As of the date of this application, has it been more than two years since the last time you were actively engaged in clinical practice or direct patient care?
Has your medical education, training, or medical practice been interrupted or suspended, or have you ceased to engage in direct patient care, for a period longer than 60 days for any reason other than a vacation or for the birth or adoption of a child?

I hereby authorize the release of any information concerning me in your files, favorable or otherwise, to the Alabama Board of Medical Examiners. A copy of this authorization shall be as valid as the original.

Release

I, [name prints here], certify that all of the information supplied in the foregoing application is true and correct to the best of my knowledge, that the photograph submitted is a true likeness of myself and was taken within sixty days prior to the date of this application. I acknowledge that any false or untrue statement or representation made in this application may result in the denial of this application or revocation of my license to practice medicine and criminal prosecution to the fullest extent of the law. I further consent to and authorize the release of this application and any information submitted with it or information collected by the Alabama Board of Medical Examiners in connection with this application, including derogatory information, to any person or organization having a legitimate need for the information, and I release the Alabama Board of Medical Examiners from all liability for the release of this information. I further consent to and authorize the release of information, including derogatory information, which may be in the possession of other individuals or organizations to the Alabama Board of Medical Examiners, and I release this individual or organization from any liability for the release of information.

Applicant’s signature

Photograph

Date

Applicant’s typed name

History

Author: Alabama Board of Medical Examiners
Authority: Code of Ala. 1975, §§34 24 70, 34 24 73, 34 24 75.
Amended: Filed February 17, 2012; effective March 23, 2012. Amended: Filed March 20, 2014; effective April 24, 2014. Repealed and New Rule: Filed February 27, 2018; effective April 14, 2018. Amended: Published February 28, 2020; effective April 13, 2020. Repealed and New Rule: Published December 30, 2022; effective February 13, 2023. Repealed and New Rule: Published March 31, 2025; effective May 15, 2025.
Editor's note: Appendix F was renamed Appendix D, and Appendix H was renamed Appendix F per certification filed February 27, 2018; effective April 14, 2018.

Alabama Administrative Code Chapter 540-X-3 — Certificate of Qualification

540 Alabama Board of Medical Examiners

Ala. Admin. Code r. 540-X-3-.01 General Requirements That Apply To All Applicants For A Certificate Of Qualification

Ala. Admin. Code r. 540-X-3-.02 Medical Education Requirement

Ala. Admin. Code r. 540-X-3-.03 Post-Graduate Education Requirement

Ala. Admin. Code r. 540-X-3-.04 Examination Requirements

Ala. Admin. Code r. 540-X-3-.05 Criminal History Background Check

Ala. Admin. Code r. 540-X-3-.06 Education Council For Foreign Medical Graduates

Ala. Admin. Code r. 540-X-3-.07 Additional Requirements For Examination For Certain Applicants

Ala. Admin. Code r. 540-X-3-.08 Interview Requirements

Ala. Admin. Code r. 540-X-3-.09 Fees Payable For Applicants For Certificates Of Qualification For Licensure To Practice Medicine In Alabama

Ala. Admin. Code r. 540-X-3-.11 Application Forms Required For A Certificate Of Qualification (Repealed 3/17/23)

Ala. Admin. Code r. 540-X-3-.12 Applicants For Certificate Of Qualification By Endorsement

Ala. Admin. Code r. 540-X-3-.13 Requirements For Applicants For A Certificate Of Qualification By Examination To Be Administered By The Board

Ala. Admin. Code r. 540-X-3-.14 Administrative Requirements For Examination By The Board

Ala. Admin. Code r. 540-X-3-.15 Provisional Approval For Certificate Of Qualification

Ala. Admin. Code r. 540-X-3-.16 Certificate Of Qualification Issued Without Examination (Limited License)

Ala. Admin. Code r. 540-X-3-.17 Training Programs Approved By The Board - Certificate Of Qualification Issued Without Examination

Ala. Admin. Code r. 540-X-3-.18 Renewal Of Certificate Of Qualification Without Examination (Limited License)

Ala. Admin. Code r. 540-X-3-.19 Grounds For Denial Of A Certificate Of Qualification

Ala. Admin. Code r. 540-X-3-.19.1 Denial Of Application For Certificate Of Qualification – Hearing

Ala. Admin. Code r. 540-X-3-.20 Non-Disciplinary Citation With Administrative Charge

Ala. Admin. Code r. 540-X-3-.21 Appeal From Denial Of Application For Certificate Of Qualification

Ala. Admin. Code r. 540-X-3-.22 Outgoing Reciprocity

Ala. Admin. Code r. 540-X-3-.23 Withdrawal Of Application For Certificate Of Qualification And Certificate Of Qualification

Ala. Admin. Code r. 540-X-3-.24 Certificate And Limited License Under Retired Senior Volunteer Program

Ala. Admin. Code r. 540-X-3-.25 Expedited Certificate Of Qualification For Military Members And Spouses

Ala. Admin. Code r. 540-X-3-Appendix-A Application For Certificate Of Qualification To Practice Medicine In Alabama

Ala. Admin. Code r. 540-X-3-Appendix-B Application For A Limited Certificate Of Qualification

Ala. Admin. Code r. 540-X-3-Appendix-C Application For A Certificate Of Qualification Under The Retired Senior Volunteer Physician Program (RSVP)

Ala. Admin. Code r. 540-X-3-Appendix-D Retired Senior Volunteer Program Certificate Of Qualification Renewal Application

Ala. Admin. Code r. 540-X-3-Appendix-E Limited Certificate Of Qualification Renewal Application

Ala. Admin. Code r. 540-X-3-Appendix-F Application For Reinstatement Of Certificate Of Qualification

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