physician is eligible to receive a certificate of qualification issued under
subsection (a) if he meets the following qualifications:
1. 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
2. The applicant
certifies, on a form prescribed by the board, that he is fully retired from the
active practice of medicine.
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.
4. The applicant certifies, on a form
prescribed by the board, that he 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 § 6-5 -662 or such other nonprofit organization
or facility that has been approved by the board and that furnishes outpatient
medical care to patients unable to pay for it.
5. The applicant certifies, on a form
prescribed by the board, that his 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the District of Columbia has never been revoked, suspended, placed on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 hospital medical staff privileges revoked, suspended,
curtailed, limited, or surrendered while under investigation.
6. The applicant acknowledges, on a form
prescribed by the board, that he is subject to the continuing medical education
requirements for physicians as specified in Chapter 14 of the rules and
regulations of the State Board of Medical Examiners.
7. The applicant furnishes a certification of
the employment arrangements or agreement with the qualified clinic or nonprofit