Forms

The forms found throughout this site available for download are listed here for convenience:

Continuing medical education

Address and name change

Initial physician license applications

Physician assistant license/registration applications

Office based surgery

Laser/other modalities affecting human tissue

Collaborative practices

Retired senior volunteer program

Miscellaneous

---

Continuing medical education web page

• request for waiver from CME due to retirement

---

Address and name change web page

• address change request
• name change request

---

Initial physician license applications web page

• Most forms must be requested - see applications page
• Application for RSVP License
• Certification of Free Medical Clinic

---

Physician assistant license/registration applications web page

• license application form
• verification of other state licenses/registrations
• registration application form
• job description
• approved formulary for legend drug prescribing
• guidelines governing prescribing
• supplemental certificate of employment
• covering physician letter
• termination of registration form

---

Office based surgery web page

• registration form (registration is online only)
• adverse event reporting form

---

Laser/other modalities  web page

• registration form
• adverse event reporting form

---

Collaborative practices web page

• notification of commencement
• notification of termination

---

Retired Senior Volunteer Program web page

• application for RSVP license
• certification of free medical clinic

---

Miscellaneous

• application for replacement of lost or destroyed wall certificate web page
• malpractice payment report form for insurance companies web page
• dispensing physician registration form web page
• inactive license reinstatement form web page

• request active-non renewal status web page

 

Copyright 2012 © The Alabama Board of Medical Examiners
All rights reserved