1. (1) The applicant shall disclose whether:

   1. (a) Applicant's privilege for dispensing or prescribing controlled substances has ever been suspended, restricted, voluntarily surrendered while under investigation, revoked, or disciplined in any manner in any state or U.S. territory.
   2. (b) Applicant has ever been convicted of any state or federal crime relating to any controlled substance or driving under the influence (DUI).
   3. (c) Any Federal Drug Enforcement Administration registration ever held by applicant has ever been suspended, restricted, revoked, or voluntarily surrendered while under investigation.
   4. (d) Applicant's privileges at any hospitals have ever been suspended, restricted, revoked, or disciplined in any manner for any reason related to the prescribing or dispensing of controlled substances.
   5. (e) Applicant is currently suffering from any condition that impairs their judgment or that would otherwise affect their ability to practice as a physician assistant in a competent, ethical, and professional manner.
   6. (f) Within the past five years, applicant has raised the issue of any physical or psychiatric health disorder as a defense, mitigation, or explanation for their 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.

   7. (g) Applicant has attested to reading and understanding the following statement:

      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 practice as a physician assistant when appropriate and as needed. The Board encourages licensees to utilize the services of the Alabama Professionals Health Program, an advocacy organization dedicated to improving the health and wellness of healthcare professionals in a confidential manner. The failure to adequately address a health condition, where the licensee is unable to practice as a physician assistant with reasonable skill and safety to patients, can result in the Board taking action against the license to practice as a physician assistant.

Author: Alabama Board of Medical Examiners

Statutory Authority: Code of Ala. 1975, §§20-2-60, et seq.

History: New Rule: Published December 30, 2022; effective February 13, 2023. Amended: Published March 31, 2025; effective May 15, 2025.