(a) Any medical professional wishing to provide services as a volunteer shall register with the Department of Health by providing:

1. (1) A completed application;
2. (2) A statement indicating that the medical professional’s intent is to provide free or low-cost services;
3. (3) Verification that the medical professional is not receiving insurance payment for services rendered, if the medical professional is registering as a healthcare professional for the purposes of Arkansas Code § 16-6-201;

4. (4) A copy of the medical professional’s current professional license, or, if a student, a copy of certification the student is currently enrolled in a school/training for which the student is seeking a:

   1. (A) Degree;
   2. (B) License; or
   3. (C) Certification;

5. (5) A statement on file that, if the medical professional is a student, the student is under supervision of a person who is licensed in the medical profession for which the student is seeking a:

   1. (A) Degree;
   2. (B) License; or
   3. (C) Certification; and

6. (6)

   1. (A) A copy of the medical professional’s policy for notifying patients that the healthcare professional is rendering voluntary healthcare services and that he or she is immune from civil suit.
   2. (B) This policy must be in language understood by the patient.

(b)

1. (1) The application must be returned to the department.
2. (2) An application meeting the intent of Acts 1997, No. 276 will be approved for a period not to exceed three (3) years.