(a) Any retired physicians and surgeons wishing to provide volunteer healthcare services shall register with the Department of Health by providing:

1. (1) A completed application;
2. (2) A statement indicating the free or low-cost healthcare clinic where the retired physician will be providing volunteer healthcare services;
3. (3) A statement indicating that the retired physicians’ and surgeons’ intent is to provide free or low-cost services;
4. (4) Verification that the free or low-cost healthcare clinic is not receiving insurance payments for services rendered;
5. (5) A copy of the medical professional’s current professional license; and

6. (6)

   1. (A) A copy of the medical professional’s policy for notifying patients that:

(i) The healthcare professional is rendering voluntary healthcare services; and

1. (ii) He or she is immune from civil suit.

   1. (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 Arkansas Code § 17-95-106 will be approved for a period not to exceed three (3) years.