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HB299 INTRODUCED
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HB299
XDIF5EE-1
By Representative Oliver
RFD: Health
First Read: 21-Jan-26
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XDIF5EE-1 10/10/2025 ZAK (L)ma 2025-2995
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First Read: 21-Jan-26
SYNOPSIS:
Under existing law, the Alabama State Board of
Respiratory Therapy regulates the practice of
respiratory therapy in this state.
This bill would authorize respiratory therapists
to practice under the direction of an advanced practice
healthcare provider in addition to a physician.
This bill would revise the requirements that
must be satisfied by an individual to be licensed by
the board.
This bill would add a member to the board.
This bill would further provide for the issuance
and privileges of temporary licenses.
This bill would also provide criminal penalties
for fraudulently obtaining a license or holding one's
self out as a licensed respiratory therapist without a
license.
A BILL
TO BE ENTITLED
AN ACT
Relating to the Alabama State Board of Respiratory
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HB299 INTRODUCED
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Relating to the Alabama State Board of Respiratory
Therapy; to amend Sections 34-27B-2, 34-27B-3, 34-27B-4,
34-27B-5 , 34-27B-7, 34-27B-8, 34-27B-9, and 34-27B-11, Code of
Alabama 1975, to authorize respiratory therapists to practice
under certain advanced practice health care providers; to
further provide for and revise requirements for licensure; to
further provide for the duties and composition of the board;
to further provide for temporary licenses; to add Section
34-27B-8.1 to the Code of Alabama 1975, to provide criminal
penalties for certain actions; and to repeal Section
34-27B-12, Code of Alabama 1975, requiring the board to
provide notice of regulations to respiratory therapists
practicing on May 17, 2004 .
BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
Section 1. Sections 34-27B-2, 34-27B-3, 34-27B-4,
34-27B-5, 34-27B-7, 34-27B-8, 34-27B-9, and 34-27B-11, Code of
Alabama 1975, are amended to read as follows:
"§34-27B-2
As used in this chapter, the following terms shall have
the following meanings:
(1) BOARD. The Alabama State Board of Respiratory
Therapy.
(2) DIRECT CLINICAL SUPERVISION. A situation where a
licensed respiratory therapist or physician is available for
the purpose of communication, consultation, and assistance.
(3) HEALTHCARE HEALTH CARE FACILITY. The definition
shall be the same meaning as in Section 22-21-260.
(4) LICENSED ADVANCED PRACTICE PROVIDER. A health care
professional who undergoes specialized education, training,
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professional who undergoes specialized education, training,
and certification to provide services such as medical
diagnosis and treatment. The term includes a physician
assistant, certified registered nurse practitioner, or
certified registered nurse anesthetist with prescribing
authority.
(4)(5) MEDICALLY APPROVED PROTOCOL. A detailed plan for
taking specific diagnostic or treatment actions, or both,
authorized by the treating physician of the patient, all of
which actions shall be which is :
a. In a hospital or other inpatient health care
facility, approved by the supervising physician of the
respiratory therapist or in an outpatient treatment setting
approved by the supervising physician of the respiratory
therapist .;
b. Except in cases of medical emergency, instituted
following an evaluation of the patient by a physician or
otherwise directed by the supervising physician of the
respiratory therapist .; and
c. Consistent with the definition of the scope of
practice of respiratory therapy, as established by this
chapter.
(5)(6) PHYSICIAN. A person An individual who is a
doctor of medicine or a doctor of osteopathy licensed to
practice in this state.
(6)(7) RESPIRATORY THERAPIST. A person An individual
licensed by the board to administer respiratory therapy and
who has the knowledge and skills necessary to administer
respiratory therapy, monitor patient responses, modify
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respiratory therapy, monitor patient responses, modify
respiratory therapy based upon patient response, provide
information and education to patients about deficiencies or
disorders of the cardiopulmonary system, and supervise others
in the delivery of appropriate respiratory therapy procedures.
(7)(8) RESPIRATORY THERAPY OR CARE. Therapy,
management, rehabilitation, diagnostic evaluation, and care of
patients with deficiencies and abnormalities of the
cardiopulmonary system and associated aspects of other
systems' functions, given by a health care professional
respiratory therapist under the direction of a physician or
licensed advanced practice provider . The term includes , but is
not limited to, the following activities conducted upon
written prescription, verbal order, or medically approved
protocol:
a. Direct and indirect pulmonary care services that are
safe, aseptic, preventive, or restorative to the patient.
b. Direct and indirect respiratory therapy services,
including , but not limited to, the administration of
pharmacologic, diagnostic, and therapeutic agents related to
respiratory therapy procedures necessary to implement a
treatment, disease prevention, pulmonary rehabilitative, or
diagnostic regimen prescribed by a physician or a licensed
advanced practice provider .
c. Observation and monitoring of signs and symptoms,
general behavior, and general physical response to respiratory
therapy treatment and diagnostic testing and determination of
whether such these signs, symptoms, reactions, behavior, or
general responses exhibit abnormal characteristics , and
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general responses exhibit abnormal characteristics , and
implementation, based on observed abnormalities, of
appropriate reporting or referral practices or prescribed and
medically approved respiratory therapy protocols or
appropriate changes in a treatment regimen, pursuant to a
prescription by a physician or a licensed advanced practice
provider , or the initiation of emergency procedures.
d. The diagnostic and therapeutic use of any of the
following, in accordance with the prescription of a physician
or a licensed advanced practice provider :
1. Administration of medical gases, exclusive of not
including general anesthesia.
2. Aerosols.
3. Humidification.
4. Environmental control systems and hyperbaric
therapy.
5. Pharmacologic agents related to respiratory therapy
procedures.
6. Mechanical or physiological ventilatory support.
7. Bronchopulmonary hygiene.
8. Cardiopulmonary resuscitation.
9. Maintenance of the natural airways.
10. Insertion without cutting tissues and maintenance
of artificial airways.
11. Diagnostic and testing techniques required for
implementation of respiratory therapy protocols.
12. Collections of specimens of blood and other body
fluids including specimens from the respiratory tract.
13. Collection of inspired and expired gas samples.
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13. Collection of inspired and expired gas samples.
14. Analysis of blood, gases, and respiratory
secretions.
15. Measurements of ventilatory volumes, pressures, and
flows.
16. Pulmonary function testing.
17. Hemodynamic and other related physiologic
measurements of the cardiopulmonary system.
18. Respiratory telecommunications.
19. Cardiopulmonary disease management.
20. Tobacco cessation.
e. The transcription and implementation of the written
and verbal orders of a physician or licensed advanced practice
provider pertaining to the practice of respiratory therapy.
f. Institution of known and medically approved
protocols relating to respiratory therapy in emergency
situations in the absence of immediate direction by a
physician or licensed advanced practice provider and
institution of specific procedures and diagnostic testing
related to respiratory therapy as ordered by a physician to
assist in diagnosis, monitoring, treatment, and medical
research.
g. Delivery of respiratory therapy procedures,
instruction, and education of patients in the proper methods
of self-care and prevention of cardiopulmonary diseases and
other conditions requiring the use of respiratory therapy
equipment or techniques."
"§34-27B-3
(a) Except as provided in Section 34-27B-7, no person
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(a) Except as provided in Section 34-27B-7, no person
individual shall hold himself or herself out to be, or
function as, a respiratory therapist in this state unless
licensed in accordance with this chapter.
(b) In order to obtain a respiratory therapist license,
an applicant shall demonstrate to the board that he or she :
(i) is a citizen of the United States or, if not a citizen of
the United States, a person an individual who is legally
present in the United States with appropriate documentation
from the federal government ,; (ii) is at least 18 years of
age,; (iii) is a high school graduate , or has the equivalent
of a high school diploma ,; (iv) demonstrates good moral
character; and (v) meets one of the following requirements:
(1) Holds and maintains credentials as a registered
respiratory therapist (RRT) or a certified respiratory
therapist (CRT), as granted by the National Board for
Respiratory Care or its successor organization.
(2) Holds a temporary license issued under subsection
(d) of Section 34-27B-7 and passes the examination leading to
the CRT or RRT credential.
(3) Has a valid respiratory therapist license from
another state, the District of Columbia, or a territory of the
United States , whose requirements for licensure are considered
by the board as substantially similar to those of Alabama this
state and who otherwise meets the reciprocity requirements
established by the board.
(4) Meets the requirements of subdivision (2) of
subsection (d) of Section 34-27B-7.
(5)(4) Has been approved by the board as otherwise
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(5)(4) Has been approved by the board as otherwise
qualified by special training and has passed the licensure
examination established by the board in subsection (c).
(c) The board shall arrange for the administration of a
licensure examination administered by the state or a national
agency approved by the board. The examination shall be
validated and nationally recognized as testing respiratory
care competencies. The board may enter into agreements or
contracts, consistent with state law, with outside
organizations for the purpose of developing, administering,
grading, and reporting the results of licensure examinations.
Such These organizations shall be capable of meeting the
standards of the National Commission for Health Certifying
Agencies, or its equivalent or successor organization. The
board shall establish criteria for satisfactory performance on
the examination.
(d) The board may request a criminal history background
check of an applicant for the purpose of determining an
applicant's suitability for a license to practice respiratory
therapy. If requested by the board, the applicant shall submit
a full set of fingerprints to the board for the purpose of
obtaining a state and national criminal history background
check.
(2) Fingerprints obtained pursuant to subdivision (1)
may be exchanged by the board, the Alabama State Law
Enforcement Agency, or any successor entity thereof, or any
channeler approved by the board, with the Federal Bureau of
Investigation for the purpose of obtaining a state and
national criminal history background check.
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national criminal history background check.
(3) The applicant shall be responsible for all costs
associated with the submission of his or her fingerprints and
obtaining a state and national criminal history background
check. The board may incorporate those costs into the cost of
licensing or may charge the applicant a separate fee, which
may be payable to the board, the Alabama State Law Enforcement
Agency, or any successor entity thereof, or the approved
channeler, as appropriate.
(4) Information received by the board pursuant to a
state and national criminal history background check shall be
confidential and shall not be a public record, except that any
information received by and relied upon by the board in
denying the issuance of a license may be disclosed as
necessary to support the denial. "
"§34-27B-4
(a) The board shall perform all of the following
functions:
(1) Set respiratory therapy licensure fees, including ,
but not limited to, application, initial, renewal, and
reinstatement fees.
(2) Establish and publish minimum standards of
continuing education of respiratory therapy in accordance with
those standards developed and accepted by the profession.
(3) Examine for, approve, deny, revoke, suspend, and
renew licensure of duly qualified applicants.
(4) Promulgate Adopt and publish rules in accordance
with the Administrative Procedure Act to administer this
chapter.
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chapter.
(5) Conduct hearings on charges calling for the denial,
suspension, revocation, or refusal to renew a license.
(6) Maintain an up-to-date list of every person
individual licensed to practice respiratory therapy pursuant
to this chapter. The list shall include the last known place
of residence and the state license number of the licensee.
(7) Maintain an up-to-date list of persons individuals
whose licenses have been suspended, revoked, or denied. The
list shall include the name, Social Security number, type,
date, and cause of action, penalty incurred, and the length of
the penalty. The information on the list, except for Social
Security numbers, shall be available for public inspection
during reasonable business hours and the information may be
shared with others as deemed necessary and acceptable by the
board.
(b) The board, by rule, shall prorate fees as
appropriate and shall provide applicants and licensees with
verification of receipt of fees. "
"§34-27B-5
(a)(1) The Alabama State Board of Respiratory Therapy
is created to implement and administer this chapter and shall
be composed of six seven members appointed by the Governor.
Three Four of the members shall be respiratory therapists, one
member shall be the chief executive officer of a hospital, one
member shall be a physician, and one member shall be a
consumer.
(2) The respiratory therapist members of the board
appointed by the Governor shall be selected from a list of
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appointed by the Governor shall be selected from a list of
names submitted by the Alabama Society for Respiratory Care.
The list shall include two names for each appointed position
to be filled. The respiratory therapist members appointed to
the board shall be registered or certified by the National
Board for Respiratory Care or its successor organization .
Respiratory therapists appointed to the initial board must be
eligible to obtain a license under this chapter. Respiratory
therapists selected for subsequent appointments must and be
licensed by the state board .
(3) The hospital member shall be selected from a list
of two names submitted by the Alabama Hospital Association.
(4) The physician member appointed shall be duly
licensed to practice medicine in Alabama and shall be a member
of at least one of the following: The American Thoracic
Society, the American College of Chest Physicians, the
American Society of Anesthesiologists, or the American Academy
of Pediatrics. The physician member of the board appointed by
the Governor shall be selected from a list of two names
submitted by the Medical Association of the State of Alabama.
(5) The consumer member appointed by the Governor shall
be selected from one of the names submitted by the American
Lung Association in Alabama, the Alabama Chapter of the Cystic
Fibrosis Foundation, and the Alabama Asthma Coalition. Each
entity shall submit one name for consideration.
(b) All board members shall be residents of Alabama and
all appointing authorities shall coordinate their appointments
so that diversity of gender, race, and geographical areas is
reflective of the makeup to assure the board's membership is
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reflective of the makeup to assure the board's membership is
inclusive and reflects the racial, gender, geographic, urban,
rural, and economic diversity of this state.
(c) The Governor shall make the appointments for all
positions for members of the board within 90 days of the date
the position becomes available, including initial
appointments, vacancies, and replacements at the end of the
term of service. All members shall continue to serve until a
successor is appointed.
(d) Members of the board shall have the same immunities
from personal liability as state employees for actions taken
in the performance of their official duties.
(e) The term of office of those members first appointed
shall be as follows: Two respiratory therapists and the
hospital member, as determined by the Governor, shall serve
for terms of two years, and one respiratory therapist and the
physician member shall serve for terms of four years. The
additional respiratory therapist member appointed after
October 1, 2026, shall serve an initial term of not more than
four years as determined by the Governor. Thereafter, the term
of all members, including the consumer member, shall be for
four years. No member shall be appointed for more than three
consecutive full terms. A vacancy in an unexpired term shall
be filled in the manner of the original appointment. The board
shall elect a chair and vice chair annually.
(f) The board shall meet at least twice each year at a
time and place determined by the chair. A majority of the
members of the board shall constitute a quorum for the
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members of the board shall constitute a quorum for the
transaction of business.
(g) Each member shall serve without compensation, but
shall be reimbursed for travel expenses incurred in attendance
at meetings of the board and any other expenses incurred on
business of the board at its discretion. Board members shall
also receive a per diem allowance following the guidelines for
state employees. The reimbursement for expenses and per diem
shall be paid from funds derived from the Alabama State Board
of Respiratory Therapy Fund."
"§34-27B-7
(a) The board shall issue a respiratory therapist
license to any person individual who meets the qualifications
required by this chapter and who pays the license fee
established herein .
(b) Any person individual who is issued a regular or
temporary respiratory therapy license as a respiratory
therapist under this chapter may use the words "licensed
respiratory therapist" or the letters "L .R.T." in connection
with his or her name to denote his or her license.
(c) A license issued under this chapter shall be
subject to biennial renewal every two years .
(d)(1) The board may issue a six-month temporary
license as a respiratory therapist to persons individuals who
have graduated from a respiratory therapy educational program
accredited by the Council on Allied Health Education Programs
(CAHEP) in collaboration with the Committee on Accreditation
for Respiratory Care (CoARC), or their successor
organizations, and who have applied for and are awaiting
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organizations, and who have applied for and are awaiting
competency examination. The temporary license shall be
renewable only once for an additional six-month period if the
applicant fails the examination. Exceptions may be made at the
discretion of the board based upon an appeal identifying
extenuating circumstances. The holder of a temporary license
may only provide respiratory therapy or care activities,
services, and procedures as defined in Section 34-27B-2 under
the direct clinical supervision of a licensed onsite
respiratory therapist or physician .
(2) The board shall grant a license as a respiratory
therapist to other persons who do not meet the qualifications
for licensure pursuant to Section 34-27B-3, but who, on the
effective date of the adoption of the rules and regulations of
the board, are currently employed in the administration of
respiratory therapy under the direction of a physician in the
State of Alabama. The opportunity to apply for a respiratory
therapy license issued under this subdivision shall expire 365
days after implementation of the rules of the board. Holders
of these licenses shall be eligible to renew their licenses as
are any other licensed respiratory therapists under this
chapter. "
"§34-27B-8
(a) The board may refuse to renew a license, may
suspend or revoke a license, may impose probationary
conditions, or may impose an administrative fine not to exceed
five hundred dollars ($500) per violation, as disciplinary
actions if a licensee or applicant for licensure has been
found guilty of unprofessional conduct that has endangered, or
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found guilty of unprofessional conduct that has endangered, or
is likely to endanger, the health, welfare, or safety of the
public. Unprofessional conduct includes , but is not limited
to, each of the following:
(1) Obtaining a license by means of fraud,
misrepresentation, or concealment of material facts.
(2) Being found guilty of unprofessional conduct as
defined by the rules established by the board, or violating
the code of ethics adopted and published by the American
Association for Respiratory Care or its successor
organization.
(3) Conviction of a crime, other than a minor offense,
in any court if the offense has a direct bearing on whether
the person should be entrusted to serve the public in the
capacity of a respiratory therapist.
(b) The board, after a hearing, may exercise the
disciplinary actions authorized in subsection (a). The board
shall adopt policies for the conduct of the hearings. One year
after the date of the revocation of a license, application may
be made to the board for reinstatement. The board shall hold a
hearing to consider any application for reinstatement.
(c) The board may establish adopt rules regarding the
disciplinary actions authorized in subsection (a) in
accordance with the Administrative Procedure Act.
(d) A suspended license is subject to expiration during
the suspension period.
(e) The board may subpoena any person or document and
take testimony to carry out this chapter.
(f) The board shall promote the early identification,
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(f) The board shall promote the early identification,
intervention, treatment, and rehabilitation of respiratory
therapy licensees who may be impaired by reason of illness,
inebriation, excessive use of drugs, narcotics, alcohol,
chemicals, or other substances, or as a result of any physical
or mental condition. If the board has reasonable cause to
believe that a respiratory therapy licensee is impaired, the
board may refer that licensee to a treatment program. "
"§34-27B-9
(a) A person An individual who does not hold a license
or a temporary license as a respiratory therapist or whose
license or temporary license has been suspended or revoked may
not do any of the following:
(1) Use in connection with the person's individual's
practice the words "respiratory care professional,"
"respiratory therapist," "respiratory care practitioner,"
"certified respiratory care practitioner," "licensed
respiratory therapist," "inhalation therapist," or
"respiratory therapy technician"; or use the letters "R.C.P."
or "L.R.T."; or use any other words, letters, abbreviations,
or insignia indicating or implying that the person individual
is a respiratory therapist.
(2) Directly or by implication represent in any way
that the person individual is a respiratory therapist.
(b) A person who holds a license or a temporary license
to practice respiratory therapy under this chapter may use the
title "respiratory therapist" and the abbreviation "L.R.T."
"§34-27B-11
Nothing in this chapter shall be construed as
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Nothing in this chapter shall be construed as
preventing or restricting the practice, services, or
activities of any of the following:
(1) Any person individual who is licensed in Alabama
this state or certified by an organization accredited by the
National Commission for Certifying Agencies and acceptable to
the state from engaging in the profession or occupation for
which the person individual is licensed or certified.
(2) Any person individual employed by the United States
government who provides respiratory therapy solely under the
direction or control of the United States government agency or
organization.
(3) Any person individual receiving clinical training
while pursuing a course of study leading to registry or
certification in a respiratory therapy educational program
accredited by the Council on Allied Health Education Programs
in collaboration with the Committee on Accreditation for
Respiratory Care or their successor organizations. This person
will individual shall be under direct supervision and be
designated by a title clearly indicating his or her status as
a student or trainee.
(4) Any emergency medical technician licensed by the
Alabama State Board Department of Public Health who is
providing care to a patient at the scene of an emergency, or
during transport of the patient in a licensed ground
ambulance, provided that such care may not exceed the scope of
care permissible under the rules of the Alabama State Board
Department of Public Health.
(5) The delivery of respiratory therapy of sick or
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(5) The delivery of respiratory therapy of sick or
disabled persons individuals by family members or domestic
servants or the care of non-institutionalized persons
noninstitutionalized individuals by a surrogate family member
as long as the persons individuals do not represent themselves
as, or hold themselves out to be, respiratory therapists.
(6) Any individual who has demonstrated competency in
one or more areas covered by this chapter as long as the
individual performs only those functions that he or she is
qualified by examination to perform. The standards of the
National Commission for Certifying Agencies, or its
equivalent, shall serve as a standard with which to evaluate
those examinations and examining organizations.
(7) Any person individual performing respiratory
services or care not licensed as a respiratory therapist in
accordance with this chapter who is employed in a diagnostic
laboratory, physician's office, clinic, or outpatient
treatment facility and whose function is to administer
treatment or perform diagnostic procedures confined to that
laboratory, office, clinic, or outpatient facility under the
direction of a licensed physician.
(8) Any respiratory therapy student who performs
limited respiratory therapy procedures as an employee of any a
health care provider organization while enrolled in a
respiratory therapy educational program accredited by the
Council on Allied Health Education Programs in collaboration
with the Committee on Accreditation for Respiratory Care or
their successor organizations , provided any procedure
performed by a respiratory therapy student is a procedure that
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performed by a respiratory therapy student is a procedure that
the student has previously studied and completed in clinical
training . The employee shall be designated by title as a
student or trainee and shall work under direct supervision of
a licensed respiratory therapist. The board shall maintain a
list of all such students .
(9) Any individual employed by a durable medical
equipment or home medical equipment company who delivers, sets
up, or maintains respiratory equipment, but not including
assessment , treatment, or evaluation of the patient.
(10) Any individual employed as a polysommagraphic
technologist working in a sleep center or diagnostic sleep
clinic.
(11) Any licensed respiratory therapist performing
advances in the art and techniques of respiratory therapy
learned through special training acceptable to the board."
Section 2. Section 34-27B-8.1 is added to the Code of
Alabama 1975, to read as follows:
An individual shall be guilty of a Class B misdemeanor
if he or she does any of the following:
(1) Sells or fraudulently obtains or furnishes, or aids
or abets in selling or fraudulently obtaining, any license
issued pursuant to this chapter.
(2) Practices respiratory therapy, uses the title
respiratory therapist, or uses in connection with his or her
name any designation tending to imply that he or she is a
respiratory therapist without a valid and active license
issued pursuant to this chapter.
Section 3. Section 34-27B-12, Code of Alabama 1975,
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HB299 INTRODUCED
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Section 3. Section 34-27B-12, Code of Alabama 1975,
requiring the Alabama State Board of Respiratory Therapy to
provide notice of regulations to respiratory therapists
practicing on May 17, 2004 , is repealed.
Section 4. This act shall become effective on October
1, 2026.
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