Home 5 Retired Status Application and Attestation

Retired Status Application and Attestation

Name
Date of Retirement

With my signature, I attest that as of the above date, I have been/will be fully retired from the practice of medicine and completely disengaged from patient care or providing medical advice. This includes the practice of Urology and any other aspect of medical care either on a paid or voluntary basis.


My ABU Certificate is/was active and in good standing.


My medical license(s) is unrestricted in any jurisdiction.


I am not/will not be performing any function for which ABU certification is required.


I have no intention of returning to the practice of medicine.

Clear Signature