al-al-6a84731739f78e1daad5916b: 165-X-1-.04 — Medical Requirements
Public comment closed · opened August 31, 2026.
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The proposed rule establishes medical requirements for boxers in Alabama, including mandatory neurological and eye examinations for those who have competed in over 200 rounds, to be conducted by licensed specialists within the previous year. Additionally, it mandates a pre-fight medical examination and a pregnancy test for female boxers, with certain conditions allowing for waivers of the pregnancy test.
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The rule, in full
3,064 words as published, August 31, 2026. View the original →
APA-1 TRANSMITTAL SHEET FOR NOTICE OF INTENDED ACTION Control: 165 Department or Agency: State of Alabama Alabama Athletic Commission Rule No.: 165-X-1-.04 Rule Title: Medical Requirements Intended Action Amend endanger the public health, welfare, or safety?antly harm or Yes Is there a reasonable relationship between the state’s police Yes power and the protection of the public health, safety, or welfare? Is there another, less restrictive method of regulation available that could adequately protect the public? No Does the proposed rule have the effect of directly or indirectly No increasing the costs of any goods or services involved? To what degree?: N/A Is the increase in cost more harmful to the public than the harm NA that might result from the absence of the proposed rule? Are all facets of the rule-making process designed solely for the purpose of, and so they have, as their primary effect, the Yes protection of the public? Does the proposed action relate to or affect in any manner any litigation which the agency is a party to concerning the subject No matter of the proposed rule? Does the proposed rule have an economic impact? No If the proposed rule has an economic impact, the proposed rule is required to be 41-22-23, Code of Alabama 1975.epared in accordance with subsection (f) of Section Certification of Authorized Official I certify that the attached proposed rule has been proposed in full compliance with the requirements of Chapter 22, Title 41, Code of Alabama 1975, and that it Division of the Legislative Services Agency.ts of the Administrative Procedure Signature of certifying officer John Parris D john Parris R E C ’D & F IL E 02 6 Date Wednesday, August 19, 2026 AU G 19 ,2 V C A G E N C Y L EG IS LA TIV E S APA-2 STATE OF ALABAMA ALABAMA ATHLETIC COMMISSION NOTICE OF INTENDED ACTION AGENCY NAME: Alabama Athletic Commission RULE NO. & TITLE: 165-X-1-.04 Medical Requirements INTENDED ACTION: Amend SUBSTANCE OF PROPOSED ACTION: Paramedic requirements: This amendment is to set rules for the reqired equiment that the ringside paramedic must have with them while working ringside saftey. TIME, PLACE AND MANNER OF PRESENTING VIEWS: September 26, 2026 Board Meeting AAC Office 5809 Felspar Way, Birmingham Alabama 35244. John Parris 205-335-2334 FINAL DATE FOR COMMENT AND COMPLETION OF NOTICE: Monday, October 5, 2026 CONTACT PERSON AT AGENCY: John Parris 205-334-2334 aac.alabama@gmail.com John Parris john Parris (Signature of officer authorized to promulgate and adopt rules or his or her deputy) 165-X-1-.04 Medical Requirements. (1) Medical Examinations. (a) Neurological Examination.
1. All boxers intended to compete in Alabama who have
competed in over two-hundred (200) rounds during their professional career, according to the number of rounds disclosed on such boxer’s official ring record, and prior to competing in Alabama, must submit to the Commission the results of a detailed neurological examination performed within the previous twelve (12) months by a board certified and state licensed neurologist or Commission approved physician.
2. Such examination shall include a careful examination
for signs of any trauma-induced neurological damage along with any other specific test or tests requested by the neurologist.
1. All boxers intending to compete in Alabama who have
competed in over two-hundred (200) rounds during their professional career, according to the number of rounds disclosed on such boxer’s official ring record, and prior to competing in Alabama, must submit to the Commission results from a complete ophthalmological or optometric examination performed within the previous twelve (12) months by a state licensed optometrist or board-certified ophthalmologist.
2. Such examination shall include a careful dilated
examination of the retinal periphery utilizing indirect ophthalmoscope sufficient to identify any sign of previous trauma or retinal damage along with any other specific test or tests requested by said ophthalmologist or optometrist.
3. Any boxer not submitting said results prior to the
match may be allowed to compete provided however that such boxer’s license will, at the conclusion of the 1-.04-1 match, be medically suspended until such time as this ophthalmological or optometric requirement is fulfilled. (i) The Commission may require updated examinations pursuant to sub-paragraphs (a) and (b) of this rule after each successive fifty (50) fought rounds after the previous submission, as disclosed on such boxer’s official ring record. (2) Pre-Fight Examination. At the time of weigh-in, or at such other time as is then announced, all boxers must pass a pre-fight medical examination and a Commission designated physician must complete a Pre-Fight Medical Examination Form. The examining physician shall deliver all Pre-Fight Examination Forms to the Athletic Commission or to its authorized representative on the day of the weigh-in. (a) Pregnancy Testing.
1. Each female boxer, during the pre-fight physical, will
be required to submit to a pregnancy test administered under the direction of the examining physician, or such physician’s authorized assistant. The cost of such test, unless the boxer’s contract or bout agreement states otherwise, shall be the responsibility of the promoter. Pregnant fighters may not fight.
2. Female boxers submitting written documentation
acceptable to the examining physician may be waived from the pre-fight physical pregnancy test requirement. Such documentation shall be limited to: (i) A copy of a lab report from a recognized clinical laboratory and dated within ten (10) days of the pre-fight physical attesting that the boxer is not pregnant, or (ii) A statement from a state licensed physician, on such physician’s letterhead stationery, stating that the boxer has undergone certain medical procedures rendering her medically improbable of bearing children. (b) Failed Pre-Fight Physical.
1. Whenever a boxer’s examination indicates that he or
she is unfit for competition, because of any weakness or disability discovered by the physician, an immediate report of such evidence must be made to the Commission. 1-.04-2 In such case, the boxer shall be prohibited from participating in the match.
2. The examining physician shall deliver all pre-fight
examination reports to the Commission or to its authorized representative immediately after the weigh-in.
3. Any contestant who fails his or her pre-fight physical
for medical reasons or for lack of general conditioning shall be placed on immediate medical suspension and reported to the Commission. (c) Hydration Testing.
1. At the official weigh-in, all boxers’ hydration shall
be tested using digital fiber optic refractometers or other hydration testing method as determined by the appointed event physician. (d) Minimum Uncorrected Visual Acuity.
1. A boxer must have a minimum uncorrected visual acuity
of 20/200 in both eyes. Any person who applies for a license or renewal of license to compete as a professional boxer in Alabama may, upon the request of the Commission, be required to present evidence of his/ her visual acuity. (e) Additional Medical Examinations.
1. Upon recommendation of the examining physician or the
medical advisory panel, the Commission may require a boxer to undergo additional medical examinations performed by a state licensed physician to determine the boxer’s medical fitness to compete. (i) The Commission shall require re-examinations submitted after each successive fifty (50) professional rounds after the previous submission, as disclosed on such boxer’s official ring record. (f) Medical Suspensions by Other Commissions.
1. Medical suspensions. Other athletic commissions
recognized by the Association of Boxing Commissions and which are published by any boxing registry approved for such purposes by the Association of Boxing Commissions shall be recognized by the Commission. 1-.04-3
2. Medical examinations after suspensions. A boxer who is
under medical suspension in another state shall submit to any medical examination listed in this chapter as requested by the Commission prior to competing in a contest or exhibition in this state. (g) Drugs Prohibited.
1. The administration or use of any drugs, alcohol,
stimulants, or injections in any part of the boxer’s body, either prior to or during a match, is prohibited unless such drugs are administered by a physician and with the approval of the commission. (i) The Commission may order a boxer to undergo a drug screening at any time. A Drug Screen Form must be completed by an approved laboratory and submitted to the Commission within seven (7) days of the order. (h) Post Contest Inactive Period.
1. No boxer shall be permitted to engage in another
contest or exhibition in this state for a period of seven (7) days after competing in a contest or exhibition. (i) Head Injury.
1. Any boxer who suffers a knockout, concussion, or other
serious head injury shall be examined by the Ringside Physician. The Physician shall immediately report to the Commission or its representative, the condition of such boxer and whether or not additional medical attention is advised. (j) Knock Out and Technical Knock Out.
1. When a boxer is defeated by knock out, that boxer’s
license shall be placed on an immediate sixty (60) day medical suspension.
2. A Post-Knock Out Examination Form shall be completed
by a physician and submitted to the Commission along with request for medical clearance for thirty (30) days prior to participating in a contest or exhibition in this state. Any boxer losing by knock out in two (2) or more consecutive fights shall be placed on immediate medical suspension for a period of six (6) months. 1-.04-4
3. Unless otherwise ordered by the attending ringside
physician, there shall be a minimum thirty (30) day medical suspension after a technical knockout.
4. Technical knock outs caused by a severe cut shall
result in either a forty-five (45) day or sixty (60) day medical suspension.
5. Submissions with injury may also warrant a medical
suspension as determined by the ringside physician.
6. Completing a suspension may require approved medical
evaluations as determined by the ringside physician. (k) Under-Conditioned Fighter.
1. A boxer deemed under-conditioned by the referee, the
Commission, or any designated representative of the Commission, shall be immediately disqualified and suspended for ninety (90) days. (i) If it should be determined by the referee, any member of the Commission present, or any designated representative of the Commission present that a boxer did not give a good faith effort to display his or her skills, then that boxer shall be subject to disciplinary action. (ii) A disqualified boxer may be disciplined by the Commission. (l) Consecutive Losses.
1. Four or More Consecutive Losses by TKO, KO, or DQ. A
boxer who has lost four (4) consecutive fights by knock- out, technical knock-out, or disqualification, according to the boxer’s official ring record compiled and maintained by the boxing registry, may be summarily suspended pending a hearing by the Commission. Suspension will be listed as “Indefinite Pending Hearing.” (m) Verification of Contestant Experience.
1. The trainer or manager for a boxer that meets the
following criteria shall submit an affidavit that the boxer is prepared for a professional contest: (i) Boxer is making his or her pro debut 1-.04-5 (ii) Boxer has not competed in the last twelve (12) months (iii) Boxer has lost his or her last six (6) consecutive events (iv) Boxer has lost three (3) consecutive events by TKO, KO, or DQ (n) General Responsibilities and Provisions.
1. During the performance of any promotion, it shall be
the promoter’s responsibility to ensure the compliance with all laws and rules governing professional boxing in Alabama. Such responsibilities shall include, but will not be limited to the following: (i) Medical Insurance. (I) The promoter shall provide for the boxers’ insurance covering ambulance services, medical, surgical, and hospital care with a minimum limit of $20,000 for injuries sustained while participating in said program and for a $20,000 death benefit awarded to the estate of any contestant should death occur from injuries received while participating in the contest or exhibition. (ii) Physician. (I) A ringside physician shall be present at all events. A Commission designated ringside physician must be at ringside each bout. A Commission designated ringside physician shall be either a M.D. or D.O.
I. Physicians not having completed the
Ringside Physician Certification shall be licensed as “Non-Ringside Physicians,” but may serve at ring or cage side so long as a minimum of one certified Ringside Physician is present. (II) All “Ringside” physicians serving ring or cage side shall obtain ARP/ACSM Certified Ringside Physician (CRP) certification. All physicians having completed the CPR shall be licensed as a “Ringside Physician.” 1-.04-6 (iii) Ambulance Service. (I) The promoter shall provide continuous ambulance service with a state-certified EMT attendant and state-certified paramedic, who shall provide a resuscitator, stretcher, backboard, oxygen, and such other medical equipment reasonably expected for immediate trauma care, and who shall be present before the start of each contest and shall remain on site until the end of the program. (II) For the purposes of this section, a program of boxing begins with the commencement of the first contest or exhibition and ends when the last boxer leaves the site of the program. (III) The chief referee and/or Commission appointed supervisor shall meet with the EMT and paramedic prior to the beginning of the match, contest, or exhibition. During such meeting the chief referee or Commission supervisor will instruct the EMT and paramedic concerning the match, contest, or exhibition, placement of the stretcher and any other information necessary to ensure prompt and appropriate immediate care. (IV) An ambulance shall be able and available to immediately transport any severely injured boxer to an appropriate medical facility. No other scheduled contest or exhibition may proceed until there is an ambulance and paramedic at the facility, that has met with the chief referee and/or the Commission appointed supervisor as described in subparagraph (III), above. (V) In addition to the above-mentioned ambulance, a paramedic, licensed by the State of Alabama, shall be present at ringside with the ringside physician.This paramedic is required in addition to the onsite paramedic transport crew. The paramedic shall possess advanced life support equipment necessary to resuscitate a fighter and package them for transport to the hospital.The ringside paramedic must have available at the venue a functioning Automated External Defibrillator (AED). The paramedic is in addition to any EMT’s or paramedics that are hired for the safety of the crowd and shall not leave ringside while a fight is taking place and 1-.04-7 shall be in direct communication with the ringside physician at all times. The ringside paramedic shall only leave ringside to attend to a spectator or other person in the event of an emergency and when no other paramedic is available.The AED must be at ringside during all fights. (VI)Pre-Qualification Criteria for Ringside Paramedic. The Ringside Paramedic must have prior verified experience working sporting events directly as either a contract or W-2 employee for one of the following: NCAA, Alabama High School Athletic Association (AHSAA), major sporting venues such as Talladega Superspeedway, or a university athletic department or any other organization approved by the rules and regulations committee. Private ambulance employee paramedics working standby assignments at sporting events strictly in a transport capacity, including AAC events, does not pre- qualify the individual to work as the Ringside Paramedic for future AAC events. City employees that are paramedics including Fire and Rescue services that work standby events in a strictly transport capacity, including the AAC, does not pre-qualify the individual to work as the Ringside Paramedic for future AAC events.The AED must be at ringside during all fights. (VII) Alternative Pathway for new ringside paramedic providers. A state of Alabama licensed paramedic with an active NREMT certification, regardless of place of employment, full or part time status, may qualify for future AAC events by shadowing a currently credentialed ringside paramedic for one AAC commission-sanctioned event. The Director of the AAC must approve the shadowing prior to the event. This person must serve directly at ringside and not be affiliated with the transport unit onsite before, during, or after the event. After shadowing a ringside paramedic at one AAC sanctioned event, the individual is eligible to serve independently as a ringside paramedic at all future AAC events, provided they maintain a current state of Alabama paramedic license and NREMT certification. During the shadow assignment, only the credentialed Paramedic may serve in the 1-.04-8 official capacity.The AED must be at ringside during all fights. (VIII) Publication Requirement. Ringside Paramedic requirements, qualifications, AED obligations, and a list of currently qualified individuals to serve as Ringside Paramedic must be published on aac.alabama.gov and must be included in all promoter application materials.The AED must be at ringside during all fights. The AED must be at ringside during all fights. (iv) Hepatitis and HIV Testing. (I) Blood borne pathogen testing. All boxers in all bouts shall be tested for Hepatitis B, Hepatitis C, and HIV by a laboratory approved by the Commission. The initial test for Hepatitis B, Hepatitis C, and HIV detection shall be conducted within (365) days prior to competition.
I. In addition to the pre-competition test,
any boxer shall be re-tested for Hepatitis B, Hepatitis C, and HIV prior to his or her participation in each boxing match, contest, or exhibition in Alabama if the match, contest, or exhibition is scheduled to occur more than (365) days after the date of the most recent test. The results must be submitted to the Commission with the show date request prior to the official weigh-in. (II) Positive tests for blood-borne pathogens. Any boxer who tests positive for Hepatitis B, Hepatitis C, or HIV shall appear before the medical advisory panel, which after verifying the results of the test, shall advise the Commission as to whether the boxer’s participation in a match, contest, or exhibition would pose a threat to the health and safety of a participant, official, or spectator.
I. Any boxer that tests positive for
Hepatitis B, Hepatitis C, or HIV who is scheduled for competition must disclose to the promoter that he or she has tested 1-.04-9 positive for Hepatitis B, Hepatitis C, or HIV. Author: J. Matt Bledsoe, Brandon Owens, Casey Sears, Joseph B. McCormick Statutory Authority: Code of Ala. 1975, §41-9-1024. History: New Rule: Filed December 27, 2013; effective January 31, 2014. Amended: Filed December 11, 2015; effective January 25, 2016. Amended: Filed June 20, 2018; effective August 4, 2018. Amended: Published August 31, 2022; effective October 15, 2022. Amended: Published ______; effective ______. 1-.04-10
Rulemaking docket
We haven’t pulled this rulemaking’s full docket yet. View docket 165-X-1-.04 on Regulations.gov →
Documents
- Full text (state register) · August 31, 2026
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