Application Instructions
- General Information
The Fair Information Practice Act: In compliance with Ind. Code 4-1-6, this agency is notifying you that you must provide the requested information, or your application will not be processed. You have the right to challenge, correct, or explain information maintained by this agency. The information you provide will become public record. Your examination scores and grade transcripts are confidential except in circumstances where their release is required by law, in which case you will be notified.
Mandatory Disclosure of U.S. Social Security Number: Your social security number is being requested by this state agency in accordance with Ind. Code 4-1-8-1 and 25-1-5- 11(a). Disclosure is mandatory, and this record cannot be processed without it. Failure to disclose your U.S. social security number will result in the denial of your application. Application fees are not refundable.
Abandon Applications: If an applicant does not submit all requirements within one (1) year after the date on which the application is filed, the application for licensure is abandoned without any action of the Board. An application submitted after an abandoned application shall be treated as a new application.
Application Review: All applications are subject to review and approval by the Physician Assistant Committee.
- Physician Assistant by Examination
Submit the following with your online application:
- Application fee of $100.00: Pay by credit or debit card for applications submitted online. All application fees are nonrefundable.
- Criminal Background Check
- Positive Response Documentation: If you answer "Yes" to any questions on the application, explain fully in a statement that includes all details. Include the violation, location, date, cause number, and disposition. Submit copies of court documents for each instance to support the statement. If malpractice, provide the name(s) of the plaintiff(s).
- Name Change Documentation: Documentation of any legal name change if your name differs from that on any of your documents. Documentation may include a copy of your marriage certificate, divorce decree, or legal order.
- Official Transcript: Submit an official transcript of courses and grades from an approved Physician Assistant school showing that the degree has been confirmed.
- Copy of Diploma: A copy of your diploma.
- Score Report from the Examination administered by the NCCPA: Request a score report from http://www.nccpa.net/ to be sent to the Indiana Professional Licensing Agency.
- Current NCCPA Certificate: A copy of your current NCCPA Certificate. Also accessible from http://www.nccpa.net/.
- Verification of Licensure: Verification of any registration/license/certification to practice any health-related profession or occupation in another state or territory. Verifications must be submitted directly from the state of issuance. The form is linked should another state require the form to complete the request.
- Collaborative Agreement: See below, Collaborative Practice Agreement.
- Physician Assistant by Reciprocity
If you are a licensed physician assistant in another state and meet the reciprocal requirements as defined in IC 25-1-21-5*, submit the following with your online application:
- Application fee of $100.00: Pay by credit or debit card for applications submitted online. All application fees are nonrefundable.
- Criminal Background Check
- Positive Response Documentation: If you answer "Yes" to any questions on the application, explain fully in a statement that includes all details. Include the violation, location, date, cause number, and disposition. Submit copies of court documents for each instance to support the statement. If malpractice, provide the name(s) of the plaintiff(s).
- Name Change Documentation: Documentation of any legal name change if your name differs from that on any of your documents. Documentation may include a copy of your marriage certificate, divorce decree, or legal order.
- Verification of Licensure: Verification of any registration/license/certification to practice any health-related profession or occupation in another state or territory. Verifications must be submitted directly from the state of issuance. The form is linked should another state require the form to complete the request.
- Collaborative Agreement: See below, Collaborative Practice Agreement.
*Licensure by Reciprocity: The Committee shall issue a license to an applicant if the applicant satisfies the following conditions:
- Holds a current license from another state or jurisdiction; and that state's or jurisdiction's requirements for a license are substantially equivalent to or exceed the requirements for a license of the Committee; or when the person was licensed or certified by another state:
- there were minimum education requirements in the other state or jurisdiction;
- if there were applicable work experience and clinical supervision requirements in effect, the person met those requirements to be licensed in that state; and
- if required by the other state or jurisdiction, the person previously passed an examination required for the license or certification.
- Has not committed any act in any state or jurisdiction that would have constituted grounds for refusal, suspension, or revocation of a license, certificate, registration, or permit to practice that occupation in Indiana at the time the act was committed.
- Does not have a complaint or an investigation pending before the regulating agency in another state or jurisdiction that relates to unprofessional conduct.Is in good standing and has not been disciplined by the agency that has authority to issue the license or certification.
- If a law regulating the applicant's occupation requires the Committee to administer an examination on the relevant laws of Indiana, the Committee may require the applicant to take and pass an examination specific to the laws of Indiana.
- Pays any fees required by the Committee for which the applicant is seeking licensure.
- Physician Assistant Temporary Permit
Submit the following with your online application, after you have submitted your primary application for Physician Assistant:
- Application fee of $50.00: Pay by credit or debit card. All application fees are nonrefundable.
- Please note that this fee is in addition to the $100.00 Physician Assistant application fee.
- All Requirements for full licensure (including the passage of the examination) and is awaiting the next schedule meeting of the committee.
Pursuant to IC 25-27.5-4-4, your application file must be complete and pending Committee review before a temporary permit may be issued. If you wish to practice while waiting for your application file to be reviewed you must apply for and obtain a temporary permit. The temporary permit is only good while the Committee members are reviewing your full application.
Available for applicants applying by Examination or Reciprocity.
- Application fee of $50.00: Pay by credit or debit card. All application fees are nonrefundable.
- Prescriptive Authority
The initial application submitted for a Physician Assistant will include the request for Prescriptive Authority. If you are not yet prepared to request the Prescriptive Authority at the time of application for full licensure, you will be required to use the Change or Add Collaborator section below.
You must also submit a controlled substance registration application and fee if you will be prescribing controlled substances - see below
- Collaborative Practice Agreement
To obtain and maintain an Active Physician Assistant license in Indiana, you must collaborate with an Indiana Licensed Physician (IC 25-27.5-5-2) evidence by a collaborative practice agreement (CPA). Please note that you may not practice without an Active Physician Assistant license and if you do not have a current practice agreement with an Indiana-licensed practitioner and would like your application approved, it will be approved with a status of "Current/Not Practicing." Once you obtain a position as a Physician Assistant, you may submit a Change Collaborator/CPA request, pay the corresponding fee, and complete all other requirements to Activate your Physician Assistant license for practice.
The collaborative practice agreement (CPA) must meet the requirements stated in IC 25-27.5-5-2 and:
- The collaborating agreement shall be specific to the physician assistant being hired, “i.e., John Brown, PA, will be responsible for…”;
- Must include a description of procedures for dealing with emergencies;
- Must be typed entirely, on letterhead, and signed by both the physician and the physician assistant;
- Include a description of the exact privileges and tasks the physician assistant shall be performing under the physician’s collaboration;
- Include a list of the classifications of medications the physician assistant is delegated to prescribe (e.g., May prescribe schedules II-V) and a description of the protocols used in the practice;
- Protocols to be used for physician assistant prescribing may include clinical practice guidelines, reference texts, or other sources.
- All prescribing sections in an agreement must include the following statement: The PA may not prescribe Schedule I.
- If you are seeking to prescribe non-controlled substances, you must specifically state this in your agreement. Example: "The physician assistant will only be prescribing non-controlled substances.
Chart Review: Chart review must be included in every collaborating agreement submitted to the Board. If you are beginning employment with a new collaborating physician, the collaborating agreement must include that the collaborating physician will review 10% of the PA's files within 10 days during the 1st year. This is for all PAs, regardless of how long you have been practicing as a PA.
Example:
- Dr. Smith will review 10% of Mary Brown's files within 10 days.
- Subsequent years- the collaborating physician will determine the percentage of review and needs to be stated in the collaborating agreement IC 25-27.5-6-1
Collaborative Agreement Checklist
Collaborative Agreement Sample
Job Description of Physician Assistant:
In accordance with IC 25-27.5-6-2, a physician may supervise not more than four (4) physician assistants at one time. Furthermore, according to IC 25-27.5-5-4 physician assistants may not prescribe certain things, please review. Again, be sure the job description is on company letterhead and signed by the supervising physician.
- Change or Add Collaborator
A Physician Assistant (PA) may submit an application for Change or Adding additional Collaborative Physician(s) by using the Change Collaborator/CPA action under their License in MyLicense One. You may also request the removal of existing collaborators and, where applicable, update the associated Controlled Substance Registration (CSR) within the same form.
- Application Fee:
- For adding or changing collaborators, the fee is $50 per Collaborating Physician being added to the license, plus processing fees.
- For a PA license that was previously put on Inactive status, an additional $25 inactive-to-active fee will be charged for the reactivation process of the license.
- All fees are non-refundable and non-transferable.
- Collaborative Practice Agreement: A signed practice agreement must be uploaded with this application form (See Collaborative Practice Agreement).
- PAs who only need to remove existing Collaborative Physicians or CPAs, without changing/adding additional ones, may submit their request using the Remove Collaborator action in MyLicense One. Please note that to maintain active status and practice as a Physician Assistant, there must be at least one (1) active collaborative physician on the license.
- Application Fee:
- Controlled Substance Registration
For controlled substances, if you already have authority to prescribe legend drugs, you will need to submit an updated practice agreement indicating your authority to prescribe controlled substances with the CSR.
Go to https://www.in.gov/pla/professions/controlled-substance-registration/ for application and instructions.
Renewal Instructions
- Renewal Information
Physician Assistant licenses expire on June 30th of even-numbered years.
- The renewal fee for a Physician Assistant license is $50, plus additional processing fees.
- Physician Assistants are required to maintain NCCPA certification to renew their license to Active status.
- If there's a change in your collaborative practice agreement, a separate submission of the Change or Addition of Collaborative Physician application is required.
Renewal notices are sent approximately ninety (90) days prior to the expiration date. License holders with valid email addresses on file will be emailed the renewal notice. Those who do not have a valid email address on file will receive the license renewal notice by mail; it is sent to the address of record with the board. The board has no control over whether a notice reaches its destination; therefore, when a notice has been emailed to a valid email address or mailed, the duty of the board has been performed.
Inactive Status
Physician Assistants may request to be placed on Inactive status at the time of renewal. The fee for renewing in Inactive status will be $25. Physician Assistants are not required to maintain NCCPA certification while their license is in Inactive status, though they may not practice without an Active Physician Assistant license.
Controlled Substance Registration
If you have a Controlled Substance Registration (CSR), you must renew it after renewing your (primary) Physician Assistant license. If you have more than one CSR, you will need to renew each one separately.
If you have a different practice location than what is listed on your CSR, you will need to do one of the following:
- Submit a change request using the Change CSR Location action (in MyLicense One) if this is only a change of practice location for an existing and on-file practice agreement (without adding a collaborator to your license), OR;
- Submit a Change or Addition of Collaborative Physician application with the additional practice agreement that lists the new practice location.
If your primary license is currently in "Current/Not Practicing" status, you cannot renew your CSR(s). Similarly, if you renew your primary license to the Inactive status, you cannot renew your Controlled Substance Registrations. If you attempt to renew the CSR without an Active primary license, please keep in mind that all fees are nonrefundable and nontransferable.
- Activation of Inactive License
A Physician Assistant may request to activate their license from Inactive status by:
- Submit a Change or Addition of Collaborative Physician application if the license expiration is current and is not due for a renewal, OR;
- If your Inactive license is due for renewal or if it has expired for less than 3 years, you must first renew your Inactive license to update its expiration, then submit a Change or Addition of Collaborative Physician application, OR;
- If your inactive license has expired for 3 years or more, you must reinstate the license.
In either case, you will also be required to provide proof of active NCCPA certification, a valid collaborative practice agreement that meets the requirements stated in IC 25-27.5-5-2, and pay the Inactive-to-Active fee, where applicable.
- Reinstatement Information
If your Physician Assistant license has expired for three (3) or more years, you must reinstate your license to practice.
You may submit a reinstatement application online via MyLicense One and:
- Pay the current renewal fee ($50) and the current initial application fee ($100), for a total of $150 reinstatement fee plus additional processing fees.
- Provide work history detailing your work since your license expired.
- Upload proof of current NCCPA.
- In addition, you must also submit a Change or Addition of Collaborative Physician application.
If your CSR-Physician Assistant has been expired for three or more years, you must reinstate your license to practice. Please go to the Controlled Substance Registration page for instructions.
Fee Schedule
- Physician Assistant Applications/Renewals
Physician Assistant Application/Renewal Fee Initial Application $100.00 Temporary Permit $50.00 Change of Supervising Physician $50.00 Addition of Supervising Physician $50.00 Renewal - due 6/30 of even-numbered years $50.00 Controlled Substance Registration $60.00 Inactive Status $25.00
FAQs
- FAQs
- If you have more than one collaborating physician do you have to submit separate collaborative agreements?
- If you have more than one collaborating physician and you will be performing the same duties with each physician they may all be in one agreement. If you are performing separate duties for each physician then a separate agreement should be submitted for each physician.
- If I am going to practice at two separate locations for two separate physicians do I need to complete two prescriptive authority applications?
- You would need to complete Change or Addition of Collaborative Physician for every collaborating physician. All collaborative agreements will need to include prescriptive authority in the agreement to prescribe.
- Once I have prescriptive authority do I have it indefinitely or do I have to reapply each time I change supervising physicians?
- You only need to apply for prescriptive authority once. If you change or add collaborating physicians, you need to complete a Change or Addition of Collaborative Physician along with the collaborative agreement that includes the authority to prescribe within the new practice.
- Must I submit an application for a Controlled Substance Registration (CSR)?
- You only need to submit an application for a CSR for your place of employment if you are prescribing, administering or dispensing controlled substances. It is not necessary if you are only prescribing legend drugs. If you have more than one office, you must apply for a CSR at each location in which you are dispensing or administering controlled substances. One CSR will cover multiple locations for prescribing.
- Where I presently work, I do not prescribe, but I will be prescribing at my new place of employment. What do I need to submit?
- You will need to submit the Change or Addition of Collaborative Physician.
- What needs to be included in the Collaborative Agreement?
- Please review the Collaborative Practice Agreement Requirements above.
- Can I practice as soon as you receive my application?
- You cannot practice until a license is issued and a collaborative agreement is on file. You may practice with your collaborating physician as a PA (assuming you are licensed); however, you cannot practice using the prescriptive authority until you receive an approval letter from the Board. You have thirty (30) days after beginning a practice with a new or additional collaborating physician to complete a Change/Addition Application. IC 25-27.5-5-2(f)(4) states that the supervisory agreement must specify the name of the drug or drug classification being delegated to the PA and the protocol the PA shall follow in prescribing a drug. What does Protocol mean? Protocols are the instructions that the PA shall follow in prescribing a drug.
- Can I write a prescription for a Schedule II controlled substance?
- Yes, if your collaborative agreement and CSR permits you to. If your current collaborative agreement does not permit you to prescribed Schedule II controlled substances, you may have the agreement amended and submitted to the Committee for approval.
- If you have more than one collaborating physician do you have to submit separate collaborative agreements?