Collaborating in Indiana

Learn more about what requirements you must meet to practice independently in Indiana

What Is the Practice Environment for NPs in Indiana?

In which category does the state fall: NP independent practice, transition to independence, or collaboration required?

A collaboration is required in order for an APRN to prescribe.

Delegation Authority and Process

Is an agreement required?

Yes, a Practice Agreement is required for an APRN to have prescriptive authority.

What form of agreement is required and what are the requirements for the substance of the agreement?

The written Practice Agreement must contain at least the following: 

• Complete names, home and business addresses, zip codes, and telephone numbers of the physician and the NP;
• A list of all other offices or locations besides those listed in the clause above where the physician authorized the NP to prescribe;\
• All specialty or board certifications of the physician and the NP;
• The specific manner of collaboration between the physician and the NP; including how the physician and NP will work together, share practice trends and responsibilities, maintain geographic proximity, and provide coverage during absence, incapacity, infirmity, or emergency by the licensed practitioner (e.g., backup physician); 
• A description of what limitation, if any, the physician has placed on the NP prescriptive authority;
• A description of the time and manner of the physician’s review of the NP’s prescribing practices. The description shall include provisions that the NP must submit documentation of the NP’s prescribing within seven (7) days.  Documentation of review shall include, but not be limited to, at least a five percent (5%) random sampling of the charts and medications prescribed for patients;
• A list of all other written practice agreements of the physician and the NP; 
• The duration of the written practice agreement; and
• Original signatures of the physician and NP.

Where must the agreement be stored?

There is no requirement.

Does the agreement need to be filed with the state?

Written practice agreements must be submitted to the Indiana State Board of Nursing with the NPs application for prescriptive authority and a mandatory Cover Sheet. Written practice agreements for NPs applying for prescriptive authority shall not be valid until prescriptive authority is granted by the Indiana State Board of Nursing.

Are there requirements to file the agreement after the initial filing (e.g., for updates or on a specified frequency)?

Prescriptive authority for the advanced practice nurse expires on October 31 in each odd-numbered year. Applicants for renewal of prescriptive authority shall submit the following to the board along with the renewal form and fee:

1. Proof of at least thirty (30) actual contact hours of continuing education during the two (2) years immediately preceding renewal, including at least eight (8) actual contact hours of pharmacology, approved by a nationally approved sponsor of continuing education for nurses.
2. A current signed and dated written collaborative practice agreement.

APRNs must immediately notify the Indiana State Board of Nursing in writing of any changes in, or termination of, the written practice agreement, including any changes in the prescriptive authority of the physician.

Who must sign the agreement?

The NP and the collaborating physician.

How often must the agreement be reviewed/reauthorized?

See above for filing requirements.

What are the qualifications for the collaborating provider (licensure, same scope, active practice in state, etc.)?

The law says the collaborating provider must be a “licensed practitioner” and is not specific as to geography or scope.

What are the qualifications for the NP?

See requirements in 848 IAC 5-1-1.

Is an alternate collaborating physician required?

No, not required. 

Collaboration Requirements

Are there ratios/limits on the number of NPs that a collaborator may supervise or enter into collaboration agreements?

No restriction.

Is there an express requirement to review a certain number/percentage of charts?

The physician must review at least 5% of a random sampling of the charts and medications the NP has prescribed for patients on an ongoing basis.

Is there a requirement to meet and, if so, how often and how?

No restriction.

Are there proximity requirements (e.g., between the NP/collaborator or practice site)?

“Geographic proximity” between the APRN and physician is required though not defined more specifically.

Are there location-specific requirements (e.g., that collaborator must go to practice site at some frequency)?

No restriction.

Is remote supervision allowed/are there limitations on remote supervision?

No restriction.

Physician and NP Filing Requirements

Outside of filing the collab agreement, must the physician and/or NP file any separate forms?

See above for prescriptive authority requirements.

Prescription Requirements and Controlled Substance Prescribing

What are the prescription requirements?

No additional restrictions.

What are the requirements for controlled substance prescribing?

To administer, dispense, or procure controlled substances in Indiana the APRN must obtain an Indiana controlled substances registration (CSR) and a DEA registration. Specific opioid prescribing requirements are set forth in 848 IAC 5-4.

Sources

848 IAC 5-1-1.

848 IAC 5-1-3.

848 IAC 5-4.

Instructions & Information for Prescriptive Authority as an Advanced Practice Registered Nurse