Telemedicine

Notice: In response to COVID-19 and the impact it is having on the State of Indiana, the Professional Licensing Agency will have the majority of our staff working remotely in the coming weeks. While routine operations of the agency will continue, please note that there may be disruptions or delays in the processing of your requests. Please prioritize the usage of email to communicate with our staff whenever possible and scan any documents that need to be processed. We appreciate your patience and flexibility as we work best to protect our staff and serve Hoosiers in these ever-changing times.

The Telemedicine Provider Certification is required by Indiana Code 25-1-9.5. This certification is available to current Indiana licensed physicians, osteopathic physicians, physician assistants with prescriptive authority, advanced practice nurses, optometrist, and podiatrist.

Provider Application

The Certification must be completed and filed with the Indiana Professional Licensing Agency before the provider may establish a provider-patient relationship or issue a prescription under IC 25-1-9.5-8 for an individual located in Indiana. Note however, that a provider that practices predominantly in Indiana is not required to file this certification.

A provider may not establish a provider-patient relationship or issue a prescription under this statute unless and until the provider's employer or provider's contractor has filed a similar Certification with the Indiana Professional Licensing Agency.

Initial Telemedicine Provider Certification Request

Employer or Contractor Application

This Telemedicine Provider's Employer or Contractor Certification is required by Indiana Code 25-1-9.5.

This Certification must be completed and filed with the Indiana Professional Licensing Agency before the employee provider or contract provider may establish a provider-patient relationship or issue a prescription under IC 25-1-9.5-8 for an individual located in Indiana. Note however, that a provider that practices predominantly in Indiana is not required to file this certification.

Employer or Contractor Certification Request

In the event that a provider changes employers, a new employer certification request must be filed.