Physician Assistant Prescriptive Authority Application
All applications are subject to review and approval by the Physician Assistant Committee.
Documents Required for Prescriptive Authority
Application - You a must complete, date and sign the Application for prescriptive authority. All information must be completed on the application or have N/A for not applicable. Please be sure to include an email address, as status updates will be sent via email.
Application Fee - At this time a fee is not required for prescriptive authority applications; however, there is a fee attached to the Controlled Substance Registration application of $60.00.
Positive Responses - If you have answered any of the questions on the application “yes” you must submit a notarized affidavit detailing the occurrence/situation, the outcome, date of occurrence, if it is a malpractice payment include the amount paid on your behalf. If applicable, please submit copies of all court documents and/or arrest records. Letters from attorneys or insurance companies are not accepted in lieu of your statement, however they may be included with your statement.
Collaborative Agreement - The agreement must meet the requirements stated in IC 25-27.5-5-2. The Collaborating Physician shall submit a description of the exact privileges and tasks the physician assistant shall be performing under the physician’s collaboration. The collaborating agreement shall be specific to the physician assistant being hired “i.e. John Brown, PA will be responsible for…” Also include a description of procedures for dealing with emergencies. The collaborative agreement must be completely typed, on letterhead, and signed by both the physician and physician assistant. The collaborative agreement must also include a list of classifications of medications the physician assistant is delegated to prescribe and a description of protocols used in the practice. Protocols to be used for physician assistant prescribing may include clinical practice guidelines, reference texts, or other sources.
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."
A collaborating physician or physician designee shall review all patient encounters not later than 10 days after the PA has seen the patient.
- Initial year - 10% chart review
- Subsequent years- percentage collaborting physician determines to be reasonable as stated in the collaborative agreement
Controlled Substance Registration - If you are going to prescribe, dispense or administer controlled substances you must also apply for a Controlled Substance Registration. Please review the Controlled Substance Registration instructions. If you already have authority to prescribe legend drugs, you will need to submit an updated practice agreement indicating your authority prescribe controlled substances with the CSR.