Authority: IC 25-22.5-2-7

Affected: IC 25-22.5

Sec. 16. "Supervisory agreement" means a written document signed by the supervising physician or physicians and the physician assistant that:

1. (1) includes the tasks delegated to the physician assistant;
2. (2) describes the supervisory plan for the physician assistant, including emergency procedures that the physician assistant must follow;
3. (3) specifies the names of the drug or drug classification the physician assistant is delegated to prescribe and the protocol the physician assistant shall follow in prescribing a drug;
4. (4) specifies the names of medical devices the physician is delegated to prescribe;

5. (5) includes the:

   1. (A) name;
   2. (B) address; and
   3. (C) phone number;
6. of the physician or physicians who will be supervising the physician assistant; and
7. (6) includes a description of the setting or settings in which the physician assistant will be working.

(Medical Licensing Board of Indiana; 844 IAC 2.2-1.1-16; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR- 844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA)