Indiana Administrative Code › Title 848 - INDIANA STATE BOARD OF NURSING › Article 5 - PRESCRIPTIVE AUTHORITY FOR ADVANCED PRACTICE NURSING › Rule 1 - Prescriptive Authority › Section 1-1 - Initial authority to prescribe legend drugs

Current through July 10, 2024
Authority: IC
				  25-23-1-7
Affected: IC
				  25-23-1
Sec. 1.
(a) An
				advanced practice nurse may be authorized to prescribe legend drugs, including
				controlled substances, if the advanced practice nurse does the following:
(1) Submits an application on a form
				prescribed by the board with the required fee, including, but not limited to,
				the following information:
(A) Complete name,
				residence and office addresses with zip codes, and residence and business
				telephone numbers with area codes.
(B) All names used by the applicant,
				explaining the reasons for any name change or use.
(C) Date and place of birth.
(D) Citizenship and visa status, if
				applicable.
(E) A complete
				statement of all nursing education received, providing the following:
(i) Names and locations of all colleges,
				schools, or universities attended.
(ii) Dates of attendance.
(iii) Degrees obtained or received.
(F) Whether the applicant has ever
				had any disciplinary action taken against the applicant's nursing license by
				the board or by the licensing agency of any other state or jurisdiction and the
				details and dates thereof.
(G) A
				complete list of all places of employment, including the following:
(i) The names and addresses of
				employers.
(ii) The dates of each
				employment.
(iii) Employment
				responsibilities held or performed that the applicant had since graduation from
				nursing school.
(H)
				Whether the applicant is, or has been, addicted to any narcotic drug, alcohol,
				or other drugs and, if so, the details thereof.
(I) Whether the applicant has been convicted
				of any violation of law relating to drug abuse, controlled substances, narcotic
				drugs, or any other drugs.
(J)
				Whether the applicant has previously been licensed to practice nursing in any
				other state or jurisdiction and, if so, the following:
(i) The names of such states or jurisdictions
				that previously licensed the applicant.
(ii) The dates of such licensure.
(iii) The license number.
(iv) The current status of such
				licensure.
(K) Whether
				the applicant has been denied a license to practice nursing by any state or
				jurisdiction and, if so, the details thereof, including the following:
(i) The name and location of the state or
				jurisdiction denying licensure.
(ii) The date of denial of such
				licensure.
(iii) The reasons
				relating thereto.
(L) A
				certified statement that the applicant has not been convicted of a criminal
				offense (excluding minor traffic violations) or a certified statement listing
				all criminal offenses of which the applicant has been convicted. This listing
				must include the following:
(i) The offense of
				which the applicant was convicted.
(ii) The court in which the applicant was
				convicted.
(iii) The cause number
				in which the applicant was convicted.
(M) All information in the application shall
				be submitted under oath or affirmation, subject to the penalties for
				perjury.