reglab/statecodes huggingface dataset:
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 2 - Standards of Professional Conduct › Section 2-17 - Contingency fees prohibited

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  25-1-9; IC
				  25-22.5-1
Sec. 17.
A practitioner shall not base his fee upon the uncertain
				  outcome of a contingency, whether such contingency be the outcome of litigation
				  or any other occurrence or condition which may or may not develop, occur, or
				  happen.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 2 - Standards of Professional Conduct › Section 2-18 - Liability to patients

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  25-1-9; IC
				  25-22.5-1
Sec. 18.
A practitioner shall not attempt to exonerate himself from
				  or limit his liability to a patient for his/her personal malpractice except
				  that a practitioner may enter into agreements which contain informed, voluntary
				  releases and/or waivers of liability in settlement of a claim made by a patient
				  or by those responsible for a patient's care.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 2 - Standards of Professional Conduct › Section 2-19 - Patient complaints

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  25-1-9; IC
				  25-22.5-1
Sec. 19.
A practitioner shall not attempt to preclude, prohibit, or
				  otherwise prevent the filing of a complaint against him/her by a patient or
				  other practitioner for any alleged violation of this title or of any alleged
				  violation of IC
				  25-22.5-1, or any other
				  law.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 2 - Standards of Professional Conduct › Section 2-20 - Schedule II controlled substances

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  25-1-9; IC
				  25-22.5-1; IC
				  35-48-2-6
Sec. 20.
A physician shall not utilize, prescribe, order, dispense,
				  administer, supply, sell, or give any amphetamine, sympathomimetic amine drug
				  or compound designated as a Schedule II controlled substance pursuant to the
				  provisions of IC
				  35-48-2-6 to any person for
				  purposes of weight reduction or for control in the treatment of
				  obesity.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 2 - Standards of Professional Conduct › Section 2-22 - Use of term, "board certified"

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  25-1-9; IC
				  25-22.5-1
Sec. 22.
A practitioner shall not represent in any manner that he or
				  she is "board certified" or use any similar words or phrase calculated to
				  convey the same unless the practitioner states by which board he/she is
				  certified and the specific field or area of certification.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 3 - Appropriate Use of the Internet in Medical Practice › Section 3-1 - General provisions

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  25-1-9; IC 25-22.5
Sec. 1.
A practitioner shall comply with this article when utilizing
				  the Internet in the delivery of patient care.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 3 - Appropriate Use of the Internet in Medical Practice › Section 3-2 - Evaluation of the patient

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  25-1-9; IC 25-22.5
Sec. 2.
A documented patient evaluation, including history and
				  physical evaluation adequate to establish diagnoses and identify underlying
				  conditions or contraindications to the treatment recommended or provided, must
				  be obtained prior to providing treatment, including issuing prescriptions,
				  electronically or otherwise.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 3 - Appropriate Use of the Internet in Medical Practice › Section 3-3 - Treatment

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  25-1-9; IC 25-22.5
Sec. 3.
Treatment, including issuing a prescription, based solely on
				  an on-line questionnaire or consultation is prohibited.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 3 - Appropriate Use of the Internet in Medical Practice › Section 3-4 - Electronic communications

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  25-1-9; IC 25-22.5
Sec. 4.
(a) Written
				policies and procedures must be maintained by the physician for the use of
				patient-physician electronic mail. Such policies and procedures must address
				the following:
(1) Privacy.
(2) Health care personnel (in addition to the
				physician addressee) who will process messages.
(3) Hours of operation.
(4) Types of transactions that will be
				permitted electronically.
(5)
				Required patient information to be included in the communication, such as
				patient name, identification number, and type of transaction.
(6) Archival and retrieval of patient medical
				data.
(7) Quality oversight
				mechanisms.
(8) Protocol to be
				followed in emergency situations.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 3 - Appropriate Use of the Internet in Medical Practice › Section 3-5 - Informed consent

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  25-1-9; IC 25-22.5
Sec. 5.
A written agreement must be employed documenting patient
				  informed consent for the use of patient-physician e-mail. The agreement must be
				  discussed with and signed by the patient and included in the medical record.
				  The agreement must include the following terms:
(1) Types of transmissions that will be
				permitted, such as:
(A) prescription
				refills;
(B) appointment
				scheduling; and
(C) patient
				education.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 3 - Appropriate Use of the Internet in Medical Practice › Section 3-6 - Medical records

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  25-1-9; IC 25-22.5
Sec. 6.
(a) The
				medical record must include written or electronic copies of all patient-related
				electronic communications, including the following:
(1) Patient-physician e-mail.
(2) Prescriptions.
(3) Laboratory and test results.
(4) Evaluations and consultations.
(5) Records of past care.
(6) Instructions.
Informed consent agreements related to the use of e-mail
				  shall also be filed in the medical record.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 3 - Appropriate Use of the Internet in Medical Practice › Section 3-7 - Disclosure

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  25-1-9; IC 25-22.5
Sec. 7.
(a) An
				interactive Internet medical practice site is a practice location and requires
				a defined physician-patient relationship.
(b) Internet medical practice sites must
				clearly disclose the following:
(1) The owner
				of the site.
(2) The specific
				services provided.
(3) The office
				address and contact information for the medical practice.
(4) Licensure and qualifications of the
				physician or physicians and associated health care providers.
(5) Fees for on-line consultation and
				services and how payment is to be made.
(6) Financial interests in any information,
				products, or services.
(7)
				Appropriate uses and limitations of the site, including providing health advice
				and emergency health situations.
(8) Uses and response times for e-mails,
				electronic messages, and other communications transmitted via the
				site.
(9) To whom patient health
				information may be disclosed and for what purpose.
(10) Rights of patients with respect to
				patient health information.
(11)
				Information collected and any passive tracking mechanisms utilized.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 3 - Appropriate Use of the Internet in Medical Practice › Section 3-8 - Accountability

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  25-1-9; IC 25-22.5
Sec. 8.
Medical practice sites must provide patients a clear
				  mechanism to do the following:
(1)
				Access, supplement, and amend patient-provided personal health
				information.
(2) Provide feedback
				regarding the site and the quality of information and services.
(3) Register complaints, including
				information regarding filing a complaint with the consumer protection division
				of the office of the attorney general.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 3 - Appropriate Use of the Internet in Medical Practice › Section 3-9 - Advertising or promotion of goods or products

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  25-1-9; IC 25-22.5
Sec. 9.
Advertising or promotion of goods or products from which the
				  physician receives direct remuneration, benefits, or incentives is prohibited
				  unless the physician discloses that the physician receives direct remuneration,
				  benefits, or incentives from the sale of the goods or products.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 3 - Appropriate Use of the Internet in Medical Practice › Section 3-10 - Links

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  25-1-9; IC 25-22.5
Sec. 10.
Practitioner Internet sites may provide links to general
				  health information sites to enhance patient education; however, the physician
				  shall not receive direct remuneration, benefits, or incentives from providing
				  such links or from the services or products marketed by such links unless the
				  physician discloses that the physician receives direct remuneration, benefits,
				  or incentives from providing such links or from the services or products
				  marketed by such links.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 4 - Prescribing to Persons Not Seen by the Physician › Section 4-1 - General provisions

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  25-1-9; IC
				  25-22.5-1-2; IC
				  25-23-1-19.4
Sec. 1.
(a) Except in
				institutional settings, on-call situations, cross-coverage situations, and
				situations involving advanced practice nurses with prescriptive authority
				practicing in accordance with standard care arrangements, as described in
				subsection (d), a physician shall not prescribe, dispense, or otherwise
				provide, or cause to be provided, any controlled substance to a person who the
				physician has never personally physically examined and diagnosed.
(b) Except in institutional settings, on-call
				situations, cross-coverage situations, and situations involving advanced
				practice nurses with prescriptive authority practicing in accordance with the
				requirements of IC
				25-23-1-19.4 and 848 IAC 5, as
				described in subsection (d), a physician shall not prescribe, dispense, or
				otherwise provide, or cause to be provided, any legend drug that is not a
				controlled substance to a person who the physician has never personally
				physically examined and diagnosed unless the physician is providing care in
				consultation with another physician who has an ongoing professional
				relationship with the patient, and who has agreed to supervise the patient's
				use of the drug or drugs to be provided.
(c) A physician shall not advertise or offer,
				or permit the physician's name or certificate to be used in an advertisement or
				offer, to provide any legend drug in a manner that would violate subsection (a)
				or (b).
(d) Subsections (a) and (b)
				do not apply to or prohibit the following:
(1)
				The provision of drugs to a person who is admitted as an inpatient to or is a
				resident of an institutional facility.
(2) The provision of controlled substances or
				legend drugs by a physician to a person who is a patient of a colleague of the
				physician, if the drugs are provided pursuant to an on-call or cross-coverage
				arrangement between the physicians.
(3) The provision of controlled substances or
				legend drugs by emergency medical squad personnel, nurses, or other
				appropriately trained and licensed individuals as permitted by IC
				25-22.5-1-2.
(4) The provision of controlled substances or
				drugs by an advanced practice nurse with prescriptive authority practicing in
				accordance with a standard care arrangement that meets the requirements of IC
				25-23-1-19.4 and 848 IAC
				5.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 4 - Prescribing to Persons Not Seen by the Physician › Section 4-2 - Expedited partner therapy

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  25-1-9
Sec. 2.
Section 1 of this rule does not apply if the physician is
				  prescribing or dispensing medications for the treatment of Chlamydia
				  trachomatis or Neisseria gonorrhoeae to sex partner(s) of the physician's
				  diagnosed patient without requiring examination of the sex partner(s).
				  Medications must be in accordance with current professional theory or practice
				  for the treatment of these infections. The current Centers for Disease Control
				  and Prevention of Sexually Transmitted Diseases Treatment Guidelines shall be
				  considered an authoritative source of such current professional theory or
				  practice. Partner management of patients with gonorrhea or chlamydia shall
				  include providing the following items:
(1) Notification to the infected patient that
				all partners should be evaluated and treated;
(2) Written materials for the infected
				patient to give partners that state that a clinical evaluation is desirable;
				lists common medication side effects and the appropriate response to them; fact
				sheets regarding sexually transmitted diseases; and emergency contact
				information;
(3) Prescriptions or
				dispensed medications and accompanying written materials shall be given to the
				physician's patient for distribution to named partners; and
(4) The physician shall maintain appropriate
				documentation of partner management. Documentation shall include the names of
				partners, if available, and a record of treatment provided. If the partner's
				name is not available, documentation shall be kept within patient's
				file.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-1 - Purpose

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 1.
This rule establishes standards for procedures performed in
				  office-based settings that require:
(1) moderate sedation/analgesia;
(2) deep sedation/analgesia;
(3) general anesthesia; or
(4) regional anesthesia.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-2 - Application of rule

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 2.
Except as provided in section 15 of this rule, this rule
				  does not apply to:
(1) local
				anesthesia;
(2) topical
				anesthesia;
(3) superficial nerve
				blocks; or
(4) minimal
				sedation/anxiolysis.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-3 - "Accreditation agency" defined

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 3.
As used in this rule, "accreditation agency" means a public
				  or private organization that is approved to issue certificates of accreditation
				  to office-based settings by the board under this rule.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-4 - "American Society of Anesthesiologists (ASA) Physical Status Classification System" defined

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 4.
As used in this rule, "American Society of Anesthesiologists
				  (ASA) Physical Status Classification System" refers to the following
				  classifications:
(1) P1 - A normal
				healthy patient.
(2) P2 - A patient
				with mild systemic disease.
(3) P3
				- A patient with severe systemic disease.
(4) P4 - A patient with severe systemic
				disease that is a constant threat to life.
(5) P5 - A moribund patient who is not
				expected to survive without the operation.
(6) P6 - A declared brain-dead patient whose
				organs are being removed for donor purposes.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-5 - "Anesthesia" defined

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 5.
As used in this rule, "anesthesia" includes the
				  following:
(1) Moderate
				sedation/analgesia.
(2) Deep
				sedation/analgesia.
(3) General
				anesthesia.
(4) Regional
				anesthesia.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-6 - "Deep sedation/analgesia" defined

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 6.
(a) As used
				in this rule, "deep sedation/analgesia" means a drug-induced depression of
				consciousness during which patients cannot be easily aroused but respond
				purposefully following repeated or painful stimulation. For purposes of this
				rule, reflex withdrawal from a painful stimulus is not considered a purposeful
				response.
(b) The following are
				conditions that a patient under deep sedation/analgesia may experience:
(1) The ability to independently maintain
				ventilatory function may be impaired.
(2) Patients may require assistance in
				maintaining a patent airway, and spontaneous ventilation may be
				inadequate.
(3) Cardiovascular
				function is usually maintained.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-7 - "General anesthesia" defined

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 7.
(a) As used
				in this rule, "general anesthesia" means a drug-induced loss of consciousness
				during which patients are not arousable, even by pain stimulation.
(b) The following are conditions that a
				patient under general anesthesia may experience:
(1) The ability to independently maintain
				ventilatory function is often impaired.
(2) Patients often require assistance in
				maintaining a patent airway, and positive pressure ventilation may be required
				because of depressed spontaneous ventilation or drug-induced depression of
				neuromuscular function.
(3)
				Cardiovascular function may be impaired.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-8 - "Health care provider" defined

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 8.
As used in this rule, "health care provider" means an
				  individual licensed or legally authorized by this state to provide health care
				  services.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-9 - "Immediate presence" defined

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 9.
As used in this rule, "immediate presence" means, at a
				  minimum, that the directing practitioner must be:
(1) physically located within the
				office-based setting;
(2) prepared
				to immediately conduct hands-on intervention if needed; and
(3) not engaged in activities that could
				prevent the practitioner from being able to immediately intervene and conduct
				hands-on interventions if needed.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-10 - "Local anesthesia" defined

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 10.
As used in this rule, "local anesthesia" means a transient
				  and reversible loss of sensation in a circumscribed portion of the body
				  produced by:
(1) a local anesthetic
				agent; or
(2) cooling a
				circumscribed area of the skin.
The term includes subcutaneous infiltration of an agent.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-11 - "Minimal sedation/anxiolysis" defined

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 11.
As used in this rule, "minimal sedation/anxiolysis" means a
				  drug-induced state during which a patient responds normally to verbal commands.
				  Although cognitive function and coordination may be impaired, ventilatory and
				  cardiovascular functions are usually not affected.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-12 - "Moderate sedation/analgesia" defined

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 12.
(a) As used
				in this rule, "moderate sedation/analgesia" (also sometimes called "conscious
				sedation") means a drug-induced depression of consciousness during which
				patients respond purposefully to verbal commands, either alone or accompanied
				by light tactile stimulation.
(b)
				The following are conditions that a patient under moderate sedation/analgesia
				may experience:
(1) No interventions are
				required to maintain a patent airway, and spontaneous ventilation is
				adequate.
(2) Cardiovascular
				function is usually maintained.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-13 - "Office-based setting" defined

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  16-21-2; IC 25-22.5
Sec. 13.
As used in this rule, "office-based setting" means
				  any:
(1) facility;
(2) clinic;
(3) center;
(4) office; or
(5) other setting;
where procedures are performed that require moderate
				  sedation/analgesia, deep sedation/analgesia, general anesthesia, or regional
				  anesthesia. The term does not include a hospital operated by the federal
				  government or a setting licensed under IC
				  16-21-2 as a hospital, ambulatory
				  surgical center, abortion clinic, or birthing center.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-14 - "Practitioner" defined

Current through July 10, 2024
Authority: IC 25-22.5-2-7
Affected: IC 25-22.5
Sec. 14.
As used in this rule, "practitioner" has the meaning set
				  forth in 844 IAC
				  5-1-1(14).
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-15 - "Regional anesthesia" defined

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 15.
(a) As used
				in this rule, "regional anesthesia" means the administration of anesthetic
				agents to a patient to interrupt nerve impulses without the loss of
				consciousness and includes the following:
(1)
				Major conduction blocks, such as:
(A)
				epidural;
(B) spinal; and
(C) caudal; blocks.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-16 - "Rescue" defined

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 16.
As used in this rule, "rescue" means an intervention by a
				  practitioner proficient in airway management and advanced life support. In
				  rescuing a patient, the practitioner must:
(1) correct adverse physiologic consequences
				of the deeper-than-intended level of sedation, such as:
(A) hypoventilation;
(B) hypoxia; and
(C) hypotension; and
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-17 - "Superficial nerve block" defined

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 17.
As used in this rule, "superficial nerve block" means an
				  agent placed in the proximity of any nerve or group of nerves outside of the
				  vertebral canal to produce a loss of sensation in an anatomic or circumscribed
				  area. For purposes of this rule, the term is limited to:
(1) ankle;
(2) metacarpal;
(3) digit; and
(4) paracervical;
blocks.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-18 - "Topical anesthesia" defined

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 18.
As used in this rule, "topical anesthesia" means a transient
				  and reversible loss of sensation to a circumscribed area produced by an
				  anesthetic agent applied directly or by spray to the skin or mucous membranes.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-19 - Standards for procedures performed in office-based settings

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 19.
(a) Because
				sedation is a continuum, it is not always possible to predict how an individual
				patient will respond. Practitioners intending to produce a given level of
				sedation must be able to rescue a patient whose level of sedation becomes
				deeper than initially intended. Practitioners administering deep
				sedation/analgesia in an office-based setting, or directing or supervising the
				administration of deep sedation/analgesia in an office-based setting, must be
				able to rescue patients who enter a state of general anesthesia. Practitioners
				administering moderate sedation/analgesia in an office-based setting, or
				directing or supervising the administration of moderate sedation/analgesia in
				an office-based setting, must be able to rescue patients who enter a state of
				deep sedation/analgesia.
(b)
				Practitioners administering regional anesthesia, or supervising or directing
				the administration of regional anesthesia, must be knowledgeable about the
				risks of regional anesthesia and the interventions required to correct any
				adverse physiological consequences that may occur in the administration of
				regional anesthesia.
(c) A health
				care provider may not administer or monitor an anesthetic agent containing
				alkylphenols in an office-based setting unless the health care provider is:
(1) trained in the administration of general
				anesthesia; and
(2) not involved in
				the conduct of the procedure.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-20 - Accreditation required

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 20.
After January 1, 2010, a practitioner may not perform or
				  supervise a procedure that requires anesthesia in an office-based setting
				  unless the office-based setting is accredited by an accreditation agency
				  approved by the board under this rule.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-21 - Approval of accreditation agencies; requirements

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC
				  25-22.5-1-2
Sec. 21.
In approving accreditation agencies to perform accreditation
				  of office-based settings, the board shall ensure that the certification
				  program, at a minimum, includes standards for the following aspects of an
				  office-based setting's operations:
(1)
				Anesthesia, as follows:
(A) The level of
				anesthesia administered shall be appropriate for the:
(i) patient;
(ii) procedure;
(iii) clinical setting;
(iv) education and training of the personnel;
				and
(v) equipment available.
				Practitioners shall select patients for procedures in office-based settings
				using anesthesia by criteria, including the American Society of
				Anesthesiologists (ASA) Physical Status Classification System, and so
				document.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 5 - Standards for Procedures Performed in Office-Based Settings That Require Moderate Sedation/Analgesia, Deep Sedation/Analgesia, General Anesthesia, or Regional Anesthesia › Section 5-22 - Practitioners requirements

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7
Affected: IC 25-22.5
Sec. 22.
(a) A
				practitioner who performs a procedure that requires anesthesia in an
				office-based setting, or who directs or supervises the administration of
				anesthesia in an office-based setting, must have:
(1) admitting privileges at a nearby
				hospital;
(2) a transfer agreement
				with another practitioner who has admitting privileges at a nearby hospital;
				or
(3) an emergency transfer
				agreement with a nearby hospital.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 6 - Opioid Prescribing Requirements › Section 6-1 - Scope

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7; IC
				  25-22.5-13-2
Affected: IC
				  25-1-9; IC 25-22.5
Sec. 1.
This rule establishes standards and protocols for physicians
				  in the prescribing of opioid controlled substances for pain management
				  treatment.
IC
				  4-22-2-36
				  suspends the effectiveness of a rule document for 30 days after filing with the
				  Publisher. LSA Document #14-289 was filed
				  10/7/2014.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 6 - Opioid Prescribing Requirements › Section 6-2 - Definitions

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7; IC
				  25-22.5-13-2
Affected: IC
				  25-1-9; IC 25-22.5; IC
				  35-48-1-9
Sec. 2.
(a) The
				definitions in this section apply throughout this rule.
(b) "Abuse deterrent formulation" means an
				opioid formulation that has properties shown to meaningfully deter the
				intentional, nontherapeutic use, even once, to achieve a desirable
				psychological or physiological effect, even if such formulation does not fully
				prevent such intentional, nontherapeutic uses.
(c) "Chronic pain" means a state in which
				pain persists beyond the usual course of an acute disease or healing of an
				injury, or that may or may not be associated with an acute or chronic
				pathologic process that causes continuous or intermittent pain over months or
				years.
(d) "Controlled substances"
				has the meaning set forth in IC
				35-48-1-9.
(e) "Morphine equivalent dose" means a
				conversion of various opioids to a standardized dose of morphine by the use of
				accepted conversion tables.
(f)
				"Opioid" means any of various narcotics containing opium or one (1) or more of
				its natural or synthetic derivatives. However, if such a narcotic is not a
				controlled substance, it shall not be an opioid for the purposes of this
				rule.
(g) "Outset of an opioid
				treatment plan" means that a patient has been prescribed opioids as described
				in section 3(c) of this rule, and, therefore, the provisions stated in section
				3(a) of this rule become applicable to that patient.
(h) "Terminal" means a condition caused by
				injury, disease, or illness from which, to a reasonable degree of medical
				certainty:
(1) there can be no recovery;
				and
(2) progression to death can be
				anticipated as an eventual consequence of that condition.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 6 - Opioid Prescribing Requirements › Section 6-3 - Triggers for imposition of requirements; exemptions

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7; IC
				  25-22.5-13-2
Affected: IC 16-21; IC 16-25; IC 16-28; IC
				  25-1-9; IC 25-22.5
Sec. 3.
(a) This
				section and sections 4 through 10 of this rule establish requirements
				concerning the use of opioids for chronic pain management for
				patients.
(b) Notwithstanding
				subsection (a), this section and sections 4 through 10 of this rule shall not
				apply to the use of opioids for chronic pain management for the following:
(1) Patients with a terminal
				condition.
(2) Residents of a
				health facility licensed under IC 16-28.
(3) Patients enrolled in a hospice program
				licensed under IC 16-25.
(4)
				Patients enrolled in an inpatient or outpatient palliative care program of a
				hospital licensed under IC 16-21 or a hospice licensed under IC 16-25.
However, a period of time that a patient who was, but is no
				  longer, a resident or patient as described in subdivisions (2) through (4)
				  shall be included in the calculations under subsection (c).
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 6 - Opioid Prescribing Requirements › Section 6-4 - Evaluation and risk stratification by physician

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7; IC
				  25-22.5-13-2
Affected: IC
				  25-1-9; IC 25-22.5
Sec. 4.
(a) The
				physician shall do the physician's own evaluation and risk stratification of
				the patient by doing the following in the initial evaluation of the patient:
(1) Performing an appropriately focused
				history and physical exam and obtain or order appropriate tests, as
				indicated.
(2) Making a diligent
				effort to obtain and review records from previous health care providers to
				supplement the physician's understanding of the patient's chronic pain problem,
				including past treatments, and documenting this effort.
(3) Asking the patient to complete an
				objective pain assessment tool to document and better understand the patient's
				specific pain concerns.
(4)
				Assessing both the patient's mental health status and risk for substance abuse
				using available validated screening tools.
(5) After completing the initial evaluation,
				establishing a working diagnosis and tailoring a treatment plan to meaningful
				and functional goals with the patient reviewing them from time to
				time.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 6 - Opioid Prescribing Requirements › Section 6-5 - Physician discussion with patient; treatment agreement

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7; IC
				  25-22.5-13-2
Affected: IC
				  25-1-9; IC 25-22.5
Sec. 5.
The physician shall discuss with the patient the potential
				  risks and benefits of opioid treatment for chronic pain, as well as
				  expectations related to prescription requests and proper medication use. In
				  doing so, the physician shall do the following:
(1) Where alternative modalities to opioids
				for managing pain exist for a patient, discuss them with the patient.
(2) Provide a simple and clear explanation to
				help patients understand the key elements of their treatment plans.
(3) Counsel women between fourteen (14) and
				fifty-five (55) years of age with child bearing potential about the risks to
				the fetus when the mother has been taking opioids while pregnant. Such
				described risks shall include fetal opioid dependency and neonatal abstinence
				syndrome (NAS).
(4) Discuss with
				the patient risks of dependency and addiction.
(5) Discuss with the patient safe storage
				practices for prescribed opioids.
(6) Provide a written warning to the patient
				disclosing the risks associated with taking extended release medications that
				are not in an abuse deterrent form, if the physician prescribes for the patient
				a hydrocodone-only extended release medication that is not in an abuse
				deterrent form.
(7) Discuss with
				the patient the risks and benefits of using an abuse deterrent formulation, as
				opposed to a non-abuse deterrent formulation, if such a formulation exists for
				the opioid product the physician is prescribing to the patient. Nothing in this
				subdivision shall be construed to require a physician to prescribe an opioid in
				an abuse deterrent formulation.
(8)
				Together with the patient, review and sign a "Treatment Agreement", which shall
				include at least the following:
(A) The goals
				of the treatment.
(B) The patient's
				consent to drug monitoring testing in circumstances where the physician
				determines that drug monitoring testing is medically necessary.
(C) The physician's prescribing policies,
				which must include at least a:
(i) requirement
				that the patient take the medication as prescribed; and
(ii) prohibition of sharing medication with
				other individuals.
(D) A
				requirement that the patient inform the physician:
(i) about any other controlled substances
				prescribed or taken by the patient; and
(ii) if the patient drinks alcohol while
				taking opioids.
(E) The
				granting of permission to the physician to conduct random pill
				counts.
(F) Reasons the opioid
				therapy may be changed or discontinued by the physician. A copy of the
				treatment agreement shall be retained in the patient's
				chart.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 6 - Opioid Prescribing Requirements › Section 6-6 - Patient visits to physician

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7; IC
				  25-22.5-13-2
Affected: IC
				  25-1-9; IC 25-22.5
Sec. 6.
(a)
				Physicians shall not prescribe opioids for patients without periodic scheduled
				visits. Visits for patients with a stable medication regimen and treatment plan
				shall occur face to face at least once every four (4) months. More frequent
				visits may be appropriate for patients working with the physician to achieve
				optimal management. For patients requiring changes to the medication and
				treatment plan, if changes are prescribed by the physician, the visits required
				by this subsection shall be scheduled at least once every two (2) months until
				the medication and treatment has been stabilized.
(b) During the visits required by subsection
				(a), the physician shall evaluate patient progress and compliance with the
				patient's treatment plan regularly and set clear expectations along the way,
				such as attending physical therapy, counseling, or other treatment options.
IC
				  4-22-2-36
				  suspends the effectiveness of a rule document for 30 days after filing with the
				  Publisher. LSA Document #14-289 was filed
				  10/7/2014.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 6 - Opioid Prescribing Requirements › Section 6-7 - INSPECT report

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7; IC
				  25-22.5-13-2
Affected: IC
				  25-1-9; IC 25-22.5; IC
				  25-26-24-19
Sec. 7.
At the outset of an opioid treatment plan, and at least
				  annually thereafter, a physician prescribing opioids for a patient shall run an
				  INSPECT report on that patient under IC
				  35-48-7-11.1(d)(4)
[IC
				  35-48-7 was repealed by
				  P.L.
				  51-2019,
				  SECTION
				  21, effective April 18, 2019. See IC
				  25-26-24-19.]
and
				  document in the patient's chart whether the INSPECT report is consistent with
				  the physician's knowledge of the patient's controlled substance use
				  history.
IC
				  4-22-2-36
				  suspends the effectiveness of a rule document for 30 days after filing with the
				  Publisher. LSA Document #14-289 was filed
				  10/7/2014.
Indiana Administrative Code › Title 844 - MEDICAL LICENSING BOARD OF INDIANA › Article 5 - STANDARDS OF PROFESSIONAL CONDUCT AND COMPETENT PRACTICE OF MEDICINE › Rule 6 - Opioid Prescribing Requirements › Section 6-9 - Morphine equivalent doses above 60; revising of assessments and treatment plans

Current through July 10, 2024
Authority: IC
				  25-22.5-2-7; IC
				  25-22.5-13-2
Affected: IC
				  25-1-9; IC 25-22.5
Sec. 9.
When a patient's opioid dose reaches a morphine equivalent
				  dose of more than sixty (60) milligrams per day, a face-to-face review of the
				  treatment plan and patient evaluation must be scheduled, including
				  consideration of referral to a specialist. If the physician elects to continue
				  providing opioid therapy at a morphine equivalent dose of more than sixty (60)
				  milligrams per day, the physician must develop a revised assessment and
				  treatment plan for ongoing treatment. The revised assessment and treatment plan
				  must be documented in the patient's chart, including an assessment of increased
				  risk for adverse outcomes, including death, if the physician elects to provide
				  ongoing opioid treatment.
IC
				  4-22-2-36
				  suspends the effectiveness of a rule document for 30 days after filing with the
				  Publisher. LSA Document #14-289 was filed
				  10/7/2014.