IC 25-27.5-6-5: Information required

Sec. 5. (a) Before initiating practice the collaborating physician and the physician assistant must submit, on forms approved by the board, the following information:

(1) The name, the business address, and the telephone number of the collaborating physician.

(2) The name, the business address, and the telephone number of the physician assistant.

(3) A brief description of the setting in which the physician assistant will practice.

(4) Any other information required by the board.

(b) A physician assistant must notify the committee of any changes or additions in practice sites or collaborating physicians not more than thirty (30) days after the change or addition.