844 IAC 2.2-1.1-16 "Supervisory agreement" defined

Sec. 16. "Supervisory agreement" means a written document signed by the supervising physician or physicians and the physician assistant that: (1) includes the tasks delegated to the physician assistant; (2) describes the supervisory plan for the physician assistant, including emergency procedures that the physician assistant must follow; (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) specifies the names of medical devices the physician is delegated to prescribe; (5) includes the: (A) name; (B) address; and (C) phone number; of the physician or physicians who will be supervising the physician assistant; and (6) includes a description of the setting or settings in which the physician assistant will be working.