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This version of the form is not currently in use and is provided for reference only. Download this version of
State Form 56084
for the current year.
State Form 56084 Out-of-State Telehealth Practitioner Certification - Indiana
What Is State Form 56084?
This is a legal form that was released by the Indiana Professional Licensing Agency - a government authority operating within Indiana. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 56084?
A: Form 56084 is a certification form for out-of-state telehealth practitioners in Indiana.
Q: Who is required to fill out Form 56084?
A: Out-of-state telehealth practitioners who want to provide services in Indiana are required to fill out Form 56084.
Q: What is the purpose of Form 56084?
A: The purpose of Form 56084 is to certify out-of-state telehealth practitioners to ensure they meet the necessary requirements to provide services in Indiana.
Q: What documents are required to be submitted along with Form 56084?
A: The required documents may vary, but typically you need to provide proof of your current license, proof of professional liability insurance, and any other supporting documentation as specified on the form.
Q: How long does it take to process Form 56084?
A: The processing time for Form 56084 may vary, but typically it takes several weeks to review and process the application.
Q: Can I start practicing telehealth in Indiana without Form 56084?
A: No, you must have a valid out-of-state telehealth practitioner certification on Form 56084 in order to legally practice telehealth in Indiana.
Form Details:
- Released on August 1, 2022;
- The latest edition provided by the Indiana Professional Licensing Agency;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of State Form 56084 by clicking the link below or browse more documents and templates provided by the Indiana Professional Licensing Agency.
Download State Form 56084 Out-of-State Telehealth Practitioner Certification - Indiana
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