844 IAC 4-4.5-17 Limited scope temporary medical permits Sec. 17. (a) A person not currently licensed to practice medicine in Indiana, yet licensed to practice medicine or osteopathic medicine by any board or licensing agency of any state or jurisdiction may make application for a limited scope temporary medical permit that, if issued under this section, shall remain valid for a nonrenewable period not to exceed thirty (30) days. (b) A person seeking a limited scope temporary medical permit under this section shall do the following: (1) Complete an application form supplied by the board, specifying the following: (A) The reasons for seeking a temporary medical permit. (B) The location or locations where the applicant will provide medical services. (C) The type, extent, and specialization of medical services that the applicant intends to, or may, provide. (D) The activity, organization, function, or event with regard to which the applicant may provide medical services. (2) The applicant's residence and office addresses and phone numbers. (3) Pay to the board the nonrefundable fee specified by 844 IAC 4-2- 2, at the time the application for temporary medical permit is filed. (4) Submit one (1) recent passport-type photograph of the applicant, taken within eight (8) weeks prior to filing the application, simultaneously with filing the application for a temporary medical permit. (5) Submit proof of holding a current and valid unrestricted license to practice medicine or osteopathic medicine in another state or jurisdiction. (6) Submit a certified copy of the original medical school or osteopathic medical school diploma.
