State Form 56085 Out-of-State Telehealth Practitioner's Employer or Contractor Certification - Indiana

What Is State Form 56085?

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.

Form Details:

• Released on May 1, 2023;
• 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 56085 by clicking the link below or browse more documents and templates provided by the Indiana Professional Licensing Agency.