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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 56085
for the current year.
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.
FAQ
Q: What is form 56085?
A: Form 56085 is the Out-of-State Telehealth Practitioner's Employer or Contractor Certification form in Indiana.
Q: Who needs to fill out form 56085?
A: Out-of-state telehealth practitioners who want to provide services in Indiana need to fill out this form.
Q: What is the purpose of form 56085?
A: The form is used to certify the employer or contractor of an out-of-state telehealth practitioner.
Q: Are there any fees associated with form 56085?
A: There are no fees associated with form 56085.
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 56085 by clicking the link below or browse more documents and templates provided by the Indiana Professional Licensing Agency.
Download State Form 56085 Out-of-State Telehealth Practitioner's Employer or Contractor Certification - Indiana
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