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Indiana Professional Licensing Agency

PLA > Professions > Indiana Controlled Substances Advisory Committee > Application and Information > Practitioner Controlled Substances Registration Application and Instructions Practitioner Controlled Substances Registration Application and Instructions

Application for CSR for Practitioners

An Indiana Controlled Substances Registration ("CSR") may be issued by one of the following practitioners:

  1. physician,
  2. osteopathic physician, 
  3. veterinarian,
  4. dentist,
  5. podiatrist,
  6. advanced practice nurse who meets the requirements of IC 25-23-1-19.5, or
  7. a physician assistant licensed under IC 25-27.5 and is delegated prescriptive authority under IC 25-27.5-5-6.

The practitioner must hold an Indiana CSR and a federal Drug Enforcement Agency ("DEA") registration or is exempted from registration pursuant to 856 IAC 2-3-5(b) or 856 IAC 2-3-6 in order to prescribe, administer, or dispense controlled substances in the State of Indiana.

Active Indiana Practitioner License
Applicants must have an active Indiana practitioner license before they can obtain a CSR.  Practitioners must hold one CSR in order to prescribe, administer, and dispense controlled substances in the State of Indiana.  A separate registration is required for each location where a practitioner physically possesses controlled substances to administer or dispense.  A separate registration is NOT required for each place where a practitioner merely prescribes controlled substances; one valid CSR is sufficient for a practitioner to prescribe controlled substances throughout Indiana.

Indiana Practice Location
Applicants MUST use an Indiana practice address when applying for a CSR.  The CSR can only be mailed to the address submitted on the application.  A CSR will only be issued to a street address; post office boxes will not be acceptable unless accompanied by a street address.  An application with an incomplete or out of state address will be returned. 

Controlled Substance Schedules to Request
Applicants may apply for authorization for Schedules II through V; a Schedule I controlled substance has no accepted medical use and are generally restricted to researchers only.

Application Instructions
A CSR may be issued to an applicant who submits the completed CSR application and $60 application fee.

If an applicant responds in the affirmative ("yes") to one of the questions on the application, then the applicant must explain fully, including all related details, in a signed and notarized statement.  You must also submit documentation regarding the incident(s) in question, this documentation includes the following:  court documentation that indicates charges, plea, sentencing requirements, and, if applicable, verification of completion of sentencing requirements; and any orders indicating action filed or taken against their DEA registration.

Application fee can be paid by check or money order, made payable to "Professional Licensing Agency".

Application, fee, and any other documentation required, must be submitted to the following:

Professional Licensing Agency
402 W Washington Street, Room W072
Indianapolis, IN  46204

Additional Information Pertaining to CSRs

Drug Enforcement Administration
Practitioners may apply for the Drug Enforcement Administration (DEA) registration after their Indiana CSR is issued.  The Professional Licensing Agency does not have DEA forms.  For information regarding the DEA registration, please contact the DEA Indianapolis Field Office at 575 North Pennsylvania Street, Indianapolis, IN 46204 or by telephone at (317) 226-7977.

Renewals
Each registrant will receive renewal information for their CSR at the same time that he or she receives renewal information for his or her professional license with the Professional Licensing Agency.  Renewal information is sent 60 days prior to the expiration of the permit.  For additional renewal information, contact your individual licensing
Board.

Address Change
Controlled substances registrations are issued for a particular purpose at a specified location.  Any change of address for practitioners must be reported to the PLA and to the appropriate professional licensing board.  The request for address change must be made in writing to our office by faxing 317.233.4236, e-mailing your individual licensing
Board, or by mailing 402 W Washington Street Room W072, Indianapolis, Indiana, 46204.  Your written notice must include your name, license number, and both your old and new addresses.

To receive an updated license with your changed address, please verify that the address change has been completed by our office at http://www.in.gov/pla/license.htm.  Once it has been updated, you may request a duplicate license to be issued to you at the same website.  There is a $10 fee to receive a new license.

Name Change
If you have a legal name change and wish to change the name on your license, you will need to submit official documentation to verify the change.  This documentation includes a marriage license/certificate, social security card, or divorce decree.  The request for name change must be made in writing (including the official documentation) to our office by faxing 317.233.4236, e-mailing your individual licensing
Board, or by mailing 402 W Washington Street Room W072, Indianapolis, Indiana, 46204.  Your name change request must include your license number and how you want your name to read on your license. 

To receive an updated license with your changed name, please verify that the name change has been completed by our office at http://www.in.gov/pla/license.htm.  Once it has been updated, you may request a duplicate license to be issued to you at the same website.  There is a $10 fee to receive a new license card.

Contact Information
For additional information regarding CSRs and/or the application process, please contact your individual licensing
Board.