Sec. 4. The physician or advanced practice registered nurse applying for free biologicals as provided in this chapter and IC 12-20-16-14 shall sign in ink the following affirmation printed on the application form:
I solemnly affirm that the free biologicals applied for will be administered to the person named above, and it is my belief after inquiry that the person is financially unable to pay for the biologicals.
[Pre-1993 Recodification Citation: 16-1-14-4.]
As added by P.L.2-1993, SEC.24. Amended by P.L.262-2003, SEC.8; P.L.129-2018, SEC.16.