To begin the self-report process licensees need to submit a complete set of forms including the following:
Submit a copy of your substance use and/or mental health (co-occurring diagnosis) evaluation if you have one.
If you have not had a co-occurring evaluation, you will need to have one completed to be considered for INAP.
Does INAP have your permission to contact you at the above provided addresses and phone numbers?
Are you currently being investigated by the Iowa Board of Nursing?
Has any action ever been taken against you by the Iowa Board of Nursing or any other state Nursing Board?
Are you currently employed as a nurse?
Have any of your nursing employers ever submitted a complaint against you to the Board?
Is your employer aware of your self-report to INAP?
Have you been evaluated by a professional for substance use or mental health?
Have you received treatment for substance use or mental health?
Have you received ongoing care for substance use and or mental health?
Some licensees may not be eligible for the INAP program. If you answer YES to any of the questions on the following page, please contact INAP before submitting this form.
Did you divert drugs to third parties for profit?
Did you adulterate/misbrand or tamper with drugs intended for patients?
Did you provide inaccurate, misleading, or fraudulent information or fail to fully cooperate with INAP?
Did you participate in the program or similar program offered by other states without success?
Are you a participant, or have you been a participant in another state’s monitoring program?
If you need to attach additional documentation you can upload files here:
All information submitted to the Iowa Nurse Assistance Program regarding individual licensees is confidential.
Do you give INAP permission to inquire about the facts provided in this self-report?