Online Prescribing

Practitioners’ Responsibilities

A physician has the same duty to exercise reasonable care, diligence, and skill whether providing services in-person or via telehealth, including when appropriate, to:

• Establish a diagnosis.
• Disclose the diagnosis and evidence for it.
• Discuss the risks and benefits of treatment options.
• Provide a visit summary to the patient and information how to obtain appropriate follow-up and emergency care if needed.
• A physician-patient relationship must be established either at the initiation of the patient or referral by the patient’s established physician.

Before providing telehealth medical services, the physician must:

• Verify the patient’s identity;
• Require the patient to identify his or her physical location, including city and state;
• Disclose the identity and credentials of the physician and any other personnel; and
• Obtain the patient’s consent for the use of telehealth and document it in the patient’s medical record.

In-Person Visit Requirement

If a physician or practice group provides telehealth services more than four times in a 12-month period to the same patient for the same medical condition without resolution, the physician shall either:

• See the patient in person within a reasonable amount of time, which shall not exceed 12 months; or
• Appropriately refer the patient to a physician who can provide the in-person care within a reasonable amount of time, which shall not exceed 12 months.

The provision of telehealth services that includes video communication to a patient at an originating site with the in-person assistance of a licensed physician, physician assistant, certified registered nurse practitioner, certified nurse midwife, or other person licensed by the Alabama Board of Nursing shall constitute an in-person visit for this purpose.

This requirement does not apply to the provision of mental health services as defined in state law (Ala. Code § 22-50-1).

Prescribing via Telemedicine

A prescriber may prescribe a legend drug, medical supplies, or a controlled substance via telehealth if the prescriber is authorized to do so under state and federal law.

A prescription for a controlled substance may only be issued via telehealth if:

• The telehealth visit includes synchronous audio or audio-visual communication using HIPAA-compliant equipment with the prescriber;
• The prescriber has had at least one in-person encounter with the patient within the preceding 12 months; and
• The prescriber has established a legitimate medical purpose for issuing the prescription within the preceding 12 months.
• The in-person encounter may be satisfied by the in-person assistance of personnel licensed by the Board of Medical Examiners or Board of Nursing at the originating site when the prescriber is evaluating the patient from a distant site using video communication. An LPC or LSW at the originating site does not meet this requirement.

SOURCE: Alabama Board of Medical Examiners & Medical Licensure Commission, Telemedicine (Accessed Mar. 2025).

Telehealth medical services may only be provided following the patient’s initiation of a physician-patient relationship, or pursuant to a referral made by a patient’s licensed physician with whom the patient has an established physician-patient relationship, in the usual course of treatment of the patient’s existing health condition. The physician-patient relationship may be formed without a prior in-person examination.

Prior to providing any telehealth medical service, the physician, to the extent possible, shall do all of the following:

• Verify the identity of the patient.
• Require the patient to identify his or her physical location, including the city and state.
• Disclose to the patient the identity and credentials of the physician and any other applicable personnel.
• Obtain the patient’s consent for the use of telehealth as an acceptable mode of delivering health care services, including, but not limited to, consent for the mode of communication used and its limitations. Acknowledgment of consent shall be documented in the patient’s medical record.

If a physician or practice group provides telehealth medical services more than four times in a 12-month period to the same patient for the same medical condition without resolution, the physician shall do either of the following:

• See the patient in person within a reasonable amount of time, which shall not exceed 12 months.
• Appropriately refer the patient to a physician who can provide the in-person care within a reasonable amount of time, which shall not exceed 12 months.

The provision of telehealth medical services that includes video communication to a patient at an originating site with the in-person assistance of a person licensed by the Board of Medical Examiners or by the Board of Nursing pursuant to Chapter 21 of Title 34 of the Code of Alabama 1975, shall constitute an in-person visit for the purposes of this subsection.

This section does not apply to the provision of telehealth medical services provided by a physician in active consultation with another physician who is providing in-person care to a patient.

This section shall not apply to the provision of mental health services as defined in Section 22-50-1.

A prescriber may prescribe a legend drug, medical supplies, or a controlled substance to a patient as a result of a telehealth medical service if the prescriber is authorized to prescribe the drug, supplies, or substance under applicable state and federal laws. To be valid, a prescription must be issued for a legitimate medical purpose by a prescriber acting in the usual course of his or her professional practice.

A prescription for a controlled substance may only be issued as a result of telehealth medical services if each of the following apply:

• The telehealth visit includes synchronous audio or audio-visual communication using HIPAA compliant equipment with the prescriber responsible for the prescription.
• The prescriber has had at least one in-person encounter with the patient within the preceding 12 months.
• The prescriber has established a legitimate medical purpose for issuing the prescription within the preceding 12 months.

This subsection shall not apply in an in-patient setting.

A physician shall be exempt from the requirements of subsection (b) and may issue a prescription for a controlled substance to a patient if the prescription is for the treatment of a patient’s medical emergency, as further defined by rule by the Board of Medical Examiners and the Medical Licensure Commission.

SOURCE: AL Code Sec. 34-24-703 & 704, (Accessed Mar. 2025).

The Alabama Board of Medical Examiners & Medical Licensure Commission

It is the position of the Board that, when prescribing medications to an individual, the prescriber, when possible, should personally examine the patient. Before prescribing a medication, a physician should make an informed medical judgment based on appropriate medical history, the circumstances of the situation and on his or her training and experience. This process must be documented appropriately.

Prescribing medications for a patient whom the physician has not personally examined may be suitable under certain circumstances. These circumstances may include, but not be limited to, electronic encounters such as those in telemedicine; admission orders for a patient newly admitted to a health care facility, prescribing for a patient of another physician for whom the prescribing physician is taking call, continuing medication on a short-term basis for a new patient prior to the patient’s first appointment, or prescribing for the sexual partner(s) of a patient in accordance with an Expedited Partner Therapy (EPT) and/or Patient Delivered Partner Therapy (PDPT) protocol for the prevention of transmission and spread of sexually transmitted diseases.

Licensees are expected to adhere to all federal and state statutes regarding the prescribing of controlled substances and all Alabama Board of Medical Examiners’ Rules regarding the prescribing of controlled substances.

SOURCE: AL Admin. Code. r. 540-X-9-.11, (Accessed Mar. 2025).

Board of Optometry

The provision of optometric diagnosis, treatment, or other services to a patient through telemedicine at an established treatment site may be used for all patient visits, including initial evaluations to establish an optometrist-patient relationship between a provider and a patient.

A distant site provider who provides telemedicine services to a patient that is not present at an established treatment site shall ensure that a proper provider-patient relationship is established, which shall include at least the following:

• Having had at least one face-to-face meeting, either in person, or at an established treatment site via telecommunications;
• Confirming the identity of the person requesting treatment by establishing that the person requesting the treatment is in fact whom he or she claims to be.

Evaluation, treatment, and consultation recommendations made via telemedicine, including, but not limited to the issuance of prescriptions, shall be held to the same standards of practice as those in traditional in-person clinical settings. The provision of optometric diagnosis, treatment, or other services through telemedicine shall comply with the requirements of the Alabama Code, this chapter, and these regulations. Failure to comply with such requirements shall be considered a failure to meet standard of care as required by 630-X-12-.06 herein.

SOURCE: AL Admin Code 630-X-13-.02. (Accessed Mar. 2025).

Telemedicine services provided at an established treatment site may be used for all patient visits, including initial evaluations to establish a proper doctor-patient relationship between a provider and a patient.

• A provider shall be reasonably available onsite at the established medical site to assist with the provision of care.
• A provider may delegate tasks and activities at an established treatment site to an assistant who is properly trained and supervised or directed.

A distant site provider who provides telemedicine services to a patient that is not present at an established treatment site shall ensure that a proper provider-patient relationship is established, which at a minimum includes all of the following:

• Having had at least one face-to-face meeting at an established treatment site before engaging in telemedicine services. A face-to-face meeting is not required for new conditions relating to an existing patient, unless the provider deems that such a meeting is necessary to provide adequate care.
• Establishing that the person requesting the treatment is in fact whom he or she claims to be.

Evaluation, treatment, and consultation recommendations made in a telemedicine setting, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional in-person clinical settings.

SOURCE: Code of Alabama Sec. 34-22-83, (Accessed Mar. 2025).

A registered certifying physician is prohibited from utilizing any form of telemedicine when certifying or recommending, or recertifying or re-recommending, a patient for the use of medical cannabis, or when conducting any examination associated therewith.

SOURCE: Code of Alabama Sec. 540-X-25-.09 (Accessed Mar. 2025).