Online Prescribing

Temporary Rule

*Temporary rule regarding controlled substance prescribing does the following:

• The full set of telemedicine flexibilities regarding prescription of controlled medications as were in place during the COVID-19 PHE will remain in place through Dec. 31, 2024.

During the period May 12, 2023, through December 31, 2024, a DEA-registered practitioner is authorized to prescribe schedule II-V controlled substances via telemedicine, as defined in 21 CFR 1300.04(i), to a patient without having conducted an in-person medical evaluation of the patient if all of the conditions listed in paragraph (e) of this section are met.

SOURCE: Drug Enforcement Agency, Second Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications, Federal Register RIN 1117-AB40 and 1117-AB78, 21 CFR Part 1307, (Accessed Jul. 2024).

Rules addressing prescribing of controlled substances without an in-person medical evaluation and expansion of induction of buprenorphine via telemedicine encounters have been proposed and are under revision. They will be integrated into this section if and when they are final.

Controlled Substance Act

No controlled substance that is a prescription drug as determined under the Federal Food, Drug, and Cosmetic Act [21 U.S.C. 301 et seq.] may be delivered, distributed, or dispensed by means of the Internet without a valid prescription. … Nothing in this subsection shall apply to the delivery, distribution, or dispensing of a controlled substance by a practitioner engaged in the ‘practice of telemedicine’ [see definition in section above].

SOURCE:  21 USCS Sec. 829, (Accessed Jul. 2024).

Note that the practice of telemedicine is allowed to be used in prescribing controlled substances during a public health emergency declared by the Secretary under section 247d of title 42; and involves patients located in such areas, and such controlled substances, as the Secretary, with the concurrence of the Attorney General, designates, provided that such designation shall not be subject to the procedures prescribed by subchapter II of chapter 5 of title 5.

SOURCE:  21 USCS Sec. 802, (Accessed Jul. 2024).

See Definitions section for all telemedicine exceptions.

The Attorney General may issue to a practitioner a special registration to engage in the practice of telemedicine for purposes of section 802(54)(E) of this title if the practitioner, upon application for such special registration—

• demonstrates a legitimate need for the special registration; and
• is registered under section 823(g) of this title in the State in which the patient will be located when receiving the telemedicine treatment, unless the practitioner—
  • is exempted from such registration in all States under section 822(d) of this title; or
  • is an employee or contractor of the Department of Veterans Affairs who is acting in the scope of such employment or contract and is registered under section 823(g) of this title in any State or is utilizing the registration of a hospital or clinic operated by the Department of Veterans Affairs registered under section 823(g) of this title.

Regulations. Not later than 1 year after October 24, 2018, in consultation with the Secretary, the Attorney General shall promulgate final regulations specifying—

• the limited circumstances in which a special registration under this subsection may be issued; and
• the procedure for obtaining a special registration under this subsection.

SOURCE:  21 USCS Sec. 831, (Accessed Jul. 2024).

* The US Health and Human Services Administration maintains a website that summarizes information related to prescribing controlled substances.

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.

SOURCE: Alabama Board of Medical Examiners & Medical Licensure Commission, Telemedicine (Accessed Nov. 2024).

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 Nov. 2024).

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 Nov. 2024).

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 Nov. 2024).

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 Nov. 2024).

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 Nov. 2024).

A health care provider licensed in this state may provide health care services within the health care provider’s authorized scope of practice to a patient in this state through telehealth without first conducting an in-person visit.

A physician licensed in another state may provide health care services through telehealth to a patient located in the state as provided in this subsection, subject to the investigative and enforcement powers of the department under AS 08.01.087, and subject to disciplinary action by the State Medical Board under AS 08.64.333. The privilege to practice under this subsection extends only to

1. ongoing treatment or follow-up care related to health care services previously provided by the physician to the patient and applies only if
   1. the physician and the patient have an established physician patient relationship; and
   2. the physician has previously conducted an in-person visit with the patient; or
2. a visit regarding a suspected or diagnosed life-threatening condition for which
   1. the patient has been referred to the physician licensed in another state by a physician licensed in this state and that referral has been documented by the referring physician; and
   2. the visit involves communication with the patient regarding diagnostic or treatment plan options or analysis of test results for the life threatening condition.

If a health care provider determines in the course of a telehealth encounter with a patient under this section that some or all of the encounter will extend beyond the health care provider’s authorized scope of practice, the health care provider shall advise the patient that the health care provider is not authorized to provide some or all of the services to the patient, recommend that the patient contact an appropriate provider for the services the health care provider is not authorized to provide, and limit the encounter to only those services the health care provider is authorized to provide. The health care provider may not charge for any portion of an encounter that extends beyond the health care provider’s authorized scope of practice.

A fee for a service provided through telehealth under this section must be reasonable and consistent with the ordinary fee typically charged for that service and may not exceed the fee typically charged for that service.

A physician, podiatrist, osteopath, or physician assistant licensed under AS 08.64 may prescribe, dispense, or administer through telehealth under this section a prescription for a controlled substance listed in AS 11.71.140 — 11.71.190 if the physician, podiatrist, osteopath, or physician assistant complies with state and federal law governing the prescription, dispensing, or administering of a controlled substance.

An advanced practice registered nurse licensed under AS 08.68 may prescribe, dispense, or administer through telehealth under this section a prescription for a controlled substance listed in AS 11.71.140 — 11.71.190 if the advanced practice registered nurse complies with state and federal law governing the prescription, dispensing, or administering of a controlled substance.

Except as authorized under (e) and (f) of this section, a health care provider licensed under this title may not prescribe, dispense, or administer through telehealth under this section a controlled substance listed in AS 11.71.140 — 11.71.190.

SOURCE: AK Statute Sec. 08.02.130, (Accessed Nov. 2024).

The nursing board shall

• adopt regulations necessary to implement this chapter, including regulations …
  • establishing guidelines for rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug to a person without conducting a physical examination under AS 08.68.710; the guidelines must include a nationally recognized model policy for standards of care of a patient who is at a different location than the advanced practice registered nurse

SOURCE: AK Statute Sec. 08.68.100, (Accessed Nov. 2024).

Nursing

The board may not impose disciplinary sanctions on an advanced practice registered nurse for rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug that is not a controlled substance to a person without conducting a physical examination if

• the advanced practice registered nurse or another licensed health care provider in the medical practice is available to provide follow-up care; and
• the advanced practice registered nurse requests that the person consent to sending a copy of all records of the encounter to the person’s primary care provider if the prescribing advanced practice registered nurse is not the person’s primary care provider and, if the person consents, the advanced practice registered nurse sends the records to the person’s primary care provider

The board may not impose disciplinary sanctions on an advanced practice registered nurse for prescribing, dispensing, or administering a prescription drug that is a controlled substance if the requirements under (a) of this section and 15 AS 08.68.705 are met and the advanced practice registered nurse prescribes, dispenses, or administers the controlled substance.

Notwithstanding (a) and (b) of this section, an advanced practice registered nurse may not prescribe, dispense, or administer a prescription drug in response to an Internet questionnaire or electronic mail message to a person with whom the advanced practice registered nurse does not have a prior provider-patient relationship.

SOURCE: AK Statute Sec. 08.68.710, (Accessed Nov. 2024).

The guiding principles for telemedicine practice in the American Medical Association (AMA), Report 7 of the Council on Medical Service (A-14), Coverage of and Payment for Telemedicine, dated 2014, and the Federation of State Medical Boards (FSMB), Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine, dated April 2014, are adopted by reference as the standards of practice when providing treatment, rendering a diagnosis, prescribing, dispensing, or administering a prescription or controlled substance without first conducting an in-person physical examination under AS 08.64.364.

During a public health emergency declared by the governor or commissioner of health and social services, an appropriate licensed health care provider need not be present with the patient to assist a physician or physician assistant with examination, diagnosis, and treatment if the physician or physician-assistant is prescribing, dispensing, or administering buprenorphine to initiate or continue treatment for opioid use disorder and the physician or physician assistant

•  is a waived practitioner under 21 U.S.C 823(g)(2) (Drug Addiction Treatment Act (DATA));
• documents all attempts to conduct a physical examination under AS 08.64.364(b), the reason why the examination cannot be performed, and the reason why another health care provider cannot be present with the patient; and
• requires urine or oral toxicology screening as part of the patient’s medication adherence plan.

SOURCE: AK Admin. Code, Title 12, Sec. 40.943 (Accessed Nov. 2024).

The board may not impose disciplinary sanctions on a physician or physician assistant for rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug that is not a controlled substance to a person without conducting a physical examination if

• the physician, physician assistant, or another licensed health care provider in the medical practice is available to provide follow-up care; and
• the physician or physician assistant requests that the person consent to sending a copy of all records of the encounter to the person’s primary care provider if the prescribing physician or physician assistant is not the person’s primary care provider and, if the person consents, the physician or physician assistant sends the records to the person’s primary care provider.

The board may not impose disciplinary sanctions on a physician or physician assistant for prescribing, dispensing, or administering a prescription drug that is a controlled substance if the requirements under (a) of this section and AS 08.64.363 are met.

Notwithstanding (a) and (b) of this section,

• Notwithstanding (a) and (b) of this section,
• a physician or physician assistant may not prescribe, dispense, or administer a prescription drug in response to an Internet questionnaire or electronic mail message to a person with whom the physician or physician assistant does not have a prior physician-patient relationship.

SOURCE: Alaska Statute Sec. 08.64.364 (Accessed Nov. 2024).

For purposes of AS 08.64.240(b) and AS 08.64.326, “unprofessional conduct” means an act or omission by an applicant or licensee that does not conform to the generally accepted standards of practice for the profession for which the applicant seeks licensure or a permit under AS 08.64 or which the licensee is authorized to practice under AS 08.64. “Unprofessional conduct” includes the following:

• providing treatment, rendering a diagnosis, or prescribing medications based solely on a patient-supplied history that a physician licensed in this state received by telephone, facsimile, or electronic format
• for a physician or physician assistant, prescribing, dispensing, or furnishing a prescription medication without first conducting a physical examination of the person, unless the licensee has a patient-physician or patient-physician assistant relationship with the person; this paragraph does not apply to prescriptions written or medications issued
  • For use in emergency treatment;
  • For expedited partner therapy for sexually transmitted diseases;
  • In response to an infectious disease investigation, public health emergency, infectious disease outbreak, or act of bioterrorism; or
  • by a physician or physician assistant practicing telemedicine under AS 08.64.364;

SOURCE: AK Admin. Code, Title 12, Sec. 40.967. (Accessed Nov. 2024).

Nursing

In accordance with the American Association of Nurse Practitioners, Position Statement: Telehealth, dated 2022, adopted by reference, an APRN shall, for the purpose of rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug to a person without conducting a physical examination under AS 08.68.710, provide the same standard of care to a patient who is at a different location as would be provided to that patient in person.

An APRN may practice telehealth if

• the APRN is licensed by the board; and
• the APRN or another licensed health care provider is available to provide follow-up care.

For a telehealth encounter, an APRN must complete and document

• The patient’s informed consent to use telehealth technologies;
• A clinical history and review of systems establishing diagnoses and identifying conditions and contraindications to recommended treatment;
• A plan of care that lists all recommendations and prescriptions issued by electronic means;
• The patient and provider locations at the time of the telehealth visit; and
• The provider-patient relationship prior to prescribing.

An APRN practicing telehealth shall comply with P.L. 104 – 191 (Health Insurance Portability and Accountability Act of 1996 (HIPAA)) and medical record retention rules. Transmissions, including patient electronic mail, prescriptions, and laboratory results must be secure within existing technology, including the use of password-protected, encrypted electronic prescriptions or other reliable authentication techniques.

In this section, a “provider-patient relationship” is established when there is an in-person health examination or examination by telehealth technology of the patient by the APRN or another licensed health care provider and the patient record is available to the treating APRN.

SOURCE: AK Admin Code Title 12, 44.925 (Accessed Nov. 2024).

Optometry Board

An optometrist conducting a patient visit through telehealth

• shall, before treating the patient, establish an optometrist-patient relationship verbally, in writing, or by conducting an in-person exam;
• shall verify the patient’s identity;
• shall maintain confidentiality of patient records as required by state and federal law;
• shall provide patient services through telehealth at the same quality as would be provided in person; if a patient service through telehealth cannot be provided at the same quality as it would be in person, the optometrist shall advise the patient in accordance with AS 08.02.130(c);
• shall make or identify a diagnosis at the time of the patient visit;
• may not determine an ophthalmic prescription used to correct a refractive error based solely on an examination conducted through telehealth;
• shall provide complete patient records of a patient visit conducted through telehealth in a timely manner in accordance with state and federal law.

SOURCE: AK Admin Code Title 12, 48.370, (Accessed Nov. 2024).

Who may prescribe a controlled substance via telehealth? Under what conditions?

When an initial in-person exam is not required:

• Alaska-licensed physicians (including osteopaths and podiatrists) and physician assistants may prescribe a controlled substance via telehealth if the provider complies with AS 08.64.364 and federal law.
• Alaska-licensed APRNs may prescribe a controlled substance via telehealth if the provider complies with AS 08.68.710 and federal law.
• Prescription, dispensation, and administration of a controlled substance may not be conducted via telehealth except by physicians (including osteopaths and podiatrists), physician assistants, or APRNs. Alaska-licensed dentists and optometrists may only prescribe a controlled substance via telehealth subsequent to an in-person exam.

SOURCE:  Alaska Department of Commerce, Community and Economic Development, Division of Corporations, Business and Professional Licensing, Telehealth Information, (Accessed Nov. 2024)

Medical Board

Unprofessional conduct includes prescribing, dispensing or furnishing a prescription medication or a prescription-only device to a person unless the licensee first conducts a physical or mental health status examination of that person or has previously established a doctor-patient relationship. The physical or mental health status examination may be conducted through telehealth with a clinical evaluation that is appropriate for the patient and the condition with which the patient presents, unless the examination is for the purpose of obtaining a written certification from the physician for the purposes of title 36, chapter 28.1. This subdivision does not apply to:

• A physician who provides temporary patient supervision on behalf of the patient’s regular treating licensed health care professional or provides a consultation requested by the patient’s regular treating licensed health care professional.
• Emergency medical situations as defined in section 41-1831.
• Prescriptions written to prepare a patient for a medical examination.
• Prescriptions written or prescription medications issued for use by a county or tribal public health department for immunization programs or emergency treatment or in response to an infectious disease investigation, public health emergency, infectious disease outbreak or act of bioterrorism. For the purposes of this item, “bioterrorism” has the same meaning prescribed in section 36-781.
• Prescriptions written or antimicrobials dispensed to a contact as defined in section 36-661 who is believed to have had significant exposure risk as defined in section 36-661 with another person who has been diagnosed with a communicable disease as defined in section 36-661 by the prescribing or dispensing physician.
• Prescriptions written or prescription medications issued for administration of immunizations or vaccines listed in the United States centers for disease control and prevention’s recommended immunization schedule to a household member of a patient.
• Prescriptions for epinephrine auto-injectors written or dispensed for a school district or charter school to be stocked for emergency use pursuant to section 15-157 or for an authorized entity to be stocked pursuant to section 36-2226.01.
• Prescriptions written by a licensee through a telehealth program that is covered by the policies and procedures adopted by the administrator of a hospital or outpatient treatment center.
• Prescriptions for naloxone hydrochloride or any other opioid antagonist approved by the United States food and drug administration that are written or dispensed for use pursuant to section 36-2228 or 36-2266.
•  Performing office based surgery using sedation in violation of board rules.
• Practicing medicine under a false or assumed name in this state.

SOURCE: Arizona Revised Statute Sec. 32-1401 (Accessed Oct. 2024).

Osteopathic Physicians and Surgeons

Prescribing, dispensing or furnishing a prescription medication or a prescription-only device to a person if the licensee has not conducted a physical or mental health status examination of that person or has not previously established a physician-patient relationship.  The physical or mental health status examination may be conducted through telehealth as defined in section 36-3601 with a clinical evaluation that is appropriate for the patient and the condition with which the patient presents, unless the examination is for the purpose of obtaining a written certification from the physician for the purposes of title 36, chapter 28.1. This paragraph does not apply to:

• Emergencies.
• A licensee who provides patient care on behalf of the patient’s regular treating licensed health care professional or provides a consultation requested by the patient’s regular treating licensed health care professional.
• Prescriptions written or antimicrobials dispensed to a contact as defined in section 36-661 who is believed to have had significant exposure risk as defined in section 36-661 with another person who has been diagnosed with a communicable disease as defined in section 36-661 by the prescribing or dispensing physician.
• Prescriptions for epinephrine auto-injectors written or dispensed for a school district or charter school to be stocked for emergency use pursuant to section 15-157 or for an authorized entity to be stocked pursuant to section 36-2226.01.
• Prescriptions written by a licensee through a telehealth program that is covered by the policies and procedures adopted by the administrator of a hospital or outpatient treatment center.
• Prescriptions for naloxone hydrochloride or any other opioid antagonist approved by the United States food and drug administration that are written or dispensed for use pursuant to section 36-2228 or 36-2266.

SOURCE: Arizona Revised Statute Sec. 32-1854 (Accessed Oct. 2024).

For schedule II drugs, a health care provider regulatory board or agency may not enforce any statute, rule or policy that would require a health care provider who is licensed by that board or agency and who is authorized to write prescriptions or dispense or administer prescription drugs and devices to provide an in-person examination of the patient before issuing a prescription except as specifically prescribed by federal law. A physical or mental health status examination may be conducted during a telehealth encounter. Schedule II drugs may be prescribed only after an in-person or audio-visual examination and only to the extent allowed by federal and state law.

Services provided through telehealth are subject to this state’s laws and rules governing the health care provider’s scope of practice and the practice guidelines adopted by the telehealth advisory committee on telehealth best practices established by section 36-3607.

SOURCE: Arizona Revised Statute Sec. 36-3602 (Accessed Oct. 2024).

Naturopathic Physicians

Prescribing, dispensing or furnishing a prescription medication or a prescription-only device as defined in section 32-1901 to a person unless the licensee first conducts a physical examination of that person or has previously established a doctor-patient relationship. The physical examination may be conducted through telehealth as defined in section 36-3601 unless the examination is for the purpose of obtaining a written certification from the physician for the purposes of title 36, chapter 28.1. This subdivision does not apply to:

• A licensee who provides temporary patient supervision on behalf of the patient’s regular treating licensed health care professional.
• An emergency medical situation as defined in section 41-1831.
• Prescriptions written to prepare a patient for a medical examination.
• Prescriptions written or prescription medications issued for use by a county or tribal public health department for immunization programs or emergency treatment or in response to an infectious disease investigation, a public health emergency, an infectious disease outbreak or an act of bioterrorism. For the purposes of this item, “bioterrorism” has the same meaning prescribed in section 36-781.
• Prescriptions written or antimicrobials dispensed to a contact as defined in section 36-661 who is believed to have had significant exposure risk as defined in section 36-661 with another person who has been diagnosed with a communicable disease as defined in section 36-661 by the prescribing or dispensing physician.
• Prescriptions written by a licensee through a telehealth program that is covered by the policies and procedures adopted by the administrator of a hospital or outpatient treatment center.
• If medical treatment is considered experimental or investigational, failing to include in a patient’s record a consent to treatment document that is signed by the patient or the patient’s parent or legal guardian and that indicates that the patient or the patient’s parent or legal guardian has been informed of the risk of any treatment to be provided and the expected cost of that treatment.
• When issuing a written certification, failing or refusing to include in the adequate medical records of a patient a copy of certain information (see regulation for more details).

SOURCE: Arizona Revised Statute Sec. 32-1501, (Accessed Oct. 2024).

Pharmacy

Unprofessional conduct includes knowingly dispensing a drug on a prescription order that was issued in the course of the conduct of business of dispensing drugs pursuant to diagnosis by mail or the internet, unless the order was any of the following: …

• Written by a licensee through a telehealth program that is covered by the policies and procedures adopted by the administrator of a hospital or outpatient treatment center.
• Written pursuant to a physical or mental health status examination that was conducted through telehealth as defined in section 36-3601 and consistent with federal law.

SOURCE: Arizona Revised Statute Sec. 32-1901.01.01  (Accessed Oct. 2024).

Veterinarians

Veterinarian client patient relationship means a relationship between a veterinarian and a client or the owner or caretaker of an animal in which the veterinarian meets all the following:

• Assumes the responsibility for making medical judgments regarding the animal’s health and need for medical treatment and the client, owner or caretaker has agreed to follow the veterinarian’s instructions.
• Has sufficient knowledge of the animal to initiate at least a general or preliminary diagnosis of the animal’s medical condition. For the purposes of this subdivision, sufficient knowledge is obtained when any of the following occurs:
  • The veterinarian has recently seen and is personally acquainted with the keeping and caring of the animal as a result of examining the animal.
  • The veterinarian makes medically appropriate and timely visits to the premises where the animal is kept.
  • A veterinarian affiliated with the practice has reviewed the medical record of such examinations or visits.
  • The veterinarian obtains current knowledge of the animal by conducting a real-time electronic examination using an audio-video based communication medium.
• Is readily available for a follow-up evaluation or the veterinarian has arranged for either of the following:
  • Emergency coverage.
  • Continuing care and treatment by another veterinarian who has access to the animal’s medical records.

Notwithstanding any other law and except for an animal that is used in commercial food production that is regulated under title 3, a veterinarian may establish a veterinarian client patient relationship through electronic means if all of the following apply:

• The veterinarian is licensed pursuant to this chapter or holds a permit pursuant to section 32-2217.01.
• The veterinarian obtains informed consent from the client, including an acknowledgement that the standards of care prescribed by this chapter apply to in-person visits and visits through electronic means. The veterinarian shall maintain for at least three years documentation of the consent described in this paragraph.
• The veterinarian provides the client with the veterinarian’s name and contact information and secures an alternate means of contacting the client if the electronic means is interrupted. The electronic or written record provided to the client after the telemedicine visit must include the veterinarian’s license number.
• Before conducting an evaluation of the patient through electronic means, the veterinarian advises the client of all of the following:
  • the veterinarian may ultimately recommend an in-person visit.
  • the veterinarian is prohibited by federal law from prescribing some drugs or medications based only on an electronic examination.
  • the appointment through electronic means may be terminated at any time.
• The veterinarian is able to recommend the client to a local veterinarian who can see the animal in person. The client has the option to choose an in-person visit.

A veterinarian may prescribe drugs or medications after establishing a veterinary client patient relationship through electronic means, except that:

• Prescriptions based only on an electronic examination may be initially issued for up to fourteen days and may be renewed one time for up to fourteen days with an additional electronic examination.
• Prescriptions based only on electronic examinations and that have been renewed once may not be renewed again without an in-person examination.
• The veterinarian must notify the client that some prescription drugs or medications may be available at a pharmacy and, if requested, the veterinarian will submit a prescription to a pharmacy that the client chooses.
• The veterinarian may not order, prescribe or make available a controlled substance as defined in section 36-2501 unless the veterinarian has performed an in-person physical examination of the patient or made medically appropriate and timely visits to the premises where the patient is kept.
• The veterinarian shall prescribe all drugs and medications in accordance with all federal and state laws.

Veterinarian services provided through electronic means are subject to the rules adopted pursuant to section 32-2275 relating to the practice of veterinary medicine.

SOURCE: Arizona Revised Statute 32-2240.02 (Accessed Oct. 2024).

A health care provider shall not use telehealth to provide an abortion.

SOURCE: Arizona Revised Statute Sec. 36-3604  (Accessed Oct. 2024).

If a health professional believes that a patient requires more than ninety morphine milligram equivalents per day and the patient is not exempt from the limit pursuant to subsection B of this section, the health professional shall first consult with a physician who is licensed pursuant to chapter 13 or 17 of this title and who is board-certified in pain, or an opioid assistance and referral call service, if available, that is designated by the department of health services.  The consultation may be done by telephone or through telehealth.

SOURCE: Arizona Revised Statute Sec. 32-3248.01, (Accessed Oct. 2024).

A distant site provider will not utilize telemedicine to treat a patient located in Arkansas unless a professional relationship exists between the healthcare provider and the patient or as otherwise meets the definition of a professional relationship as defined in Section 17-80-402.  Existence of a professional relationship is not required in the following circumstances:

• Emergency situations where life or health of the patient is in danger or imminent danger or
• Simply providing information in a generic nature not meant to be specific to an individual patient.

“Professional relationship” means at a minimum a relationship established between a healthcare professional and a patient when:

• The healthcare professional has previously conducted an in-person examination of the patient and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals;
• The healthcare professional personally knows the patient and the patient’s relevant health status through an ongoing personal or professional relationship and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals;
• The treatment is provided by a healthcare professional in consultation with, or upon referral by, another healthcare professional who has an ongoing professional relationship with the patient and who has agreed to supervise the patient’s treatment, including follow-up care;
• An on-call or cross-coverage arrangement exists with the patient’s regular treating healthcare professional or another healthcare professional who has established a professional relationship with the patient;
• A relationship exists in other circumstances as defined by rule of the Arkansas State Medical Board for healthcare professionals under its jurisdiction and their patients.
• A relationship established under rules of the Arkansas State Medical Board may be utilized for telehealth certification;
• A relationship exists in other circumstances as defined by rule of a licensing or certification board for other healthcare professionals under the jurisdiction of the appropriate board and their patients if the rules are no less restrictive than the rules of the Arkansas State Medical Board; or
• The healthcare professional who is licensed in Arkansas has access to a patient’s personal health record maintained by a healthcare professional and uses any technology deemed appropriate by the healthcare professional, including the telephone, with a patient located in Arkansas to diagnose, treat, and if clinically appropriate, prescribe a noncontrolled drug to the patient.
• For purposes of this subchapter, a health record may be created with the use of telemedicine and consists of relevant clinical information required to treat a patient, and is reviewed by the healthcare professional who meets the same standard of care for a telemedicine visit as an in-person visit

A professional relationship cannot be established only through:

• An internet questionnaire
• Email message
• Patient generated medical history
• Text messaging
• Facsimile machine
• Any combination of means listed above

See statute for additional avenues to establish the professional relationship.

SOURCE: AR Code 17-80-402 & 403 (Accessed Oct. 2024).

A physician-patient relationship must be established in accordance with Regulation 2.8 before the delivery of services via telemedicine. A patient completing a medical history online and forwarding it to a physician is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology. See regulation for additional requirements.

A Provider using telemedicine may NOT issue a prescription for any controlled substances defined as any scheduled medication under schedules II through V unless the Provider has seen the patient for an in-person exam or unless a relationship exists through consultation or referral; on-call or cross-coverage situations; or through an ongoing personal or professional relationship.

SOURCE: AR Rules and Regulation. Sec. 060.00.16-005 (060 01 CARR 001), (Accessed Oct. 2024).

When mifepristone or another drug or chemical regimen is used to induce an abortion, the initial administration of the drug or chemical shall occur in the same room and in the physical presence of the physician who prescribed, dispensed, or otherwise provided the drug or chemical to the patient.

SOURCE:  AR Code Annotated Section 20-16-603(b)(1). (Accessed Oct. 2024).

When mifepristone or another drug or chemical regimen is used to induce an abortion, the initial administration of the drug or chemical shall occur in the same room and in the physical presence of the physician who prescribed, dispensed, or otherwise provided the drug or chemical to the patient.

SOURCE: AR Medical Board: Rule 36 – Abortion Procedures, (007 33 CARR 012) (Accessed Oct. 2024).

Without a prior and proper patient-provider relationship, providers are prohibited from issuing prescriptions solely in response to an Internet questionnaire, an Internet consultation, or a telephone consultation.

“Proper practitioner-patient relationship” means that before the issuance of a prescription, a practitioner, physician, or other prescribing health professional performs a history and in-person physical examination of the patient adequate to establish a diagnosis and to identify underlying conditions or contraindications to the treatment recommended or provided unless:

• The prescribing practitioner is consulting at the specific request of another practitioner who:
  • Maintains an ongoing relationship with the patient
  • Has performed an in-person physical examination of the patient; and
  • Has agreed to supervise the patient’s ongoing care and use of prescribed medications;
• The prescribing practitioner interacts with the patient through an on-call or cross-coverage situation; or
• The relationship is established through telemedicine pursuant to the Telemedicine Act, § 17-80-401 et seq.

SOURCE: AR Code Annotated Sec. 17-92-1003(14)(B). (Accessed Oct. 2024).

Medical Board

Requiring minimum standards for establishing Patient/Provider relationships. Provider is defined as a person licensed by the Arkansas State Medical Board. A Provider exhibits gross negligence if he provides and/or recommends any form of treatment, including prescribing legend drugs, without first establishing a proper Patient/Provider relationship.

• For purposes of this regulation, a proper Patient/Provider relationship, at a minimum requires that:
  • The Provider performs a history and an “in person” physical examination of the patient adequate to establish a diagnosis and identify underlying conditions and/or contraindications to the treatment recommended/provided, OR
• The Provider performs a face to face examination using real time audio and visual telemedicine technology that provides information at least equal to such information as would have been obtained by an in-person examination; OR
• The Provider personally knows the patient and the patient‘s general health status through an “ongoing” personal or professional relationship;

Appropriate follow-up be provided or arranged, when necessary, at medically necessary intervals.

• For the purposes of this regulation, a proper Patient/Provider relationship is deemed to exist in the following situations:
  • When treatment is provided in consultation with, or upon referral by, another Provider who has an ongoing relationship with the patient, and who has agreed to supervise the patient‘s treatment, including follow up care and the use of any prescribed medications.
  • On-call or cross-coverage situations arranged by the patient‘s treating Provider.

SOURCE: AR Regulations, 060 01 CARR 001, (Accessed Oct. 2024).

A Patient/Provider relationship must be established in accordance with Rule 2.8 before the delivery of services via telemedicine. Provider is defined as a person licensed by the Arkansas State Medical Board. A patient completing a medical history online and forwarding it to a Provider is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology.

A physician shall not issue a written medical marijuana certification to a patient based on an assessment performed through telemedicine. A Patient/Provider relationship established under Rule 2.8 may be utilized for medical marijuana recertification by telehealth. “Telehealth certification” means the electronic assessment of a patient by a provider in connection with an application for a registry identification card under the Arkansas Medical Marijuana Amendment of 2016.

Telemedicine does not include the use of audio-only electronic technology by a provider to renew a written certification that was previously issued to the same patient.

SOURCE:  AR Rule 239.02.22-003 –  Rule 38, Telemedicine, (Accessed Oct. 2024).

Medical Marijuana Certification

“Telehealth certification” means the electronic assessment of a patient by a practitioner in connection with an application for a registry identification card under § 5 of the Arkansas Medical Marijuana Amendment of 2016, Arkansas Constitution, Amendment 98.

SOURCE: AR Code 17-80-402 (Accessed Oct. 2024)

Drug-induced, chemical and surgical abortions shall not be performed by telemedicine.

SOURCE: AR Admin Code 007.05.009 (Accessed Oct. 2024).

When a physician or other licensed prescriber authorizes or provides new prescriptions or refill medications to a pharmacy that is not physically located in this state or to a pharmacy that utilizes common carriers to deliver medications through the mail for a new patient who has not previously received pharmacist services or prescriptions filled through that pharmacy, that pharmacy shall:

• Establish a professional relationship between a pharmacist and the patient by telephone or telemedicine consult.

SOURCE: AR Code 17-92-120  (Accessed Oct. 2024).

Social Work

“Professional relationship” does not include a relationship between a social worker and a client established only by the following:

• An internet questionnaire;
• An email message;
• Patient-generated medical history;
• Text messaging;
• A facsimile machine; or
• Any combination thereof.

See regulations for further requirements.

SOURCE: Rules and Regulations, Social Work Licensing Board, Sec. XIV (120 00 CARR 001), (Accessed Oct. 2024).

Licensed Counselor or Marriage Family Therapist

A licensed counselor or marriage and family therapists/client relationship must be established in accordance with Ark. Code Ann. §§ 17-80-402 & 403 and Section 12.3 & 12.4 before the delivery of services via telemedicine. A client’s completing a psychosocial history online and forwarding it to a licensed counselor or marriage and family therapist is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology. A licensed counselor or marriage and family therapist exhibits gross negligence if he or she provides and/or recommends any form of treatment via telemedicine without first establishing a proper licensed counselor or marriage and family therapist/client relationship.

“Professional relationship” does not include a relationship between a licensed counselor or marriage and family therapist and a client established only by the following:

• An internet questionnaire;
• An email message;
• Patient-generated medical history;
• Text messaging;
• A facsimile machine; or
• Any combination thereof.

See regulations for further requirements.

SOURCE: Rules and Regulations, Board of Examiners in Counseling, Rule XII, Sec. 12.2 (122 00 CARR 001), (Accessed Oct. 2024).

Dietitians

“Professional relationship” does not include a relationship between a licensed dietitian and a client established only by the following:

• An internet questionnaire;
• An email message;
• Patient-generated medical history;
• Text messaging;
• A facsimile machine; or
• Any combination thereof.

SOURCE: Rules and Regulations, Dietetics Licensing Board Sec. 239.00.22-002 (007 33 CARR 045), (Accessed Oct. 2024).

Establishing a Licensed Dietitian/Client Relationship -A licensed dietitian/client relationship must be established in accordance with Ark. Code Ann. §§ 17-80-402 & 403 and Section VII before the delivery of services via telemedicine. A client’s completing a nutrition history online and forwarding it to a licensed dietitian is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology. A licensed dietitian exhibits gross negligence if he or she provides and/or recommends any form of treatment via telemedicine without first establishing a proper licensed dietitian/client relationship.

Minimum Requirements for Licensed Dietitian/Client Relationship – For purposes of this regulation, a proper licensed dietitian/client relationship, at a minimum requires that:

• The licensed dietitian performs an “in person” nutrition history of the client adequate to establish a diagnosis and develop a treatment plan, OR
• The licensed dietitian performs a face to face nutrition history using real time audio and visual telemedicine technology that provides information at least equal to such information as would have been obtained by an in-person nutrition history, OR
• The licensed dietitian knows the client and the client’s general nutrition issues through a previously established professional relationship; AND
• Appropriate follow-up be provided or arranged, when necessary.

When a Licensed Dietitian/Client Relationship is Deemed to Exist- For the purposes of this regulation, a proper licensed dietitian/client relationship is deemed to exist in the following situations:

• When treatment is provided in consultation with, or upon referral by, another provider or treatment team who has an ongoing relationship with the client, and who has agreed to supervise the client’s treatment, including follow up care.
• On-call or cross-coverage situations arranged by the client’s treating provider or treatment team.

Exceptions -Recognizing a licensed dietitian’s duty to adhere to the applicable standard of care and to comply with mandatory reporting laws, the following situations are excluded from the requirement of this regulation by Ark. Code Ann. § 17-80-403(a)(2):

• Emergency situations where the life or health of the client is in danger or imminent danger.
• Simply providing information of a generic nature, not meant to be specific to an individual client.

Professional Relationship Exceptions- Under Ark. Code Ann. § l 7-80-403(c), “Professional relationship” does not include a relationship between a licensed dietitian and a client established only by the following:

• An internet questionnaire;
• An email message;
• Patient-generated medical history;
• Text messaging;
• A facsimile machine; or
• Any combination thereof.

See regulation for additional requirements.

SOURCE: AR Rules and Regulations, Board of Dietetics, Sec. 007.45.24-001, (Accessed Oct. 2024).

APRN

The APRN shall establish a proper APRN/patient relationship prior to providing any patient care. A proper APRN/patient relationship, at a minimum requires that:

• The APRN perform a history and an “in person” physical examination of the patient adequate to establish a diagnosis and identify underlying conditions and/or contraindications to the treatment recommended/provided;
• The APRN perform a face-to-face examination using real-time audio or visual telemedicine technology that provides information at least equal to such information as would have been obtained by an in-person examination; AND
• Appropriate follow-up be provided or arranged, when necessary, at medically necessary intervals.

An APRN/patient relationship shall be established in accordance with Chapter 4, Section XIII before the delivery of services via telemedicine. A patient completing a medical history online and forwarding it to an APRN is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology.

An APRN using telemedicine may NOT issue a prescription for any controlled substances defined as any scheduled medication under schedules III through V and only hydrocodone combination products which were reclassified from Schedule III to Schedule II as of October 6, 2014 unless the APRN has seen the patient for an in-person exam or unless a relationship exists through consultation or referral; or on-call or cross-coverage situations.

SOURCE: Rule 007.34.22-003, Sec XV (067 00 CARR 004) (Accessed Oct. 2024).

Physical Therapy

“Professional relationship” means at a minimum a relationship established between a licensee and a patient when:

• The licensee has previously conducted an in-person examination of the patient and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals;
• The licensee personally knows the patient and the patient’s relevant health status through an ongoing personal or professional relationship and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals;
• The treatment is provided by a licensee in consultation with, or upon referral by, another healthcare professional who has an ongoing professional relationship with the patient and who has agreed to supervise the patient’s treatment, including follow-up care;
• An on-call or cross-coverage arrangement exists with the patient’s regular treating healthcare professional or another healthcare professional who has established a professional relationship with the patient;
• A relationship exists in other circumstances as defined by rule of the Arkansas State Medical Board for healthcare professionals under its jurisdiction and their patients; or
• The licensee has access to a patient’s personal health record maintained by a licensee and uses any technology deemed appropriate by the licensee, including the telephone, with a patient located in Arkansas to diagnose and treat the patient.

A licensee at a distant site shall not utilize telehealth with respect to a patient located in Arkansas unless a professional relationship exists between the licensee and the patient or the licensee otherwise meets the requirements of a professional relationship as defined in Section 1.(5) of this rule.

The existence of a professional relationship is not required in the following circumstances: (A) Emergency situations where the life or health of the patient is in danger or imminent danger; or(B) Simply providing information of a generic nature, not meant to be specific to an individual patient.

“Professional relationship” does not include a relationship between a licensee and a patient established only by the following:

• An internet questionnaire;
• An email message;
• Patient-generated medical history;
• Text messaging;
• A facsimile machine; or
• Any combination thereof.

SOURCE: Telehealth Rule, AR Physical Therapy Website. (Accessed Oct. 2024).

Psychology

A psychologist/psychological examiner exhibits gross negligence if he provides and/or recommends any form of treatment/service, without first establishing a proper psychologist/psychological examiner-patient/client relationship.

For purposes of this rule, a proper psychologist/psychological examiner- patient/client relationship, at a minimum requires that:

•  The psychologist/psychological examiner performs a history and an “in person” interview of the patient/client adequate to establish a diagnosis and identify underlying conditions and/or contraindications to the treatment/service recommended/provided, OR
• The psychologist/psychological examiner has access to a patient/client’s personal health record, as defined by A.C.A. §17-80-401 et seq., maintained by a psychologist/psychological examiner and uses any technology deemed appropriate by the psychologist/psychological examiner, including the telephone, with a patient/client located in Arkansas to diagnose or treat the patient/client; OR
• The psychologist/psychological examiner personally knows the patient/client and the patient/client’s general health status through an “ongoing” personal or professional relationship;

For the purposes of this rule, a proper psychologist/psychological examiner-patient/client relationship is deemed to exist in the following situations:

• When treatment/service is provided in consultation with, or upon referral by, another provider who has an ongoing relationship with the patient/client, and who has agreed to supervise the patient/client’s treatment/service, including follow up care.
• On-call or cross-coverage situations arranged by the patient/client’s treating psychologist/psychological examiner.

Exceptions — Recognizing a psychologist/psychological examiner’s duty to adhere to the applicable standard of care, the following situations are hereby excluded from the requirement of this rule:

• Emergency situations where the life or health of the patient/client is in danger or imminent danger.
• Simply providing information of a generic nature not meant to be specific to an individual patient/client.

A Patient/client/Provider relationship must be established in accordance with Rule 19.1 before the delivery of services via telepsychology. Provider is defined as a person licensed by the Arkansas Psychology Board who has documented training in telepsychology. A patient/client completing a history online and forwarding it to a Provider is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology.

SOURCE: Rules and Regulations Board of Psychology, Sec. 007.00.22-001, (074 00 CARR 001), (Accessed Oct. 2024).

Speech-Language Pathology and Audiology

“Professional relationship” means at a minimum a relationship established between a licensee and a patient when:

• The licensee has previously conducted an in-person examination of the patient and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals;
• The licensee personally knows the patient and the patient’s relevant health status through an ongoing personal or professional relationship and is available to provide appropriate follow-up care, when necessary, at therapeutically necessary intervals;
• The treatment is provided by a licensee in consultation with, or upon referral by, another healthcare professional who has an ongoing professional relationship with the patient and who has agreed to supervise the patient’s treatment, including follow-up care;
• An on-call or cross-coverage arrangement exists with the patient’s regular treating healthcare professional or another healthcare professional who has established a professional relationship with the patient;
• A relationship established under rules of the Arkansas State Medical Board may be utilized for telepractice certification; or
• The licensee has access to a patient’s personal health record maintained by a healthcare professional and uses any technology deemed appropriate by the licensee, including the telephone, with a patient located in Arkansas to diagnose and treat the patient.  For purposes of this subchapter, a health record may be created with the use of telepractice and consists of relevant clinical information required to treat a patient, and is reviewed by the licensee who meets the same standard of care for a telepractice visit as an in-person visit;

“Professional relationship” does not include a relationship between a licensee and a patient established only by the following:

• An internet questionnaire;
• An email message;
• Patient-generated medical history;
• Text messaging;
• A facsimile machine; or
• Any combination of means listed in subdivisions (c)(1)-(5) of this section.

SOURCE:  AR Board of Examiners in Speech-Language Pathology and Audiology Rules, Section 12: Telepractice, (Accessed Oct. 2024).

Prescribing, dispensing, or furnishing dangerous drugs as defined in Section 4022 without an appropriate prior examination and a medical indication, constitutes unprofessional conduct. An appropriate prior examination does not require a synchronous interaction between the patient and the licensee and can be achieved through the use of telehealth, including, but not limited to, a self-screening tool or a questionnaire, provided that the licensee complies with the appropriate standard of care.

SOURCE: CA Business & Professions Code Sec. 2242 (a). (Accessed Jul. 2024).

Remote Dispensing Site Pharmacies

Remote dispensing site pharmacies are permitted to dispense or provide pharmaceutical care services in medically underserved areas. A supervising pharmacy must provide telepharmacy services to the remote dispensing site pharmacy and shall not be located greater than 150 road miles from the remote dispensing site pharmacy.

SOURCE: CA Business & Professions Code Sec. 4130-4135 (Accessed Jul. 2024).

Occupational Therapy

An occupational therapist shall determine whether an in-person evaluation or in-person interventions are necessary considering: the complexity of the patient’s/client’s condition; his or her own knowledge, skills, and abilities; the nature and complexity of the intervention; the requirements of the practice setting; and the patient’s/client’s context and environment.

SOURCE: CA Code of Regulations, Title 16, Div. 39, Art. 8, Sec. 4172(c). (Accessed Jul. 2024).

Veterinarians

A veterinarian shall not prescribe, dispense, or administer a drug, medicine, application, or treatment of whatever nature for the prevention, cure, or relief of a wound, fracture, bodily injury, or disease of animals unless a veterinarian-client-patient relationship exists or as otherwise permitted by law, except when the animal patient is a wild animal or the owner of the animal patient is unknown. A veterinarian-client-patient relationship exists if all of the following conditions are met:

• The client has authorized the veterinarian to assume responsibility for medical judgments regarding the health of the animal patient.
• The veterinarian possesses sufficient knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the animal patient’s medical condition.
• The veterinarian has assumed responsibility for making medical judgments regarding the health of the animal patient and has communicated with the client a medical, treatment, diagnostic, or therapeutic plan appropriate to the circumstances.

A veterinarian possesses sufficient knowledge of the animal patient if the veterinarian has recently seen, or is personally acquainted with, the care of the animal patient by doing any of the following:

• Examining the animal patient in person.
• Examining the animal patient by use of synchronous audio-video communication.
• Making medically appropriate and timely visits to the premises on which the animal patient is kept.

Synchronous audio-video communication is not required for the delivery of veterinary medicine via telehealth after a veterinarian-client-patient relationship has been established unless the veterinarian determines that it is necessary in order to provide care consistent with prevailing veterinary medical practice.

A veterinarian-client-patient relationship shall not be established solely by audio-only communication or by means of a questionnaire.

Only a person who holds a current license to practice veterinary medicine in this state is authorized to practice veterinary medicine via telehealth on an animal patient located in this state.

Before delivering veterinary medicine via telehealth, the veterinarian shall inform the client about the use and potential limitations of telehealth and obtain consent from the client to use telehealth, including acknowledgment of all of the following:

• The same standards of care apply to veterinary medicine services via telehealth and in-person veterinary medical services.
• The client has the option to choose an in-person visit from a veterinarian at any time.
• The client has been advised how to receive follow-up care or assistance in the event of an adverse reaction to the treatment or in the event of an inability to communicate resulting from technological or equipment failure.

A veterinarian who practices veterinary medicine via telehealth shall do all of the following:

• Ensure that the technology, method, and equipment used to provide veterinary medicine services via telehealth comply with all current privacy protection laws.
• Have historical knowledge of the animal patient by obtaining and reviewing the animal patient’s relevant medical history, and, if available, medical records. If medical records exist from a previous in-person visit and are available to the client, the client may transmit those records, including any diagnostic data contained therein, to the veterinarian electronically.
• Employ sound professional judgment to determine whether using telehealth is an appropriate method for delivering medical advice or treatment to the animal patient and providing quality of care consistent with prevailing veterinary medical practice.
• Be familiar with available medical resources, including emergency resources near the animal patient’s location, be able to provide the client with a list of nearby veterinarians who may be able to see the animal patient in person upon the request of the client, and keep, maintain, and make available a summary of the animal patient record, as specified in Section 4855.
• Provide the client with the veterinarian’s name, contact information, and license number.
• Secure an alternative means of contacting the client if the electronic means is interrupted.

A veterinarian shall not prescribe a drug for a duration of time that is inconsistent with the medical condition of the animal patient or the type of drug prescribed.

A veterinarian who established the required veterinarian-client-patient relationship by examining the animal patient in person or by making medically appropriate and timely visits to the premises on which the animal patient is kept shall not prescribe a drug for a duration of time that is longer than one year from the date that the veterinarian examined the animal patient in person or visited the premises and prescribed the drug.

Except as provided in paragraphs (4) to (8), inclusive, a veterinarian who practices veterinary medicine via telehealth may order, prescribe, or make available drugs, as defined in Section 11014 of the Health and Safety Code, in accordance with all relevant state and federal regulations.

A veterinarian who established the required veterinarian-client-patient relationship using synchronous audio-video communication shall not prescribe a drug to the animal patient for use for a period longer than six months from the date upon which the veterinarian examined the animal patient or prescribed the drug. The veterinarian shall not issue another prescription to the animal patient for the same drug unless they have conducted another examination of the animal patient, either in person or using telehealth.

A veterinarian who established the required veterinarian-client-patient relationship using synchronous audio-video communication shall not prescribe an antimicrobial drug to the animal patient for a period longer than 14 days of treatment. The veterinarian shall not issue any further antimicrobial drug prescription, including a refill, to treat the condition of the animal patient unless the veterinarian has conducted an in-person examination of the animal patient.

The veterinarian shall not order, prescribe, or make available a controlled substance, as defined in Section 4021, or xylazine, unless the veterinarian has performed an in-person physical examination of the animal patient or made medically appropriate and timely visits to the premises where the animal patient is kept.

The veterinarian shall notify the client that some prescription drugs or medications may be available at a pharmacy and, if requested, the veterinarian shall submit a prescription to a pharmacy that the client chooses.

A veterinarian shall not prescribe via telehealth any drug or medication for use on a horse engaged in racing or training at a facility under the jurisdiction of the California Horse Racing Board pursuant to Chapter 4 (commencing with Section 19400) of Division 8.

As used in this section, “drug” means any controlled substance, as defined in Section 4021, or any dangerous drug, as defined in Section 4022.

A veterinarian is permitted to use telehealth without establishing a veterinarian-client-patient relationship in order to provide advice in an emergency, as defined in Section 4840.5.

SOURCE: CA Business and Professions Code Section 4826.6. (Accessed Jul. 2024).

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Colorado Medical Board

Provider-patient relationships may be established using telehealth technologies so long as the relationship is established in conformance with generally accepted standards of practice. Where an existing provider-patient relationship is not present, a provider must take appropriate steps to establish a provider-patient relationship consistent with the guidelines identified in Board Policy 40-3 and listed below.

The Board defines “Provider” to include licensees regulated by the Board and the “Provider-Patient Relationship” as the mutual understanding, between a provider and patient, of the shared responsibility for the patient’s healthcare. This relationship is established when:

• The provider agrees to undertake diagnosis and treatment of the patient, and the patient, or a medical proxy for the patient, agrees to be treated- whether or not there has been an in-person encounter between the
  patient and the provider; and,
• The provider:
  • Verifies and authenticates the patient’s identity and location;
  • Discloses his or her identity and applicable credential(s) to the patient; and
  •  Obtains appropriate informed consent after any relevant disclosures regarding the delivery models and treatment methods or limitations, including any special informed consents regarding the use of telehealth technologies.

A “Provider-Patient Relationship” has not been established when either the identity of the provider is unknown to the patient, or the identity of the patient is not known to the provider.

SOURCE: The Colorado Medical Board Policies, 40-03, page 57. Colorado Medical Board Policy Statement Regarding the Provider/Patient Relationship. 8/20/15. (Accessed Aug. 2024).

It is the position of the Colorado Medical Board that it is unprofessional conduct for a provider to provide treatment and consultation recommendations, including issuing a prescription, via any means, unless a provider-patient relationship, as defined in Board Policy 40-3, has been established.

Prescribing for a patient whom the provider has not personally examined may or may not be suitable under certain circumstances. Such circumstances may include, but are not limited to, admission orders for a newly hospitalized patient, prescribing for a patient of another provider for whom the provider is taking call, or continuing medication on a short-term basis for a new patient prior to the patient’s first appointment. Providers of medical care through telehealth technologies should adhere to the guidelines articulated in Board Policy 40-27.

SOURCE: The Colorado Medical Board Policies, 40-09, page 63. Guidelines for Prescribing for Unknown Patients. 8/20/15. (Accessed Aug. 2024).

An appropriate medical evaluation and review of relevant clinical history, commensurate with the presentation of the patient to establish diagnoses and identify underlying conditions and/or contra-indications to the treatment recommended/provided, should be performed prior to providing treatment, including issuing prescriptions, electronically or otherwise. Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in traditional (encounter in person) settings. Treatment, including issuing a prescription based solely on an online questionnaire, does not constitute an acceptable standard of care.

Prescribing medications, in-person or via telehealth technologies, is at the professional discretion of the provider. The indication, appropriateness, and safety considerations for each telehealth visit prescription must be evaluated by the provider in accordance with current standards of practice and consequently carry the same professional accountability as prescriptions delivered during an encounter in person. However, where such measures are upheld, and the appropriate clinical consideration is carried out and documented, providers may exercise their judgment and prescribe medications as part of telehealth encounters.

The recommendation of medical marijuana via telehealth technologies is prohibited.

Pharmacists

A pharmacist shall not dispense a prescription drug if the pharmacist knows or should know that the order for such drug was issued without a valid preexisting patient-practitioner relationship. Such relationship need not involve an in-person encounter between the patient and practitioner if otherwise permissible under Colorado law. A pharmacist may, in good faith, dispense an opiate antagonist pursuant to an order that was issued without a valid preexisting patient-practitioner relationship that is approved by the Federal Food and Drug Administration for the treatment of a drug overdose. 

SOURCE: 3 CO Code of Regulation 719-1. 3.00.21, p. 9. (Accessed Aug. 2024).

Medical Marijuana Program

“Bona fide physician-patient relationship”, for purposes of the medical marijuana program, means:

A physician and a patient have a treatment or counseling relationship, in the course of which the physician has completed a full in-person assessment of the patient’s medical history, including an assessment of the patient’s medical and mental health history to determine whether the patient has a medical or mental health issue that could be exacerbated by the use of medical marijuana and reviewing a previous diagnosis for a debilitating or disabling medical condition, and current medical condition, including an appropriate personal physical examination. If the physician is not the patient’s primary care physician, the recommending physician shall review the existing records of the diagnosing physician or licensed mental health provider. This does not require a mental health examination prior to making a recommendation per requirements established in § 25.1.5-106, C.R.S.

SOURCE: 5 CO Regs. Rule 1006-2; CO Revised Statute 25-1.5-106. (Accessed Aug. 2024).

Psychologists

In regard to licensed psychologists prescribing psychotropic medication for the treatment of mental health disorders, practice requirements for telemedicine include:

• Prescribing psychologist must be licensed in Colorado and have a Colorado prescription certificate to prescribe to a patient whose originating site is in Colorado as defined in section 10-16-123(4)(b), C.R.S., and adhere to the standards for care laid out for both telepsychology and psychology prescribing in Colorado and the state where the client is receiving treatment.
• Prescribing psychologists licensed in Colorado must be in Colorado at the time services are provided and will only provide telemedicine services to clients whose originating site is in Colorado as defined in section 10-16-123(4)(b), C.R.S.
• Prescribing psychologists must follow federal and state laws regarding prescribing controlled substances and other medications.

SOURCE: 3 CCR 721-1. (Accessed Aug. 2024).

Veterinarians

“Veterinarian-client-patient relationship” means the relationship established when:

• The veterinarian has assumed the responsibility for making medical judgments regarding the health of an animal and the need for medical treatment, and the owner, owner’s agent, or authorized caretaker has agreed to follow the instruction of the veterinarian;
• There is sufficient knowledge of an animal by the veterinarian to initiate at least a general or preliminary diagnosis of the medical condition of the animal, which means that the veterinarian has recently seen and is personally acquainted with the keeping and care of the animal by virtue of an in-person, physical examination of the animal or by medically appropriate and timely visits to the premises where the animal is kept; and
• The practicing veterinarian is readily available, or has arranged for emergency coverage, for follow-up evaluation in the event of adverse reactions or failure of the treatment regimen.

A veterinarian-client-patient relationship established according to the above may extend to other licensed veterinarians working out of the same physical practice location as the veterinarian who established the veterinarian-client-patient relationship if the other licensed veterinarians have access to and have reviewed the patient’s medical records.

SOURCE: CO Revised Statute 12-315-104 as proposed to be amended by HB 24-1048 (2024 Legislative Session). (Accessed Aug. 2024).

Only a licensed veterinarian may establish a veterinarian-client-patient relationship in this state. A veterinarian-client-patient relationship must be established by an in-person, physical examination of the animal or timely visits to the premises where the animal is kept. A veterinary specialist may use telecommunications technology to see a patient under another veterinarians previously established veterinarian-client-patient relationship pursuant to 12-315-306. An established veterinarian-client-patient relationship may be maintained through examinations that occur using telecommunications technology in between appropriate in-person physical examinations or visits to the premises where the patient is kept.

A licensed veterinarian shall not recommend treatment of care for an animal based solely on a client’s responses to an online questionnaire.

Only a licensed veterinarian with an established veterinarian-client-patient relationship may prescribe medication through telemedicine.

A licensed veterinarian who does not have an established veterinarian-client-patient relationship with an animal and its owner may use telemedicine to administer, distribute, or dispense a prescription drug that has been prescribed by another licensed veterinarian who has an established veterinarian-client-patient relationship.

Telereferral – A veterinarian with an established veterinarian-client-patient relationship may refer a patient to a veterinary specialist. A veterinary specialist to whom a patient is referred may provide veterinary services using telecommunications technology for the patient and client under the referring veterinarian’s veterinarian-client-patient relationship. A veterinary specialist to whom a patient is referred shall not prescribe medications to the patient unless the veterinary specialist establishes a veterinarian-client-patient relationship through an in-person, physical examination of the patient.

See legislation for additional information applicable to veterinarian use of telehealth.

SOURCE: CO Revised Statute 12-315-302; 12-315-304; 12-315-305; 12-315-306 as proposed to be added by HB 24-1048 (2024 Legislative Session). (Accessed Aug. 2024).

No telehealth provider shall prescribe any schedule I, II or III controlled substance through the use of telehealth, except a schedule II or III controlled substance other than an opioid drug, as defined in section 20- 14o, in a manner fully consistent with the Ryan Haight Online Pharmacy Consumer Protection Act, 21 USC 829(e), as amended from time to time, for the treatment of a person with a psychiatric disability or substance use disorder, as defined in section 17a-458, including, but not limited to, medication-assisted treatment. A telehealth provider using telehealth to prescribe a schedule II or III controlled substance pursuant to this subsection shall electronically submit the prescription pursuant to section 21a-249, as amended by this act.

SOURCE: CT General Statute 19a, Sec. 906(c) as proposed to be amended by HB 5198 (Public Act 24-110 – 2024 Session). (Accessed Jul. 2024).

Notwithstanding any provision of the general statutes or any regulation of Connecticut state agencies concerning the certification of qualifying patients through telehealth services, a physician, physician assistant or advanced practice registered nurse may issue a written certification to a qualifying patient and provide any follow-up care utilizing telehealth services, provided all other requirements for issuing such written certification to the qualifying patient, including, but not limited to, all recordkeeping requirements, are satisfied.

SOURCE: CT General Statute 21a-408c (f) as proposed to be added by HB 6768 (2023 Session), Sec. 13. (Accessed Jul. 2024).

A licensed practitioner shall not be required to electronically transmit a prescription when:

• Electronic transmission is not available due to a temporary technological or electrical failure. In the event of a temporary technological or electrical failure, the practitioner shall, without undue delay, reasonably attempt to correct any cause for the failure that is within his or her control. A practitioner who issues a prescription, but fails to electronically transmit the prescription, as permitted by this subsection, shall document the reason for the practitioner’s failure to electronically transmit the prescription in the patient’s medical record as soon as practicable, but in no instance more than seventy-two hours following the end of the temporary technological or electrical failure that prevented the electronic transmittal of the prescription. For purposes of this subdivision, “temporary technological or electrical failure” means failure of a computer system, application or device or the loss of electrical power to such system, application or device, or any other service interruption to such system, application or device that reasonably prevents the practitioner from utilizing his or her certified application to electronically transmit the prescription in accordance with subsection (b) of this section;
• The practitioner reasonably determines that it would be impractical for the patient to obtain substances prescribed by an electronically transmitted prescription in a timely manner and that such delay would adversely impact the patient’s medical condition, provided if such prescription is for a controlled substance, the quantity of such controlled substance does not exceed a five-day supply for the patient, if the controlled substance was used in accordance with the directions for use. A practitioner who issues a prescription, but fails to electronically transmit the prescription, as permitted by this subsection, shall document the reason for the practitioner’s failure to electronically transmit the prescription in the patient’s medical record;
• The prescription is to be dispensed by a pharmacy located outside this state. A practitioner who issues a prescription, but fails to electronically transmit the prescription, as permitted by this subsection, shall document the reason for the practitioner’s failure to electronically transmit the prescription in the patient’s medical record;
• Use of an electronically transmitted prescription may negatively impact patient care, such as a prescription containing two or more products to be compounded by a pharmacist, a prescription for direct administration to a patient by parenteral, intravenous, intramuscular, subcutaneous or intraspinal infusion, a prescription that contains long or complicated directions, a prescription that requires certain elements to be included by the federal Food and Drug and Administration, or an oral prescription communicated to a pharmacist by a health care practitioner for a patient in a chronic and convalescent nursing home, licensed pursuant to chapter 368v; or
• The practitioner demonstrates, in a form and manner prescribed by the commissioner, that such practitioner does not have the technological capacity to issue an electronically transmitted prescription. For the purposes of this subsection, “technological capacity” means possession of a computer system, hardware or device that can be used to electronically transmit controlled substance prescriptions consistent with the requirements of the federal Controlled Substances Act, 21 USC 801, as amended from time to time. The provisions of this subdivision shall not apply to a practitioner when such practitioner is prescribing as a telehealth provider, as defined in section 19a-906, as amended by this act, pursuant to subsection (c) of said section. 

SOURCE: CT General Statute 21a-249 (c) as proposed to be amended by HB 5198 (Public Act 24-110 – 2024 Session). (Accessed Jul. 2024).

Health-care providers may not deliver health-care services by telehealth and telemedicine in the absence of a health-care provider-patient relationship. A health-care provider-patient relationship may be established either in-person or through telehealth and telemedicine but must include all of the following:

• Thorough verification and authentication of the location and, to the extent possible, identity of the patient.
• Disclosure and validation of the provider’s identity and credentials.
• Receipt of appropriate consent from a patient after disclosure regarding the delivery model and treatment method or limitations, including informed consent regarding the use of telemedicine technologies as required by paragraph (a)(5) of this section.
• Establishment of a diagnosis through the use of acceptable medical practices, such as patient history, mental status examination, physical examination (unless not warranted by the patient’s mental condition), and appropriate diagnostic and laboratory testing to establish diagnoses, as well as identification of underlying conditions or contra-indications, or both, for treatment recommended or provided.
• Discussion with the patient of any diagnosis and supporting evidence as well as risks and benefits of various treatment options.
• The availability of a distant site provider or other coverage of the patient for appropriate follow-up care.
• A written visit summary provided to the patient.

Health-care services delivered by telehealth and telemedicine may be synchronous or asynchronous using store-and-forward technology. Telehealth and telemedicine services may be used to establish a provider-patient relationship only if the provider determines that the provider is able to meet the same standard of care as if the health-care services were being provided in-person.

Treatment and consultation recommendations delivered by telehealth and telemedicine shall be subject to the same standards of appropriate practice as those in traditional (in-person encounter) settings. In the absence of a proper health-care provider-patient relationship, health-care providers are prohibited from issuing prescriptions solely in response to an Internet questionnaire, an Internet consult, or a telephone consult.

Telehealth and telemedicine may be practiced without a health-care provider-patient relationship during:

1. Informal consultation performed by a health-care provider outside the context of a contractual relationship and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation.
2. Furnishing of assistance by a health-care provider in case of an emergency or disaster when circumstances do not permit the establishment of a health-care provider-patient relationship prior to the provision of care if no charge is made for the medical assistance.
3. Episodic consultation by a specialist located in another jurisdiction who provides such consultation services at the request of a licensed health-care professional.
4. Circumstances which make it impractical for a patient to consult with the health-care provider in-person prior to the delivery of telemedicine services.

A mental health provider, behavioral health provider, or social worker licensed in another jurisdiction who would be authorized to deliver health-care services by telehealth or telemedicine under this chapter if licensed in this State pursuant to Chapter 30 (Mental Health and Chemical Dependency Professionals), Chapter 35 (Psychologists), or Chapter 38 (Social Workers) of this title may provide treatment to Delaware residents through telehealth and telemedicine services. The Division of Professional Regulation shall require any out-of-state health-care provider practicing in this State pursuant to this section to complete a Medical Request Form and comply with any other registration requirements the Division of Professional Regulation may establish.

Delaware Board of Medical Licensure has specific requirements for electronic prescribing.

SOURCE: DE Admin Code, Title 24, Sec. 1700(19). (Accessed Jul. 2024).

Consulting Physician

Consultation may be done telephonically, electronically or in person. Consultation shall ordinarily consist of a history and physical examination, review of records and imaging pathology or similar studies. Consultation includes providing opinions and recommendations. An active Delaware certificate is required of any out of state physician who comes into Delaware to perform a consultation more than twelve (12) times per year. A physician who comes into Delaware to perform consultations must be actively licensed in another State or country on a full and unrestricted basis. Any consultations done for teaching and/or training purposes may include active participation in procedures and treatment, whether surgical or otherwise, provided a Delaware licensed physician remains responsible as the physician of record, and provided the patient is not charged a fee by the consultant.

SOURCE: DE Admin Code, Title 24, Sec. 1700, 6. (Accessed Jul. 2024).

Pharmacists

Telehealth may be used for patient counseling only.

SOURCE: 24 DAC 2500, 5.2. (Accessed Jul. 2024).

Pharmacists practicing within or outside of the state are prohibited from dispensing prescription drug orders through an Internet pharmacy if the pharmacist knows that the prescription order was issued solely on the basis of an Internet consultation or questionnaire, or medical history form submitted to an Internet pharmacy through an Internet site or that the prescription was issued by a practitioner who does not have a patient-practitioner relationship with the Delaware patient.

SOURCE: DE Code, Title 16, Chapter 47, Sec. 4744(d)(1)(a-b). (Accessed Jul. 2024).

Optometrists

All initial evaluations shall be performed face to face and not through telehealth or internet unless another Delaware-licensed optometrist or ophthalmologist is present at the originating site with the patient at the time of the diagnosis, or the provider meets the standard of service required by applicable professional societies in guidelines developed for establishing a health-care provider-patient relationship as part of an evidenced-based clinical practice in telemedicine.

SOURCE: 24 DAC 2100, 5. (Accessed Jul. 2024).

NOTE: DE Professional Boards have different and varying requirements related to establishing a patient-provider relationship. See Professional Board Standards section for references and additional Board telehealth practice requirements.

A physician shall perform a patient evaluation to establish diagnoses and identify underlying conditions or contraindications to recommended treatment options before providing treatment or prescribing medication for a patient utilizing the appropriate standards of care, except when performing interpretive services.

If a physician-patient relationship does not include a prior in-person interaction with a patient, the physician may use real-time telemedicine to allow a free exchange of protected health information between the patient and the physician to establish the physician-patient relationship and perform the patient evaluation.

SOURCE: DC Reg Sec. 17-4618.3 & 4 (Accessed Jun. 2024).

A health professional licensed, registered, or certified in the District pursuant to this act may provide a telehealth service to a District resident or person located in the District if doing so is:

• Consistent with the applicable standard of care in the District and the health professional’s scope of authorized practice in the District; and
• Not otherwise prohibited by law or regulation.

A practitioner-patient or practitioner-client relationship may be established through telehealth in accordance with the appropriate standard of care and the practitioner’s competence and scope of practice; provided, that the Mayor may through rulemaking issue additional requirements for specific health professionals to establish a practitioner-client relationship, including an initial in-person physical examination.

A health professional providing telehealth services who is authorized to prescribe medications shall comply with the Prescription Drug Monitoring Program Act of 2013, effective February 22, 2014 (D.C. Law 20-66; D.C. Code § 48-853.01 et seq.), and all District or federal laws and rules related to prescription and controlled substances.

SOURCE: DC Code Sec. 1201.05 as proposed to be added by B 25-0545 (2024 Session). (Accessed Jun. 2024).

Medical Marijuana

Authorized practitioners may provide telehealth medicine services to qualifying patients, including recommending the use of medical marijuana in accordance with this title, consistent with the laws and regulations governing their medical practice.

SOURCE: DC Regs. Sec. 22-C-807.1 as added by Alcoholic Beverage and Cannabis Administration – Notice of Final Rulemaking – Amending 22-C DCMR Ch. 1, etc. – Medical Marijuana, (Mar. 2024). (Accessed Jun. 2024).

A telehealth provider may use telehealth to perform a patient evaluation. If a telehealth provider conducts a patient evaluation sufficient to diagnose and treat the patient, the telehealth provider is not required to research a patient’s medical history or conduct a physical examination of the patient before using telehealth to provide health care services to the patient.

A telehealth provider may not use telehealth to prescribe a controlled substance listed in Schedule II of s. 893.03 unless the controlled substance is prescribed for the following:

1. The treatment of a psychiatric disorder;
2. Inpatient treatment at a hospital licensed under chapter 395;
3. The treatment of a patient receiving hospice services as defined in s. 400.601; or
4. The treatment of a resident of a nursing home facility as defined in s. 400.021.

SOURCE: FL Statute 456.47. (Accessed Nov. 2024).

Effective once certain contingencies are met:

Only a physician may perform or induce a termination of pregnancy. A physician may not use telehealth as defined in s. 456.47 to perform an abortion, including, but not limited to, medical abortions. Any medications intended for use in a medical abortion must be dispensed in person by a physician and may not be dispensed through the United States Postal Service or by any other courier or shipping service.

SOURCE: FL Statute Sec. 390.0111, (see notes section for contingencies) (Accessed Nov. 2024).

Medical Marijuana

A qualified physician may issue a physician certification only if the qualified physician:

• Conducted an examination of the patient and a full assessment of the medical history of the patient. Before issuing an initial certification to a patient, the qualified physician must conduct an in-person physical examination of the patient. For certification renewals, a qualified physician who has issued a certification to a patient after conducting an in-person physical examination may conduct subsequent examinations of that patient through telehealth as defined in s. 456.47. For the purposes of this subparagraph, the term “in-person physical examination” means an examination conducted by a qualified physician while the physician is physically present in the same room as the patient.  (see statute for more requirements).

A qualified physician must evaluate an existing qualified patient at least once every 30 weeks before issuing a new physician certification. A qualified physician who has issued a certification to the patient after conducting an in-person physical examination as defined in subparagraph (a)1. may conduct the evaluation through telehealth as defined in s. 456.47. A physician must:

• Determine if the patient still meets the requirements to be issued a physician certification under paragraph (a).
• Identify and document in the qualified patient’s medical records whether the qualified patient experienced either of the following related to the medical use of marijuana:
  • An adverse drug interaction with any prescription or nonprescription medication; or
  • A reduction in the use of, or dependence on, other types of controlled substances as defined in s. 893.02.
• Submit a report with the findings required pursuant to subparagraph 2. to the department. The department shall submit such reports to the Consortium for Medical Marijuana Clinical Outcomes Research established pursuant to s. 1004.4351.

SOURCE: FL Statute Sec. 381.986, (Accessed Nov. 2024).

Dental

An advertisement of dental services provided through telehealth as defined in s. 456.47(1) must include a disclaimer that reads, in a clearly legible font and size, “An in-person examination with a dentist licensed under chapter 466, Florida Statutes, is recommended before beginning telehealth treatment in order to prevent injury or harm” for each of the following services, if advertised:

• The taking of an impression or the digital scanning of the human tooth, teeth, or jaws, directly or indirectly and by any means or method.
• Furnishing, supplying, constructing, reproducing, or repairing any prosthetic denture, bridge, or appliance or any other structure designed to be worn in the human mouth.
• Placing an appliance or a structure in the human mouth or adjusting or attempting to adjust the appliance or structure.
• Correcting or attempting to correct malformations of teeth or jaws

SOURCE: FL Statute Sec. 466.019, (Accessed Jun. 2024).

Veterinary Practice

A veterinarian practicing veterinary telehealth:

• May not engage in the practice of veterinary telehealth unless it is within the context of a veterinarian/client/patient relationship;
• Shall practice in a manner consistent with his or her scope of practice and the prevailing professional standard of practice for a veterinarian who provides in-person veterinary services to patients in this state and shall employ sound, professional judgment to determine whether using veterinary telehealth is an appropriate method for delivering medical advice or treatment to the patient;
• May use veterinary telehealth to perform an initial patient evaluation to establish the veterinarian/client/patient relationship if the evaluation is conducted using synchronous, audiovisual communication. The evaluation may not be performed using audio only communications, text messaging, questionnaires, chatbots, or other similar means. If a veterinarian practicing telehealth conducts a patient evaluation sufficient to diagnose and treat the patient, the veterinarian is not required to research a patient’s medical history or conduct a physical examination of the patient before using veterinary telehealth to provide a veterinary health care service to the patient;
• If the initial patient evaluation is performed using veterinary telehealth, must provide the client with a statement containing the veterinarian’s name, license number, and contact information and the contact information for at least one physical veterinary clinic in the vicinity of the patient’s location and instructions for how to receive patient follow-up care or assistance if the veterinarian and client are unable to communicate because of a technological or equipment failure or if there is an adverse reaction to treatment, and inform the client that, if medication is prescribed, the client may obtain a prescription that may be filled at the pharmacy of his or her choice. The veterinarian shall obtain from the client a signed and dated statement indicating the client has received the required information before practicing veterinary telehealth;
• Shall prescribe all drugs and medications in accordance with all federal and state laws and the following requirements:
  • A veterinarian practicing veterinary telehealth may order, prescribe, or make available medicinal drugs or drugs specifically approved for use in animals by the United States Food and Drug Administration, the use of which conforms to the approved labeling. Prescriptions based solely on a telehealth evaluation may be issued for up to 1 month for products labeled solely for flea and tick control and up to 14 days of treatment for other animal drugs. Prescriptions based solely on a telehealth evaluation may not be renewed without an in-person examination.
  • A veterinarian practicing veterinary telehealth may not order, prescribe, or make available medicinal drugs or drugs as defined in s. 465.003 approved by the United States Food and Drug Administration for human use or compounded antibacterial, antifungal, antiviral, or antiparasitic medications, unless the veterinarian has conducted an in-person physical examination of the animal or made medically appropriate and timely visits to the premises where the animal is kept.
  • A veterinarian may not use veterinary telehealth to prescribe a controlled substance as defined in chapter 893 unless the veterinarian has conducted an in-person physical examination of the animal or made medically appropriate and timely visits within the past year to the premises where the animal is kept.
  • A veterinarian practicing veterinary telehealth may not prescribe a drug or other medication for use on a horse engaged in racing or training at a facility under the jurisdiction of the Florida Gaming Control Commission or on a horse that is a covered horse as defined in the federal Horseracing Integrity and Safety Act, 15 U.S.C. ss. 3051 et seq.;
• Shall be familiar with available veterinary resources, including emergency resources, near the patient’s location and be able to provide the client with a list of nearby veterinarians who may be able to see the patient in person upon the request of the client;
• Shall keep, maintain, and make available a summary of the patient record as provided in s. 474.2165; and
• May not use veterinary telehealth to issue an international or interstate travel certificate or a certificate of veterinary inspection.

SOURCE: House Bill 849 (2024 Session), (Accessed Nov. 2024).

In order for a physician to practice within the minimum standards of practice while providing treatment and/or consultation recommendations by electronic or other such means, all the following conditions must be met:

• All treatment and/or consultations must be done by Georgia licensed practitioners;
• A history of the patient shall be available to the Georgia licensed physician, physician assistant or advanced practice registered nurse who is providing treatment or consultation via electronic or other such means;
• Georgia licensed physician, physician assistant or advanced practice registered nurse either: (a) Has personally seen and examined the patient and provides ongoing or intermittent care by electronic or other such means; or (b) Is providing medical care by electronic or other such means at the request of a physician, physician assistant or advanced practice registered nurse licensed in Georgia who has personally seen and examined the patient; or (c) Is providing medical care by electronic or other such means at the request of a Public Health Nurse, a Public School Nurse, the Department of Family and Children’s Services, law enforcement, community mental health center or through an established child advocacy center for the protection for a minor, and the physician, physician assistant or advanced practice registered nurse is able to examine the patient using technology and peripherals that are equal or superior to an examination done personally by a provider within that provider’s standard of care; or (d) Is able to examine the patient using technology and peripherals that are equal or superior to an examination done personally by a provider within that provider’s standard of care.
• The Georgia licensed physician, physician assistant or advanced practice registered nurse providing treatment or consultations by electronic or other means must maintain patient records on the patient and must document the evaluation and treatment along with the identity of the practitioners providing the service by electronic or other means, and if there is a referring practitioner, a copy of this record must also be provided to the referring physician, physician assistant or advanced practice registered nurse.
• To delegate to a nurse practitioner or to supervise a physician assistant doing telemedicine, the physician must document to the board that the provision of care by telemedicine is in his or her scope of practice and that the NP or PA has demonstrated competence in the provision of care by telemedicine.
• Patients treated by electronic or other such means or patient’s agent must be given the name, credentials and emergency contact information for the Georgia licensed physician, physician assistant and/or advanced practice registered nurse providing the treatment or consultation. Emergency contact information does not need to be provided to those treated within the prison system while incarcerated but should be provided to the referring provider. For the purposes of this rule, “credentials” is defined as the area of practice and training for physicians, and for physician assistants and advanced practice registered nurses, “credentials” shall mean the area of licensure and must include the name of the delegating physician or supervising physician.
• The patient being treated via electronic or other means or the patient’s agent must be provided with clear, appropriate, accurate instructions on follow-up in the event of needed emergent care related to the treatment. In the case of prison patients, prison staff will be provided this information if the consult is provided to an inmate.
• The physician, physician assistant or nurse practitioner who provides care or treatment for a patient by electronic or other such means must make diligent efforts to have the patient seen and examined in person by a Georgia licensed physician, physician assistant or nurse practitioner at least annually.

This rule should not be interpreted to interfere with care and treatment by telephonic communication in an established physician-patient relationship, call coverage for established physician-patients relationships, or telephone and internet consultations between physicians, nurse practitioners, physician assistants, other health care providers or child protection agencies.

This rule does not authorize the prescription of controlled substances for the treatment of pain or chronic pain by electronic or other such means. All treatment of pain or chronic pain must be in compliance with Rule 360-3-.06.

SOURCE: GA Rules & Regulations revised 360-3-.07. (Accessed May. 2024). 

Unprofessional conduct shall include but not be limited to prescribing controlled substances and/or dangerous drugs for a patient based solely on a consultation via electronic means with the patient, patient’s guardian or patient’s agent. This shall not prohibit a licensee from prescribing a dangerous drug for a patient pursuant to a valid physician­ patient relationship in accordance with O.C.G.A. 33-24-56.4 or a licensee who is on-call or covering for another licensee from prescribing up to a 30-day supply of medications for a patient of such other licensee nor shall it prohibit a licensee from prescribing medications when documented emergency circumstances exist.

This shall also not prevent a licensed physician from prescribing Schedule II sympathomimetic amine drugs for the treatment of attention deficit disorder to a patient in the physical presence of a licensed nurse, provided the initial diagnosis was made and an initial prescription was issued in accordance with 21 U .S .C. § 829(e), as amended from time to time, including but not limited to the following:

• The physician has conducted at least one in-person medical evaluation of the patient; or
• The physician is covering for a licensee who is temporarily unavailable and has conducted at least one in-person medical evaluation of the patient; or
• The physician is engaged in the practice of telemedicine in accordance with Board Rule 360-3-.07 and with 21 U.S.C. §§ 802(54) and 829(e)(3)(A), including, but not limited to:
  • Where the patient is being treated by, and physically located in, a hospital or clinic registered with the U.S. Drug Enforcement Agency (“DEA”), the physician is registered with the DEA, and all other requirements of 21 U.S.C. § 802(54)(A) are met; or
  • Where the patient is being treated by, and physically in the presence of, a licensee who is registered with the DEA, and all other requirements of 21 U.S.C. § 802(54)(B) are met; or
  • Where the physician has obtained from the U.S. Attorney General a special registration for telemedicine in accordance with 21 U.S.C. §§ 802(54)(E) and 831(h).

Providing treatment via electronic or other means is considered unprofessional conduct unless a history and physical examination of the patient has been performed by a Georgia licensee.  This shall not prohibit a licensee who is on call or covering for another licensee from treating and/or consulting a patient of such other licensee. Also, this paragraph shall not prohibit a patient’s attending physician from obtaining consultations or recommendations from other licensed health care providers.

SOURCE: GA Rules & Regulations revised 360-3-.02. (Accessed May. 2024).

Contact Lenses & Spectacles

SOURCE: GA OCGA Section 31-12-12. (Accessed May. 2024).

Medicaid

All providers prescribing controlled substances must be located in the State of Hawai’i.

Until December 31, 2024, Federally Qualified Health Center (FQHC) behavioral health providers may be located at a non-HRSA approved site or satellite within the United States and the United States’ territories. If the FQHC provider is prescribing controlled substances, they must be located in the State of Hawai’i.

SOURCE:  HI Med-QUEST Memo QI-2338/FFS 23-22/CCS-2311. (Accessed Jun. 2024).

Prescribing providers must have a provider-patient relationship prior to prescribing. This includes:

• A face-to-face history and appropriate physical exam to make a diagnosis and therapeutic plan;
• Discussion of diagnosis or treatment with the patient; including the benefits of other treatment options; and
• Ensure the availability of appropriate follow-up care.

SOURCE: HI Revised Statutes § 329-1. (Accessed Jun. 2024)

Treatment recommendations made via telehealth, including issuing a prescription via electronic means, shall be held to the same standards of practice as traditional settings that do not include a in-person visit but in which prescribing is appropriate, including on-call telephone encounters and encounters for which a follow-up visit is arranged.

Issuing a prescription based solely on an online questionnaire is not treatment for the purposes of this section and does not constitute an acceptable standard of care.

A physician-patient relationship may be established via a telehealth interaction; provided that the physician has a license to practice medicine in the State.  Once a physician-patient relationship is established, a patient or physician licensed in this State may use telehealth for any authorized purpose, including consultation with a medical provider licensed in another state, authorized by this section or as otherwise provided by law.

For the purposes of prescribing opiates or medical cannabis, a physician-patient relationship shall only be established after an in-person consultation between the prescribing physician and the patient.

SOURCE: HI Revised Statutes § 453-1.3.  Amended by HB 907 (To be repealed December 31, 2025). (Accessed Jun. 2024).

For purposes of prescribing medical cannabis, a bona fide physician-patient relationship may be established via telehealth, and a nurse-patient relationship can be established via telehealth; provided that treatment recommendations that certify a patient for the medical use of cannabis via telehealth shall be allowed only after an initial in-person consultation between the certifying physician or advanced practice registered nurse and the patient.

SOURCE: HI Revised Statutes § 329-126. (Accessed Jun. 2024).

A provider may provide virtual care to a patient if such provider has first established a provider-patient relationship with the patient, the patient has a provider-patient relationship with another provider in the provider group, the provider is covering calls for a provider with an established relationship with the patient, or the provider is performing any activities set forth in section 54-1733(2), Idaho Code. A provider-patient relationship may be established by use of virtual care technologies, provided that the applicable Idaho community standard of care is satisfied.

SOURCE: ID Code 54-5705. (Accessed Jun. 2024).

When delivering health care services via virtual care, including a prescription drug order or prescription medical device order, a provider shall obtain and document a patient’s relevant clinical history and current symptoms to establish the diagnosis and identify underlying conditions and contraindications to the treatment recommended. A provider delivering health care services via virtual care has a duty to practice in a manner consistent with the provider’s scope of practice and shall be held to the applicable Idaho community standard of care that applies in an in-person setting. Treatment based solely on a static online questionnaire does not constitute an acceptable standard of care.

SOURCE: ID Code 54-5706. (Accessed Jun. 2024).

SOURCE ID Code Section 54-5707 (Accessed Jun. 2024).

Prescribers must have prescriber-patient relationship, which includes a documented patient evaluation adequate to establish diagnoses and identify underlying conditions and/or contraindications to the treatment.  A valid prescriber-patient relationship may be established through virtual care technologies, provided that the applicable Idaho community standard of care must be satisfied.

Prescriptions based solely on static online questionnaires does not constitute a legitimate medical purpose.

SOURCE: ID Code § 54-1733. (Accessed Jun. 2024).

An optometrist treating a patient through telehealth must perform at least a minimum eye examination as required by 68 Ill. Adm. Code 1320.90 before prescribing eyeglasses or contact lenses to the patient. Nothing in this Section authorizes an eye examination that:

• does not assess the ocular health and visual status of a patient, or
• consists solely of objective refractive data or information generated by an automated testing device, including an autorefractor, in order to establish a medical diagnosis or to determine a refractive error.

To be repealed Jan. 1, 2027.

SOURCE: Illinois Consolidated Statute 225, 80/15.4. (Accessed Jul. 2024).

A person age 18 or older must be evaluated by a hearing instrument professional in person or via telehealth before receiving a prescription for a hearing aid. A person age 18 or older may not waive evaluation by a hearing instrument professional unless he or she is replacing a lost or stolen hearing aid that is subject to warranty replacement.

SOURCE:  Illinois 225 ILCS 50/4.6.  (Accessed Jul. 2024).

A documented patient evaluation, including history and physical evaluation adequate to establish diagnoses and identify underlying conditions or contraindications to the treatment recommended or provided, must be obtained prior to providing treatment, including issuing prescriptions, electronically or otherwise.

SOURCE: IN Admin. Code, “Article 5” Title 844, 5-3-2. p. 10 (Accessed Aug. 2024). 

Telehealth may not be used to provide any abortion, including the writing or filling of a prescription for any purpose that is intended to result in an abortion.

SOURCE: IN code, 16-34-1-11 & 25-1-9.5-8(a)(4) & 25-1-9.5-0.5. (Accessed Aug. 2024).

A practitioner who:

• Provides health care services through telehealth; or
• Directs an employee of the practitioner to perform a health care service listed in the chapter;

shall be held to the same standards of appropriate practice as those standards for health care services provided at an in-person setting.

A practitioner who uses telehealth shall, if such action would otherwise be required in the provision of the same health care services in a manner other than telehealth, ensure that a proper provider-patient relationship is established. The provider-patient relationship by a  practitioner who uses telehealth must at a minimum include the following:

1. Obtain the patient’s name and contact information (see regulation for other related requirements);
2. Disclose the practitioner’s name and practitioner’s licensure, certification or registration;
3. Obtain informed consent from the patient;
4. Obtain the patient’s medical history and information necessary to establish a diagnosis;
5. Discuss with the patient the diagnosis, evidence for the diagnosis and risks and benefits of the various treatment options;
6. Create and maintain a medical record for the patient. If a prescription is issued for the patient, and subject to the consent of the patient, the prescriber shall notify the patient’s primary care provider of any prescriptions the provider has issued (see regulation for other related requirements);
7. Issue proper instructions for appropriate follow-up care
8. Provide a telehealth visit summary to the patient, including information that indicates any prescriptions that is being prescribed.

SOURCE: IN Code, 25-1-9.5-7. (Accessed Aug. 2024)

A prescription for a controlled substance can be issued for a patient the prescriber has not previously examined if the following conditions are met:

1. The prescriber has satisfied the applicable standard of care in the treatment of the patient.
2. The issuance of the prescription is within the prescriber’s scope of practice and certification
3. The prescription meets the requirements outline in the following section and it is not an opioid.  However, opioids may be prescribed if the opioid is a partial agonist that is used to treat or manage opioid dependence.
4. The prescription is not for an abortion inducing drug

If the prescription is for a medical device, including an ophthalmic device, the prescriber must use telehealth technology that is sufficient to allow the provider to make an informed diagnosis and treatment plan that includes the medical device being prescribed.

Additionally, the following conditions must be met for a prescription for a controlled substance:

• The prescriber maintains a valid controlled substance registration under IC 35-48-3.
• The prescriber meets the conditions set forth in 21 U.S.C. 829 et seq.
• A practitioner acting in the usual course of the practitioner’s professional practices issues the prescription for a legitimate medical purpose.
• The telehealth communication is conducted using an audiovisual, real time, two-way interactive communication system.
• The prescriber complies with the requirements of the INSPECT program (IC 35-48-7).
• All other applicable federal and state laws are followed.

SOURCE: IN Code 25-1-9.5-8. (Accessed Aug. 2024).

A pharmacy does not violate this chapter if the pharmacy fills a prescription for an opioid and the pharmacy is unaware that the prescription was written or electronically transmitted by a prescriber providing telehealth services under this chapter.

SOURCE: IN Code 25-1-9.5-11. (Accessed Aug 2024)

A prescriber may not issue a prescription for an ophthalmic device unless the following conditions are met:

• If the prescription is for contact lenses or eyeglasses, the patient must be at least eighteen (18) years of age but not more than fifty-five (55) years of age.
• The patient must have completed a medical eye history that includes information concerning the following:
  • Chronic health conditions.
  • Current medications.
  • Eye discomfort.
  • Blurry vision.
  • Any prior ocular medical procedures.
• The patient must have had a prior prescription from a qualified eye care professional that included a comprehensive in person exam that occurred within two (2) years before the initial use of telehealth for a refraction under subdivision (5)(A).
• If the patient desires a contact lens prescription, at the discretion of the eye care professional, that patient must have had a prior contact lens fitting or evaluation by a qualified eye care professional that occurred within two (2) years before the initial use of telehealth for a refraction under subdivision (5)(A).
• The patient:
  • May not use telehealth more than two (2) consecutive times within two (2) years from the date of the examination that occurred under subdivision (3) for a refraction without a subsequent in person comprehensive eye exam; and
  • Must acknowledge that the patient has had a comprehensive eye exam as required under clause (A) before receiving an online prescription.
• The patient may allow the prescriber to access the patient’s medical records using an appropriate HIPAA compliant process.
• The prescriber must ensure that the transfer of all information, including the vision test and prescription, comply with HIPAA requirements.
• The prescriber must use technology to allow the patient to have continuing twenty-four (24) hour a day online access to the patient’s prescription as soon as the prescription is signed by the prescriber.

SOURCE: IN Code 25-1-9.5-13. (Accessed Aug. 2024)

If a veterinarian is required to establish a veterinarian-client-patient relationship to perform a health care service, the veterinarian shall ensure that a proper veterinarian-client-patient relationship is established, when providing the service using telehealth.

SOURCE: IN Code 25-1-9.5-15. (Accessed Aug. 2024)

Telehealth Services Pilot Program

Prescriptions may not be issued for a controlled substance or an abortifacient.

Telehealth shall not include any encounter in which the patient is assured that any outcome, including the issuance of a prescription, will be issued as a quid pro quo for the payment of the provider’s consultation fee or solely on the basis of an online questionnaire.

SOURCE: IN Code, 844-Article 5-8-3, p. 31. (Accessed Aug. 2024).

READ LESS

Generally, a licensee shall perform an in-person medical interview and physical examination for each patient. However, the medical interview and physical examination may not be in-person if the technology utilized in a telemedicine encounter is sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed in-person. Prior to providing treatment, including issuing prescriptions, electronically or otherwise, a licensee who uses telemedicine shall interview the patient to collect the relevant medical history and perform a physical examination, when medically necessary, sufficient for the diagnosis and treatment of the patient. An Internet questionnaire that is a static set of questions provided to the patient, to which the patient responds with a static set of answers, in contrast to an adaptive, interactive and responsive online interview, does not constitute an acceptable medical interview and physical examination for the provision of treatment, including issuance of prescriptions, electronically or otherwise, by a licensee.

Under certain circumstances, whether or not such circumstances involve the use of telemedicine, a licensee may treat a patient who has not been personally interviewed, examined and diagnosed by the licensee.  See rule.

SOURCE: Iowa Admin Code, Sec. 653-13.11, (Accessed Dec. 2024).

When inducing an abortion by providing an abortion-inducing drug, a physician must be physically present with the woman at the time the abortion-inducing drug is provided.

SOURCE: IA Admin. Code, 653 13.10(3) (Accessed Dec. 2024).

Specific requirements apply for mental health professionals establishing a provider-patient relationship in a school-based setting. See full law text for details.

A mental health professional with prescribing authority who provides telehealth services in accordance with this section shall not prescribe any new medication to a student during a telehealth session. However, a mental health professional with prescribing authority may initiate new prescriptions, alter the dosage of an existing medication, or discontinue an existing medication for the treatment of the student’s behavioral health condition after consultation with the student’s parent or guardian.

SOURCE: IA Code Chapter 280A.4 (Accessed Dec. 2024).

If a mental health professional provides behavioral health services via telehealth on school/AEA premises, the mental health professional will first establish a valid provider-patient relationship. The provider-patient relationship is established when:

• The student, with the consent of the student’s parent or guardian when the student has not yet reached the age of majority, seeks help from a mental health professional;
• The mental health professional agrees to provide treatment of the student; and
• The student’s parent or guardian agrees to have the student treated by the mental health professional.

If a provider-patient relationship is established and the student has not yet reached the age of majority, parent or guardian consent will be obtained prior to the student receiving behavioral health services via telehealth in a school or AEA setting and is necessary each academic year that the student receives telehealth services.

SOURCE: IA Admin Code 281.14.22, (Accessed Dec. 2024).

Behavioral health services provided via telehealth in a school setting: Iowa Code section 280A.4 is incorporated by this reference.

[see code above]

SOURCE: IA Admin Code 281.14.23, (Accessed Dec. 2024).

The pharmacy and professional pharmacy staff shall ensure that the prescription drug or medication order, regardless of the means of transmission, has been issued for a legitimate medical purpose by a prescriber acting in the usual course of the prescriber’s professional practice. A pharmacist shall not dispense a prescription drug if the pharmacist knows or should have known that the prescription was issued solely on the basis of an Internet-based questionnaire.

SOURCE: IA Admin. Code, 657 8.19(5). (Accessed Dec. 2024).

Physician Assistant-Patient Relationship

A licensee who uses telemedicine will establish a valid physician assistant-patient relationship with the person who receives telemedicine services. The physician assistant-patient relationship begins when:

• The person with a health-related matter seeks assistance from a licensee;
• The licensee agrees to undertake diagnosis and treatment of the person; and
• The person agrees to be treated by the licensee whether or not there has been an in-person encounter between the physician assistant and the person.

A valid physician assistant-patient relationship may be established by:

• In-person encounter. Through an in-person medical interview and physical examination where the standard of care would require an in-person encounter;
• Consultation with another licensee. Through consultation with another licensee (or other health care provider) who has an established relationship with the patient and who agrees to participate in, or supervise, the patient’s care; or
• Telemedicine encounter. Through telemedicine, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

Generally, a licensee will perform an in-person medical interview and physical examination for each patient. However, the medical interview and physical examination may not be in person if the technology utilized in a telemedicine encounter is sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed in person. Prior to providing treatment, including issuing prescriptions, electronically or otherwise, a licensee who uses telemedicine will interview the patient to collect the relevant medical history and perform a physical examination, when medically necessary, sufficient for the diagnosis and treatment of the patient. An Internet questionnaire that is a static set of questions provided to the patient, to which the patient responds with a static set of answers, in contrast to an adaptive, interactive and responsive online interview, does not constitute an acceptable medical interview and physical examination for the provision of treatment, including issuance of prescriptions, electronically or otherwise, by a licensee.

See rule for circumstances where the standard of care may not require a licensee to personally interview or examine a patient.

Prescribing to a patient based solely on an Internet request or Internet questionnaire (i.e., a static questionnaire provided to a patient, to which the patient responds with a static set of answers, in contrast to an adaptive, interactive and responsive online interview) is prohibited. Absent a valid physician assistant-patient relationship, a licensee’s prescribing to a patient based solely on a telephonic evaluation is prohibited, with the exception of the circumstances described in subrule 327.9(21).

SOURCE: Iowa Admin Code, Sec. 645-327.6, (Accessed Dec. 2024).

Nursing – ARNPs

Prior to providing services through telehealth, the licensee shall first establish a practitioner-patient relationship. A practitioner-patient relationship is established when:

• The person with a health-related matter seeks assistance from the licensee;
• The licensee agrees to provide services; and
• The person agrees to be treated, or the person’s legal guardian or legal representative agrees to the person’s being treated, by the licensee regardless of whether there has been a previous in-person
  encounter between the licensee and the person.

A practitioner-patient relationship can be established through an in-person encounter, consultation with another licensee or health care provider, or telehealth encounter.

Notwithstanding paragraphs 7.9(5) “a” and “b,” services may be provided through telehealth without first establishing a practitioner-patient relationship in the following settings or circumstances:

1. Institutional settings;
2. Licensed or certified nursing facilities, residential care facilities, intermediate care facilities, assisted living facilities, and hospice settings;
3. In response to an emergency or disaster;
4. Informal consultations with another health care provider performed by a licensee outside of the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
5. Episodic consultations by a specialist located in another jurisdiction who provides consultation services upon request to a licensee;
6. A substitute licensee acting on behalf and at the designation of an absent licensee or other health care provider in the same specialty on an on-call or cross-coverage basis; or
7. When a sexually transmitted disease has been diagnosed in a patient, a licensee prescribes or dispenses antibiotics to the patient’s named sexual partner(s) for the treatment of the sexually transmitted disease as recommended by the U.S. Centers for Disease Control and Prevention.

A licensee providing services through telehealth may issue a prescription to a patient as long as the issuance of such prescription is consistent with the standard of care applicable to the in-person setting.

SOURCE: IA Admin Code Sec. 655-7.9(152), (Accessed Dec. 2024).

Nursing – Midwives

Prior to initiating contact with a client for the purpose of providing services to the client using telehealth, a CPM shall:

• Review the client’s history and all relevant medical records; and
• Determine as to each unique client encounter whether the CPM will be able to provide the same standard of care using telehealth as would be provided if the services were provided in person

Prior to providing services through telehealth, the CPM shall first establish a CPM-client relationship.  A CPM-client relationship is established when:

• The client seeks assistance from the CPM;
• The CPM agrees to provide services; and
• The client agrees to be treated, or the client’s legal guardian or legal representative agrees to the client being treated, by the CPM regardless of whether there has been a previous in-person encounter between the CPM and the client.

A CPM-client relationship can be established through an in-person encounter, consultation with another CPM or health care provider, or telehealth encounter.

Notwithstanding paragraphs 16.7(5)“a” and “b,” services may be provided through telehealth without first establishing a CPM-client relationship in the following settings or circumstances:

• In response to an emergency or disaster;
• Via informal consultations with another health care provider performed by a CPM outside of the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or
  exchange of direct or indirect compensation;
• A substitute CPM acting on behalf and at the designation of an absent CPM in the same specialty on an on-call or cross-coverage basis

SOURCE: IA Admin Code Sec. 655-16.7, (Accessed Dec. 2024).

A licensee under the purview of the board who provides treatment for the correction of malpositions of human teeth or the initial use of orthodontic appliances shall not begin orthodontic treatment on a new patient unless one of the following conditions is met:

• The licensee performs an initial in-person or teledentistry examination of the teeth and supporting structures of the new patient prior to beginning orthodontic treatment.
• The new patient provides the licensee with the portion of the dental record taken within the prior six months of an in-person or teledentistry examination of the teeth and supporting structures of the new patient prior to the licensee beginning orthodontic treatment.

SOURCE: Iowa Annotated Statute Sec. 153.24, (Accessed Dec. 2024).

The same laws and regulations that apply to a healthcare provider prescribing drugs, including controlled substances, by means of in-person contact with a patient shall apply to prescribing drugs, including controlled substances, by means of telemedicine.

SOURCE: KS Admin. Regs., Sec. 100-77-3. (Accessed Nov. 2024).

Telemedicine may be used to establish a valid provider-patient relationship.

SOURCE:  KS Statute Ann. § 40-2,212(b). (Accessed Nov. 2024).

“Legitimate medical purpose,” when used regarding the dispensing of a prescription drug, means that the prescription for the drug was issued with a valid preexisting patient-prescriber relationship rather than with a relationship established through an internet-based questionnaire.

SOURCE: KS Admin. Regs., Sec. 68-2-20(2). (Accessed Nov. 2024).

“Telepharmacy” means the practice of pharmacy by a pharmacist located in Kansas using telecommunications or other automations and technologies to deliver personalized, electronically documented, real-time pharmaceutical care to patients or their agents, who are located at sites other than where the pharmacist is located, including prescription dispensing and counseling and to oversee and supervise telepharmacy outlet operations.

A pharmacist shall be in attendance at the telepharmacy outlet by connecting to the telepharmacy outlet via computer link, video link and audio link or other functionally equivalent telecommunications equipment and shall be available to consult with and assist the pharmacy technician in performing activities.

Not later than January 1, 2023, the board shall adopt rules and regulations necessary to specify additional criteria for a managing pharmacy and telepharmacy outlet under this section, including, but not limited to:

Application requirements;

• structural, security, technology and equipment requirements;
• staffing, training and electronic supervision requirements;
• inventory record keeping and storage requirements;
• labeling requirements;
• establishment of policies and procedures;
• the number of telepharmacy outlets that may be operated by a supervising pharmacy;
• use of automated dispensing machines; and
• criteria for requesting exemptions or waivers from the requirements set forth in rules and regulations adopted under this subsection.

SOURCE: KS Statute Sec. 65-16, 130, (Accessed Nov. 2024).

Out-of-state physician practice

A physician practicing telemedicine in accordance with this subsection shall conduct an appropriate assessment and evaluation of the patient’s current condition and document the appropriate medical indication for any prescription issued.

SOURCE: KS Statute Ann. Sec. 65-28, 135, (Accessed Nov. 2024).

SOURCE: KY Revised Statutes § 311.597. (Accessed Nov. 2024).

“Good-faith prior examination,” as used in KRS Chapter 218A and for criminal prosecution only, means an in-person medical examination of the patient conducted by the prescribing practitioner or other health-care professional routinely relied upon in the ordinary course of his or her practice, at which time the patient is physically examined and a medical history of the patient is obtained. “In-person” includes telehealth examinations. This subsection shall not be applicable to hospice providers licensed pursuant to KRS Chapter 216B.

SOURCE: KY Revised Statute § 218A.010(18). (Accessed Nov. 2024).

A practitioner-patient relationship may commence via telehealth. An in-person initial meeting shall not be required unless the provider determines it is medically necessary to perform those services in person as set forth in KRS 211.336(2)(a). A licensed health care practitioner may represent the licensee at the initial meeting.

See rule for additional requirements.

SOURCE: KY 201 KAR 17:110. (Accessed Nov. 2024).

A physician performing or inducing an abortion shall be present in person and in the same room with the patient. The use of telehealth as defined in 304.17A-005 shall not be allowed in the performance of an abortion.

SOURCE: KY Revised Statute Sec. 311.728. (Accessed Nov. 2024).

Veterinarians

A VCPR shall not be established solely by telehealth means. In the absence of a VCPR, any advice provided through telehealth shall be general and not specific to a patient, diagnosis, or treatment. Veterinary telemedicine shall only be conducted within an existing VCPR, with the exception for advice given in an emergency care situation until that patient can be seen in person by a licensed veterinarian.

SOURCE: KY Revised Statute Sec. 321.185, (Accessed Nov. 2024).

Counselors

A counselor-client relationship may commence via distance counseling. An in-person meeting shall not be required unless the provider determines it is medically necessary to perform those services in person as established in KRS 211.336(2) (a). A licensee using distance counseling to deliver counseling services or who practices distance counseling shall, upon initial contact complete certain tasks (see regulation).

SOURCE: KY Admin Regulations Title 201 KAR 36:045, (Accessed Nov. 2024).

Controlled Substances – Medical Cannabis

A bona fide practitioner-patient relationship may be established following a referral from the patient’s primary care provider and may be maintained via telehealth. However, a bona fide practitioner-patient relationship shall not be established via telehealth.

An initial written certification for the use of medicinal cannabis shall be provided during the course of an in-person examination of the patient by the medicinal cannabis practitioner. Subsequent written certifications, including for the purpose of renewing a registry identification card, may be provided electronically or during the course of a telehealth consultation.

For the purpose of applying for a registry identification card, a written certification provided under this section shall be valid for a period of not more than sixty (60) days. The medicinal cannabis practitioner may renew a written certification for not more than three (3) additional periods of not more than sixty (60) days each. Thereafter, the medicinal cannabis practitioner may issue another certification to the patient only after an in-person examination or an examination conducted via telehealth of the patient by the medicinal cannabis practitioner.

SOURCE: KY Revised Statute Sec. 218B.050, (Accessed Nov. 2024).

Physicians utilizing telemedicine shall establish a proper physician-patient relationship by:

• verifying the identity of the individual requesting treatment. Appropriate contact and identifying information shall be made part of the medical record;
• conducting an appropriate examination. The examination does not require an in-person visit if the technology is sufficient to provide the physician the pertinent clinical information reasonably necessary to practice at an acceptable level of skill and safety;
• establishing a diagnoses through the use of accepted medical practices e.g., history, mental status, appropriate diagnostic and laboratory testing;
• discussing the diagnoses and risks and benefits of various treatment options;
• insuring the availability for appropriate follow-up care; and
• creating and/or maintaining a medical record

Telemedicine shall not be utilized by a physician with respect to any individual located in this state in the absence of a physician-patient relationship.

The practice of medicine by telemedicine, including the issuance of any prescription via electronic means shall be held to the same prevailing and usually accepted standards of medical practice as those in traditional (face-to-face) settings. An online, electronic or written mail message does not satisfy the standards of appropriate care.

A physician using telemedicine may be at any location at the time the services are provided. A patient receiving medical services by telemedicine may be in any location at the time that the services are received.

SOURCE: LA Admin. Code 46: XLV.7503-05. p. 249-250 (Accessed Nov. 2024).

No physician shall utilize telemedicine:

1. for the treatment of non-cancer related chronic or intractable pain, as set forth in §§6915-6923 of the board’s rules;
2. for the treatment of obesity, as set forth in §§6901-6913 of the board’s rules;
3. to authorize or order the prescription, dispensation or administration of any controlled substance unless;
   1. the physician has had at least one in-person visit with the patient within the past year; provided, however, the requirement for an in-person visit shall not apply to a physician who holds an unrestricted license to practice medicine in LA and who practices telemedicine upon any patient being treated at a healthcare facility that is required to be licensed pursuant to the laws of LA and which holds a current registration with the U.S. Drug Enforcement Administration;
   2. the prescription is issued for a legitimate medical purpose;
   3. the prescription is in conformity with the standard of care applicable to an in-person visit; and
   4. the prescription is permitted by and in conformity with all applicable state and federal laws and regulations.

The board may grant an exception to the limitations of §7513.C in an individual case that is supported by a physician’s written application stating how and why he or she proposes to deviate from §7513.C. If an exception is granted by the board it shall be stated in writing and specify the manner and extent to which the physician shall be authorized to depart from §7513.C.

SOURCE: LA Admin. Code 46: XLV.7513. p. 251 (Accessed Nov. 2024).

All of the following restrictions and authorizations apply to a physician who holds an unrestricted license to practice medicine from the board and who utilizes telehealth for any patient who is being treated at a healthcare facility that is required to be licensed pursuant to the laws of this state and which holds a current registration with the United States Drug Enforcement Administration:

• The physician shall use the same standard of care as if the healthcare services were provided in person.
• The physician may prescribe any controlled dangerous substance without necessity of conducting an appropriate in-person patient history or physical examination of the patient as otherwise would be required by R.S. 40:1223.4.
• The physician shall not be subject to any regulatory prohibition or restriction on the utilization of telehealth, including prohibitions or restrictions related to prescribing controlled dangerous substances, which are in any manner more restrictive than the prohibitions and restrictions that are otherwise applicable to the entire practice of medicine.

The physician may prescribe any controlled dangerous substance without necessity of conducting an appropriate in-person patient history or physical examination of the patient as otherwise would be required by R.S. 40:1223.4.

The physician shall not be subject to any regulatory prohibition or restriction on the utilization of telehealth, including prohibitions or restrictions related to prescribing controlled dangerous substances, which are in any manner more restrictive than the prohibitions and restrictions that are otherwise applicable to the entire practice of medicine.

SOURCE: LA Statute Sec. 37:1271.1, (Accessed Nov. 2024).

Except as otherwise provided in Paragraph (6) of this Subsection, a healthcare provider shall not be required to conduct an in-person patient history or physical examination of the patient before engaging in a telehealth encounter but shall provide a referral to a healthcare provider in this state or arrange for follow-up care in this state as necessary.

Except as authorized by R.S. 37:1271.1 or otherwise by rule promulgated by a state agency or professional or occupational licensing board or commission, no healthcare provider shall prescribe any controlled dangerous substance prior to conducting an appropriate in-person patient history or physical examination of the patient as determined by the appropriate state agency or professional or occupational licensing board or commission.

A healthcare provider may use interactive audio without the requirement of video if, after access and review of the patient’s medical records, the healthcare provider determines that he is able to meet the same standard of care as if the healthcare services were provided in person.

Creation of a record on each patient. The record shall be made available, upon request, to the state agency or professional or occupational licensing board or commission that regulates the practice of the healthcare provider.

SOURCE: LA Revised Statute 40:1223.4 (Accessed Nov. 2024).

Except as authorized by R.S. 37:1271.1 [see above] or otherwise by rule promulgated by the board, no physician practicing telemedicine pursuant to this Subsection shall prescribe any controlled dangerous substance prior to conducting an appropriate in-person patient history or physical examination of the patient as determined by the board.

SOURCE: LA Revised Statutes 37:1271(B)(3). (Accessed Nov. 2024).

Teledentistry

Controlled substances may not be prescribed via teledentistry except in emergency situations where the dentist determines:

• That immediate administration of the controlled substance is necessary for proper treatment of the intended ultimate user, and
• That no appropriate alternate treatment is available, including administration of a drug that is not a controlled substance.

In an emergency situation the prescription for a controlled substance must be limited to the amount adequate to treat the patient during the emergency period.

SOURCE: LA Admin. Code LAC 46:XXXIII.203 (Accessed Nov. 2024).

Board of Optometry

Evaluation, treatment, and consultation recommendations made in an optometric 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: LA Admin Code LAC 46:LI.509, (Accessed Nov. 2024).

Insurers may not place any restriction on the prescribing of medication through telehealth by a provider whose scope of practice includes prescribing medication that is more restrictive than any requirement in state and federal law for prescribing medication through in-person consultation.

The carrier shall require that a clinical evaluation is conducted either in person or through telehealth before a provider may write a prescription that is covered.

SOURCE: Maine Revised Statutes Annotated, Title 24-A, Sec. 4316 (Accessed Oct. 2024).

Board of Licensure in Medicine, State Board of Nursing, & Board of Osteopathic Licensure

A licensee who uses telehealth in providing health care shall establish a valid licensee-patient relationship with the person who receives telehealth services. The licensee-patient relationship begins when:

• The person with a health-related matter seeks assistance from the licensee;
• The licensee agrees to undertake examination, diagnosis, nursing assessment, consultation or treatment of the person; and
• The person agrees to receive health care services from the licensee whether or not there has been an in-person encounter between the licensee and the person.

A valid licensee-patient relationship may be established between a licensee who uses telehealth in providing health care and a patient who receives telehealth services through any of the following circumstances:

• Consultation with another licensee. Through consultation with another licensee (or other health care provider) who has an established relationship with the patient upon agreement to participate in, or supervise, the patient’s care; or
• Telehealth encounter. Through telehealth, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telehealth practice guidelines that address the clinical and technological aspects of telehealth.

Medical History and Physical Examination

Generally a physician, physician assistant, and advanced practice registered nurse shall perform an in-person clinical interview and physical examination for each patient. However, the clinical interview and physical examination may not be in-person if the technology utilized in a telehealth encounter is sufficient to establish an informed diagnosis as though the clinical interview and clinician examination had been performed in-person. Prior to providing treatment, including issuing prescriptions, electronically or otherwise, a licensee who uses telehealth in providing health care shall interview the patient to collect the relevant medical history and perform a pertinent physical examination as defined by the standard of care for the purpose of the visit, when clinically necessary, sufficient for the diagnosis and treatment of the patient. An internet questionnaire that is a static set of questions provided to the patient, to which the patient responds with a static set of answers, in contrast to an adaptive interactive and responsive online interview, does not constitute an acceptable clinical interview and physical examination for the provision of treatment, including issuance of prescriptions, electronically or otherwise, by the licensee.

Prescribing Based Solely on an Internet Request, Internet Questionnaire or a Telephonic Interview Prohibited

Prescribing to a patient based solely on an Internet request or Internet questionnaire (i.e. static questionnaire provided to a patient, to which the patient responds with a static set of answers, in contrast to an adaptive, interactive and responsive online interview) is prohibited. Absent a valid licensee-patient relationship, a licensee’s prescribing to a patient based solely on a telephonic evaluation is prohibited, with the exception of the circumstances described in Section 3, subsection 20, subparagraph A(3) of this rule.

Telehealth technologies, where prescribing may be contemplated, must implement measures to uphold patient safety in the absence of traditional physical examination. Such measures should guarantee that the identity of the patient and provider is clearly established and that detailed documentation for the clinical evaluation and resulting prescription is required. Measures to assure informed, accurate and error prevention prescribing practices (e.g. integration with e-Prescription systems) are encouraged. All applicable law shall be complied with.

Prescribing medications, in-person or via telehealth, is at the professional discretion of the licensee. The licensee prescribing via telehealth must ensure that the clinical evaluation, indication, appropriateness, and safety consideration for the resulting prescription are appropriately documented and meet the applicable standard of care. Consequently, prescriptions via telehealth carry the same accountability as prescriptions delivered during an encounter in person. However, where such measures are upheld, and the appropriate clinical consideration is carried out and documented, licensees may exercise their judgment and prescribe medications as part of telehealth encounters.

Circumstances Where the Standard of Care May Not Require A Licensee to Personally Interview or Conduct a Nursing Assessment or Physical Examination of a Patient

Under the following circumstances, whether or not such circumstances involve the use of telehealth in providing health care, a licensee may treat a patient who has not been personally interviewed, examined, assessed and diagnosed by the licensee:

1. Situations in which the licensee prescribed medications on a short-term basis for a new patient and has scheduled an appointment to personally examine the patient;
2. For institutional settings, including writing initial admission orders for a newly hospitalized patient;
3. Call situations in which a licensee is taking call for another licensee who has an established licensee-patient relationship with the patient;
4. Cross-coverage situations in which a licensee is taking call for another licensee who has an established licensee-patient relationship with the patient;
5. Situations in which the patient has been examined in person by an advanced practice registered nurse or a physician assistant or other licensed practitioner with whom the licensee has a supervisory or collaborative relationship;
6. Emergency situations in which the life or health of the patient is in imminent danger;
7. Emergency situations that constitute an immediate threat to the public health including, but not limited to, empiric treatment or prophylaxis to prevent or control an infectious disease outbreak;
8. Situations in which the licensee has diagnosed a sexually transmitted disease in a patient and the licensee prescribes or dispenses antibiotics to the patient’s named sexual partner(s) for the treatment of the sexually transmitted disease as recommended by the U.S. Centers for Disease Control and Prevention;
9. Situations where the patients are in a licensed or certified long term care facility, nursing facility, residential care facility, intermediate care facility, assisted living facility or hospice setting and doing so is within the practice standards for that setting; and
10. Circumstances in which a patient’s treating clinician determines that a radiology or pathology consultation is warranted

SOURCE: ME Regulation Sec. 02-373 Ch. 11, 02-380; Ch. 11, 02-383 Ch. 11. (Accessed Oct. 2024).

 Teledentistry

Prior to establishing a patient relationship as defined by Board Rules, Chapter 1(I)(N) and prior to providing teledentistry services, a dentist, denturist, or a dental hygienist (when the dental hygienist is providing services as an independent practice dental hygienist, public health dental hygienist, dental therapist, or and provisional dental therapist) must take reasonable steps to verify the patient’s physical location.

Practice Requirements Specific to Prescribing Medications (Dentistry)

• The validity when prescribing medication to a patient as a result of a teledentistry service is determined by the same standards that would apply when prescribing medication to a patient in an in-person setting.
• This section does not limit the professional judgment, discretion or decision-making authority when prescribing medication to a patient. It is the expectation that the standard of care is met with demonstrated professional practice standards and judgment, consistent with all applicable statutes and rules when prescribing medication as a result of a teledentistry service.
• Prescribing medication must be for a legitimate dental purpose as part of an established patient relationship and must meet all other applicable laws and rules governing prescribing practices, including the use of controlled substances.

SOURCE: ME Regulation Sec. 02-313 Ch. 15,  (Accessed Oct. 2024).

Optometrists

“Optometrist-patient relationship” includes the relationship established between a licensee who uses telehealth in providing optometric care and a patient who receives telehealth services through consultation with another licensee or other health care provider who has an established relationship with the patient upon agreement to participate in, or supervise, the patient’s care through telehealth, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telehealth practice guidelines that address the clinical and technological aspects of telemedicine.

SOURCE: ME Statute Title 32, Ch. 151, Subch. 1, 19601, (Accessed Oct. 2024).

A health care practitioner may establish a practitioner-patient relationship through either a synchronous telehealth interaction or an asynchronous telehealth interaction, if the health care practitioner:

• Verifies the identity of the patient receiving health care services through telehealth;
• Discloses to the patient the health care practitioner’s name, contact information, and type of health occupation license held by the health care practitioner; and
• Obtains oral or written consent from the patient or from the patient’s parent or guardian.

A health care practitioner shall perform a clinical evaluation that is appropriate for the patient and the condition with which the patient presents before providing treatment or issuing a prescription through telehealth. Synchronous or asynchronous telehealth interaction may be used for the clinical evaluation.

A health care practitioner may not prescribe a Schedule II controlled substance that is an opiate for the treatment of pain through telehealth unless:

• The individual receiving the prescription is a patient in a health care facility; or
• The governor has declared a state of emergency due to a catastrophic health emergency

A health care practitioner who prescribes a controlled substance through telehealth is subject to federal and state prescribing laws.

SOURCE: MD Code Health Occupations Sec. 1-1002, Section 1-1003. (Accessed Nov. 2024).

Before performing telehealth services, a telehealth practitioner shall develop and follow a procedure to:

• Verify the identification of the patient receiving telehealth services;
• Except for interpretive services, obtain oral or written acknowledgement from a patient or person in interest as defined by Health-General Article, §4-301(m), Annotated Code of Maryland, to perform telehealth services;
• Prevent access to data by unauthorized persons through encryption or other means;
• Notify patients in the event of a data breach;
• Ensure that the telehealth practitioner provides a secure and private telehealth connection that complies with federal and state privacy laws; and
• Establish safety protocols to be used in the case of an emergency.

Except when providing store and forward telehealth services, remote patient monitoring, or other asynchronous telehealth services, a telehealth practitioner shall:

• Obtain or confirm an alternative method of contacting the patient in case of a technological failure;
• Confirm whether the patient is in Maryland and identify the practice setting in which the patient is located;
• For an initial patient-telehealth practitioner interaction only, disclose the telehealth practitioner’s name, contact information, and medical specialty; and
• Identify all individuals present at each location and confirm they are allowed to hear personal health information.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.32.05.04. (Accessed Nov. 2024).

 A telehealth practitioner shall perform a synchronous, audio-visual patient evaluation adequate to establish diagnoses and identify underlying conditions or contraindications to recommended treatment options before providing treatment or prescribing medication. A telehealth practitioner may use surrogate examiner; or a patient evaluation performed by another licensed health care practitioner providing coverage.

These requirements do not apply to:

• Interpretive services where a prior patient evaluation was performed by another provider;
• Remote patient monitoring; or
• Asynchronous telehealth services for a patient who has had a prior synchronous, audio-visual telehealth patient evaluation or in-person patient evaluation that complies with the requirements of this regulation.

SOURCE:  Code of Maryland Admin. Regs. Sec. 10.32.05.05. (Accessed Nov. 2024).

A telehealth practitioner may not treat a patient or prescribe medication based solely on an online questionnaire.

A telehealth practitioner may not prescribe opioids for the treatment of pain through telehealth except if the patient is in a health care facility as defined in Health-General Article, §19-114(d)(1), Annotated Code of Maryland.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.32.05.06. (Accessed Nov. 2024).

Audiologists, Hearing Aid Dispensers, Speech-Language Pathologists, Music Therapists

Except when providing asynchronous telehealth services or remote patient monitoring, a telehealth practitioner shall:

• Perform a clinical patient evaluation adequate to establish a diagnosis and identify underlying conditions or contraindications to recommended treatment options before providing treatment or services through telehealth; and
• If clinically appropriate for the patient, provide or refer a patient to:
  • In-person health care services; or
  • Another type of telehealth service.

If the evaluation is adequate to comply with §A of this regulation, a telehealth practitioner may use:

• Telehealth devices;
• Live synchronous audio-visual communication;
• Other methods of performing a patient examination remotely; or
• A patient evaluation performed by another licensed health care practitioner providing coverage.

A telehealth practitioner shall comply with all applicable laws and regulations governing referrals, testing, and evaluation of patients including, but not limited to, the requirements of:

• COMAR 10.41.08; and
• Health Occupations Article, §2-314.1, Annotated Code of Maryland.

A telehealth practitioner may not treat a patient based solely on an online questionnaire.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.41.06.05. (Accessed Nov. 2024).

Podiatrists

Except when providing asynchronous telehealth services or remote patient monitoring, a telehealth practitioner shall:

• Perform a clinical patient evaluation adequate to establish a diagnosis and identify underlying conditions or contraindications to recommended treatment options before providing treatment or prescribing medication through telehealth; and
• If clinically appropriate for the patient, provide or refer a patient to:
  • In-person health care services; or
  • Another type of telehealth service.

If the evaluation is adequate to comply with §A of this regulation, a telehealth practitioner may use:

• Telehealth devices;
• Live synchronous audio-visual communication;
• Other methods of performing a medical examination remotely; or
• A patient evaluation performed by another licensed health care practitioner providing coverage.

A telehealth practitioner may not treat a patient or issue a prescription based solely on an online questionnaire.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.40.12.05. (Accessed Nov. 2024).

Occupational and Physical Therapists

An occupational or physical therapist who practices telehealth shall:

• Perform a synchronous or asynchronous clinical patient evaluation that is appropriate for the patient and the condition with which the patient presents before providing a treatment plan through telehealth; and
• If clinically appropriate for the patient, provide or refer a patient to:
  • In-person treatment; or
  • Another type of telehealth service.

A telehealth practitioner may not treat a patient based solely on an online questionnaire.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.46.08.05; 10.38.13.05. (Accessed Nov. 2024).

Massage Therapists

A telehealth practitioner shall:

• Perform a synchronous or asynchronous clinical client evaluation that is appropriate for the client and the condition with which the client presents before providing health care services through telehealth; and
• If clinically appropriate for the client, provide or refer a client to:
  • In-person treatment; or
  • Another type of telehealth service.

A telehealth practitioner may not treat a client based solely on an online questionnaire.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.65.10.05. (Accessed Nov. 2024).

Chiropractors

A telehealth practitioner shall:

• Perform a synchronous or asynchronous clinical patient evaluation that is appropriate for the patient and the condition with which the patient presents before providing a treatment plan through telehealth; and
• If clinically appropriate for the patient, provide or refer a patient to:
  • In-person treatment; or
  • Another type of telehealth service.

A telehealth practitioner may not treat a patient based solely on an online questionnaire.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.43.17.05. (Accessed Nov. 2024).

Professional Counselors and Therapists and Social Workers

A teletherapy practitioner shall:

• Perform a synchronous or asynchronous clinical client evaluation that is appropriate for the client and the condition with which the client presents before providing treatment or services through teletherapy; and
• If clinically appropriate for the client, provide or refer a client to:
  • In-person treatment; or
  • Another type of teletherapy service.

A teletherapy practitioner may not treat a client based solely on an online questionnaire.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.58.06.05; 10.42.10.05. (Accessed Nov. 2024).

Dieticians

A dietician who practices telehealth shall:

• Perform a synchronous or asynchronous clinical patient evaluation that is appropriate for the patient and the condition with which the patient presents before providing a treatment plan through telehealth; and
• If clinically appropriate for the patient, provide or refer a patient to:
  • In-person treatment; or
  • Another type of telehealth service.

A telehealth practitioner may not treat a patient based solely on an online questionnaire.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.56.10.05. (Accessed Nov. 2024).

Optometrists

Subject to the provisions of Health Occupations Article, §11-208, Annotated Code of Maryland, a telehealth practitioner shall:

• Perform a synchronous or asynchronous clinical patient evaluation that is appropriate for the patient and the condition with which the patient presents before providing treatment or issuing a prescription through telehealth; and
• If clinically appropriate for the patient, provide or refer a patient to:
  • In-person health care services; or
  • Another type of telehealth service.

A telehealth practitioner may not treat a patient or issue a prescription based solely on a static online questionnaire.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.28.01.05. (Accessed Nov. 2024).

Psychologists

Before engaging in the practice of psychology using telepsychology, a psychologist or psychology associate shall evaluate the client to determine that delivery of telepsychology is appropriate considering at least the following factors:

• The client’s:
  • Diagnosis;
  • Symptoms;
  • Medical and psychological history; and
  • Preference for receiving services via telepsychology; and
• The nature of the services to be provided, including anticipated:
  • Benefits;
  • Risks; and
  • Constraints resulting from their delivery via telepsychology.

The client evaluation set forth in §A of this regulation shall take place at an initial in-person session, unless the psychologist or psychology associate documents in the record the reason for not meeting in person.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.36.10.05. (Accessed Nov. 2024).

The practice of medicine shall not require a face-to-face encounter between the physician and the patient prior to health care delivery via telemedicine.  The standard of care applicable to the physician is the same whether the patient is seen in-person or through telemedicine.

SOURCE: “Policy on Telemedicine,” Board of Registration in Medicine.  Oct. 6, 2022. (Accessed Dec. 2024).

To be valid, a prescription must be issued in the usual course of the physician’s professional practice, and within a physician-patient relationship that is for the purpose of maintaining the patient’s well-being.  In addition, the physician must conform to certain minimum standards of patient care, such as taking an adequate medical history, doing a physical and/or mental status examination and documenting the findings. This rule applies to any prescription, issued by any means, including the Internet or other electronic process.  Prescribing that does not meet these requirements is unlawful.

SOURCE: Prescribing Practices Policy and Guidelines Policy 15-05 (Adopted Oct. 8, 2015), (Amended June 15, 2023). (Accessed Dec. 2024).

A prescription for a controlled substance to be valid shall be issued for a legitimate medical purpose by a practitioner acting in the usual course of his professional practice.…An order purporting to be a prescription issued not in the usual course of professional treatment or in legitimate and authorized research is not a prescription within the meaning and intent [of this act]. M.G.L. c. 94C, Section 19(a)

This statutory language sets forth the minimum requirements that must be met in order for a prescription to be valid in the Commonwealth. To satisfy the requirement that a prescription be issued by a practitioner in the usual course of his professional practice, there must be a physician-patient relationship that is for the purpose of maintaining the patient’s well-being and the physician must conform to certain minimum norms and standards for the care of patients, such as taking an adequate medical history and conducting an appropriate physical and/or mental status examination and recording the results. Issuance of a prescription, by any means, including the Internet or other electronic process, that does not meet these requirements is therefore unlawful.

SOURCE: “Internet Prescribing,” MA Board of Registration in Medicine.  Dec. 17, 2003, (Accessed Dec. 2024).

Cannabis Control Commission

Clinical Visit means an in-person or telehealth visit during which a Certifying Healthcare Provider establishes a Bona Fide Healthcare Provider Patient Relationship and conducts a full assessment of the Patient’s medical history and current medical condition, including the Debilitating Medical Condition, and explains the potential benefits and risks of Marijuana use. A Clinical Visit for an initial Certificate of Registration shall be performed in-person or upon request of the patient, via a telehealth visit that includes a synchronous face-to-face encounter between the Certifying Healthcare Provider and patient. Synchronous telehealth happens in live, real-time settings where the patient interacts with a provider, usually via phone or video.

SOURCE: MA Regulations, Cannabis Control Commission, Ch. 935 CMR 501.002. (Accessed Dec. 2024).

• Except as otherwise authorized under section 5110, 17744a, or 17744b, if the prescriber is not a veterinarian, that the prescription was issued pursuant to an existing prescriber-patient relationship.
• That the prescription is authentic.
• That the prescribed drug is appropriate and necessary for the treatment of an acute, chronic, or recurrent condition..

A pharmacist or a prescriber shall dispense a drug or device pursuant to a prescription only if the prescription falls within the scope of practice of the prescriber.

A pharmacist shall not knowingly dispense a drug or device pursuant to a prescription after the death of the prescriber or patient.

A pharmacist shall not dispense a drug or device pursuant to a prescription transmitted by facsimile or created in electronic format and printed out for use by the patient unless the document is manually signed by the prescriber.

See statute for additional requirements.

SOURCE: MI Compiled Laws Sec. 333.17751(2)(a).  (Accessed Dec. 2024).

A licensed prescriber shall not prescribe a controlled substance listed in schedules 2 to 5 unless the prescriber is in a bona fide prescriber-patient relationship with the patient for whom the controlled substance is being prescribed.

If a licensed prescriber prescribes a controlled substance under this subsection, the prescriber shall provide follow-up care to the patient to monitor the efficacy of the use of the controlled substance as a treatment of the patient’s medical condition. If the licensed prescriber is unable to provide follow-up care, he or she shall refer the patient to the patient’s primary care provider for follow-up care or, if the patient does not have a primary care provider, he or she shall refer the patient to another licensed prescriber who is geographically accessible to the patient for follow-up care.

SOURCE:  MI Compiled Laws Sec. 333.7303a. (Accessed Dec. 2024). 

A health professional providing telehealth service to a patient may prescribe the patient a drug if both the following are met:

• The health professional is a prescriber who is acting within the scope of his or her practice; and
• If the health professional is prescribing a controlled substance, the health professional must meet the requirements of this act applicable to that health professional for prescribing a controlled substance.

A health professional who prescribes a drug under subsection (1) shall comply with both of the following:

• If the health professional considers it medically necessary, he or she shall provide the patient with a referral for other health care services that are geographically accessible to the patient, including, but not limited to, emergency services.
• After providing a telehealth service, the health professional, or a health professional who is acting under the delegation of the delegating health professional, shall make himself or herself available to provide follow-up health care services to the patient or refer the patient to another health professional for follow-up health care services.

SOURCE:  MI Compiled Laws, Sec. 333.16285. (Accessed Dec. 2024).

Podiatric Medicine

A podiatrist providing a telehealth service may prescribe a drug if the podiatrist is a prescriber acting within the scope of his or her practice and in compliance with section 16285 of the code, MCL 333.16285, if he or she does both of the following:

• If medically necessary, refers the patient to a provider that is geographically accessible to the patient.
• Makes himself or herself available to provide follow up care services to the patient, or to refer the patient to another provider, for follow up care.

A podiatrist providing any telehealth service must do both of the following:

• Act within the scope of his or her practice.  
• Exercise the same standard of care applicable to a traditional, in-person health care service.

SOURCE: MI Administrative Code 338.8145, (Accessed Dec. 2024).

SOURCE: MI Administrative Code R 338.4901a, (Accessed Dec. 2024).

Dentistry

A licensee who is authorized to prescribe may prescribe a drug during a telehealth service if the licensee complies with all of the following: 

“Telehealth” has the meaning given in section 62A.673, subdivision 2, paragraph (h).

A physician-patient relationship may be established through telehealth.

A physician providing health care services by telehealth in this state shall be held to the same standards of practice and conduct as provided in this chapter for in-person health care services.

SOURCE: MN Statute 147.033. (Accessed Nov. 2024).

A prescription drug order for the following drugs is not valid, unless it can be established that the prescription drug order was based on a documented patient evaluation, including an examination, adequate to establish a diagnosis and identify underlying conditions and contraindications to treatment:

• Controlled substance drugs listed in section 152.02, subdivisions 3 to 5;
• Drugs defined by the Board of Pharmacy as controlled substances under section 152.02, subdivisions 7, 8, and 12;
• Muscle relaxants;
• Centrally acting analgesics with opioid activity;
• Drugs containing butalbital; or
• Phosphodiesterase type 5 inhibitors when used to treat erectile dysfunction.

The requirement for an examination shall be met if:

An in-person examination has been completed in any of the following circumstances:

• The prescribing practitioner examines the patient at the time the prescription or drug order is issued;
• The prescribing practitioner has performed a prior examination of the patient;
• Another prescribing practitioner practicing within the same group or clinic as the prescribing practitioner has examined the patient;
• A consulting practitioner to whom the prescribing practitioner has referred the patient has examined the patient; or
• The referring practitioner has performed an examination in the case of a consultant practitioner issuing a prescription or drug order when providing services by means of telehealth; or

The prescription order is for a drug listed in paragraph (d), clause (6), or for substance use disorder treatment with medications for opioid use disorder, and the prescribing practitioner has completed an examination of the patient via telehealth as defined in section 62A.673, subdivision 2, paragraph (h).

Nothing in paragraph (d) or (e) prohibits a licensed practitioner from prescribing a drug through the use of a guideline or protocol pursuant to paragraph (a).

SOURCE: MN Statute Sec. 151.37 Subd. 2(d) & (e).(Accessed Nov. 2024).

Optometry

For the purposes of a provider prescribing ophthalmic goods to a patient, the provider must establish a provider-patient relationship through an examination pursuant to paragraph (c).

An examination meets the requirements of paragraph (b) if it takes place:

1. In person;
2. through face-to-face interactive, two-way, real-time communication; or
3. through store-and-forward technologies when all of the following conditions are met:
   1. The provider obtains an updated medical history and makes a diagnosis at the time of prescribing;
   2. the provider conforms to the standard of care expected of in-person care as appropriate to the patient’s age and presenting condition, including when the standard of care requires the use of diagnostic testing and performance of a physical examination, which may be carried out through the use of peripheral devices appropriate to the patient’s condition;
   3. the ophthalmic prescription is not determined solely by use of an online questionnaire;
   4. the provider is licensed and authorized to issue an ophthalmic prescription in MN; and
   5. upon request, the provider provides patient records in a timely manner in accordance with state and federal requirements.

This subdivision does not apply to the sale of over-the-counter eyeglasses, also known as readers, that are not designed to address the visual needs of the individual wearer.

SOURCE:  MN Statute Sec. 145.713, Subd. 4, (Accessed Nov. 2024).

Medical Cannabis

Before issuing a written certification of qualifying condition, a health care practitioner must: …

• assess the patient’s medical history and current medical condition, which includes:
  • an in-person physical examination of the patient appropriate to confirm the diagnosis of a qualifying medical condition. This examination must not be performed by remote means, including telehealth or via the Internet; and
  • developing a treatment plan for the patient

SOURCE: MN Administrative Rule. 4770.4014, Subpart 2(B)(1). (Accessed Nov. 2024).

Controlled Substances – Medical Cannabis

A health care practitioner may utilize telehealth, as defined in section 62A.673, subdivision 2, for certifications and recertifications.

SOURCE: MN Statute Sec. 152.28, (Accessed Nov. 2024).

A prescription for a controlled substance based solely on a consumer’s completion of an online medical questionnaire is not a valid prescription.

SOURCE: MS Code Annotated 41-29-137. (Accessed Aug. 2024).

Subject to the limitations of the license under which the individual is practicing, a health care practitioner licensed in this state may prescribe, dispense, or administer drugs or medical supplies, or otherwise provide treatment recommendations to a patient after having performed an appropriate examination of the patient either in person or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically. Treatment recommendations made via electronic means, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional provider-patient settings.

SOURCE: MS Code Sec. 41-127-1, (Accessed Aug. 2024).

Patients with Terminal Disease Pain 

The medical director of a licensed hospice, in his or her discretion, may prescribe controlled substances for a patient of the hospice for terminal disease pain without having an in-person face-to-face visit with the patient before issuing the prescription. The provisions of this section supersede the provisions of any rule or regulation of a licensing agency to the contrary.

SOURCE: MS Code Sec. 41-29-137.1 (Accessed Aug. 2024).

Practice of Medicine

In order to practice any form of telemedicine, as defined in R.5.1, a valid “physician patient relationship” must be established. The elements of this valid relationship are:

• verify that the person requesting the medical treatment is in fact who they claim to be;
• conducting an appropriate history and physical examination of the patient that meets the applicable standard of care;
• establishing a diagnosis through the use of accepted medical practices, i.e., a patient history, mental status exam, physical exam and appropriate diagnostic and laboratory testing;
• discussing with the patient the diagnosis, risks and benefits of various treatment options to obtain informed consent;
• insuring the availability of appropriate follow-up care; and
• maintaining a complete medical record available to patient and other treating health care providers.

Providers using telemedicine technologies to provide medical care to patients located in Mississippi must provide an appropriate examination prior to diagnosis and treatment of the patient. However, this exam need not be in person if the technology is sufficient to provide the same information to the physician as if the exam had been performed face to face.

Store-and-Forward Transfer Technology may be used to enhance, but never replace, real-time provider-patient interaction. Provider-patient interaction may be audio-visual or audio only where medically appropriate.

Other exams may be appropriate if a licensed health care provider is on site with the patient and is able to provide various physical findings that the physician needs to complete an adequate assessment. However, a simple questionnaire without an appropriate exam is in violation of this policy and may subject the physician to discipline by the Board.

Any physician utilizing the automated dispensary will be responsible for the proper maintenance and inventory/accountability requirements as if the physician were personally dispensing the medications to the patient from his or her stock in their personal practice, as required in Rule 1.9 of Part 2640. An automated dispensary may not dispense controlled substances, and refills of medications may not be issued without a follow-up visit with the physician.

Any telemedicine service devices or systems which contain automated dispensaries, containing medications ordered and maintained by physician licensees, shall be subject to the oversight of the Board and the Mississippi Board of Pharmacy, as stated in Part 2640, Rule 1.9, and may not operate in this state until approved by both Boards.

SOURCE: MS Admin. Code Title 30, Part 2635, Rule 5.4 to 5, & 9. (Accessed Aug. 2024).

Prescriptions may not be written outside of a valid licensee-patient relationship. While not all of the elements in subsection A are necessary each time a prescription is authorized (e.g., via appropriate telemedicine as defined in Rule 5.5 of Part 2635, calling in refills, taking call for a practice partner for short term care, etc.), all initial encounters, and at reasonable intervals thereafter, should conform to this rule and be done pursuant to a valid licensee-patient relationship. The elements of this valid relationship are: …

• conducting an appropriate history and physical examination of the patient that meets the applicable standard of care, which as previously stated may also be accomplished through appropriate telemedicine as defined in Part 2635 Rule 5.5

Licensees must not prescribe, administer or dispense any legend drug; any controlled substance; or any drug having addiction-forming or addiction-sustaining liability without a good faith prior examination and medical indication. A determination as to whether a “good faith prior examination and medical indication” exists depends upon the facts and circumstances in each case. One of the primary roles of a physician is to elicit detailed information about the signs and symptoms which a patient presents in order that he or she may recommend a course of treatment to relieve the symptoms and cure the patient of his or her ailment or maintain him or her in an apparent state of good health. In order for a licensee to achieve a reasonable diagnosis and treatment plan, a history and physical examination consistent with the nature of the complaint are necessary. The importance of these aspects of proper medical practice cannot be over emphasized. The paramount importance of a complete medical history in establishing a correct diagnosis is well established. Standards of proper medical practice require that, upon any encounter with a patient, in order to establish proper diagnosis and regimen of treatment, a licensee must take three steps: (a) take and record an appropriate medical history, (b) carry out an appropriate physical examination, and (c) record the results. The observance of these principles is an integral component of the “course of legitimate professional practice.”

Some of the factors used in determining the presence or absence of “good faith” may include, but are not limited to:

• the quality and extent of the documented history and physical exam, which may also be accomplished through appropriate telemedicine as defined in Part 2635 Rule 5.5…

SOURCE: MS Admin Code Title 30, Part 2640, Rule 1.4 and 1.11, (Accessed Aug. 2024).

Optometry

The use of eye and vision telehealth services is not appropriate for establishing the doctor-patient relationship, for an initial diagnosis, as a replacement for recommended face-to-face interactions. It is therefore mandated that the doctor-patient relationship begin with an initial face-to-face encounter.

The standard of care must remain the same regardless of whether eye and vision telehealth services are provided in-person, remotely, via telehealth, or through any combination thereof. Doctors of optometry may not waive this obligation, or require patients to waive their right to receive the established standard of care in the state of Mississippi.

Eye and vision telehealth services cannot, based on current technologies and uses, replace an in-person comprehensive eye examination provided by an eye doctor. Eye and vision telehealth services provided must be consistent with and in compliance with existing rules and regulations of practice established in the State of Mississippi. In order to protect and insure patient safety, the Board recommends the use of only technology approved by the Food and Drug Administration, designed specifically for use in optometric care.

During telehealth encounters the patient must be in the presence of an onsite health provider.

An Established Treatment Site or distant site Mississippi licensed health care provider means a person licensed to provide health care to patients in Mississippi.

During telehealth encounters a Mississippi licensed optometrist must be present either onsite or distant site or both.

“Bona-fide practitioner-patient relationship” means:

• A certifying practitioner and patient have a treatment or consulting relationship, during the course of which the certifying practitioner, within his or her scope of practice, has completed an in-person assessment of the patient’s medical history and current mental health and medical condition and has documented their certification in the patient’s medical records;
• The certifying practitioner has consulted in person with the patient with respect to the patient’s debilitating medical condition; and
• The certifying practitioner is available to or offers to provide follow-up care and treatment to the patient.

SOURCE: MS Rules and Regulations, Title 30 Part 2901 Chapters 1-11.6, 12.2 Part 2901 (Accessed Aug. 2024).

Occupational Therapy

An occupational therapist using telehealth technologies to deliver health-care services to a patient must, prior to diagnosis and treatment, establish a provider-patient relationship by one of the following methods:

• The occupational therapist has previously conducted an in-person examination for the current condition requiring treatment and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals;
• The occupational therapist personally knows the patient and the patient’s relevant health status through an ongoing personal or professional relationship and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals;
• The treatment is provided by an occupational therapist in consultation with or upon referral by, another occupational therapist who has an ongoing relationship with the patient and who has agreed to supervise the patient’s treatment, including follow-up care;
• An on-call or cross-coverage arrangement exists with the patient’s regular treating occupational therapist who has established a professional relationship with the patient.

An appropriate occupational therapy evaluation may be composed of multiple components, tests, or measurement tools. It is the responsibility of the evaluating occupational therapist to select and utilize evaluation components that are appropriate and reliable to administer via telehealth.

See regulations for additional requirements.

SOURCE: Title 15, Part 19, Subpart 60, Rule 8.1.5 (Accessed Aug. 2024).

Signing a blank prescription form; or dispensing, prescribing, administering or otherwise distributing any drug, controlled substance or other treatment without sufficient examination including failing to establish a valid physician-patient relationship pursuant to section 334.108, or for other than medically accepted therapeutic or experimental or investigative purposes duly authorized by a state or federal agency, or not in the course of professional practice, or not in good faith to relieve pain and suffering, or not to cure an ailment, physical infirmity or disease, except as authorized in section 334.104.

SOURCE: MO Revised Statutes § 334.100(4)(h). (Accessed Sept. 2024).

A telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

• In order to establish a physician-patient relationship through telemedicine:
  • The technology utilized shall be sufficient to establish an informed diagnosis as though the medical interview and physical examination has been performed in person; and
  • Prior to providing treatment, including issuing prescriptions or physician certifications under Article XIV of the Missouri Constitution, a physician who uses telemedicine shall interview the patient, collect or review relevant medical history, and perform an examination sufficient for the diagnosis and treatment of the patient.  A questionnaire completed by the patient, whether via the internet or telephone, does not constitute an acceptable medical interview and examination for the provision of treatment by telehealth.

SOURCE: MO Revised Statute Ch. 191 Sec. 191.1146. (Accessed Sept. 2024).

Prior to prescribing any drug, controlled substance, or other treatment through telemedicine, as defined in section 191.1145, or the internet, a physician shall establish a valid physician-patient relationship as described in section 191.1146.  This relationship shall include:

• Obtaining a reliable medical history and performing a physical examination of the patient, adequate to establish the diagnosis for which the drug is being prescribed and to identify underlying conditions or contraindications to the treatment recommended or provided;
• Having sufficient dialogue with the patient regarding treatment options and the risks and benefits of treatment or treatments;
• If appropriate, following up with the patient to assess the therapeutic outcome;
• Maintaining a contemporaneous medical record that is readily available to the patient and, subject to the patient’s consent, to the patient’s other health care professionals; and
• Maintaining the electronic prescription information as part of the patient’s medical record.

The requirements of subsection 1 (see above) may be satisfied by the prescribing physician’s designee when treatment is provided in:

• A hospital;
• A hospice program;
• Home health services provided by a home health agency;
• Accordance with a collaborative practice agreement;
• Conjunction with a physician assistant licensed;
• Conjunction with an assistant physician;
• Consultation with another physician who has an ongoing physician-patient relationship with the patient, and who has agreed to supervise the patient’s treatment, including use of any prescribed medications; or
• On-call or cross-coverage situations.

No health care provider, as defined in section 376.1350, shall prescribe any drug, controlled substance, or other treatment to a patient based solely on an evaluation over the telephone; except that, a physician or such physician’s on-call designee, or an advanced practice registered nurse, a physician assistant, or an assistant physician in a collaborative practice arrangement with such physician, may prescribe any drug, controlled substance, or other treatment that is within his or her scope of practice to a patient based solely on a telephone evaluation if a previously established and ongoing physician-patient relationship exists between such physician and the patient being treated.

No health care provider shall prescribe any drug, controlled substance, or other treatment to a patient based solely on an internet request or an internet questionnaire.

SOURCE: MO Revised Statute Sec. 334.108. (Accessed Sept. 2024).

 “Remote dispensing site pharmacy”, any location in this state where the practice of pharmacy occurs and that is licensed as a pharmacy to dispense prescription drugs and is staffed by one or more qualified pharmacy technicians, as defined by the board, or intern pharmacists, whose activities are supervised by a pharmacist at a supervising pharmacy through a continuous real-time audio and video link.  “Remote dispensing site pharmacy” does not include the office of a dispensing prescriber or an automated device.

A remote dispensing site pharmacy shall be located at least ten miles from an existing retail pharmacy unless:

• The remote dispensing site pharmacy is part of a community mental health center, federally qualified health center, rural health clinic, or outpatient clinic setting; or
• An applicant of a proposed remote dispensing site pharmacy demonstrates to the board how the proposed remote dispensing site pharmacy will promote public health.

SOURCE: MO Revised Statutes Sec. 338.215, (Accessed Sept. 2024).

HealthNet Medicaid Program

SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330, (Accessed Sept. 2024).

Mental Health – Division of Behavioral Health Community Treatment Program

For purposes of the provision of all services via telemedicine and audio-only, the provider-patient relationship may be established by the following:

• An in-person encounter through a medical interview and physical examination; or
• Consultation with another health care professional, or that health care professional’s delegate, who has an established relationship with the patient and an agreement with the health care professional to participate in the individual’s care; or
• A telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

In order to establish a provider-patient relationship via telemedicine and/or audio-only for all services:

• The technology utilized shall be sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed in person; and
• Prior to providing treatment, including issuing prescriptions and physician certifications under Article XIV of the Missouri Constitution, a physician who uses telemedicine shall interview the patient, collect or review relevant medical history, and perform an examination sufficient for diagnosis and treatment of the patient. A questionnaire completed by the patient, whether via the telephone or internet, does not constitute a medical interview and examination for provision of treatment via telemedicine.

In-Person Requirements Post Federal Declaration of Public Health Emergency (PHE)

• Individuals who have only received telemedicine and/or audio-only services must receive an in person service within 6 months of their last service. After the initial 6-month in-person visit, all individuals must be seen in person, at minimum, once every 12 months.
• All new individuals being served via telemedicine and/or audio-only require an in-person service within 6 months of beginning services and then every 12 months following.

SOURCE:  MO Division of Behavioral Health, Community Treatment Program, July 8, 2022, (Accessed Sept. 2024).

The licensee using telemedicine in the treatment and care of patients in Montana shall adhere to the same standards of care required for in-person medical care settings.

A provider-patient relationship may be established for purposes of telemedicine:

• by an in-person medical interview and physical examination when the standard of care requires an in-person encounter;
• by consultation with another licensee or health care provider who has a documented relationship with the patient and who agrees to participate in, or supervise, the patient’s care; or
• through telemedicine if the standard of care does not require an in-person encounter.

The licensee using telemedicine in patient care may prescribe Schedule II drugs in compliance with Drug Enforcement Agency requirements and 37-20-404, MCA.

The licensee using telemedicine in patient care shall:

• make available to the patient verification of the licensee’s identity and credentials;
• verify the identity of the patient;
• establish a provider-patient relationship prior to initiating care;
• obtain a medical history sufficient for diagnosis and treatment in keeping with the applicable standard of care prior to providing treatment or issuing prescriptions, or delegating the patient’s medical services to other health care providers;
• delegate the patient’s medical care only to health care providers:
  • who are known by the licensee to be qualified and competent to perform the delegated services;
  • with whom the patient has an established provider-patient relationship; or
  • who have physical or electronic access to the licensee for consultation and follow-up while the patient is under the licensee’s or the delegee’s care;
• securely maintain and make timely available:
  • to the patient or the patient’s representative all relevant medical and billing records received or produced in connection with the patient’s care; and
  • to other health care providers all medical records received or produced in connection with the patient’s care.

SOURCE: Montana State Board of Medical Examiners. Administrative Rules of MT. Rule 24.156.813 Practice Requirements for Physicians Using Telemedicine. (Accessed Oct. 2024).

 “Practice pharmacy by means of telehealth” means to provide pharmaceutical care through the use of information technology to patients at a distance.

SOURCE: Montana Code Annotated 37-7-101 (Accessed Oct. 2024).

Except as otherwise provided in this section, a medical practitioner:

• May dispense only those drugs that the practitioner is allowed to prescribe under the practitioner’s scope of practice unless the practitioner is engaged in the practice of pharmacy and dispensing a drug pursuant to Title 37, chapter 7; and
• May not dispense a controlled substance unless the practitioner is engaged in the practice of pharmacy and is dispensing a controlled substance pursuant to Title 37, chapter 7.

SOURCE: MT Statute Sec. 37-2-104 (Accessed Oct. 2024).

Any credential holder under the Uniform Credentialing Act may establish a provider-patient relationship through telehealth.

Any credential holder under the Uniform Credentialing Act who is providing a telehealth service to a patient may prescribe the patient a drug if the credential holder is authorized to prescribe under state and federal law.

This section does not apply to a credential holder under the Cosmetology, Electrology, Esthetics, Nail Technology, and Body Art Practice Act, the Dialysis Patient Care Technician Registration Act, the Environmental Health Specialists Practice Act, the Funeral Directing and Embalming Practice Act, the Massage Therapy Practice Act, the Medical Radiography Practice Act, the Nursing Home Administrator Practice Act, the Perfusion Practice Act, the Surgical First Assistant Practice Act, or the Veterinary Medicine and Surgery Practice Act.

SOURCE: NE Revised Statute 38-1,143. (Accessed Aug. 2024).

Before a provider of health care who is located at a distant site may use telehealth to direct or manage the care or render a diagnosis of a patient who is located at an originating site in this State or write a treatment order or prescription for such a patient, the provider must hold a valid license or certificate to practice his or her profession in this State, including, without limitation, a special purpose license issued pursuant to NRS 630.261. The requirements of this subsection do not apply to a provider of health care who is providing services within the scope of his or her employment by or pursuant to a contract entered into with an urban Indian organization, as defined in 25 U.S.C. § 1603.

A provider of health care may establish a relationship with a patient using telehealth when it is clinically appropriate to establish a relationship with a patient in that manner. The State Board of Health may adopt regulations governing the process by which a provider of health care may establish a relationship with a patient using telehealth.

SOURCE: NV Revised Statutes Sec. 629.515, (Accessed Jul. 2024).

A bona fide relationship between the patient and the person prescribing the controlled substance shall be deemed to exist if the patient was examined in person, electronically, telephonically or by fiber optics, including, without limitation, through telehealth, within or outside this State or the United States by the person prescribing the controlled substances within the 6 months immediately preceding the date the prescription was issued.

SOURCE: NV Revised Statutes Sec. 639.235(4). (Accessed Jul. 2024).

Before issuing an initial prescription for a controlled substance listed in schedule II, III or IV for the treatment of pain, a practitioner, other than a veterinarian, must:

• Have established a bona fide relationship, as described in subsection 4 of NRS 639.235, with the patient;
• Perform an evaluation and risk assessment of the patient that meets the requirements of subsection 1 of NRS 639.23912;
• Establish a preliminary diagnosis of the patient and a treatment plan tailored toward treating the pain of the patient and the cause of that pain;
• Document in the medical record of the patient the reasons for prescribing the controlled substance instead of an alternative treatment that does not require the use of a controlled substance; and
• Obtain informed consent to the use of the controlled substance.

If a practitioner, other than a veterinarian, prescribes a controlled substance listed in schedule II, III or IV for the treatment of pain, the practitioner shall not issue more than one additional prescription that increases the dose of the controlled substance unless the practitioner meets with the patient, in person or using telehealth, to reevaluate the treatment plan.

SOURCE: NV Revised Statutes Sec. 639.23911. (Accessed Jul. 2024).

Before prescribing a controlled substance listed in schedule II, III or IV to continue the treatment of pain of a patient who has used the controlled substance for 90 consecutive days or more, a practitioner, other than a veterinarian, must: …

• Meet with the patient, in person or using telehealth, to review the treatment plan established pursuant to paragraph (c) of subsection 1 of NRS 639.23911 to determine whether continuation of treatment using the controlled substance is medically appropriate

SOURCE: NV Revised Statutes Sec. 639.23913. (Accessed Jul. 2024).

An advanced practice registered nurse may perform the acts described in paragraphs (a), (b) and (c) of subsection 2 by using equipment that transfers information concerning the medical condition of a patient in this State electronically, telephonically or by fiber optics, including, without limitation, through telehealth, as defined in NRS 629.515, from within or outside this State or the United States.

SOURCE: NV Revised Statutes Sec. 632.237(4). (Accessed Jul. 2024).

Veterinarians

A veterinarian-client-patient relationship is not established solely through veterinary telemedicine. However, once established, a veterinarian-client-patient relationship may be maintained via veterinary telemedicine between:

• Medically necessary examinations; or
• Visits, within periods of time that are appropriate for the medical issue in question, to the premises where the animal is kept.

Advice and recommendations may be provided via veterinary telemedicine in an emergency, but only until the animal can be examined in person by a licensed veterinarian.  See statute for additional requirements related to a veterinarian-client-patient relationship.

SOURCE: NV Revised Statutes Sec. 638.1521(4), (Accessed Jul. 2024).

Dentistry

A licensee who provides dental services through teledentistry, including, without limitation, providing consultation and recommendations for treatment, issuing a prescription, diagnosing, correcting the position of teeth and using orthodontic appliances, shall provide such services in accordance with the same standards of care and professional conduct as when providing those services in person or by other means.

A licensee shall not:

• Provide treatment for any condition based solely on the results of an online questionnaire; or
• Engage in activity that is outside his or her scope of practice while providing services through teledentistry.

SOURCE: NV Revised Statute Ch. 631, (Accessed Jul. 2024).

A licensee may:

Use teledentistry to examine an existing patient for the purpose of providing a new diagnosis, or to examine a new patient if the examination is sufficient, in accordance with evidence-based standards of practice, to provide an informed diagnosis.

Collaborate in real time through teledentistry with a person who is not licensed pursuant to this chapter, including, without limitation, a community health worker, provider of health care or student who is enrolled in a program of study in dentistry, dental therapy or dental hygiene, to provide diagnostic services or plan treatment for a dental emergency.

SOURCE: NV Revised Statute Ch. 631, (Accessed Jul. 2024).

Except as otherwise provided in this subsection, a licensee must establish a bona fide relationship, as defined by regulation of the Board, with a patient before providing services to the patient through teledentistry. A licensee may establish such a relationship through teledentistry only:

• For the purpose of emergent care;
• In connection with a public health program; or
• To make an initial diagnosis of a malposition of teeth and a determination of the need for an orthodontic appliance. Such an initial diagnosis and determination must be confirmed through an in-person visit before the patient begins using the orthodontic appliance.

SOURCE: NV Revised Statute Ch. 631, (Accessed Jul. 2024).

Optometry

Except as otherwise provided in subsection 3, a licensee may engage in synchronous or asynchronous optometric telemedicine to provide health care services to a patient only if the licensee has completed a comprehensive examination on the patient within the immediately preceding 2 years.

A licensee may engage in synchronous optometric telemedicine to perform a non-comprehensive examination of a new patient if the licensee has access to all the information obtained from a comprehensive examination of the patient that was conducted by an optometrist or ophthalmologist within the immediately preceding 2 years.

A licensee may engage in asynchronous optometric telemedicine to conduct a consultation regarding a patient on whom the licensee has not completed a comprehensive examination within the immediately preceding 2 years if:

• An optometrist, ophthalmologist or primary care physician providing care to the patient requests that the licensee conduct the consultation and provides the licensee with all the information about the patient that is necessary to determine whether the patient requires a comprehensive examination; and
• The consultation performed by the licensee is limited to a determination of whether the patient requires a comprehensive examination and does not involve any diagnosis, recommendation for or treatment of the patient or a prescription for the patient.

A licensee may engage in remote patient monitoring of a patient on whom the licensee has completed a comprehensive examination within the immediately preceding 2 years for the purposes of:

• Acquiring data about the health of the patient;
• Assessing changes in previously diagnosed chronic health conditions;
• Confirming the stability of the health of the patient; or
• Confirming expected therapeutic results.

A licensee may engage in optometric telemedicine to provide health care services to a patient who is located at an originating site outside this State if the licensee has completed a comprehensive examination of the patient within the immediately preceding 2 years and such action is permitted by the laws of the state in which the patient is located.

A licensee shall not engage in optometric telemedicine to provide any health care service to the patient that the licensee has determined should be provided in person.

A licensee engaging in optometric telemedicine or remote patient monitoring shall not:

• Conduct himself or herself in a manner that violates the standard of care required of an optometrist who is treating a patient in person, including, without limitation, by issuing a prescription for ophthalmic lenses based solely upon one or more of the following:
  • Answers provided by a patient in an online questionnaire;
  • The application of lensometry; or
  • The application of auto-refraction; or
• Condition the provision of optometric telemedicine or remote patient monitoring on the patient consenting to receiving a standard of care below the previous bullet.

SOURCE: NV Revised Statute Ch. 636, (Accessed Jul. 2024).

A licensee who is engaging in optometric telemedicine or remote patient monitoring may not issue a prescription for ophthalmic lenses without first performing a manifest refraction.

SOURCE: NV Admin Code. Sec. 636, Sec. 5.1, (Accessed Dec. 2024).

“Physician-patient relationship” means a medical connection between a licensed physician and a patient that includes an in-person exam or an exam using telemedicine, as defined in RSA 310, provided the physician:

• verifies the identity of the patient receiving health care services through telemedicine;
• discloses to the patient the physician’s name, contact information, and the type of health occupation license held by the physician;
• obtains oral or written consent from the patient or from the patient’s parent or guardian, if state law requires the consent of a parent or guardian for use of telemedicine services; and
• meets the standard of care.

A physician shall complete or review a history, a diagnosis, a treatment plan appropriate for the licensee’s medical specialty, and documentation of all prescription drugs including name and dosage. A licensee may prescribe for a patient whom the licensee does not have a physician-patient relationship under the following circumstances: writing admission orders for a newly hospitalized patient; for a patient of another licensee for whom the prescriber is taking call; for a patient examined by a physician assistant, nurse practitioner, or other licensed practitioner; or for medication on a short-term basis for a new patient prior to the patient’s first appointment or when providing limited treatment to a family member in accordance with the American Medical Association Code of Medical Ethics. Prescribing drugs to individuals without a physician-patient relationship shall be unprofessional conduct subject to discipline under RSA 329:17, VI. The definition of a physician-patient relationship shall not apply to a physician licensed in another state who is consulting to a New Hampshire licensed physician with whom the patient has a relationship.

SOURCE: NH Revised Statutes Annotated, Sec. 329:1-c.  (Accessed Dec. 2024).

A physician licensed under this chapter may prescribe non-opioid and opioid controlled drugs classified in schedule II through IV by means of telemedicine after establishing a physician-patient relationship with the patient. When prescribing a non-opioid or opioid controlled drug classified in schedule II through IV by means of telemedicine a subsequent in-person exam shall be conducted by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and drug, but not less than annually. The prescription authority under this paragraph shall be limited to a physician licensed under this chapter, or a physician assistant in accordance with RSA 328-D:3-b, and all prescribing shall be in compliance with all federal and state laws and regulations.

A physician providing services by means of telemedicine directly to a patient shall:

• Use the same standard of care as used in an in-person encounter;
• Maintain a medical record; and
• Subject to the patient’s consent, forward the medical record to the patient’s primary care or treating provider, if appropriate.

A physician issuing a prescription for spectacle lenses, as defined in RSA 327-A:1, III, or a prescription for contact lenses, as defined in RSA 327-A:1, IV, by means of telemedicine directly to a patient shall:

• Obtain an updated medical history at the time of prescribing;
• Make a diagnosis at the time of prescribing;
• Conform to the standard of care expected of in-person care as appropriate to the patient’s age and presenting condition, including when the standard of care requires the use of diagnostic testing and performance of a physical examination, which may be carried out through the use of peripheral devices appropriate to the patient’s condition;
• Not determine an ophthalmic prescription solely by use of an online questionnaire; and
• Upon request, provide patient records in a timely manner in accordance with the provisions of RSA 332-I and all other state and federal laws and regulations.

Under this section, Medicaid coverage for telehealth services shall comply with the provisions of 42 C.F.R. section 410.78 and RSA 167:4-d.

SOURCE: NH Revised Statutes Annotated, 329:1-d, (Accessed Dec. 2024).

An APRN licensed under this chapter may prescribe non-opioid and opioid controlled drugs classified in schedule II through IV by means of telemedicine after establishing an advanced practice registered nurse-patient relationship with the patient. When prescribing a non-opioid or opioid controlled drug classified in schedule II through IV by means of telemedicine a subsequent in-person exam shall be conducted by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and drug, but not less than annually. The prescription authority under this paragraph shall be limited to an APRN licensed under this chapter, and all prescribing shall be in compliance with all federal and state laws and regulations.

SOURCE: NH Revised Statutes Annotated, 326-B:2 (Accessed Dec. 2024).

The prescribing of a non-opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a).

Subsequent in-person exams shall be by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and drug, but not less than annually.

The prescribing of an opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a).

The prescription authority under this paragraph shall be limited to a practitioner licensed to prescribe the drug and in compliance with all federal laws, including the United States Drug Enforcement Agency registration or waiver when required.

SOURCE: NH Revised Statutes Annotated 318-B:2(XVI). (Accessed Dec. 2024).

A physician providing services by means of telemedicine directly to a patient shall:

• Use the same standard of care as used in an in-person encounter;
• Maintain a medical record; and
• Subject to the patient’s consent, forward the medical record to the patient’s primary care or treating provider, if appropriate.

A physician issuing a prescription for spectacle lenses, as defined in RSA 327-A:1, III, or a prescription for contact lenses, as defined in RSA 327-A:1, IV, by means of telemedicine directly to a patient shall:

• Obtain an updated medical history at the time of prescribing;
• Make a diagnosis at the time of prescribing;
• Conform to the standard of care expected of in-person care as appropriate to the patient’s age and presenting condition, including when the standard of care requires the use of diagnostic testing and performance of a physical examination, which may be carried out through the use of peripheral devices appropriate to the patient’s condition;
• Not determine an ophthalmic prescription solely by use of an online questionnaire; and
• Upon request, provide patient records in a timely manner in accordance with the provisions of RSA 332-I and all other state and federal laws and regulations.

Under this section, Medicaid coverage for telehealth services shall comply with the provisions of 42 C.F.R. section 410.78 and RSA 167:4-d.

SOURCE: NH Revised Statutes Annotated, 329:1-d (Accessed Dec. 2024).

Unless specifically prohibited or limited by federal or State law, a health care provider who establishes a proper provider-patient relationship with a patient may remotely provide health care services to a patient through the use of telemedicine.  A health care provider may also engage in telehealth as may be necessary to support and facilitate the provision of health care services to patients.  Nothing in this section shall be construed to allow a provider to require a patient to use telemedicine or telehealth in lieu of receiving services from an in-network provider.

Any health care provider who uses telemedicine or engages in telehealth while providing health care services to a patient, shall: (1) be validly licensed, certified, or registered, pursuant to Title 45 of the Revised Statutes, to provide such services in the State of New Jersey; (2) remain subject to regulation by the appropriate New Jersey State licensing board or other New Jersey State professional regulatory entity; (3) act in compliance with existing requirements regarding the maintenance of liability insurance; and (4) remain subject to New Jersey jurisdiction.

Telemedicine services may be provided using interactive, real-time, two way communication technologies or, subject to the requirements of below, asynchronous store-and-forward technology.

A health care provider engaging in telemedicine or telehealth may use asynchronous store-and-forward technology to provide services with or without the use of interactive,r eal-time, two-way audio if, after accessing and reviewing the patient’s medical records, the provider determines that the provider is able to meet to meet the same standard of care as if the health care services were being provided in person and informs the patient of this determination at the outset of the telemedicine or telehealth encounter.

A health care provider engaging in telemedicine or telehealth shall review the medical history and any medical records provided by the patient. For an initial encounter with the patient, the provider shall review the patient’s medical history and medical records prior to initiating contact with the patient. In the case of a subsequent telemedicine or telehealth encounter conducted pursuant to an ongoing provider-patient relationship, the provider may review the information prior to initiating contact with the patient or contemporaneously with the telemedicine or telehealth encounter.

Diagnosis, treatment, and consultation recommendations, including discussions regarding the risk and benefits of the patient’s treatment options, which are made through the use of telemedicine or telehealth, including the issuance of a prescription based on a telemedicine or telehealth encounter, shall be held to the same standard of care or practice standards as are applicable to in-person settings. Unless the provider has established a proper provider-patient relationship with the patient, a provider shall not issue a prescription to a patient based solely on the responses provided in an online static questionnaire.

In the event that a mental health screener, screening service, or screening psychiatrist determines that an in-person psychiatric evaluation is necessary to meet standard of care requirements, or in the event that a patient requests an in-person psychiatric evaluation in lieu of a psychiatric evaluation performed using telemedicine or telehealth, the mental health screener, screening service, or screening psychiatrist may nevertheless perform a psychiatric evaluation using telemedicine and telehealth if it is determined that the patient cannot be scheduled for an in-person psychiatric evaluation within the next 24 hours. Nothing in this paragraph shall be construed to prevent a patient who receives a psychiatric evaluation using telemedicine and telehealth as provided in this paragraph from receiving a subsequent, in-person psychiatric evaluation in connection with the same treatment event, provided that the subsequent in-person psychiatric evaluation is necessary to meet standard of care requirements for that patient.

The prescription of Schedule II controlled dangerous substances through the use of telemedicine or telehealth shall be authorized only after an initial in-person examination of the patient, as provided by regulation, and a subsequent in-person visit with the patient shall be required every three months for the duration of time that the patient is being prescribed the Schedule II controlled dangerous substance.  However, the provisions of this subsection shall not apply, and the in-person examination or review of a patient shall not be required, when a health care provider is prescribing a stimulant which is a Schedule II controlled dangerous substance for use by a minor patient under the age of 18, provided that the health care provider is using interactive, real-time, two-way audio and video technologies when treating the patient and the health care provider has first obtained written consent for the waiver of these in-person examination requirements from the minor patient’s parent or guardian.

SOURCE: NJ Statute C.45:1-62. (Accessed Aug. 2024).

Any health care provider who engages in telemedicine or telehealth shall ensure that a proper provider-patient relationship is established. The establishment of a proper provider-patient relationship shall include, but shall not be limited to:

• • Properly identifying the patient, using at minimum the patient’s name, date of birth, phone number, and address.
  • Disclosing and validating the provider’s identity and credentials, such as license, title, specialty, and board certifications.
  • prior to initiating contact with a patient in an initial encounter for the purpose of providing services to the patient using telemedicine or telehealth, reviewing the patient’s medical history and any available medical records; and
  • prior to initiating contact with a patient for the purpose of providing services to the patient using telemedicine or telehealth, determining whether the provider will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in person. The provider shall make this determination prior to each unique patient encounter.

Telemedicine or telehealth may be practiced without a proper provider-patient relationship, as defined in subsection a. of this section, in the following circumstances:

• • during informal consultations performed by a health care provider outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • during episodic consultations by a medical specialist located in another jurisdiction who provides consultation services, upon request, to a properly licensed or certified health care provider in this State;
  • when a health care provider furnishes medical assistance in response to an emergency or disaster, provided that there is no charge for the medical assistance; or
  • when a substitute health care provider, who is acting on behalf of an absent health care provider in the same specialty, provides health care services on an on-call or cross-coverage basis, provided that the absent health care provider has designated the substitute provider as an on-call provider or cross-coverage service provider.

SOURCE: NJ Statute C.45:1-63. (Accessed Aug. 2024).

A health care practitioner may initially authorize any qualifying patient for the medical use of cannabis using telemedicine or telehealth, provided that the use of telemedicine or telehealth, rather than an in-person visit, is consistent with the standard of care required for assessment and treatment of the patient’s condition. Following the initial authorization, the practitioner may provide continued authorization for the use of medical cannabis via telemedicine or telehealth if the practitioner determines that an in-person visit is not required, consistent with the standard of care. The practitioner may require in-office consultations if additional consultations are necessary to continue to authorize the patient’s use of medical cannabis.

See statute for additional requirements.

SOURCE:  NJ Statute C.24:6I-5.1. (Accessed Aug. 2024).

Licensee-patient relationship

Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-patient relationship by:

• Identifying the patient with, at a minimum, the patient’s name, date of birth, phone number, and address. A licensee may also use a patient’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the patient; and
• Disclosing and validating the licensee’s identity, license, title, and, if applicable, specialty and board certifications.

Prior to initiating contact with a patient for the purpose of providing services to the patient using telemedicine or telehealth, a licensee shall:

• Review the patient’s medical history and any available medical records;
• Determine as to each unique patient encounter, whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in-person; and
• Provide the patient the opportunity to sign a consent form that authorizes the licensee to release medical records of the encounter to the patient’s primary care provider or other healthcare provider identified by the patient.

Notwithstanding (a) and (b) above, health care services may be provided through telemedicine or telehealth without a proper licensee-patient relationship if the provision of health care services is:

• For informal consultations with another healthcare provider performed by a licensee outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
• During episodic consultations by a medical specialist located in another jurisdiction who provides consultation services, upon request, to a licensee in this State;
• Related to medical assistance provided in response to an emergency or disaster, provided that there is no charge for the medical assistance; or
• Provided by a substitute licensee acting on behalf of, and at the designation of, an absent licensee in the same specialty on an on-call or cross-coverage basis.

SOURCE: NJ Administrative Code 13:30-9.4 (Dentist), 13:34-6A.4 (Marriage and Family Therapist), 13:34-32. (Professional Counselors),  13:34C-7.4 (Alcohol and Drug Counselor), 13:35-2C.4 (Physician Assistant), 13:35-12A4 (Electrologists), 13:35-6B.4 (Physicians), 13:35-8.24 (Hearing Aid Dispensers) 13:35-10.29 (Athletic Trainer) 13:37-8A4 (Nurses), 13:39A-10.4 (Physical Therapist & Physical Therapist Assistant), 13:44-4A.4 (Veterinarians), 13:44C-11.4 (Audiology & Speech-Language Pathologist), 13:44F-11.4 (Respiratory Care), 13:44H-11.4 (Orthotics & Prosthetics), 13:44K-7.4 (Occupational Therapy), 13:44L-7.4 (Polysomnography); 13:35-2A.21 (Midwifery). (Accessed Aug. 2024).

Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-client relationship by:

• Identifying the client with, at a minimum, the client’s name, date of birth, phone number, and address. A licensee may also use a client’s assigned identification number, Social Security Number, photo, health insurance policy number, or other identifier associated directly with the client; and
• Disclosing and validating the licensee’s identity, license, title, and, if applicable, specialty and board certifications.

Prior to an initial contact with a client for the purpose of providing services to the client using telemedicine or telehealth, a licensee shall review the client’s history and any available records.

Prior to initiating contact with a client for the purpose of providing services through telemedicine or telehealth, licensees shall determine whether they will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in-person. The licensee shall make this determination prior to each unique client encounter.

Notwithstanding (a), (b), and (c) above, service may be provided through telemedicine or telehealth without a proper provider-client relationship if:

• The provision of services is for informal consultation with another healthcare provider, performed by a licensee outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
• The provision of services is during episodic consultations by a medical and/or specialist located in another jurisdiction who provides consultation services, upon request, to a licensee in this State;
• A licensee furnishes assistance in response to an emergency or disaster, provided that there is no charge for the assistance; or
• A substitute licensee, who is acting on behalf of an absent licensee in the same specialty, provides services on an on-call or cross-coverage basis, provided that the absent licensee has designated the substitute licensee as an on-call licensee or cross-coverage service provider.

SOURCE: NJ Administrative Code 13:35-14.22 (Genetic Counselors); NJ Administrative Code 13:42B-7.4 (Applied Behavior Analysts); NJ Administrative Code 13:42-13.4 (Psychological Examiners); NJ Administrative Code 13:44C-11.4. (Audiology and Speech Language Pathology); NJ Administrative Code 13:44G-15.4 (Social Workers); NJ Administrative Code 13:42A-8.4 (Certified Psychoanalysts). (Accessed Aug. 2024).

Prescriptions

Notwithstanding the requirements for in-person interaction in N.J.A.C. 13:35-7 , a licensee providing services through telemedicine or telehealth may issue a prescription to a patient, if the issuance of such a prescription is consistent with the standard of care or practice standards applicable to the in-person setting.

A licensee shall not issue a prescription based solely on responses provided in an online questionnaire, unless the licensee has established a proper licensee-patient relationship.

Notwithstanding (a) above, and except as provided in (d) below, a licensee shall not issue a prescription for a Schedule II controlled dangerous substance unless the licensee has had an initial in-person examination of the patient and a subsequent in-person visit with the patient at least every three months for the duration of the time the patient is prescribed the Schedule II controlled dangerous substance.

The prohibition of (c) above shall not apply when a licensee prescribes a stimulant for a patient under the age of 18 years, as long as the licensee is using interactive, real-time, two-way audio and video technologies and the licensee has obtained written consent for a waiver of in-person examination requirements from the patient’s parent or guardian.

SOURCE: NJ Administrative Code 13:35-6B.6 (Board of Medical Examiners); NJ Administrative Code 13:35-2C.6 (Physician Assistants). (Accessed Aug. 2024).

Board of Veterinary Medical Examiners

A licensee providing services through telemedicine or telehealth may issue a prescription to a patient, as long as the issuance of such a prescription is consistent with the standard of care or practice standards applicable to the in-person setting.

A licensee shall not issue a prescription based solely on responses provided in an online questionnaire, unless the licensee has established a proper licensee-client-patient relationship pursuant to N.J.A.C. 13:44-4A.4.

Notwithstanding (a) above, a licensee shall not issue a prescription for a Schedule II controlled dangerous substance unless the licensee has had an initial in-person examination of the patient and a subsequent in-person visit with the patient at least every three months for the duration of the time the patient is prescribed the Schedule II controlled dangerous substance.

SOURCE: NJ Administrative Code 13:44-4A.6. (Accessed Aug. 2024).

Board of Medical Examiners – Limited Licenses: Midwifery

Notwithstanding requirements for in-person interaction in N.J.A.C. 13:35-7 , a certified nurse midwife (CNM) with prescriptive authority pursuant to N.J.A.C. 13:35-2A.14 providing services through telemedicine or telehealth may issue a prescription to a patient, as long as the issuance of such a prescription is consistent with the standard of care or practice standards applicable to the in-person setting.

A CNM with prescriptive authority pursuant to N.J.A.C. 13:35-2A.14 shall not issue a prescription based solely on responses provided in an online questionnaire, unless the CNM has established a proper licensee-patient relationship pursuant to N.J.A.C. 13:35-2A.21 .

Notwithstanding (a) above, and except as provided in (d) below, a CNM with prescriptive authority pursuant to N.J.A.C. 13:35-2A.14 shall not issue a prescription for a Schedule II controlled dangerous substance unless the CNM has had an initial in-person examination of the patient and a subsequent in-person visit with the patient at least every three months for the duration of the time the patient is prescribed the Schedule II controlled dangerous substance.

The prohibition of (c) above shall not apply when a CNM with prescriptive authority pursuant to N.J.A.C. 13:35-2A.14 prescribes a stimulant for a patient under the age of 18 years, as long as the CNM is using interactive, real-time, two-way audio and video technologies and the CNM has obtained written consent for a waiver of in-person examination requirements from the patient’s parent or guardian.

SOURCE: NJ Administrative Code 13:35-2A.23. (Accessed Aug. 2024).

Board of Nursing

An advanced practice nurse providing services through telemedicine or telehealth may issue a prescription to a patient, as long as the issuance of such a prescription is consistent with the standard of care or practice standards applicable to the in-person setting.

An advanced practice nurse shall not issue a prescription based solely on responses provided in an online questionnaire, unless the advanced practice nurse has established a proper licensee-patient relationship pursuant to N.J.A.C. 13:37-8A.4.

Notwithstanding (a) above, and except as provided in (d) below, an advanced practice nurse shall not issue a prescription for a Schedule II controlled dangerous substance unless the advanced practice nurse has had an initial in-person examination of the patient and a subsequent in-person visit with the patient at least every three months for the duration of the time the patient is prescribed the Schedule II controlled dangerous substance.

The prohibition of (c) above shall not apply when an advanced practice nurse prescribes a stimulant for a patient under the age of 18 years, as long as the advanced practice nurse is using interactive, real-time, two-way audio and video technologies and the advanced practice nurse has obtained written consent for a waiver of in-person examination requirements from the patient’s parent or guardian.

SOURCE: NJ Administrative Code 13:37-8A.6. (Accessed Aug. 2024).

Prescribing, dispensing or administering drugs or medical supplies to a patient when there is no established physician-patient relationship, including prescribing over the internet or via other electronic means that is based solely on an on-line questionnaire is unprofessional conduct, except for:

• Physicians and physician assistants on call for another practitioner, or responsible for another practitioner’s patients in an established clinic or office, or acting as locum tenens where a physician-patient relationship has previously been established and documented in the practitioner’s or clinic’s record;
• Physicians and physician assistants in emergency room or urgent care settings;
• Prescriptions written to prepare a patient for special examination(s) or laboratory testing;
• Prescribing or dispensing for immunization programs;
• The provision of treatment for partners of patients with sexually transmitted diseases when this treatment is conducted in accordance with the expedited partner therapy guidelines and protocol published by the New Mexico department of health; and
• The provision of consultation, recommendation, or treatment during a face-to-face telehealth encounter online, using standard videoconferencing technology, where a medical history and informed consent are obtained and a medical record generated by the practitioner, and a physical examination is:
  • Recorded as appropriate by the practitioner, or a practitioner such as a physician, a physician or anesthesiologist assistant, or an advanced practice nurse, with the results communicated to the telehealth practitioner; or
  • Waived when a physical examination would not normally be part of a typical physical face-to-face encounter with the patient for the specific services being provided.

SOURCE: NM Administrative Code 16.10.8.8(L). (Accessed Nov. 2024).

APRN

Telemedicine may be used by an APRN or other licensed independent healthcare providers for assessment and face-to-face examinations provided that such use complies with any applicable state and federal law and that the quality of the video examination does not adversely affect the face-to-face assessment or diagnosis.

SOURCE: NM Administrative Code 16.12.14.10, (Accessed Nov. 2024).

Related to Medical Cannabis

Qualified patient means a resident of New Mexico who has been diagnosed by a practitioner as having a debilitating medical condition and has received written certification and a registry identification card pursuant to the Lynn and Erin Compassionate Use Act on the basis of having been diagnosed, in person or via telemedicine, by a practitioner as having a debilitating medical condition.

SOURCE: NM Administrative Code 7.34.3.7 & 7.34.2.7. (Accessed Nov. 2024).

Office of Alcoholism and Substance Abuse Services (OASAS)

Buprenorphine is a controlled substance and requires appropriate evaluation for use and ongoing monitoring. As such, buprenorphine initiation must include an evaluation by a practitioner with a valid DEA registration prior to issuance of a buprenorphine prescription; this visit may be done in person or via telehealth (an audio and video visit or an audio-only visit); all follow up visits may be done via telehealth.

SOURCE: OASAS Telehealth Standards for OASAS Designated Providers, p. 9. Aug. 2023. (Accessed Dec. 2024).

Induction and prescribing of addiction medications must be done in accordance any and all applicable Federal rules and regulations; guidance may be found in the Telepractice Standards for OASAS Designated Providers posted on the OASAS website.

SOURCE: NY Codes, Rules and Regulations, Title 14, Chapter XXI, Part 830.5. (Accessed Dec. 2024).

Mental Health

OMH Telehealth Standards outline various considerations and program-specific requirements related to prescribing medications via telehealth.

SOURCE: NY Office of Mental Health. Telehealth Services Guidance for OMH Providers. (Apr. 2023). (Accessed Dec. 2024).

Workers’ Compensation

When rendering medical treatment or care via telehealth, an Authorized Medical Provider must be available for an in-person clinical encounter with the claimant should such in-person encounter be medically necessary. This means the Authorized Medical Provider must be able to meet the claimant at the Authorized Medical Provider’s office within a reasonable travel time and distance from the claimant’s residence. Telehealth must be used in accordance with this section and any applicable New York State Medical Treatment Guideline incorporated by reference under section 324.2 of this Title.

See regulations for additional rules related to when telehealth may be rendered following an initial in-person clinical encounter and related restrictions.

SOURCE: Title 12 NYCRR Section. 325-1.26 as proposed to be added by Notice Of Adoption. (Accessed Dec. 2024).

Teledentistry

The indication, appropriateness, and safety considerations for each prescription for medication, laboratory services, or dental laboratory services provided through the use of teledentistry shall be evaluated by the licensed dentist in accordance with applicable law and current standards of care, including those for appropriate documentation. A licensed dentist’s use of teledentistry carries the same professional accountability as a prescription issued in connection with an in‑person encounter. A licensed dentist who prescribes any type of analgesic or pain medication as part of the provision of teledentistry services shall comply with all applicable North Carolina Controlled Substance Reporting System requirements. (2021‑95, s. 1(b).)

SOURCE: NC Statute Sec. 90-30.2. (Accessed Dec. 2024).

“In-person medical evaluation” means a medical evaluation that is conducted with the patient in the physical presence of the practitioner, without regard to whether portions of the evaluation are conducted by other practitioners, and must include one of the following actions: … The referring practitioner has performed an examination in the case of a consultant practitioner issuing a prescription or drug order when providing services by means of telemedicine.

“Valid prescription” means a prescription that is issued for a legitimate medical purpose in the usual course of professional practice by a practitioner who has conducted an in-person medical evaluation of the patient.

SOURCE: ND Century Code Sec. 19-02.1-15.1.(c) & (f) (Accessed Nov. 2024).

A licensee practicing telemedicine shall establish a bona fide relationship with the patient before the diagnosis or treatment of a patient. A licensee practicing telemedicine shall verify the identity of the patient seeking care and shall disclose, and ensure the patient has the ability to verify, the identity and licensure status of any licensee providing medical services to the patient.

Before initially diagnosing or treating a patient for a specific illness or condition, an examination or evaluation must be performed. An examination or evaluation may be performed entirely through telemedicine, if the examination or evaluation is equivalent to an in-person examination.

• An examination utilizing secure videoconferencing or store-and-forward technology for appropriate diagnostic testing and use of peripherals that would be deemed necessary in a like in-person examination or evaluation meets this standard, as does an examination conducted with an appropriately licensed intervening health care provider, practicing within the scope of the provider’s profession, providing necessary physical findings to the licensee. An examination or evaluation consisting only of a static online questionnaire or an audio conversation does not meet the standard of care.
• Once a licensee conducts an acceptable examination or evaluation, whether in-person or by telemedicine, and establishes a patient-licensee relationship, subsequent followup care may be provided as deemed appropriate by the licensee, or by a provider designated by the licensee to act temporarily in the licensee’s absence. In certain types of telemedicine utilizing asynchronous store-and-forward technology or electronic monitoring, such as teleradiology or intensive care unit monitoring, it is not medically necessary for an independent examination of the patient to be performed.

A licensee practicing telemedicine is subject to all North Dakota laws governing the adequacy of medical records and the provision of medical records to the patient and other medical providers treating the patient.

A licensee must have the ability to make appropriate referrals of patients not amenable to diagnosis or complete treatment through a telemedicine encounter, including a patient in need of emergent care or complementary in-person care.

SOURCE: ND Century Code Sec. 43-17-44, (Accessed Nov. 2024).

A controlled substance that is a prescription drug may not be delivered, distributed, or dispensed by means of the internet without a valid prescription, but nothing in this subsection may be construed to imply that one in-person medical evaluation by itself demonstrates that a prescription has been validly issued for a legitimate medical purpose within the usual course of professional practice.

This section applies to the delivery, distribution, and dispensing of a controlled substance by means of the internet from a location whether within or outside this state to a person or an address in this state.

Nothing in this section applies to the delivery, distribution, or dispensing of a controlled substance by a practitioner engaged in the practice of telemedicine in accordance with applicable federal and state laws.

“Valid prescription” means a prescription that is issued for a legitimate medical purpose in the usual course of professional practice by a:

• Practitioner who has conducted at least one in-person medical evaluation of the patient; or
• Covering practitioner.

SOURCE: North Dakota Century Code, Sec. 19-03.1-22.4, (Accessed Nov. 2024).

A licensee who has performed a telemedicine examination or evaluation meeting the requirements of this chapter may prescribe medications according to the licensee’s professional discretion and judgment. Opioids may only be prescribed through telemedicine if done so as a federal food and drug administration-approved medication-assisted treatment for opioid use disorder. Opioids may not be prescribed through a telemedicine encounter for any other purpose.

Licensees who prescribe controlled substances, as defined by North Dakota law, in circumstances allowed under this rule, must comply with all state and federal laws regarding the prescribing of controlled substances, and must participate in the North Dakota prescription drug monitoring program.

SOURCE: ND Admin Code Sec. 50-02-15-02, (Accessed Nov. 2024).

Medicaid – Medication for Opioid Use Disorder

For OTPs, a clinical assessment that meets the requirements in 42 CFR § 8.12(f)(4) must be conducted, face to face or by telehealth, as clinically appropriate, at least once every three months for the first year of continuous treatment, and at least once every six months for each subsequent year

The member must require at least one face-to-face or telehealth check‐in per month for prescribing or dispensing OBOT/OTP medication. For those receiving buprenorphine based treatment, the prescriber has deemed it medically necessary to treat the member’s opioid addiction with buprenorphine products.

Telehealth must be provided in accordance with applicable federal and state laws and policies and follow the Controlled Substances Act (CSA) (28 USC Part 802) for prescribing and administration of controlled substances.

SOURCE: ND Medicaid, Medication for Opioid Use Disorder, Jan. 2024, (Accessed Nov. 2024).

Each health care professional licensing board shall permit a health care professional under its jurisdiction to provide the professional’s services as telehealth services in accordance with this section. Subject to division (B)(2) of this section, a board may adopt any rules it considers necessary to implement this section. All rules adopted under this section shall be adopted in accordance with Chapter 119. of the Revised Code. Any such rules adopted by a board are not subject to the requirements of division (F) of section 121.95 of the Revised Code.

Except as provided in division (B)(2)(b) of this section, the rules adopted by a health care professional licensing board under this section shall establish a standard of care for telehealth services that is equal to the standard of care for in-person services.

Subject to division (B)(2)(c) of this section, a board may require an initial in-person visit prior to prescribing a schedule II controlled substance to a new patient, equivalent to applicable state and federal requirements.

A board shall not require an initial in-person visit for a new patient whose medical record indicates that the patient is receiving hospice or palliative care, who is receiving medication-assisted treatment or any other medication for opioid-use disorder, who is a patient with a mental health condition, or who, as determined by the clinical judgment of a health care professional, is in an emergency situation.

Notwithstanding division (B) of section 3796.01 of the Revised Code, medical marijuana shall not be considered a schedule II controlled substance.

SOURCE:  Ohio Revised code 4743.09, (Accessed Nov. 2024).

When the physician, or physician assistant who holds a valid prescriber number issued by the state medical board and who has been granted physician-delegated prescriptive authority prescribes, personally furnishes, otherwise provides, or causes to be provided a prescription drug that is a controlled substance during the provision of telehealth services, the physician or physician assistant shall comply with all requirements in rule 4731-37-01 of the Administrative Code.

The physician, or physician assistant who holds a valid prescriber number issued by the state medical board and who has been granted physician-delegated prescriptive authority shall conduct a physical examination of a new patient as part of an initial in-person visit before prescribing a schedule II controlled substance to the patient except for any of the following patient medical conditions and situations:

• The medical record of a new patient indicates that the patient is receiving hospice or palliative care;
• The patient has a substance use disorder, and the controlled substance is FDA approved for and prescribed for medication assisted treatment or to treat opioid use disorder.
• The patient has a mental health condition and the controlled substance prescribed is prescribed to treat that mental health condition;
• The physician or physician assistant determines in their clinical judgment that the new patient is in an emergency situation provided that the following occurs:

1. The physician or physician assistant prescribes only the amount of a schedule II controlled substance to cover the duration of the emergency or an amount not to exceed a three-day supply whichever is shorter;
2. After the emergency situation ends, the physician or physician assistant conducts the physical examination as part of an initial in-person visit before any further prescribing of a drug that is a schedule II controlled substance; or

• The prescribing of a controlled substance through telehealth services is being done under an exception permitted by federal law governing prescription drugs that are controlled substances.

When prescribing a controlled substance through the provision of telehealth services under one of the exceptions in paragraph (E) of this rule, the physician or physician assistant shall document one of the reasons listed in paragraph (E) for the prescribing in the medical record of the new patient in addition to the documentation already required to meet the standard of care in rule 4731-37-01 of the Administrative Code.

SOURCE:  OH Administrative Code 4731-11-09. (Accessed Nov. 2024).

For purposes of paragraph (D) of rule 4731-11-09 of the Administrative Code, “active patient” as that term is used in paragraph (C) of this rule, means that within the previous twenty-four months the physician or other healthcare provider acting within the scope of their professional license conducted at least one in-person medical evaluation of the patient or an evaluation of the patient through the practice of telemedicine as that term is defined in 21 C.F.R. 1300.04, in effect as of the effective date of this rule.

SOURCE: OAC 4731-11-01(D). (Accessed Nov. 2024).

A pharmacist may provide telehealth services in accordance with section 4743.09 of the Revised Code, except that in the case of dispensing a dangerous drug, a pharmacist shall not use telehealth mechanisms or other virtual means to perform any of the actions involved in dispensing the dangerous drug unless the action is authorized by the state board of pharmacy through rules it adopts under this chapter or section 4743.09 of the Revised Code.

SOURCE: OH Revised Code Section 4729.285. (Accessed Nov. 2024).

Certificate to recommend medical use of marijuana

For purposes of recommending use of marijuana, a physician who holds a certificate to recommend may recommend that a patient be treated with medical marijuana if all of the following conditions are met:

• The patient has been diagnosed with a qualifying medical condition;
• A bona fide physician-patient relationship has been established through all of the following:
  • An examination of the patient by the physician either in person or through the use of telehealth services in accordance with section 4743.09 of the Revised Code;
  • A review of the patient’s medical history by the physician;
  • An expectation of providing care and receiving care on an ongoing basis.

See Code for additional requirements.

SOURCE: OH Revised Code Section 4731.30, (Accessed Nov. 2024).

In order to practice within the minimal standards of care when recommending treatment with medical marijuana, a physician shall comply with all of the following requirements:

• The physician shall establish and maintain a bona fide physician-patient relationship with the patient for the provision of medical services that is established through an examination of the patient by the physician either in-person or through the use of telehealth services that complies with this rule and for which there is an expectation that the physician will provide care to the patient on an ongoing basis.

SOURCE: OH Admin Code Sec. 4731-32-03, (Accessed Nov. 2024).

Opioid Treatment Program – Medication Units

Medication units may also provide telecounseling services if they provide appropriate privacy and adequate space with appropriately credentialed staff in accordance with all federal and state regulation. Telecounseling services may include individual or group sessions. Medication units that choose to provide telecounseling will:

• Provide telecounseling services with appropriate application of clinical judgment to best meet patient treatment needs;
• Be in compliance with paragraphs (H)(3) and (H)(4) of rule 5122-40-09 of the Administrative Code; and,
• Ensure that every patient has a designated counselor who is the primary contact for behavioral health treatment and care coordination. While the patient may utilize other counselors for emergencies, all counseling, including telecounseling, will be handled by the primary counselor. All patients, whether seen in person or via telehealth, count equally toward the staffing ratio specified in paragraph (F)(1) of rule 5122-40-09 of the Administrative Code, and opioid treatment programs will maintain clear and accurate caseload records for auditing purposes.

SOURCE: OAC 5122-40-15, (Accessed Nov. 2024).

Vision Professionals

An optometrist licensed under this chapter may provide telehealth services in accordance with section 4743.09 of the Revised Code.

SOURCE: OH Revised Code Section 4725.35. (Accessed Nov. 2024).

A health care professional may provide telehealth services to a patient located in a health care facility in this state. The health care professional shall comply with all of the following requirements: …

• That in the absence of an existing doctor-patient relationship, a health care professional shall not provide telehealth services which offer a prescription for glasses or contact lenses without including all the elements of a comprehensive eye exam; however, such doctor-patient relationship may be established by telehealth protocols.

While providing telehealth services, a health care professional may only prescribe, personally furnish, otherwise provide, or cause to be provided a prescription drug that is not a controlled substance to a patient through the provision of telehealth services by complying with all requirements of this rule.

SOURCE: Ohio Administrative Code 4725-25-01. (Accessed Nov. 2024).

A valid physician-patient relationship may be established by an allopathic or osteopathic physician with a patient located in this state through telemedicine, provided that the physician:

• Holds a license to practice medicine in this state;
• Confirms the patient’s identity and physical location; and
• Provides the patient with the treating physician’s identity and professional credentials.

Telemedicine encounters shall comply with the Health Insurance Portability and Accountability Act of 1996 and ensure that all patient communications and records are secure and confidential.

Telemedicine encounters in this state shall not be used to establish a valid physician-patient relationship for the purpose of prescribing opiates, synthetic opiates, semisynthetic opiates, benzodiazepine or carisprodol, unless the encounter is used to prescribe:

• Opioid antagonists or partial agonists pursuant to Sections 1-2506.1 and 1-2506.2 of Title 63 of the Oklahoma Statutes; or
• A Schedule III, IV, or V controlled dangerous substance approved by the United States Food and Drug Administration for medication assisted treatment or detoxification treatment for substance use disorder.

A physician-patient relationship shall not be created solely based on the receipt of patient health information by a physician. The duties and obligations created by a physician-patient relationship shall not apply until the physician affirmatively:

• Undertakes to diagnose and treat the patient; or
• Participates in the diagnosis and treatment of the patient.

SOURCE: OK Statutes, Title 59, Ch. 11 Sec. 478.1, (Accessed Jul. 2024).

Unprofessional conduct includes … Prescribing or administering a drug or treatment without sufficient examination and the establishment of a valid physician-patient relationship and not prescribing in a safe, medically accepted manner;

SOURCE: OK Statute, Title 59, Sec. 509.(12), (Accessed Jul. 2024).

A physician/patient relationship is established when a physician agrees by direct or indirect contact with a patient to diagnose or treat any condition, illness or disability presented by a patient to that physician, whether or not such a presenting complaint is considered a disease by the general medical community. The physician/patient relationship shall include a medically appropriate, timely-scheduled, face-to-face encounter with the patient, subject to any supervisory responsibilities established elsewhere in these rules except the following providers are not subject to the face-to-face encounter:

• Providers covering the practice of another provider may approve refills of previously ordered medications if they have access to the medical file of the patient.
• Hospice medical directors may initiate prescriptions based on requests from licensed health care providers and on information from Hospice records.
• Providers ordering appropriate medications for persons with laboratory-proven, sexually transmitted diseases and persons who have been in contact with certain infectious diseases.
• Telemedicine physicians who meet the criteria set out in OAC 435:10-7-13 of this Subchapter.
• Licensed healthcare providers providing medical immunizations, which may be implemented by means of standing order(s) and/or policies.
• Licensed providers ordering opioid antagonists pursuant to 63 O.S. §1-2506.2.

SOURCE: OK Admin. Code Sec. 435:10-7-12. (Accessed Jul. 2024).

Abortion-inducing drugs shall not be provided directly to the patient through the mail, telemedicine or otherwise outside of the parameters of the Oklahoma Abortion-Inducing Drug Certification Program.

SOURCE: OK Statute, Title 63, Ch. 1, Sec.1-757.4, (Accessed Jul. 2024).

The Board has the right to refuse to issue, renew or reinstate a license and may revoke a license or impose other appropriate sanctions for unprofessional conduct. In addition to those acts of unprofessional conduct listed in Title 59 O.S., Section 637 the following acts shall be included without limiting, in any way the Board’s ability to interpret other acts as unprofessional conduct …

• It shall not be considered unprofessional conduct for a physician to renew a prescription for controlled drugs over telemedicine provided an initial script was issued in person.

SOURCE: OK Admin. Code Sec. 510:5-7-1. (Accessed Jul. 2024).

Optometry

The comprehensive visual examination.  The prescribing for spectacles or contacts lenses by an optometrist requires a comprehensive visual examination conducted by a physician holding a license to practice optometry in this state.  Board Rule 505:10-5-9 establishes the tests and measurements that require findings on the comprehensive examination of a patient when an optometrist intends to sign a prescription for ophthalmic lenses or contact lenses.  Some of these required findings must be based on an examination made in person by an optometrist physically present with the patient.  Therefore, a comprehensive visual examination shall be in-person by an eye doctor with a face-to-face encounter.  In the absence of an existing doctor patient relationship, a prescription for glasses or contact lenses can only be derived through the completion of a comprehensive eye examination.  While technology has advanced and continues to advance, in-person care, provided by a doctor of optometry, is the criterion standard for the delivery of a comprehensive eye exam.  Direct-to-patient eye and vision-related applications, based on current technologies and uses, cannot replace or replicate a comprehensive eye exam provided by a doctor of optometry who is physically present with the patient. Direct-to-patient eye and vision-related applications may provide data related to elements of a comprehensive eye exam, but do not constitute patient care and fragmentation of a comprehensive eye exam into components delivered independently is deleterious and deceptive to patients.  Telemedicine encounters in this state shall not be used to establish a valid physician-patient relationship for prescribing contact lenses and or spectacles because it is not on par with the same service delivered in person.  The relationship for prescribing shall include a medically appropriate and timely scheduled face to face encounter between the patient and a physician.  The prescribing physician must provide the patient with the treating physicians’ identity and professional credentials.  Screenings cannot be used to diagnosis or treat conditions. Screenings cannot be used to replace in person comprehensive eye examination.  Refractive tests, including online vision tests and other mobile vision related applications, cannot be, based on current technologies and uses, used to provide a refractive diagnosis and/or an eyeglass or contact lens prescription.

Physicians cannot establish a doctor-patient relationship via telehealth alone. During telemedicine encounters, the distant site physician performs an exam of a patient at a separate, remote originating site location which shall be registered with the Board of Examiners in optometry by the distant site physician as a primary or branch practice location pursuant to Rule OAC 505:10-5-7.  If the distant site physician deems it to be medically necessary, or if Oklahoma law requires manual procedures at the near site in order to meet legal definitions of procedures which meet the standard of care, a licensed optometrist in this state trained in the use of the equipment shall be utilized at the originating site to “present” the patient, manage the camera, and perform any physical activities to successfully complete the exam.

Unprofessional conduct includes prescribing for treatment without sufficient examination as provided in Board Rule 505:10-5-9, proceeding without the establishment of a valid physician-patient relationship, violations of this telemedicine rule under the authority of 59 O.S. § 585(A). and not prescribing in a safe, medically accepted manner.

On-line refractions do NOT meet acceptable standards of care.  Physicians cannot prescribe controlled substances via telehealth.  Physicians cannot split fees for care.  The optometrist who utilizes telemedicine in Oklahoma should be mindful of certain requirements and challenges inherent in practice via remote means, among them the following.

• Examination, evaluation, and diagnosis. The optometrist must conduct an appropriate evaluation prior to diagnosing or treating the patient, including prior to rendering a prescription for pharmaceuticals, spectacles, or contact lenses. Physical remoteness of the patient does not change the need for a proper patient identification, appropriate intake procedures, adequate patient history, examination, and, where indicated, testing. An optometrist is not excused from performing an appropriate examination, evaluation, and assessment of the patient’s condition by virtue of the patient’s physical remoteness from the optometrist. Any technician involved in the telemedicine patient encounter should be trained in the use of all equipment utilized in the telemedicine encounter and competent in the operation of such equipment.
• Prescribing. Prior to prescribing any medication or ophthalmic device (such as spectacles, contact lenses, or low vision devices) the optometrist must conduct an appropriate assessment of the ocular health and visual status of the patient. It is the position of this Board that the standard of care does not permit an examination consisting solely of objective refractive data or information generated by an automated testing device such as an autorefractor in order to establish a medical diagnosis or to establish refractive error. Likewise, issuing a prescription based solely on a patient’s responses to a written or online questionnaire does not meet the standard of care in Oklahoma.

SOURCE: OK Admin Code Sec. 505:10-5-19. (Accessed Nov. 2024).

“Telepharmacy” means the delivery of pharmacy services by a pharmacist, through the use of a variety of electronic and telecommunications technologies, to a patient at a remote location staffed by a pharmacy technician.

The pharmacy services for which a pharmacist may use telepharmacy include the supervision of the dispensation of prescription drugs to a patient.

The remote location at which a patient receives pharmacy services through the use of telepharmacy must be affiliated with the pharmacy where the pharmacist providing the pharmacy services through telepharmacy regularly engages in the practice of pharmacy.

The State Board of Pharmacy shall adopt rules to carry out this section. The rules adopted under this section must include rules:

• Regarding remote supervision of a pharmacy technician in order to facilitate the use of telepharmacy; and
• Describing the pharmacy services that a pharmacist may provide through telepharmacy.

SOURCE: OR Revised Statutes 689.700, (Accessed Dec. 2024).

“Telepharmacy” means the delivery of pharmacy services by an Oregon licensed Pharmacist through the use of a telepharmacy system to a patient at a remote location staffed by a Certified Oregon Pharmacy Technician or Pharmacy Technician.

“Telepharmacy system” means a system of telecommunications technologies that enables monitoring, documenting, and recording of the delivery of pharmacy services at a remote location by an electronic method which must include the use of audio and video, still image capture, and store and forward.

See rule for telepharmacy regulations.

SOURCE: OAR 855-139-0005. (Accessed Dec. 2024).

Remote Dispensing Site Pharmacy

A location in Oregon where the practice of pharmacy occurs by an Oregon licensed Pharmacist through the use of a telepharmacy system to a patient at a remote location staffed by a Certified Oregon Pharmacy Technician must be registered by the board in Oregon as a Retail Drug Outlet RDSP.

SOURCE: OAR 855-139-0010. (Accessed Dec. 2024).

Non-Resident Affiliated Pharmacies

A non-resident pharmacy includes a RDSP Affiliated Pharmacy located outside of Oregon and providing pharmacy services through a telepharmacy system to a Retail Drug Outlet RDSP located in Oregon.

Each non-resident RDSP Affiliated Pharmacy must be registered with the Oregon Board of Pharmacy.

To qualify for registration under these rules, every non-resident RDSP Affiliated Pharmacy must be registered and in good standing with the Board of Pharmacy in the pharmacy’s state of residence.

Each out-of-state non-resident RDSP Affiliated Pharmacy must designate an Oregon licensed Pharmacist-in-Charge (PIC), who is responsible for all pharmacy services and to provide supervision and control of the RDSP. To qualify for this designation, the person must:

• Hold a license to practice pharmacy in the resident state;
• Be normally working for the RDSP Affiliated Pharmacy a minimum of 20 hours per week;
• Annually complete a self-inspection using the board’s RDSP Self-Inspection Form prior to July 1; and
• Provide the PIC self-inspection report as requested by the board.

Every non-resident RDSP Affiliated Pharmacy will have a Pharmacist-in-Charge (PIC) who is licensed in Oregon prior to initial registration of the RDSP.

The PIC must comply with the requirements of OAR 855-115-0210.

SOURCE: OAR 855-139-0030. (Accessed Dec. 2024).

The Oregon licensed Pharmacist-in-charge of the RDSP Affiliated Pharmacy is responsible for all operations at the RDSP including responsibility for the telepharmacy system and enforcing policies and procedures.

SOURCE: OAR 855-139-0050. (Accessed Dec. 2024).

Technology

A RDSP and its RDSP Affiliated Pharmacy must:

• Utilize a shared telepharmacy system and have appropriate technology or interface to allow access to information required to process and fill a prescription drug order;
• Use still image capture or store and forward for verification of prescriptions with a camera that is of sufficient quality and resolution so that the Oregon licensed Pharmacist from the RDSP Affiliated Pharmacy can visually identify each

Please see rule for additional requirements.

SOURCE: OAR 855-139-0205. (Accessed Dec. 2024).

Chiropractic Physician

The use of telehealth as described in subsection (2) of this section is not an expansion of the scope of practice of chiropractic physicians. The use of telehealth establishes a doctor-patient relationship.

SOURCE: OAR 811-015-0066. (Accessed Dec. 2024).

Rules for Practice Across State Lines

A telemedicine licensee is subject to all the provisions of the Medical Practice Act (ORS Chapter 677), and to all the administrative rules of the Oregon Medical Board.

A telemedicine licensee has the same duties and responsibilities and is subject to the same penalties and sanctions as any other physician or physician associate licensed under ORS Chapter 677, including but not limited to the following:

• The telemedicine licensee must establish an appropriate provider-patient relationship;
• The telemedicine licensee must make a judgment based on some type of objective criteria upon which to diagnose, treat, correct, or prescribe;
• The telemedicine licensee must engage in all necessary practices that are in the best interest of the patient; and
• The telemedicine licensee must provide for an acceptable continuity of care for patients, including follow-up care, information, and documentation of care provided to the patient or suitably identified care providers of the patient.

SOURCE: OR Admin. Rules, 847-025-0000. (Accessed Dec. 2024).

Optometry

“Telehealth prescription” may only be issued on an intial spectacle or contact lens prescription only after conducting an in-person eye exam prior to delivering telemedicine.

Note: The word ‘initial’ seems to be misspelled in official regulation.

SOURCE: OAR 852-001-0002. (Accessed Dec. 2024).

A telemedicine licensee [physicians practicing medicine across state lines] must not:

• Act as a dispensing physician as described in ORS 677.010(5) or dispensing physician associate as described in ORS 677.511;
• Prescribe controlled substances for the management of chronic pain to a person located in Oregon;
• Provide written documentation for purposes of ORS 475C.783;
• Employ a physician associate as defined in ORS 677.495 to treat a person located within Oregon;
• Assert a lien for services under ORS 87.555;
• Act as a supervising physician of an Oregon-certified First Responder or Emergency Medical Technician as defined in ORS 682.245;
• Be eligible for any tax credit provided by ORS 316.076;
• Participate in the Rural Health Services Program under 442.550 to 442.570; or
• Prescribe medication based only on a sale or form over the Internet, unless an appropriate provider-patient relationship is established and the standard of care described in ORS 677.095 and 677.265 is met.

SOURCE: OR Admin Rules, 847-025-0030. (Accessed Dec. 2024).

Medical Marijuana

Except as provided in subsection (b), a dispensary shall ensure that a physician or a pharmacist is available, either in person or by synchronous interaction, to verify patient certifications and to consult with patients and caregivers at all times during the hours the facility is open to dispense or to offer to dispense medical marijuana products to patients and caregivers.

If a dispensary is authorized to operate more than one facility under its permit, a physician assistant or a certified registered nurse practitioner may be available, either in person or by synchronous interaction, to verify patient certifications and to consult with patients and caregivers at each of the other locations instead of a physician or pharmacist. The physician, pharmacist, physician assistant or certified registered nurse practitioner may rotate coverage of the facilities, provided that a physician or pharmacist is always available, either in person or by synchronous interaction, at one of the facilities. Furthermore, no less than one dedicated medical professional must be present either, physically or by synchronous interaction, for each distinct dispensary facility location and shall not cover more than one dispensary facility location regardless of whether in-person coverage or synchronous interaction is used.

SOURCE: Rules and Regulations, Title 28, 1161a.25, (Accessed Sept. 2024).

See FAQ Number 13 on federal requirements for substance use disorder treatment and Medication Assisted Treatment.

SOURCE: PA Dept. of State, Professional Licensing, Telemedicine FAQs. (Accessed Sept. 2024).

No reference found.

Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in face-to-face settings. Treatment, including issuing a prescription, based solely on an online questionnaire without an appropriate evaluation does not constitute an acceptable standard of care and is considered unprofessional conduct.

Sufficient security measures must be in place and documented to assure confidentiality and integrity of patient-identifiable information. Transmissions, including patient e-mail, prescriptions and laboratory results must be secure within existing technology (i.e., password protected, encrypted electronic prescriptions, or other reliable authentication techniques). Patient-physician e-mail, as well as other patient-related electronic communications that is pertinent to the diagnosis and treatment of the patient should be stored and filed in the patient’s medical record.

SOURCE: RI Department of Health. Telemedicine. (Accessed Oct. 2024).

Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in face-to-face settings. Therefore, consistent with the definition of telemedicine, provided in § 1.2(A)(25) of this Part, treatment, including issuing a prescription, based solely on an online questionnaire without an appropriate evaluation does not constitute an acceptable standard of care and is considered unprofessional conduct. Asynchronous evaluation of a patient, without contemporaneous real-time, interactive exchange between the physician and patient, is not appropriate.

SOURCE: Code of RI Rules, 216-40-05-1, (Accessed Oct. 2024).

This relationship is complex and based on the mutual understanding between physician and patient of the shared responsibility for the patient’s health care. The physician should recognize that the patient-physician relationship in Telemedicine and Internet medicine is inherently different. It is possible, if not probable, that the physician and patient will never meet in-person. It is the physician who has the professional responsibility to consider these differences in their evaluation and management of the patient. The BMLD defines the beginning of the physician-patient relationship as being clearly established when the physician agrees to undertake diagnosis and treatment of the patient and the patient agrees, whether or not there has been an in-person encounter between the physician (or other health care practitioner) and patient.

The physician-patient relationship is fundamental to the provision of acceptable medical care. It is the expectation of the BMLD that physicians recognize the obligations, responsibilities and patient rights associated with establishing and maintaining an appropriate physician-patient relationship whether or not face-to-face contact between physician and patient has occurred. However, whenever a patient’s clinical presentation suggests the need for an in-person physical examination, the patient should be referred for an in-person evaluation which is documented in the medical record. Failure to make necessary referrals or progressions to treatments without doing so constitutes unprofessional conduct.

Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in face-to-face settings. Treatment, including issuing a prescription, based solely on an online questionnaire without an appropriate evaluation does not constitute an acceptable standard of care and is considered unprofessional conduct. The BMLD specifically highlights that prescribing controlled substances without an established in-person physician-patient relationship is prohibited. (Exception* a covering physician may prescribe a controlled substance if an established coverage agreement is in place and the quantity reflects the prescription is for a short duration)

SOURCE: Rhode Island Board of Medical Licensure and Discipline, Guidelines for the Appropriate Use of Telemedicine and the Internet in Medical Practice, (Accessed Oct. 2024).

Life-Saving Allergy Medication – Emergency Administration

An authorized entity that acquires a stock supply of epinephrine auto-injectors pursuant to a prescription issued in accordance with this chapter, may make such epinephrine auto-injectors available to individuals other than those trained individuals described in § 23-6.4-6, and such individuals may administer such epinephrine auto-injector to any individual believed in good faith to be experiencing anaphylaxis, if the epinephrine auto-injectors are stored in a locked, secure container and are made available only upon remote authorization by an authorized healthcare provider after consultation with the authorized healthcare provider by audio, televideo, or other similar means of electronic communication. Consultation with an authorized healthcare provider for this purpose shall not be considered the practice of telemedicine or otherwise be construed as violating any law or rule regulating the authorized healthcare provider’s professional practice.

SOURCE: RI Gen. Laws 23-6.4-5, (Accessed Oct. 2024).

Prescribing of EpiPens

An authorized entity described in § 5.3.1 of this Part which chooses to acquire and stock a supply of epinephrine auto-injectors must maintain an Operations plan on the premises. The plan shall include at a minimum:…

• Description of the process to allow individuals, other than those trained per R.I. Gen. Laws § 23-6.4-6, to be provided the epinephrine auto-injectors via remote authorization by an authorized health care provider, after consultation with the authorized health care provider by audio, tele-video, or other similar means of electronic communication, pursuant to R.I. Gen. Laws § 23-6.4-5.

SOURCE:  RI Regulations Title 216, Sec. 20-10-5, (Accessed Oct. 2024).

Any health care professional who utilizes telehealth shall ensure that a proper health provider-patient relationship is established and includes:

• Verifying and authenticating the location and, to the extent reasonable, identifying the requesting patient;
• Disclosing and validating the health care professional’s identity and applicable credentials, as appropriate;
• Obtaining appropriate consent for treatment from a requesting patient after disclosure regarding the delivery models and treatment methods or limitations;
• Establishing a diagnosis through the use of acceptable medical practices, including patient history, mental status examination, physical examination, and appropriate diagnostic and laboratory testing;
• Discussing with the patient the diagnosis and its evidentiary basis and the risks and benefits of various treatment options;
• Ensuring appropriate follow-up care for the patient;
• Providing a visit summary to the patient or consult note; and
• Utilizing technology sufficient to evaluate or diagnose and appropriately treat a patient for the condition as presented in accordance with the applicable standard of care.

Exceptions to the requirements of this section include on-call, cross coverage situations, and consultation with another health care professional who has an ongoing health care provider relationship with the patient and agrees to supervise the patient’s care and emergency treatment.

SOURCE: SD Codified Laws Sec. 34-52-3  (Accessed Jul. 2024).

A health care professional using telehealth to provide medical care to any patient located in the state shall provide an appropriate face-to-face examination using real-time audio and visual technology prior to diagnosis and treatment of the patient, if a face-to-face encounter would otherwise be required in the provision of the same service not delivered via telehealth.

SOURCE: SD Codified Laws Sec. 34-52-5. (Accessed Jul. 2024).

Without a proper provider-patient relationship, a health care professional using telehealth may not prescribe a controlled drug or substance, as defined by § 34-20B-3, solely in response to an internet questionnaire or consult, including any encounter via telephone.

SOURCE: SD Codified Laws Sec. 34-52-6. (Accessed Jul. 2024).

SOURCE: SD Codified Laws Sec. 36-4-47. (Accessed Jul. 2024).

For the purposes of this section, a healthcare provider-patient relationship with respect to telemedicine or telehealth is created by mutual consent and mutual communication, except in an emergency, between the patient and the provider. The consent by the patient may be expressed or implied consent; however, the provider-patient relationship is not created simply by the receipt of patient health information by a provider unless a prior provider-patient relationship exists. The duties and obligations created by the relationship do not arise until the healthcare provider:

• Affirmatively undertakes to diagnose or treat the patient; or
• Affirmatively participates in the diagnosis or treatment.

A healthcare provider who is authorized to prescribe buprenorphine under federal law shall not prescribe via telehealth a buprenorphine product, as approved by the federal food and drug administration for use in recovery or medication-assisted treatment, unless:

• The healthcare provider is employed by or contracted with:
  • A licensed nonresidential office-based opiate treatment facility or licensed nonresidential opioid treatment program, as defined in § 33-2-402;
  • A community mental health center, as defined in § 33-1-101;
  • A federally qualified health center, as defined in§ 63-10-601;
  • A hospital licensed under title 68 or 33; or
  • The bureau of TennCare’s comprehensive enhanced buprenorphine treatment network; and
• The delivery of telehealth is being provided on behalf of the entity that employs or contracts with the provider.

SOURCE:  TN Code Sec. 63-1-155, (Accessed Aug. 2024).

Prerequisites to Issuing Prescriptions or Dispensing Medications – In Person, Electronically, and Over the Internet

Except as provided in subparagraph (b), it shall be a prima facie violation of T.C.A. §63-6-214(b)(1), (4), and (12) for a physician to prescribe or dispense any drug to any individual, whether in person or by electronic means or over the Internet or over telephone lines, unless the physician, or his/her licensed supervisee pursuant to appropriate protocols or medical orders, has first done and appropriately documented, for the person to whom a prescription is to be issued or drugs dispensed, all of the following:

• Performed an appropriate history and physical examination; and
• Made a diagnosis based upon the examinations and all diagnostic and laboratory tests consistent with good medical care; and
• Formulated a therapeutic plan, and discussed it, along with the basis for it and the risks and benefits of various treatments options, a part of which might be the prescription or dispensed drug, with the patient; and
• Insured availability of the physician or coverage for the patient for appropriate follow-up care.

SOURCE: TN Rule Annotated, 0880-02-.14(7)(a). (Accessed Aug. 2024).

Except as provided under paragraphs seven (7) and eight (8) of this rule, the patient encounter to establish or maintain the physician-patient relationship via telemedicine between the physician in a remote location and the patient in Tennessee may occur with or without the use of a facilitator so long as such encounter is consistent with parts 1. and 2. of this Rule: Certain conditions apply in each case. See rule for details.

SOURCE: TN Rule Annotated, 0880-02.-16(6)(a). (Accessed Aug. 2024).

Optometry

Optometrist-patient relationship. Pursuant to T.C.A. § 63-1-155(b), an optometrist- patient relationship with respect to telemedicine or telehealth is created by mutual consent and mutual communication, except in an emergency, between the patient and the optometrist. The consent by the patient may be expressed or implied consent; however, the optometrist-patient relationship is not created simply by the receipt of patient health information by an optometrist unless a prior optometrist-patient relationship exists. The duties and obligations created by the relationship do not arise until the optometrist:

• Affirmatively undertakes to diagnose or treat the patient; or
• Affirmatively participates in the diagnosis or treatment.

The optometrist-patient relationship established via telehealth, shall at a minimum, meet the requirements of T.C.A. § 63-1-155(b).

SOURCE: TN Rule Annotated 1045-02-.18, (Accessed Aug. 2024).

Physician Assistant

A physician assistant authorized to prescribe drugs under this section who provides services in a free or reduced fee clinic under the Volunteer Health Care Services Act, compiled in chapter 6, part 7 of this title, may arrange for required personal review of the physician assistant’s charts by a collaborating physician in the office or practice site of the physician or remotely via HIPAA compliant electronic means rather than at the site of the clinic.

A physician assistant authorized to prescribe drugs under this section who provides services in a community mental health center as defined in § 33-1-101, or federally qualified health center as defined in § 63-10-601, may arrange for the required personal review of the physician assistant’s charts by a collaborating physician, with the same authority to render prescriptive services that the physician assistant is authorized to render, in the remote office or practice site of the physician, or any required visit by a collaborating physician to any remote site, or both, via HIPAA-compliant electronic means rather than at the site of the clinic.

Except as provided above:

• A physician assistant licensed to prescribe drugs who provides services at a remote healthcare setting may arrange for any required personal review of the physician assistant’s charts by a collaborating physician either via HIPAA-compliant electronic means or in person; and
• A physician assistant licensed to prescribe drugs may arrange for up to ten (10) of the required annual remote site visits by a collaborating physician by HIPAA-compliant electronic means rather than at the site of the clinic. All other of the required site visits by a collaborating physician to a remote site must take place in person at the site of the clinic. As used in this subdivision, “annual” means a rolling twelve-month period.

Protocols must also include, at a minimum, the following requirements: …

• That if the advance practice registered nurse practices in a remote location site from the collaborating physician’s practice site, the collaborating physician conducts a remote site visit at least every thirty (30) days as described in § 63-7-126;

Collaborative agreements governing advance practice registered nurses who have six thousand (6,000) or more hours of documented postgraduate clinical experience and are endorsed by the board must include, at a minimum, the following: …

• Requirements of patient chart review and remote site visits, if any, established at the practice level and commensurate with the level of training, experience, and competence of the advance practice registered nurse within the expected scope of practice of the advance practice registered nurse.

SOURCE:  Section 63-19-107, & Title 63, Ch. 7, Part 1 as amended by HB 2318 & SB 2136, (Accessed Aug. 2024).

Optometry

Telehealth technologies, where prescribing medications and ophthalmic materials may be contemplated, shall require an optometrist to implement measures to uphold patient safety in the absence of a traditional in-person patient encounter. Such measures shall guarantee that the identity of the patient and provider is clearly established and that detailed documentation for the clinical patient encounter and resulting prescription is both enforced and independently kept.

Prescribing medications, in-person or via telehealth, is at the professional discretion of the optometrist based on licensure. The indication, appropriateness, and safety considerations for each telehealth visit prescription shall be evaluated by the optometrist in accordance with current standards of practice and consequently carry the same professional accountability as prescriptions delivered during an in-person patient encounter. However, where such measures are upheld, and the appropriate clinical consideration is carried out and documented, optometrists may exercise their judgment and prescribe medications as part of telehealth encounters.

For telehealth ophthalmic prescriptions, the same requirements exist as for fixed fee in-person services as outlined in Tenn. Comp. R. & Regs. 1045-02-.08(3).

SOURCE: Section 1045-02-.18, (Accessed Aug. 2024).

A valid practitioner-patient relationship is present between a practitioner providing a telemedicine medical service or a teledentistry dental service and a patient receiving the service as long as the practitioner complies with the standard of care described in Section 111.007 and the practitioner:

• Has a preexisting practitioner-patient relationship with the patient established in accordance with rules adopted under Section 111.006;
• communicates, regardless of the method of communication, with the patient pursuant to a call coverage agreement established in accordance with:
  • Texas Medical Board rules with a physician requesting coverage of medical care for the patient; or
  • State Board of Dental Examiners rules with a dentist requesting coverage of dental care for the patient; or
• provides the telemedicine medical services or teledentistry dental services through the use of one of the following methods, as long as the practitioner complies with the follow-up requirements in Subsection (b), and the method allows the practitioner to have access to, and the practitioner uses, the relevant clinical information that would be required in accordance with the standard of care described in Section 111.007:
  • Synchronous audiovisual interaction between the practitioner and the patient in another location
  • asynchronous store and forward technology, including asynchronous store and forward technology in conjunction with synchronous audio interaction between the practitioner and the patient in another location, as long as the practitioner uses clinical information from:
    • clinically relevant photographic or video images, including diagnostic images; or
    • the patient’s relevant clinical records, such as the relevant medical or dental history, laboratory and pathology results, and prescriptive histories; or
• another form of audiovisual telecommunication technology that allows the practitioner to comply with the standard of care described in Section 111.007.

A practitioner who provides telemedicine medical services to a patient as described in Subsection (a)(3) shall:

• provide the patient with guidance on appropriate follow-up care; and
• if the patient consents and the patient has a primary care physician, provide to the patient’s primary care physician within 72 hours after the practitioner provides the services to the patient a medical record or other report containing an explanation of the treatment provided by the practitioner to the patient and the practitioner’s evaluation, analysis, or diagnosis, as appropriate, of the patient’s condition.

Notwithstanding any other provision of this section, a practitioner-patient relationship is not present if a practitioner prescribes an abortifacient or any other drug or device that terminates a pregnancy.

The Texas Medical Board, the Texas Board of Nursing, the Texas Physician Assistant Board, and the Texas State Board of Pharmacy shall jointly adopt rules that establish the determination of a valid prescription in accordance with Section 111.005. Rules adopted under this section must allow for the establishment of a practitioner-patient relationship by a telemedicine medical service provided by a practitioner to a patient in a manner that complies with Section 111.005(a)(3).

The Texas Medical Board, the Texas Board of Nursing, the Texas Physician Assistant Board, and the Texas State Board of Pharmacy shall jointly develop and publish on each respective board’s Internet website responses to frequently asked questions relating to the determination of a valid prescription issued in the course of the provision of telemedicine medical services.

The State Board of Dental Examiners and the Texas State Board of Pharmacy shall jointly adopt rules that establish the determination of a valid prescription in accordance with Section 111.005. Rules adopted under this subsection must allow for the establishment of a practitioner-patient relationship by a teledentistry dental service provided by a dentist to a patient in a manner that complies with Section 111.005(a)(3) and must be substantially similar to the rules adopted under Subsection (a) of this section. The State Board of Dental Examiners and the Texas State Board of Pharmacy shall jointly develop and publish on each respective board’s Internet website responses to frequently asked questions relating to the determination of a valid prescription issued in the course of the provision of teledentistry dental services.

An agency with regulatory authority over a health professional may not adopt rules pertaining to telemedicine medical services, teledentistry dental services, or telehealth services that would impose a higher standard of care than the standard described in Subsection (a).

The State Board of Dental Examiners by rule shall establish limits on the quantity of a controlled substance, including an opiate, that a dentist may prescribe to a patient as a teledentistry dental service. Except as provided by Subsection (c), the rules may not authorize a dentist to prescribe more than is necessary to supply a patient for:

1. if the prescription is for an opiate, a two-day period; or
2.  if the prescription is for a controlled substance other than an opiate, a five-day period.

For each day in a period described by Subsection (b)(1) or (2) that is a Saturday, Sunday, or national holiday, the period is extended to include the next day that is not a Saturday, Sunday, or national holiday.

SOURCE: TX Occupations Code 111.005-.009, (Accessed Aug. 2024).

Teledentistry 

A dentist, dental hygienist, or dental assistant who delivers teledentistry services to a patient located in Texas must hold an active Texas license or registration issued by the Board.

A dental health professional providing a dental health care service or procedure as a teledentistry dental service:

• is subject to the same standard of care that would apply to the provision of the same dental health care service or procedure in an in-person setting as established in §108.7 of this title (relating to Minimum Standard of Care, General);
• must establish a practitioner-patient relationship; and
• must maintain complete and accurate dental records as set out in §108.8 of this title (relating to Records of the Dentist).

The validity of a prescription issued as a result of a teledentistry dental service is determined by the same standards that would apply to the issuance of the prescription in an in-person setting.

This rule does not limit the professional judgment, discretion or decision-making authority of a licensed practitioner. A licensed practitioner is expected to meet the standard of care and demonstrate professional practice standards and judgment, consistent with all applicable statutes and rules when issuing, dispensing, delivering, or administering a prescription medication as a result of a teledentistry dental service.

A valid prescription must be:

• Issued for a legitimate dental purpose by a practitioner as part of patient-practitioner relationship as set out in Texas Occupations Code §111.005; and
• Meet all other applicable laws and rules before prescribing, dispensing, delivering or administering a dangerous drug or controlled substance.

Any prescription drug orders issued as the result of a teledentistry dental service, are subject to all regulations, limitations, and prohibitions set out in the federal and Texas Controlled Substances Act, Texas Dangerous Drug Act and any other applicable federal and state law.

When prescribing a controlled substance to a patient as a teledentistry dental service, a dentist must not prescribe more than is necessary to supply a patient for:

• If the prescription is for an opiate, a two-day period; or
•  If the prescription is for a controlled substance other than an opiate, a five-day period.

For each day in a period described by paragraph (2) of this subsection that is a Saturday, Sunday, or national holiday, the period is extended to include the next day that is not a Saturday, Sunday, or national holiday.

SOURCE: TX Administrative Code Title 22, Part 5, Ch. 108, Rule 108.16. (Accessed Aug. 2024).

Board of Medical Examiners & Board of Nursing

A valid prescription must be:

• issued for a legitimate medical purpose by a practitioner as part of patient-practitioner relationship as set out in §111.005, Texas Occupations Code; and
• meet all other applicable laws before prescribing, dispensing, delivering or administering a dangerous drug or controlled substance.

Any prescription drug orders issued as the result of a telemedicine medical service, are subject to all regulations, limitations, and prohibitions set out in the federal and Texas Controlled Substances Act, Texas Dangerous Drug Act and any other applicable federal and state law.

Limitation on Treatment of Chronic Pain. Chronic pain is a legitimate medical condition that needs to be treated but must be balanced with concerns over patient safety and the public health crisis involving overdose deaths. The Legislature has already put into place laws regarding the treatment of pain and requirements for registration and inspection of pain management clinics. Therefore, the Board has determined clear legislative intent exists for the limitation of chronic pain treatment through a telemedicine medical service.

Treatment for Chronic Pain. For purposes of this rule, chronic pain has the same definition as used in §170.2(4) of this title (relating to Definitions). Telemedicine medical services used for the treatment of chronic pain with scheduled drugs by any means other than via audio and video two-way communication is prohibited, unless a patient:

• Is an established chronic pain patient of the physician or health professional issuing the prescription;
• Is receiving a prescription that is identical to a prescription issued at the previous visit; and
• Has been seen by the prescribing physician or health professional defined under Section 111.001(1) of Texas Occupations Code, in the last 90 days either:
  • in-person; or
  • via telemedicine using audio and video two-way communication.

Treatment for Acute Pain. For purposes of this rule, acute pain has the same definition as used in §170.2(2) of this title. Telemedicine medical services may be used for the treatment of acute pain with scheduled drugs, unless otherwise prohibited under federal and state law.

SOURCE: TX Admin. Code, Title 22, Part 9, Ch. 174.5 & Title 22, Part 11, Ch. 217.24, [text varies slightly between two codes] (Accessed Aug. 2024).

APRNs Treating Chronic Pain

An APRN, when determining whether to utilize telemedicine medical services for the treatment of chronic pain with controlled substances as permitted by paragraph (1)(A) of this subsection, shall give due consideration to factors that include, at a minimum, the date of the patient’s last in-person visit, patient co-morbidities, and occupational related COVID risks. These are not the sole, exclusive, or exhaustive factors an APRN should consider under this rule.

If a patient is treated for chronic pain with scheduled drugs through the use of telemedicine medical services as permitted by paragraph (1)(A) of this subsection, the medical records must document the exception and the reason that a telemedicine visit was conducted instead of an in-person visit.

SOURCE: TX Admin Code, Title 22, Part 11, Ch. 217.24, (Accessed Aug. 2024).

Establishing a practitioner-patient relationship is not required for:

• a physician to prescribe medications for sexually transmitted diseases for partners of the physician’s established patient, if the physician determines that the patient may have been infected with a sexually transmitted disease; or
• a physician to prescribe dangerous drugs and/or vaccines for post-exposure prophylaxis of disease for close contacts of a patient if the physician diagnoses the patient with one or more of the following infectious diseases listed in subclauses (I) – (VII) of this clause, or is providing public health medical services pursuant to a memorandum of understanding entered into between the board and the Department of State Health Services.  See rule for additional details.

SOURCE: TX Admin. Code, Title 22, Part 9, Ch. 190.8(1)(L). (Accessed Aug. 2024).

An outpatient chemical dependency treatment program provided by a treatment facility licensed under Chapter 464 may provide services under the program to adult and adolescent clients, consistent with commission rule, using telecommunications or information technology.

SOURCE: TX Health and Safety Code Sec. 462.015, (Accessed Aug. 2024).

Physicians who treat and prescribe through communications technology are practicing medicine and must possess a full Texas medical license when treating residents of Texas. An out-of-state physician may provide episodic consultations without a Texas medical license, as provided in Texas Occupations Code, §151.056, §172.2(g)(4) of this title (relating to Construction and Definitions), and §172.12(f) of this title (relating to Out-of-State Telemedicine License).

SOURCE: TX Admin. Code, Title 22, Part 9, Sec. 174.8. (Accessed Aug. 2024).

A provider offering telehealth services shall at all times:

• act within the scope of the provider’s license; and
• be held to the same standards of practice as those applicable in traditional health care settings

If the provider does not already have a provider-patient relationship with the patient, establish a provider-patient relationship during the patient encounter in a manner consistent with the standards of practice, including providing the provider’s licensure and credentials to the patient;

Before providing treatment or prescribing a prescription drug, establish a diagnosis and identify underlying conditions and contraindications to a recommended treatment after:

• obtaining from the patient or another provider the patient’s relevant clinical history; and
• documenting the patient’s relevant clinical history and current symptoms;

Be available to a patient who receives telehealth services from the provider for subsequent care related to the initial telemedicine services, in accordance with community standards of practice.

Be familiar with available medical resources, including emergency resources near the originating site, in order to make appropriate patient referrals when medically indicated.

Make available to each patient receiving telehealth services the patient’s medical records; and

If the patient has a designated health care provider who is not the telemedicine provider:

• Consult with the patient regarding whether to provide the patient’s designated health care provider a medical record or other report containing an explanation of the treatment provided to the patient and the telemedicine provider’s evaluation, analysis, or diagnosis of the patient’s condition;
• Collect from the patient the contact information of the patient’s designated health care provider; and
• Within two weeks after the day on which the telemedicine provider provides services to the patient, and to the extent allowed under HIPAA as that term is defined in Section 26-18-17, provide the medical record or report to the patient’s designated health care provider, unless the patient indicates that the patient does not want the telemedicine provider to send the medical record or report to the patient’s designated health care provider.

A provider offering telemedicine services may not diagnose a patient, provide treatment, or prescribe a prescription drug based solely on one of the following:

• an online questionnaire;
• an email message; or
• a patient-generated medical history.

A provider may not offer telehealth services if:

• the provider is not in compliance with applicable laws, rules, and regulations regarding the provider’s licensed practice; or
• the provider’s license under Title 58, Occupations and Professions, is not active and in good standing.

SOURCE: UT Code, 26B-4-704. (Accessed Nov. 2024).

Except as otherwise provided in an interstate compact enacted under this title, an individual who is licensed, in good standing, to practice mental health therapy or substance use disorder counseling in a state or territory of the United States outside of Utah, and who provides mental health therapy remotely or substance use disorder counseling remotely to a client in Utah:

• may not prescribe a prescription drug for a client in Utah unless the individual is licensed in Utah to prescribe the prescription drug

See cross-state licensing section for more details.

SOURCE: UT Code Sec. 58-60-107 (Accessed Nov. 2024).

It is considered unprofessional conduct to issue, or aid and abet in the issuance of, an order or prescription for a drug or device:

• without first obtaining information in the usual course of professional practice, that is sufficient to establish a diagnosis, to identify conditions, and to identify contraindications to the proposed treatment; or
• with prescriptive authority conferred by an exception issued under this title, or a multi-state practice privilege recognized under this title, if the prescription was issued without first obtaining information, in the usual course of professional practice, that is sufficient to establish a diagnosis, to identify underlying conditions, and to identify contraindications to the proposed treatment

SOURCE: UT Code, 58-1-501. (Accessed Nov. 2024).

Supervision of Cosmetic Medical Procedures

A physician who has an unrestricted license to practice medicine, a nurse practitioner who has an unrestricted license for advanced practice registered nursing, or a physician assistant acting in accordance with Chapter 70a, Utah Physician Assistant Act, who has an unrestricted license to practice as a physician assistant, shall: …

• conduct an evaluation of the patient either in-person or utilizing a live telemedicine visit before the initiation of a treatment.  See language for additional requirements.

SOURCE:  UT Code Sec. 58-1-506, (Accessed Nov. 2024).

Controlled substances for use in treatment of opioid use disorder may be prescribed via telehealth in accordance with federal requirements.

SOURCE: VT Statute Annotated Title 18, Sec. 4752 (Accessed Nov. 2024).

Subject to the limitations of the license under which the individual is practicing, a health care provider licensed in this State may prescribe, dispense, or administer drugs or medical supplies, or otherwise provide treatment recommendations to a patient after having performed an appropriate examination of the patient in person, through telemedicine, or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically. Treatment recommendations made via electronic means, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional provider-patient settings.

SOURCE: VT Statutes Annotated, Title 18 Sec. 9361(b)  (Accessed Nov. 2024).

A physician shall not be subject to any civil or criminal liability or professional disciplinary action if the physician prescribes to a patient with a terminal condition medication to be self-administered for the purpose of hastening the patient’s death and the physician affirms by documenting in the patient’s medical record that all of the following occurred:

• The patient made an oral request to the physician in the physician’s physical presence or by telemedicine, if the physician determines the use of telemedicine to be clinically appropriate, for medication to be self- administered for the purpose of hastening the patient’s death.
• Not fewer than 15 days after the first oral request, the patient made a second oral request to the physician in the physician’s physical presence or by telemedicine, if the physician determines the use of telemedicine to be clinically appropriate, for medication to be self-administered for the purpose of hastening the patient’s death.

See statute for complete list

SOURCE VT Statutes Annotated, Title 18, Ch. 113, Sec. 5283, (Accessed Nov. 2024).

The Board of Medical Examiners shall establish by rules and regulations the requirements for telemedicine licensure in accordance with this subchapter, provided that the rules and regulations include the following: …

The physician, when examining a patient by telemedicine, shall establish a bona fide physician-patient relationship by:

• Establishing a relationship and coordinating with the patient’s Virgin Islands-licensed healthcare professional.
• Establishing a diagnosis through the use of accepted medical practices including, but not limited to, patient history, mental status and appropriate diagnostic and laboratory testing.
• Discussing with the patient any diagnosis as well as the risks and benefits of various treatment options.
• Ensuring the availability for appropriate follow-up care.
• Fulfilling any other requirements as deemed appropriate and necessary by the Board of Medical Examiners.

SOURCE:  27 V.I. Code Section 45d(c)(2).  (Accessed Sept. 2024).

The practitioner-patient relationship is fundamental to the provision of acceptable medical care. It is the expectation of the Board that practitioners recognize the obligations, responsibilities, and patient rights associated with establishing and maintaining a practitioner-patient relationship. Where an existing practitioner-patient relationship is not present, a practitioner must take appropriate steps to establish a practitioner-patient relationship consistent with the guidelines identified in this document, with Virginia law, and with any other applicable law.  While each circumstance is unique, such practitioner-patient relationships may be established using telemedicine services provided the standard of care is met.

A practitioner is discouraged from rendering medical advice and/or care using telemedicine services without (1) fully verifying and authenticating the location and, to the extent possible, confirming the identity of the requesting patient; (2) disclosing and validating the practitioner’s identity and applicable credential(s); and (3) obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations, including any special informed consents regarding the use of telemedicine services. An appropriate practitioner-patient relationship has not been established when the identity of the practitioner may be unknown to the patient.

A documented medical evaluation and collection of relevant clinical history commensurate with the presentation of the patient to establish diagnoses and identify underlying conditions and/or contra-indications to the treatment recommended/provided must be obtained prior to providing treatment, which treatment includes the issuance of prescriptions, electronically or otherwise. Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in traditional, in-person encounters. Treatment, including issuing a prescription based solely on an online questionnaire, does not constitute an acceptable standard of care.

Prescribing controlled substances requires the establishment of a bona fide practitioner-patient relationship in accordance with § 54.1-3303 (A) of the Code of Virginia. Prescribing controlled substances, in-person or via telemedicine services, is at the professional discretion of the prescribing practitioner. The indication, appropriateness, and safety considerations for each prescription provided via telemedicine services must be evaluated by the practitioner in accordance with applicable law and current standards of practice and consequently carries the same professional accountability as prescriptions delivered during an in-person encounter. Where such measures are upheld, and the appropriate clinical consideration is carried out and documented, the practitioner may exercise their judgment and prescribe controlled substances as part of telemedicine encounters in accordance with applicable state and federal law.

Prescriptions must comply with the requirements set out in Virginia Code §§ 54.1-3408.01 and 54.1-3303(A). Prescribing controlled substances in Schedule II through V via telemedicine also requires compliance with federal rules for the practice of telemedicine. Practitioners issuing prescriptions as part of telemedicine services should include direct contact for the prescriber or the prescriber’s agent on the prescription. This direct contact information ensures ease of access by pharmacists to clarify prescription orders, and further facilitates the prescriber-patient-pharmacist relationship.

SOURCE: Telemedicine Guidance. Doc. # 85-12. VA Board of Medicine. P. 2-4 (Aug. 19, 2021). (Accessed Aug. 2024).

A practitioner who has established a bona fide practitioner-patient relationship with a patient in accordance with the provisions of this subsection may prescribe Schedule II through VI controlled substances to that patient.

A practitioner who has established a bona fide practitioner-patient relationship with a patient in accordance with the provisions of this subsection may prescribe Schedule II through VI controlled substances to that patient via telemedicine if such prescribing is in compliance with federal requirements for the practice of telemedicine and, in the case of the prescribing of a Schedule II through V controlled substance, the prescriber maintains a practice at a physical location in the Commonwealth or is able to make appropriate referral of patients to a licensed practitioner located in the Commonwealth in order to ensure an in-person examination of the patient when required by the standard of care.

A prescriber may establish a bona fide practitioner-patient relationship for the purpose of prescribing Schedule II through VI controlled substances by an examination through face-to-face interactive, two-way, real-time communications services or store-and-forward technologies when all of the following conditions are met: (a) the patient has provided a medical history that is available for review by the prescriber; (b) the prescriber obtains an updated medical history at the time of prescribing; (c) the prescriber makes a diagnosis at the time of prescribing; (d) the prescriber conforms to the standard of care expected of in-person care as appropriate to the patient’s age and presenting condition, including when the standard of care requires the use of diagnostic testing and performance of a physical examination, which may be carried out through the use of peripheral devices appropriate to the patient’s condition; (e) the prescriber is actively licensed in the Commonwealth and authorized to prescribe; (f) if the patient is a member or enrollee of a health plan or carrier, the prescriber has been credentialed by the health plan or carrier as a participating provider and the diagnosing and prescribing meets the qualifications for reimbursement by the health plan or carrier pursuant to § 38.2-3418.16; (g) upon request, the prescriber provides patient records in a timely manner in accordance with the provisions of § 32.1-127.1:03 and all other state and federal laws and regulations; (h) the establishment of a bona fide practitioner-patient relationship via telemedicine is consistent with the standard of care, and the standard of care does not require an in-person examination for the purpose of diagnosis; and (i) the establishment of a bona fide practitioner patient relationship via telemedicine is consistent with federal law and regulations and any waiver thereof. Nothing in this paragraph shall apply to (1) a prescriber providing on-call coverage per an agreement with another prescriber or his prescriber’s professional entity or employer; (2) a prescriber consulting with another prescriber regarding a patient’s care; or (3) orders of prescribers for hospital out-patients or in-patients.

SOURCE: VA Code Annotated 54.1-3303, (Accessed Aug. 2024).

A practitioner in the course of his professional practice may issue a written certification for the use of cannabis products for treatment or to alleviate the symptoms of any diagnosed condition or disease determined by the practitioner to benefit from such use. The practitioner shall use his professional judgment to determine the manner and frequency of patient care and evaluation and may employ the use of telemedicine, provided that the use of telemedicine includes the delivery of patient care through real-time interactive audiovisual technology. No practitioner may issue a written certification while such practitioner is on the premises of a pharmaceutical processor or cannabis dispensing facility. A pharmaceutical processor shall not endorse or promote any practitioner who issues certifications to patients. If a practitioner determines it is consistent with the standard of care to dispense botanical cannabis to a minor, the written certification shall specifically authorize such dispensing. If not specifically included on the initial written certification, authorization for botanical cannabis may be communicated verbally or in writing to the pharmacist at the time of dispensing.

SOURCE: VA Code Annotated Sec. 4.1-1601, (Accessed Aug. 2024).

Requirements for practitioner issuing a certification for cannabis products:

The practitioner shall use the practitioner’s professional judgment to determine the manner and frequency of patient care and evaluation, which may include the use of telemedicine, provided that the use of telemedicine:

• Includes the delivery of patient care through real-time interactive audio-visual technology;
• Conforms to the standard of care expected for in-person care; and
• Transmits information in a manner that protects patient confidentiality.

SOURCE:  VA Admin Code Title 3, Sec. 10-30-30, (Access Aug. 2024).

A pharmacist may initiate treatment with, dispense, or administer drugs, devices, controlled paraphernalia, and other supplies and equipment pursuant to this section through telemedicine services, as defined in § 38.2-3418.16, in compliance with all requirements of § 54.1-3303 and consistent with the applicable standard of care.

SOURCE: VA Code 54.1-3303.1. (Accessed Aug. 2024).

A pharmacy shall not implement or enforce a policy that prevents a pharmacist from dispensing a prescription solely on the basis of the prescriber’s use of a telemedicine platform to provide services.

A pharmacist shall not prioritize dispensing a prescription from a prescriber who does not use telemedicine over dispensing a prescription from a prescriber who does use telemedicine solely on the basis of the prescriber’s use of a telemedicine platform to provide services.

SOURCE: VA Code Sec. 54.1-3420.3 (Accessed Aug. 2024).

Teledentistry

No person shall practice dentistry unless a bona fide dentist-patient relationship is established in person or through teledentistry. A bona fide dentist-patient relationship shall exist if the dentist has:

• Obtained or caused to be obtained a health and dental history of the patient;
• Performed or caused to be performed an appropriate examination of the patient, either physically, through use of instrumentation and diagnostic equipment through which digital scans, photographs, images, and dental records are able to be transmitted electronically, or through use of face-to-face interactive two-way real-time communications services or store-and-forward technologies;
• Provided information to the patient about the services to be performed; and
• Initiated additional diagnostic tests or referrals as needed. In cases in which a dentist is providing teledentistry, the examination required by clause (ii) shall not be required if the patient has been examined in person by a dentist licensed by the Board within the six months prior to the initiation of teledentistry and the patient’s dental records of such examination have been reviewed by the dentist providing teledentistry.

SOURCE: VA Statute 54.1-2711.  (Accessed Aug. 2024).

The WA Medical Quality Assurance Commission has issued guidance on the use telemedicine.  Guidance does not have the force of law, but can be considered by the Commission to be the standard of practice in the state.

A practitioner who uses telemedicine must establish a valid practitioner-patient relationship with the person who receives telemedicine services. The relationship is established when the practitioner agrees to undertake diagnosis or treatment of the patient and the patient agrees that the practitioner will diagnose or treat the patient. A valid practitioner-patient relationship may be established through telemedicine if the standard of care does not require an initial in- person encounter.

Prior to providing treatment, including issuing prescriptions, a practitioner who uses telemedicine should interview the patient to collect the relevant medical history and perform a physical examination, when medically necessary, sufficient for the diagnosis and treatment of the patient. A practitioner may not delegate an appropriate history and physical examination to an unlicensed person or to a licensed individual for whom that function would be out of the scope of the license.

Once a practitioner has obtained a relevant medical history and performed a physical examination, it is within the practitioner’s judgment to determine whether it is medically necessary to obtain a history or perform a physical examination at subsequent encounters. The technology used in a telemedicine encounter must be sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed inperson by the practitioner. An on-line questionnaire does not constitute an acceptable medical interview for the provision of treatment, including issuance of prescriptions, by a practitioner. The standard of care requires direct interaction with a licensed practitioner.

SOURCE: Washington Medical Commission, Defining and Providing Guidance on Telemedicine Usage, p. 4 (November 19, 2021). (Accessed Jun. 2024).

For purposes of authorizing the medical use of marijuana, a physician must complete an in-person physical exam or a remote physical exam when certain conditions are met. Following an in-person physical examination to authorize the use of marijuana for medical purposes, the health care professional may determine and note in the patient’s medical record that subsequent physical examinations for the purposes of renewing an authorization may occur through the use of telemedicine technology if the health care professional determines that requiring the qualifying patient to attend a physical examination in person to renew an authorization would likely result in severe hardship to the qualifying patient because of the qualifying patient’s physical or emotional condition.

SOURCE: Revised Code Washington Sec. 69.51A.030. (Accessed Jun. 2024).

Uniform Telehealth Act – Effective June 6, 2024

A practitioner-patient relationship may be established through telehealth. A practitioner-patient relationship may not be established through email, instant messaging, text messaging, or fax.

SOURCE: RCW New Title 18 Chapter, as added by SB 5481 (2024 Legislative Session). (Accessed Jun. 2024).

Each health care board is required to propose an emergency rule for telehealth regulation. The rule must include a prohibition of prescribing any controlled substance listed in Schedule II of the Uniform Controlled Substance Act, unless authorized by another section: Provided, That the prescribing limitations contained in this section do not apply to a physician or a member of the same group practice with an established patient.

The standard of care shall require that with respect to the established patient, the patient shall visit an in-person health care practitioner within 12 months of using the initial telemedicine service or the telemedicine service shall no longer be available to the patient until an in-person visit is obtained. This requirement may be suspended, in the discretion of the health care practitioner, on a case-by-case basis, and it does not apply to the following services: acute inpatient care, post-operative follow-up checks, behavioral medicine, addiction medicine, or palliative care.

SOURCE: WV Statute Sec. 30-1-26. (Accessed Nov. 2024).

“Valid patient-practitioner relationship” means the following have been established:

• (A) A patient has a medical complaint;
• (B) A medical history has been taken;
• (C) A face-to-face physical examination adequate to establish the medical complaint has been performed by the prescribing practitioner or in the instances of telemedicine through telemedicine practice approved by the appropriate practitioner board; and
• (D) Some logical connection exists between the medical complaint, the medical history, and the physical examination and the drug prescribed.

SOURCE: WV Code Sec. 30-5-4. (Accessed Nov. 2024).

A physician-patient relationship may not be established through:

• Text-based communications such as e-mail, Internet questionnaires, text-based messaging, or other written forms of communication.

• Through the use of telemedicine technologies which incorporate interactive audio using store and forward technology, real-time videoconferencing, or similar secure video services during the initial physician-patient encounter;
• For the practice of pathology and radiology, a physician-patient relationship may be established through store and forward telemedicine or other similar technologies; or
• Through the use of audio-only calls or conversations that occur in real time. Patient communication though audio-visual communication is preferable, if available or possible. Audio-only calls or conversations that occur in real time may be used to establish the physician-patient relationship.

Once a physician-patient relationship has been established, either through an in-person encounter or in accordance with the above, the physician may utilize any telemedicine technology that meets the standard of care and is appropriate for the patient presentation.

A physician or podiatrist who practices medicine to a patient solely through the utilization of telemedicine technologies may not prescribe to that patient any controlled substances listed in Schedule II of the Uniform Controlled Substances Act: Provided, That the prescribing limitations contained in this section do not apply to a physician or a member of the same group practice with an established patient.

The prescribing limitations do not apply when a physician is providing treatment to patients who are minors, or if 18 years of age or older, who are enrolled in a primary or secondary education program and are diagnosed with intellectual or developmental disabilities, neurological disease, Attention Deficit Disorder, Autism, or a traumatic brain injury in accordance with guidelines as set forth by organizations such as the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, or the American Academy of Pediatrics. The physician must maintain records supporting the diagnosis and the continued need of treatment.

The prescribing limitations do not apply to a hospital, excluding the emergency department, when a physician submits an order to dispense a controlled substance, listed in Schedule II of the Uniform Controlled Substances Act, to a hospital patient for immediate administration in a hospital.

A physician or podiatrist may not prescribe any pain-relieving controlled substance listed in Schedule II of the Uniform Controlled Substance Act as part of a course of treatment for chronic nonmalignant pain solely based upon a telemedicine encounter: Provided, That the prescribing limitations contained in this section do not apply to a physician or a member of the same group practice with an established patient.

A physician or health care provider may not prescribe any drug with the intent of causing an abortion.

These provisions do not prohibit the use of audio-only or text-based communications by a physician who is:

• Responding to a call for patients with whom a physician-patient relationship has been established through an in-person encounter by the physician;
• Providing cross coverage for a physician who has established a physician-patient or relationship with the patient through an in-person encounter; or
• Providing medical assistance in the event of an emergency.

SOURCE: WV Statute Sec. 30-14-12d & 30-3-13a, (Accessed Nov. 2024).

“Dishonorable, unethical or unprofessional conduct of a character likely to deceive, defraud or harm the public or any member thereof” includes practice of providing treatment recommendations relating to issuing prescriptions, via electronic or other means, for persons without establishing an on-going provider-patient relationship wherein the physician, podiatric physician or physician assistant has obtained information adequate to support the prescription: Provided, That this definition does not apply: in a documented emergency; or in an on-call or cross coverage situation; or where patient care is rendered in consultation with another provider who has an ongoing relationship with the patient, and who has agreed to supervise the patient’s treatment, including use of any prescribed medications.

SOURCE: WV Code of State Rules Sec. 11-1A-12.2(k) p. 21. (Accessed Nov. 2024).

A practitioner providing medication-assisted treatment may perform certain aspects of telehealth if permitted under his or her scope of practice.

SOURCE: WV Code Sec. 16-5Y-5(r). (Accessed Nov. 2024).

Final Rule (Effective until August 1st, 2027) – Dentistry

No person shall practice teledentistry unless a bona fide practitioner-patient relationship is established. A bona fide practitioner-patient relationship shall exist if the dentist has:

• obtained or caused to be obtained a health and dental history of the patient
• performed or caused to be performed an appropriate examination of the patient, either physically, through use of instrumentation and diagnostic equipment by which digital scans, photographs, images, and dental records are able to be transmitted electronically, or through use of face-to-face interactive two-way real-time communications services or store-and-forward technologies
• provided information to the patient about the services to be performed
• initiated additional diagnostic tests or referrals as needed; or
• through audio only calls or conversations that occur in real time

In cases in which a dentist is providing teledentistry, the examination required shall not be required if the patient has been examined in person by a dentist licensed by the board within the twelve months prior to the initiation of teledentistry and the patient’s dental records of such examination have been reviewed by the practitioner providing teledentistry.

SOURCE: WV Admin Law 5-16-4. (Accessed Nov. 2024).

Final Rule (Effective until August 1st, 2027) – Medical Board

Among other ways, a provider-patient relationship is formed when a provider serves a patient’s medical needs, examines, diagnoses or treats a patient, or agrees to examine, diagnose or treat a patient.

A provider-patient relationship may be established through:

• An in-person patient encounter;
• Store and forward telemedicine or other similar technologies for the practice of pathology and radiology;
• Telemedicine technologies which incorporate interactive audio using store and forward technology, real-time videoconferencing, or similar secure video services during the initial provider-patient encounter; or
• Audio-only calls or conversations that occur in real time.

While real-time audio-only communications may be utilized to establish the provider-patient relationship, patient communication though audio-visual communication is preferable, if available or possible.  Real-time audio-only communications may not be utilized when its use does not conform to the standard of care.

The provider-patient relationship may not be established through text-based communications such as email, internet questionnaires, text-based messaging, or other written forms of communication.

A telehealth provider’s selection of telemedicine technologies for a patient encounter must permit the provider to meet the standard of care for the patient’s particular health issue and presentation.  Treatment, including issuing a prescription, based solely on an online questionnaire, does not conform to the standard of care.

When prescribing to a patient via telemedicine, a telehealth provider shall prescribe within the prescriptive authority of the provider’s profession in West Virginia.

A telehealth provider who provides health care to a patient solely through the use of telemedicine technologies is prohibited from prescribing a controlled substance listed in Schedule II of the Uniform Controlled Substance Act except under the following circumstances:

• The patient is an established patient of the prescribing telehealth provider’s group practice;
• The provider submits an order to dispense a Schedule II controlled substance to a hospital patient, other than in the emergency department, for immediate administration in a hospital
• The telehealth provider is treating patients who are minors, or if 18 years of age or older, who are emolled in a primary or secondary education program and are diagnosed with intellectual or developmental disabilities, neurological disease, Attention Deficit Disorder, Autism, or a traumatic brain injury in accordance with guidelines as set forth by organizations such as the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, or the American Academy of Pediatrics. The provider must maintain records supporting the diagnosis and the continued need of treatment.

See rule for additional requirements for prescribing controlled substances.

A telehealth provider may not, based solely upon a telemedicine encounter, prescribe any drug with the intent of causing an abortion.

SOURCE: WV Admin Law 11-15-6, 7 & 8. (Accessed Nov. 2024).

Final Rule (Effective until August 1st, 2033) – Board of Nursing

A practitioner-patient relationship may be established through:

• An in-person patient encounter;
• Telemedicine technologies which incorporate interactive audio using store and forward technology, real-time videoconferencing, or similar secure video services during the initial provider-patient encounter; or
• Audio-only calls or conversations that occur in real time.

While real-time audio-only communications may be utilized to establish the practitioner-patient relationship, patient communication through audio-visual communication is preferable, if available or possible.  Real-time audio-only communications may not be utilized when its use does not conform to the standard of care.

The practitioner-patient relationship may not be established through text-based communications such as email, internet questionnaires, text-based messaging, or other written forms of communication.

After a practitioner-patient relationship has been established, a practitioner may utilize any telemedicine technology that meets the standard of care and is appropriate for the patient presentation.

A telehealth provider’s selection of telemedicine technologies for a patient encounter must permit the provider to meet the standard of care for the patient’s particular health issue and presentation.  Treatment, including issuing a prescription if the nurse has prescriptive authority, based solely on an online questionnaire, does not conform to the standard of care.

The standard of care for the provision of health care services is the same for health care services provided in-person and health care services provided via telemedicine technologies.

Nothing in this rule requires a practitioner to use telemedicine technologies to treat a patient if the practitioner, in his or her discretion determines that an in-person encounter is required.

APRNs:  When prescribing to a patient via telemedicine, a telehealth provider shall prescribe within the prescriptive authority of the provider’s profession in the state of West Virginia pursuant to qualified advanced practice registered nurses to prescribe prescription drugs in accordance with the provisions of W. Va. Code § 60A-9-5a and the requirements set forth in §30-7-15a, 15b, and 15c and 19 CSR 08.

A telehealth provider may not, based solely upon a telemedicine encounter, prescribe any drug with the intent of causing an abortion.

See rule for requirements for controlled substances.

SOURCE: WV Admin Law 19-16-6, 7, 8. (Accessed Nov. 2024).

Final Rule (Effective until August 1st, 2027) – Board of Osteopathic Medicine

A provider-patient relationship may be established through:

• An in-person patient encounter;
• Store and forward telemedicine or other similar technologies for the practice of pathology and radiology;
• Telemedicine technologies which incorporate interactive audio using store and forward technology, real-time videoconferencing, or similar secure video services during the initial provider-patient encounter; or
• Audio-only calls or conversations that occur in real time.

The provider-patient relationship may not be established through text-based communications such as email, internet questionnaires, text-based messaging, or other written forms of communication. After a provider-patient relationship has been established, a provider may utilize any telemedicine technology that meets the standard of care and is appropriate for the patient presentation.

It is the standard of care in this state for health care practitioners to complete an appropriate controlled substance prescribing course prior to prescribing controlled substances to patients located in West Virginia.  The Board maintains a list of Board-approved courses in drug diversion training and best practice prescribing controlled substances training on its website.  Registrants may comply with the standard of care by completing a Board-approved course or a controlled substance continuing education course required by the registrant’s state of licensure.

When prescribing to a patient via telemedicine, a telehealth provider shall prescribe within the prescriptive authority of the provider’s profession in this state.

A telehealth provider who provides health care to a patient solely through the use of telemedicine technologies is prohibited from prescribing a controlled substance listed in Schedule II of the Uniform Controlled Substance Act except under the following circumstances:

• The patient is an established patient of the prescribing telehealth provider’s group practice;
• The provider submits an order to dispense a Schedule II controlled substance to a hospital patient, other than in the emergency department, for immediate administration in a hospital; or
• The telehealth provider is treating patients who are minors, or if 18 years of age or older, who are enrolled in a primary or secondary education program and are diagnosed with intellectual or developmental disabilities, neurological disease, Attention Deficit Disorder, Autism, or a traumatic brain injury in accordance with guidelines as set forth by organizations such as the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, or the American Academy of Pediatrics. The provider must maintain records supporting the diagnosis and the continued need of treatment.

See additional requirements for providers who prescribe controlled substances.

A telehealth provider may not, based solely upon a telemedicine encounter, prescribe any drug with the intent of causing an abortion.

SOURCE: WV Admin Law 24-10-6, 7, 8. (Accessed Nov. 2024).

Final Rule (Effective until August 1, 2030) – Social Workers

The practitioner-client relationship is established at the time informed consent is obtained.

SOURCE: WV Admin Law 25-1-5. (Accessed Nov. 2024).

Final Rule (Effective until August 1, 2030) – Speech Language Pathology and Audiology

Established patient means a patient who has, within the last three years, received professional services, face-to-face, from the physician, qualified health care professional, or another physician or qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice.

The standard of care requires that with respect to the established patient, the patient shall visit an in-person health care practitioner within 12 months of using the initial telepractice service or the telepractice service shall no longer be available to the patient until an in-person visit is obtained. This requirement may be suspended, in the discretion of the health care practitioner, on a case-by-case basis, but it does not apply to the following services: acute inpatient care, post-operative follow-up checks, behavioral medicine, addiction medicine, or palliative care.

SOURCE: WV Rule 29-01-16. (Accessed Nov. 2024).

Final Rule (Effective until August 1, 2028) – Optometrists

No person shall deliver optometric telehealth services unless a bona fide optometrist-patient relationship is established. A bona fide optometrist-patient relationship shall exist if the optometrist has:

• obtained or caused to be obtained and reviewed a health and ocular history of the patient
• performed or caused to be performed and reviewed appropriate examination of the patient, either physically through use of instrumentation and diagnostic equipment by which digital scans, photographs, images and records able to be transmitted electronically, or through use of face-to-face interactive two-way real-time communications services, store-and-forward technologies, or through audio only calls or conversations that occur in real time;
• provided information to the patient about the services to be performed; and
• initiated additional diagnostic tests or referrals as needed.

In cases in which an optometrist is providing telehealth, the examination required shall not be required if the patient has been examined in person by an optometrist licensed by the Board within the 12 months prior to the initiation of telehealth and the patient’s records of such examination have been reviewed by the optometrist providing telehealth.

The standard of care for providing optometric care in the State of West Virginia via telehealth services by a registrant or licensed optometrist shall be the same as for in-person care.

A telehealth provider’s selection of telemedicine technologies for a patient encounter must permit the provider to meet the standard of care for the patient’s particular health issue and presentation. Treatment, including issuing a prescription, based solely on an online questionnaire, does not conform to the standard of care.

Nothing in this rule requires a practitioner to use telemedicine technologies to treat a patient if the practitioner, in his or her discretion determines that an in-person encounter is required.

A registrant shall not prescribe any controlled substance listed in Schedule II of the Uniform Controlled Substance Act via interstate telehealth services.

Nothing in this section shall be construed to invalidate §30-8A-3 or to permit use of any automated refractor or other automated or remote testing device to generate refractive data.

SOURCE: WV Admin Law 14-12-3, 5. (Accessed Nov. 2024).

A physician-patient relationship may be established through telemedicine.

SOURCE: WI Admin. Code MED Ch. 24.03 (Accessed Aug. 2024).

When a physician uses a website to communicate to a patient located in this state, the physician may not provide treatment recommendations, including issuing a prescription, unless the following requirements are met:

• The physician shall be licensed to practice medicine and surgery by the medical examining board as required under s. Med 24.04.
• The physician’s name and contact information have been made available to the patient.
• Informed consent as required under s. 448.30, Stats., and ch. Med 18.
• A documented patient evaluation has been performed. A patient evaluation shall include a medical history and, to the extent required to meet or exceed the standard of minimally competent medical practice, an examination or evaluation, or both, and diagnostic tests.
• A patient health care record is prepared and maintained as required under ch. Med 21.

Providing treatment recommendations, including issuing a prescription, based only on a static electronic questionnaire does not meet the standard of minimally competent medical practice.

SOURCE: WI Admin. Code MED Ch. 24.07 (Accessed Aug. 2024).

The board may refuse to renew, and may revoke, suspend or restrict a license or take other disciplinary action, including the imposition of conditions or restrictions upon a license on one (1) or more of the following grounds: …

• Initially prescribing any controlled substance specified in W.S. 35-7-1016 through 35-7-1022 for any person through the Internet, the World Wide Web or a similar proprietary or common carrier electronic system absent a documented physician-patient relationship

SOURCE: WY Statutes Annotated Sec. 33-26-402(a(xxxiii)) (Accessed Oct. 2024).