Online Prescribing

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 Apr. 2026).

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 Apr. 2026).

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: Title 22, Part 11, Ch. 217.24, (Accessed Apr. 2026).

In accordance with §111.006 of the Texas Occupations Code, a valid prescription requires:

• establishing a physician-patient relationship; and
• compliance with all other applicable laws before prescribing, dispensing, delivering, or administering a dangerous drug or controlled substance, including, but not limited to, the Medical Practice Act and Texas Health and Safety Code, Chapters 481 and 483.

Requirements for Prescribing for Chronic Pain via Telemedicine. A physician must use audio and video two-way communication, unless the patient:

• is an established pain patient of the prescribing physician;
• receives a prescription identical to the prescription issued at the previous visit; and
• was seen by the prescribing physician, or their delegate, in the last 90 days either;
  • in-person; or
  • by audio and video two-way communication.

SOURCE: TX Admin Code, Title 22, Part 9, Ch. 175.3, (Accessed Apr. 2026).

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 Apr. 2026).

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 Apr. 2026).

In accordance with Chapters 155.001 and 111 of the Texas Occupations Code, a physician may not provide telemedicine medical services to patients in Texas unless they hold a full Texas medical license, except for those who held an out-of-state telemedicine license as of September 1, 2022.

SOURCE: TX Admin. Code, Title 22, Part 9, Sec. 175.1. (Accessed Apr. 2026).

Nursing

Issuance of Prescriptions. The validity of a prescription issued as a result of a telemedicine medical 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 telemedicine medical service.

A valid prescription must:

• be issued for a legitimate medical purpose by a practitioner as part of a 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.

For purposes of this rule, chronic pain has the same definition as used in 22 Texas Administrative Code §172.1(2).

• 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 patient of the APRN being treated for chronic pain;
  • is receiving a prescription that is identical to a prescription issued at the previous visit; and
  • has been seen by the prescribing APRN, physician, or other health professional as defined in Tex. Occ. Code §111.001(1) in the last 90 days, either:
    • in-person; or
    • via telemedicine medical service using audio and video two-way communication.
• 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 medical service visit was conducted instead of an in-person visit.

For purposes of this rule, acute pain has the same definition as used in 22 Texas Administrative Code §172.1(1). 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 Sec. 217.24, (Accessed Apr. 2026).

Optometry

An optometrist or therapeutic optometrist providing a health care service or procedure as a telehealth service is subject to the same standard of care that would apply to the provision of the same health care service or procedures in an in-person setting. An optometrist or therapeutic optometrist providing a telehealth service must:

• establish a practitioner-patient relationship;
• maintain complete and accurate medical records as set out in §277.7 Patient Records of this title (relating to Chapter 277. Practice and Procedure); and
• meet the minimum standard of care for the initial examination of a patient for whom an ophthalmic lens prescription is signed under Texas Occupations Code §351.353.

Issuance of a prescription

• A prescription issued as a result of a telehealth service is subject to the same standards as an in-person setting.
• A therapeutic optometrist shall 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 telehealth service.
• An optometrist or therapeutic optometrist shall meet the standard of care and demonstrate professional practice standards and judgment, consistent with all applicable statutes and rules, when prescribing or fitting lenses or prisms as a result of a telehealth service.
• A valid prescription may be issued as a result of telehealth services as part of a practitioner-patient relationship as set out in §279.16(b). A valid prescription for any pharmaceutical agent shall meet all applicable laws regarding the prescribing, dispensing, delivering or administering of a dangerous drug or controlled substance. A valid prescription for ophthalmic goods or procedures shall meet all applicable requirements of Texas Occupations Code, Chapter 351.

SOURCE: TX Admin. Code, Title 22, Part 14, Sec. 279.16. (Accessed Apr. 2026).