Online Prescribing

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 Mar. 2025).

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 Mar. 2025).

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 Mar. 2025).

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 Mar. 2025).

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 Mar. 2025).

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 amended by HB 24-1048 (2024 Legislative Session). (Accessed Mar. 2025).

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 added by HB 24-1048 (2024 Legislative Session). (Accessed Mar. 2025).