Online Prescribing

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 Jan. 2026).

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.

Notwithstanding the requirements of Rule 0880-02-.14(7), a physician licensed in Tennessee may engage in the practice of telemedicine under the following circumstances:

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:

• If no facilitator is present:
  • The patient must utilize adequately sophisticated technology to enable the remote provider to verify the patient’s identity and location with an appropriate level of confidence; and
  • The patient must transmit all relevant health information at the level of store-and-forward technology or secure video conferencing; and
  • The remote provider must disclose his or her name, current and primary practice location, medical degree and recognized specialty area, if any, and in accordance with T.C.A. § 63-1-109.
• If a facilitator is present:
  • The facilitator must personally verify the identity of the patient; however, all relevant health information must be transmitted to the remote provider using at least the level of store-and-forward technology. The facilitator and the patient may interact with the provider at the remote location via secure video conferencing or store-and-forward technology; and
  • The facilitator must identify themselves, their role, and their title to the patient and the remote physician; and
  • The remote provider must disclose his or her name, current and primary practice location, medical degree and recognized specialty area, if any, and all additional information required pursuant to T.C.A. § 63-1-109.

For patient encounters conducted via telemedicine, the physician should have appropriate patient record(s) or be able to obtain such information during the telemedicine encounter.

The physician engaging in telemedicine is responsible for ensuring that the medical record contains all pertinent data and information gleaned from the encounter. Any physician conducting a patient encounter via telemedicine must so document in the patient record and must state the technology used. All records for Tennessee patients are subject to inspection pursuant to T.C.A. § 63-1-117.

If the information transmitted through electronic or other means as part of a patient’s encounter is not of sufficient quality or does not contain adequate information for the physician to form an opinion, the physician must declare they cannot form an opinion to make an adequate diagnosis and must request direct referral for inspection and actual physical examination, request additional data, or recommend the patient be evaluated by the patient’s primary physician or other local health care provider.

A physician licensed by the Board may, if requested to do so by another physician licensed by the Board, engage in medical interpretation as defined in these rules and render an opinion based on data which is transmitted electronically. In such cases, the physician providing the medical interpretation need not examine the patient and need not have the complete medical record accessible, unless the interpreting physician believes that additional information is necessary. Any opinion rendered by such interpreting physician must be reduced to writing which includes the name and electronic signature of the interpreting physician.

No patient seeking care via telemedicine who is under the age of eighteen (18) years of age can be treated unless there is a facilitator present, except as otherwise authorized by law.

SOURCE: TN Rule Annotated, 0880-02-.14, (Accessed Jan. 2026).

Optometry

Establishment of a Healthcare Provider-Patient Relationship. A healthcare provider shall not render telehealth services, ophthalmic prescribing and eye health services, advice and/or care without:

• Fully verifying, to the extent possible, the requesting patient’s identity;
• Disclosing the healthcare provider’s identity and applicable credential(s) to the patient; and
• Obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations, including any special informed consents regarding telehealth.

Telehealth, when prescribing medications and ophthalmic materials may be contemplated, shall require a healthcare provider 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 healthcare provider based on licensure. The indication, appropriateness, and safety considerations for each telehealth visit prescription shall be evaluated by the healthcare provider in accordance with current GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02 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, healthcare providers 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.

SOURCE: TN Rule Annotated 1045-02-.18, (Accessed Jan. 2026).

Chiropractic Examiners

Chiropractic physician-patient relationship – A chiropractic physician-patient relationship is created by mutual consent and mutual communication, except in an emergency, between the patient and the chiropractic physician. The consent by the patient may be expressed or implied consent; however, the chiropractic physician-patient relationship is not created simply by the receipt of patient health information by a provider unless a prior chiropractic physician-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

See regulations for more details.

SOURCE: Section 0260-02-.27, (Accessed Jan. 2026).

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, Sec. 107 & 106 [effective upon promulgation], as amended by HB 2318 & SB 2136, (Accessed Jan. 2026).