Online Prescribing

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 Mar. 2025).

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 Mar. 2025).

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 Mar. 2025).

Pharmacists

Telehealth may be used for patient counseling only.

SOURCE: 24 DAC 2500, 5.2. (Accessed Mar. 2025).

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 Mar. 2025).

Uniform Controlled Substances Act 

Any pharmacy, distributor, manufacturer, practitioner, including a practitioner who holds a practice privilege, interstate compact license, an interstate telehealth registration, or a military registration, researcher or other controlled substance registrant who has or proposes to engage in activities accordingly within this State must obtain biennially a registration issued by the Secretary in accordance with the Secretary’s rules.

The Secretary shall register an applicant as a pharmacy, distributor, manufacturer, practitioner, researcher or other controlled substance registrant for purposes of manufacturing, distributing or dispensing, some or all of the controlled substances included in Schedules I-V who has an active, relevant underlying professional license in the State, or holds a practice privilege, interstate compact license, an interstate telehealth registration, or a military registration, unless the Secretary determines that the issuance of that registration would be inconsistent with the public interest.

SOURCE: DE Code, Title 16, Chap. 47, Sec. 4732 & 4733 as amended by SB 331 (2024). (Accessed Mar. 2025).

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.