Last updated 08/24/2022
Consent Requirements
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 is required to establish a health-care provider-patient relationship, among other things.
Informed consent must be obtained to establish a physician-patient relationship over telehealth.
SOURCE: Title 24, Ch. 60, Sec. 6003(a)(3). (Accessed Aug. 2022).
Applies to Physical Therapists:
Before services are provided through telehealth, the licensee shall obtain written, informed consent from the patient, or other appropriate person with authority to make health care treatment decisions for the patient. For the purpose of this subsection, written consent includes an electronic signature. At minimum, the informed consent shall inform the patient and document acknowledgement of the risk and limitations of:
- The use of electronic communications in the provision of care;
- The potential breach of confidentiality, or inadvertent access, of protected health information using electronic communication in the provision of care; and
- The potential disruption of electronic communication in the use of telehealth.
SOURCE: 24 DE Administrative Code 2602. 14.2.2.1. (Accessed Aug. 2022).
Informed consent required by Boards (see regulation citations in Professional Board Standards tab).
Last updated 08/24/2022
Cross State Licensing
Telehealth and telemedicine may be practiced without a health-care provider-patient relationship during:
- 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.
- 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.
- Episodic consultation by a specialist located in another jurisdiction who provides such consultation services at the request of a licensed health-care professional.
- 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.
SOURCE: Title 24, Ch. 60, Sec. 6005. (Accessed Aug. 2022).
Social Work Examiners Licensure Exemptions
General licensure requirements do not apply to an individual who meets any of the following criteria:
- Is licensed in good standing to practice social work in another jurisdiction, provided that the individual has made prior written application to the Board to practice social work in this State and the Board has approved the application. An individual may practice social work, within the scope of practice designated by the individual’s license, in this State under this subsection for no more than 30 days per year. An individual who provides services under this subsection is deemed to have submitted to the Board’s jurisdiction and bound by the laws of this State.
- Is certified or licensed in this State by any other law, and is engaged in and acting within the scope of the profession or occupation for which the individual is certified or licensed.
- Is clergy of any denomination, when engaging in activities that are within the scope of the performance of that individual’s regular or specialized ministerial duties.
- Performs assessments such as basic information collection, gathering of demographic data, and informal observations, screening, and referral to determine a client’s general eligibility for a program or service and a client’s functional status for the purpose of determining need for services unrelated to a behavioral health diagnosis or treatment plan.
- Creates, develops, or implements a service plan unrelated to a behavioral health diagnosis or treatment plan. Service plans may include job training and employability, housing, general public assistance, in-home services and supports or home-delivered meals, de-escalation techniques, peer services, or skill development.
- Participates as a member of a multi-disciplinary team to implement behavioral health services or a treatment plan in certain circumstances.
- Individuals exempted under this paragraph (c)(1)f. do not engage in any of the following restricted practices:
- Diagnosis of mental, emotional, behavioral, addictive, and developmental disorders and disabilities.
- Client assessment and evaluation.
- Provision of psychotherapeutic treatment.
- Development and implementation of assessment-based treatment plans.
Nothing in this subsection may be construed as requiring a license for any particular activity or function solely because the activity or function is not listed in this subsection.
Social Worker Reciprocity
Upon payment of the required fee and submission and acceptance of a written application on forms that the Board provides, the Board shall grant a license to an applicant who has done all of the following:
- Presented proof of a current, active license in good standing and with no disciplinary action taken against the applicant in another jurisdiction whose standards the Board has determined are substantially similar to those of this State.
- Presented proof that, in any other jurisdiction in which the applicant is or was licensed, the applicant’s license is in good standing or the applicant is voluntarily no longer licensed.
- Successfully passed an examination that the Board designated under § 3906(a)(3) of this title.
- Provided the Board with a certified statement as to whether any outstanding or ongoing disciplinary actions or ethical violations are against the applicant, or whether the applicant has engaged in any of the acts or offenses that may be grounds for disciplinary action under this chapter. Applicants are deemed to consent to the release of information regarding disciplinary actions or ethical violations and waive all objections to the admissibility of the information as evidence at any hearing or other proceeding to which the applicant may be subject under this chapter.
An applicant who has a license in another jurisdiction that has less stringent requirements than those of this State may obtain a license under this section if the applicant can prove to the Board’s satisfaction that the applicant has worked in another jurisdiction in the field for which the applicant is seeking a license in this State for at least 5 years in the 7 years immediately preceding application in this State. The Board may determine whether the requirements of another jurisdiction are less stringent than those of this State.
SOURCE: Title 24, Chap. 39, Sec. 3903 & 3909. (Accessed Aug. 2022).
Last updated 08/24/2022
Definitions
Applies to: Physicians, Podiatry, Optometry, Chiropractic, Dentistry, Nursing, Occupational Therapy, Mental Health, Chemical Dependency Professionals, Psychology, Dietetic and Nutrition Therapy, and Clinical Social Workers
“Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health-care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.
“Telemedicine” means a form, or subset, of telehealth, which includes the delivery of clinical health-care services by means of real time 2-way audio (including audio-only conversations, if the patient is not able to access the appropriate broadband service or other technology necessary to establish an audio and visual connection), visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitates the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health-care.
SOURCE: Title 24, Ch. 60, Sec. 6001(5) & (6). (Accessed Aug. 2022).
Applies to: Physical Therapy
“Telehealth, as set forth in the Board’s rules and regulations, means the use of electronic communications to provide and deliver a host of health-related information and healthcare services, including physical therapy and athletic training related information and services, over large and small distances. Telehealth encompasses a variety of healthcare and health promotion activities, including education, advice, reminders, interventions, and monitoring of intervention.”
SOURCE: 24 DE Administrative Code 2602(13). (Accessed Aug. 2022).
NOTE: DE Professional Boards have different definitions of telehealth/telepractice/telemedicine. See Professional Board Standards section for references.
Last updated 08/24/2022
Licensure Compacts
Member of Nurse Licensure (NLC) Compact.
SOURCE: Nurse Licensure Compact. Current NLC States. (Accessed Aug. 2022)
Member of the Advanced Practice Registered Nurse (APRN) Compact.
SOURCE: APRN Compact Map. (Accessed Aug. 2022).
Member of Physical Therapy Licensure Compact.
SOURCE: PT Compact. Member States. (Accessed Aug. 2022).
Member of Psychology Interjurisdictional Compact.
SOURCE: PSYPACT. PSYPACT Map. (Accessed Aug. 2022).
Member of Interstate Medical Licensure Compact (IMLC)
SOURCE: IMLC. (Accessed Aug. 2022)
Member of Emergency Medical Services Compact.
SOURCE: Interstate Commission for EMS Personnel Practice, Member States, (Accessed Aug. 2022).
Enacted Occupational Therapy Licensure Compact.
SOURCE: OT Compact Map. (Accessed Aug. 2022).
Enacted Multistate Professional Counselor Licensure Compact.
SOURCE: Counseling Compact Map. (Accessed Aug. 2022).
Enacted Audiology and Speech-Language Pathology Interstate Compact.
SOURCE: ASLP Compact Map. (Accessed Aug. 2022).
* See Compact websites for implementation and license issuing status and other related requirements.
Last updated 08/24/2022
Miscellaneous
No Reference Found
Last updated 08/24/2022
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 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:
- 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.
- 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.
- Episodic consultation by a specialist located in another jurisdiction who provides such consultation services at the request of a licensed health-care professional.
- 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.
Pharmacists:
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 Aug. 2022).
Physicians:
A remote, audio-only examination is not an “appropriate in-person examination”.
No opioid prescribing is permitted via telemedicine with the exception of addiction treatment programs offering medication assisted treatment that have received a Division of Substance Abuse and Mental Health (DSAMH) waiver to use telemedicine through DSAMH’s licensure or renewal process. All other controlled substance prescribing utilizing telemedicine is held to the same standards of care and requisite practice as prescribing for in-person visits.
For formation of the physician-patient relationship using audio and visual communications, the audio and visual communications must be live, real-time communications.
SOURCE: DE Admin Code. Title 24 Sec. 1700. Sec. 19. (Accessed Aug. 2022).
Delaware Board of Medical Licensure has specific requirements for electronic prescribing.
SOURCE: DE Admin Code, Title 24, Sec. 1713(a)(12) (Accessed Aug. 2022).
Last updated 08/24/2022
Professional Board Standards
Health-care providers licensed by the following professional boards are authorized to deliver health-care services by telehealth and telemedicine:
- The Board of Podiatry created pursuant to Chapter 5 of this title.
- The Board of Chiropractic created pursuant to Chapter 7 of this title.
- The Board of Medical Practice created pursuant Chapter 17 of this title.
- The State Board of Dentistry and Dental Hygiene created pursuant to Chapter 11 of this title.
- The Delaware Board of Nursing created pursuant to Chapter 19 of this title.
- The Board of Occupational Therapy Practice created pursuant to Chapter 20 of this title.
- The Board of Examiners in Optometry created pursuant to Chapter 21 of this title.
- The Board of Pharmacy created pursuant to Chapter 25 of this title.
- The Board of Mental Health and Chemical Dependency Professionals created pursuant to Chapter 30 of this title.
- The Board of Examiners of Psychologists created pursuant to Chapter 35 of this title.
- The State Board of Dietetics/Nutrition created pursuant to Chapter 38 of this title.
- The Board of Social Work Examiners created pursuant to Chapter 39 of this title.
A professional board may promulgate or revise regulations and establish or revise rules applicable to health-care providers under the professional Board’s jurisdiction in order to facilitate the provision of telehealth and telemedicine services.
Practice requirements:
A health-care provider using telemedicine and telehealth technologies to deliver health-care services to a patient must, prior to diagnosis and treatment, do at least one of the following:
- Provide an appropriate examination in-person.
- Require another Delaware-licensed health-care provider be present at the originating site with the patient at the time of the diagnosis.
- Make a diagnosis using audio or visual communication.
- Meet 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.
After a health-care provider-patient relationship is properly established in accordance with this section, subsequent treatment of the same patient by the same health-care provider need not satisfy the limitations of this section.
A health-care provider treating a patient through telemedicine and telehealth must maintain complete records of the patient’s care and follow all applicable state and federal statutes and regulations for recordkeeping, confidentiality, and disclosure to the patient.
Telehealth and telemedicine services shall include, if required by the applicable professional board listed, use of the Delaware Health Information Network (DHIN) in connection with the practice.
Nothing in this section shall be construed to limit the practice of radiology or pathology.
SOURCE: DE Statute Title 24, Chap. 60, Sec. 6002 & 6004. (Accessed Aug. 2022)
Physical Therapists and Athletic Trainers
SOURCE: DE Statute Title 24, Chapter 26, Sec. 2602. (Accessed Aug. 2022).
Board of Clinical Social Work Examiners
SOURCE: 24 DE Statute Title 24, Chapter 39, 3920. (Accessed Aug. 2022).
Board of Dentistry and Dental Hygiene
SOURCE: 24 DAC 1100 (Accessed Aug. 2022).
Pharmacy
SOURCE: 24 DAC 2500 (Accessed Aug. 2022).
