Professional Requirements

Online Prescribing

There are a number of nuances and differences across the states related to the use of technology and prescribing.  However, most states consider using only an internet/online questionnaire to establish a patient-provider relationship (needed to write a prescription in most states) as inadequate. States may also require that a physical exam be administered prior to a prescription being written, but not all states require an in-person examination, and some specifically allow the use of telehealth to conduct the exam.

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Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Federal

Last updated 09/01/2022

Controlled Substance Act

No controlled substance that is a prescription …

Controlled Substance Act

No controlled substance that is a prescription drug as determined under the Federal Food, Drug, and Cosmetic Act may be delivered, distributed, or dispensed by means of the Internet without a valid prescription … Nothing in this subsection shall apply to the delivery, distribution, or dispensing of a controlled substance by a practitioner engaged in the ‘practice of telemedicine’ [see definition in section above].

SOURCE:  21 USCS Sec. 829, (Accessed Sept. 2022).

Note that the practice of telemedicine is allowed to be used in prescribing controlled substances during a public health emergency declared by the Secretary under section 319 of the Public Health Service Act; and when the patients involved are located in such areas, and such controlled substances, as the Secretary, with the concurrence of the Attorney General, designates.

SOURCE:  21 USCS Sec. 802, (Accessed Sept. 2022).

The Attorney General may issue to a practitioner a special registration to engage in the practice of telemedicine for purposes of section 102(54)(E) if the practitioner, upon application for such special registration—

  • demonstrates a legitimate need for the special registration; and
  • is registered under section 303(f) in the State in which the patient will be located when receiving the telemedicine treatment, unless the practitioner—
  • is exempted from such registration in all States under section 302(d); or
  • is an employee or contractor of the Department of Veterans Affairs who is acting in the scope of such employment or contract and is registered under section 303(f) in any State or is utilizing the registration of a hospital or clinic operated by the Department of Veterans Affairs registered under section 303(f).

Regulations. Not later than 1 year after the date of enactment of the SUPPORT for Patients and Communities Act, in consultation with the Secretary, the Attorney General shall promulgate final regulations specifying—

  • the limited circumstances in which a special registration under this subsection may be issued; and
  • the procedure for obtaining a special registration under this subsection.

SOURCE:  21 USCS Sec. 831, (Accessed Sept. 2022).

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Alabama

Last updated 11/15/2022

Telehealth medical services may only be provided following the patient’s …

Telehealth medical services may only be provided following the patient’s initiation of a physician-patient relationship, or pursuant to a referral made by a patient’s licensed physician with whom the patient has an established physician-patient relationship, in the usual course of treatment of the patient’s existing health condition. The physician-patient relationship may be formed without a prior in-person examination.

Prior to providing any telehealth medical service, the physician, to the extent possible, shall do all of the following:

  • Verify the identity of the patient.
  • Require the patient to identify his or her physical location, including the city and state.
  • Disclose to the patient the identity and credentials of the physician and any other applicable personnel.
  • Obtain the patient’s consent for the use of telehealth as an acceptable mode of delivering health care services, including, but not limited to, consent for the mode of communication used and its limitations. Acknowledgment of consent shall be documented in the patient’s medical record.

If a physician or practice group provides telehealth medical services more than four times in a 12-month period to the same patient for the same medical condition without resolution, the physician shall do either of the following:

  • See the patient in person within a reasonable amount of time, which shall not exceed 12 months.
  • Appropriately refer the patient to a physician who can provide the in-person care within a reasonable amount of time, which shall not exceed 12 months.

The provision of telehealth medical services that includes video communication to a patient at an originating site with the in-person assistance of a person licensed by the Board of Medical Examiners or by the Board of Nursing pursuant to Chapter 21 of Title 34 of the Code of Alabama 1975, shall constitute an in-person visit for the purposes of this subsection.

This section does not apply to the provision of telehealth medical services provided by a physician in active consultation with another physician who is providing in-person care to a patient.

This section shall not apply to the provision of mental health services as defined in Section 22-50-1.

A prescriber may prescribe a legend drug, medical supplies, or a controlled substance to a patient as a result of a telehealth medical service if the prescriber is authorized to prescribe the drug, supplies, or substance under applicable state and federal laws. To be valid, a prescription must be issued for a legitimate medical purpose by a prescriber acting in the usual course of his or her professional practice.

A prescription for a controlled substance may only be issued as a result of telehealth medical services if each of the following apply:

  • The telehealth visit includes synchronous audio or audio-visual communication using HIPAA compliant equipment with the prescriber responsible for the prescription.
  • The prescriber has had at least one in-person encounter with the patient within the preceding 12 months.
  • The prescriber has established a legitimate medical purpose for issuing the prescription within the preceding 12 months.

This subsection shall not apply in an in-patient setting.

A physician shall be exempt from the requirements of subsection (b) and may issue a prescription for a controlled substance to a patient if the prescription is for the treatment of a patient’s medical emergency, as further defined by rule by the Board of Medical Examiners and the Medical Licensure Commission.

SOURCE: AL Code Sec. 34-24-703 & 704 & Senate Bill 272 (2022 Session), (Accessed Nov. 2022).

The Alabama Board of Medical Examiners & Medical Licensure Commission

It is the position of the Board that, when prescribing medications to an individual, the prescriber, when possible, should personally examined the patient. Before prescribing a medication, a physician should make an informed medical judgment based on appropriate medical history, the circumstances of the situation and on his or her training and experience. This process must be documented appropriately.

Prescribing medications for a patient whom the physician has not personally examined may be suitable under certain circumstances. These circumstances may include but not be limited to electronic encounters such as those in telemedicine; admission orders for a patient newly admitted to a health care facility; prescribing for a patient of another physician for whom the prescribing physician is taking call; or continuing medication on a short-term basis for a new patient prior to the patient’s first appointment.

Licensees are expected to adhere to all federal and state statutes regarding the prescribing of controlled substances and all Alabama Board of Medical Examiners’ Rules regarding the prescribing of controlled substances.

SOURCE: AL Admin. Code. r. 540-X-9-.11, p. 23 (Accessed Nov. 2022).

A prescriber may prescribe a legend drug, medical supplies, or a controlled substance via telehealth if the prescriber is authorized to do so under state and federal law.

A prescription for a controlled substance may only be issued via telehealth if:

  • The telehealth visit includes synchronous audio or audio-visual communication using HIPAA-compliant equipment with the prescriber;
  • The prescriber has had at least one in-person encounter with the patient within the preceding 12 months; and
  • The prescriber has established a legitimate medical purpose for issuing the prescription within the preceding 12 months.

SOURCE: Alabama Board of Medical Examiners & Medical Licensure Commission, Telemedicine (Accessed Nov. 2022)

Board of Optometry

The provision of optometric diagnosis, treatment, or other services to a patient through telemedicine at an established treatment site may be used for all patient visits, including initial evaluations to establish an optometrist-patient relationship between a provider and a patient.

A distant site provider who provides telemedicine services to a patient that is not present at an established treatment site shall ensure that a proper provider-patient relationship is established, which shall include at least the following:

  • Having had at least one face-to-face meeting, either in person, or at an established treatment site via telecommunications;
  • Confirming the identity of the person requesting treatment by establishing that the person requesting the treatment is in fact whom he or she claims to be.

Evaluation, treatment, and consultation recommendations made via telemedicine, including, but not limited to the issuance of prescriptions, shall be held to the same standards of practice as those in traditional in-person clinical settings.  Distant site providers shall obtain an adequate and complete medical history for the patient before providing treatment and shall document the medical history in the patient record.

SOURCE: AL Admin Code 630-X-13-.02. (Accessed Nov. 2022).

Telemedicine services provided at an established treatment site may be used for all patient visits, including initial evaluations to establish a proper doctor-patient relationship between a provider and a patient.

  • A provider shall be reasonably available onsite at the established medical site to assist with the provision of care.
  • A provider may delegate tasks and activities at an established treatment site to an assistant who is properly trained and supervised or directed.

A distant site provider who provides telemedicine services to a patient that is not present at an established treatment site shall ensure that a proper provider-patient relationship is established, which at a minimum includes all of the following:

  • Having had at least one face-to-face meeting at an established treatment site before engaging in telemedicine services. A face-to-face meeting is not required for new conditions relating to an existing patient, unless the provider deems that such a meeting is necessary to provide adequate care.
  • Establishing that the person requesting the treatment is in fact whom he or she claims to be.

Evaluation, treatment, and consultation recommendations made in a telemedicine setting, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional in-person clinical settings.

SOURCE: Code of Alabama Sec. 34-22-83, (Accessed Nov. 2022).

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Alaska

Last updated 11/17/2022

A health care provider licensed in this state may provide …

A health care provider licensed in this state may provide health care services within the health care provider’s authorized scope of practice to a patient in this state through telehealth without first conducting an in9 person visit.

A physician licensed in another state may provide health care services through telehealth to a patient located in the state as provided in this subsection, subject to the investigative and enforcement powers of the department under AS 08.01.087, and subject to disciplinary action by the State Medical Board under AS 08.64.333. The privilege to practice under this subsection extends only to (1) ongoing treatment or follow-up care related to health care services previously provided by the physician to the patient and applies only if

  • the physician and the patient have an established physician4 patient relationship; and
  • the physician has previously conducted an in-person visit with the patient; or
  • a visit regarding a suspected or diagnosed life-threatening condition for which the patient has been referred to the physician licensed in another state by a physician licensed in this state and that referral has been documented by the referring physician; and
  • the visit involves communication with the patient regarding diagnostic or treatment plan options or analysis of test results for the life threatening condition.

A physician, podiatrist, osteopath, or physician assistant licensed under AS 08.64 may prescribe, dispense, or administer through telehealth under this section a prescription for a controlled substance listed in AS 11.71.140 – 11.71.190 if the physician, podiatrist, osteopath, or physician assistant complies with state and federal law governing the prescription, dispensing, or administering of a controlled substance.

An advanced practice registered nurse licensed under AS 08.68 may prescribe, dispense, or administer through telehealth under this section a prescription for a controlled substance listed in AS 11.71.140 – 11.71.190 if the advanced practice registered nurse complies with state and federal law governing the prescription, dispensing, or administering of a controlled substance.

Except as authorized under (e) and (f) of this section, a health care provider licensed under this title may not prescribe, dispense, or administer through telehealth under this section a controlled substance listed in AS 11.71.140 – 11.71.190.

SOURCE: AK House Bill 265 (2022 Session) and Sec. 08.01.085, (Accessed Nov. 2022).

The nursing board is required to establishing guidelines for rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug to a person without conducting a physical examination under AS 08.68.710; the guidelines must include a nationally recognized model policy for standards of care of a patient who is at a different location than the advanced practice registered nurse.

SOURCE: AK House Bill 265 (2022 Session) and Sec. 08.68.100, (Accessed Nov. 2022).

Nursing

The board may not impose disciplinary sanctions on an advanced practice registered nurse for rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug that is not a controlled substance to a person without conducting a physical examination if

  • the advanced practice registered nurse or another licensed health care provider in the medical practice is available to provide follow-up care; and
  • the advanced practice registered nurse requests that the person consent to sending a copy of all records of the encounter to the person’s primary care provider if the prescribing advanced practice registered nurse is not the person’s primary care provider and, if the person consents, the advanced practice registered nurse sends the records to the person’s primary care provider

The board may not impose disciplinary sanctions on an advanced practice registered nurse for prescribing, dispensing, or administering a prescription drug that is a controlled substance if the requirements under (a) of this section and
15 AS 08.68.705 are met and the advanced practice registered nurse prescribes, dispenses, or administers the controlled substance.

Notwithstanding (a) and (b) of this section, an advanced practice registered nurse may not prescribe, dispense, or administer a prescription drug in response to an Internet questionnaire or electronic mail message to a person with whom the advanced
practice registered nurse does not have a prior provider-patient relationship.

SOURCE: AK House Bill 265 (2022 Session) and Sec. 08.68.710, (Accessed Nov. 2022).

The guiding principles for telemedicine practice in the American Medical Association (AMA), Report 7 of the Council on Medical Service (A-14), Coverage of and Payment for Telemedicine, dated 2014, and the Federation of State Medical Boards (FSMB), Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine, dated April 2014, are adopted by reference as the standards of practice when providing treatment, rendering a diagnosis, prescribing, dispensing, or administering a prescription or controlled substance without first conducting an in-person physical examination under AS 08.64.364.

During a public health emergency declared by the governor or commissioner of health and social services, an appropriate licensed health care provider need not be present with the patient to assist a physician or physician assistant with examination, diagnosis, and treatment if the physician or physician-assistant is prescribing, dispensing, or administering buprenorphine to initiate or continue treatment for opioid use disorder and the physician or physician assistant

  •  is a waived practitioner under 21 U.S.C 823(g)(2) (Drug Addiction Treatment Act (DATA));
  • documents all attempts to conduct a physical examination under AS 08.64.364(b), the reason why the examination cannot be performed, and the reason why another health care provider cannot be present with the patient; and
  • requires urine or oral toxicology screening as part of the patient’s medication adherence plan.

SOURCE: AK Admin. Code, Title 12, Sec. 40.943 (Accessed Nov. 2022).

The board may not impose disciplinary sanctions on a physician or physician assistant for rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug that is not a controlled substance to a person without conducting a physical examination if:

  • the physician, physician assistant, or another licensed health care provider in the medical practice is available to provide follow-up care; and
  • the physician or physician assistant requests that the person consent to sending a copy of all records of the encounter to the person’s primary care provider if the prescribing physician or physician assistant is not the person’s primary care provider and, if the person consents, the physician or physician assistant sends the records to the person’s primary care provider.

The board may not impose disciplinary sanctions on a physician or physician assistant for prescribing, dispensing, or administering a prescription drug that is a controlled substance if certain requirements are met.

A physician or physician assistant may not prescribe, dispense, or administer an abortion-inducing drug under (a) of this section unless the physician complies with AS 18.16.010; and a physician or physician assistant may not prescribe, dispense, or administer a prescription drug in response to an Internet questionnaire or electronic mail message to a person with whom the physician or physician assistant does not have a prior physician-patient relationship.

SOURCE: Alaska Statute Sec. 08.64.364 as amended by AK House Bill 265 (2022 Session) (Accessed Nov. 2022).

Physicians are prohibited from prescribing medications based solely on a patient-supplied history received by telephone, FAX, or electronic format.

Unprofessional conduct includes the following:

  • For a physician or physician assistant, prescribing, dispensing, or furnishing a prescription medication without first conducting a physical examination of the person, unless the licensee has a patient-physician or patient-physician assistant relationship with the person; this paragraph does not apply to prescriptions written or medications issued
    • For use in emergency treatment;
    • For expedited partner therapy for sexually transmitted diseases;
    • In response to an infectious disease investigation, public health emergency, infectious disease outbreak, or act of bioterrorism; or
    • By a physician or physician assistant practicing telemedicine under AS 08.64.364;

SOURCE: AK Admin. Code, Title 12, Sec. 40.967. (Accessed Nov. 2022).

Nursing

An advanced practice registered nurse (APRN) may practice telehealth, including prescribing, dispensing, or administering a prescription drug that is not a controlled substance if:

  • the APRN is licensed by the board;
  • the APRN, or another licensed health care provider in a group practice, is available to provide follow-up care; and
  • the APRN requests that the person consent to sending a copy of all records of the encounter to the person’s primary care provider if the prescribing APRN is not the person’s primary care provider and, if the person consents, the APRN sends the records to the person’s primary care provider.

An APRN may prescribe, dispense, or administer a prescription drug that is a controlled substance if certain requirements are met and the APRN prescribes, dispenses, or administers the controlled substance when an appropriate health care provider is present with the patient to assist the APRN with examination, diagnosis, and treatment.

During a disaster emergency declared by the governor, an appropriate health care provider need not be present with the patient to assist an APRN with examination, diagnosis, and treatment if the APRN is prescribing, dispensing, or administering buprenorphine to initiate treatment for opioid use disorder and the APRN

  • is a waived practitioner under 21 U.S.C. 823(g)(2) (Drug Addiction Treatment Act (DATA));
  • documents all attempts to conduct a physical examination under this section and the reason why the examination cannot be performed; and
  • requires urine or oral toxicology screenings as part of the patient’s medication adherence plan.

An APRN may not prescribe, dispense, or administer a prescription drug in response to an Internet questionnaire or electronic mail message to a person with whom the APRN does not have a prior APRN-patient relationship.

An “APRN-patient relationship” is established when there is an in-person health examination or examination by telehealth technology of the patient by the APRN or another APRN, physician, or physician assistant in the same group practice and the patient record is available to the treating APRN.

SOURCE: AK Admin Code Title 12, 44.925 (Accessed Nov. 2022).

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Arizona

Last updated 10/19/2022

Medical Board

Unprofessional conduct includes prescribing, dispensing or furnishing a …

Medical Board

Unprofessional conduct includes prescribing, dispensing or furnishing a prescription medication or a prescription-only device to a person unless the licensee first conducts a physical or mental health status examination of that person or has previously established a doctor-patient relationship. The physical or mental health status examination may be conducted through telehealth with a clinical evaluation that is appropriate for the patient and the condition with which the patient presents, unless the examination is for the purpose of obtaining a written certification from the physician for the purposes of title 36, chapter 28.1. This subdivision does not apply to:

  • A physician who provides temporary patient supervision on behalf of the patient’s regular treating licensed health care professional or provides a consultation requested by the patient’s regular treating licensed health care professional.
  • Emergency medical situations as defined in section 41-1831.
  • Prescriptions written to prepare a patient for a medical examination.
  • Prescriptions written or prescription medications issued for use by a county or tribal public health department for immunization programs or emergency treatment or in response to an infectious disease investigation, public health emergency, infectious disease outbreak or act of bioterrorism. For the purposes of this item, “bioterrorism” has the same meaning prescribed in section 36-781.
  • Prescriptions written or antimicrobials dispensed to a contact as defined in section 36-661 who is believed to have had significant exposure risk as defined in section 36-661 with another person who has been diagnosed with a communicable disease as defined in section 36-661 by the prescribing or dispensing physician.
  • Prescriptions written or prescription medications issued for administration of immunizations or vaccines listed in the United States centers for disease control and prevention’s recommended immunization schedule to a household member of a patient.
  • Prescriptions for epinephrine auto-injectors written or dispensed for a school district or charter school to be stocked for emergency use pursuant to section 15-157 or for an authorized entity to be stocked pursuant to section 36-2226.01.
  • Prescriptions written by a licensee through a telehealth program that is covered by the policies and procedures adopted by the administrator of a hospital or outpatient treatment center.
  • Prescriptions for naloxone hydrochloride or any other opioid antagonist approved by the United States food and drug administration that are written or dispensed for use pursuant to section 36-2228 or 36-2266.
  •  Performing office based surgery using sedation in violation of board rules.
  • Practicing medicine under a false or assumed name in this state.

SOURCE: Arizona Revised Statute Sec. 32-1401 (Accessed Oct. 2022).

Osteopathic Physicians and Surgeons

Prescribing, dispensing or furnishing a prescription medication or a prescription-only device to a person if the licensee has not conducted a physical or mental health status examination of that person or has not previously established a physician-patient relationship.  The physical or mental health status examination may be conducted through telehealth as defined in section 36-3601 with a clinical evaluation that is appropriate for the patient and the condition with which the patient presents, unless the examination is for the purpose of obtaining a written certification from the physician for the purposes of title 36, chapter 28.1. This paragraph does not apply to:

  • Emergencies.
  • A licensee who provides patient care on behalf of the patient’s regular treating licensed health care professional or provides a consultation requested by the patient’s regular treating licensed health care professional.
  • Prescriptions written or antimicrobials dispensed to a contact as defined in section 36-661 who is believed to have had significant exposure risk as defined in section 36-661 with another person who has been diagnosed with a communicable disease as defined in section 36-661 by the prescribing or dispensing physician.
  • Prescriptions for epinephrine auto-injectors written or dispensed for a school district or charter school to be stocked for emergency use pursuant to section 15-157 or for an authorized entity to be stocked pursuant to section 36-2226.01.
  • Prescriptions written by a licensee through a telehealth program that is covered by the policies and procedures adopted by the administrator of a hospital or outpatient treatment center.
  • Prescriptions for naloxone hydrochloride or any other opioid antagonist approved by the United States food and drug administration that are written or dispensed for use pursuant to section 36-2228 or 36-2266.

SOURCE: Arizona Revised Statute Sec. 32-1854 (Accessed Oct. 2022).

For schedule II drugs, a health care provider regulatory board or agency may not enforce any statute, rule or policy that would require a health care provider who is licensed by that board or agency and who is authorized to write prescriptions or dispense or administer prescription drugs and devices to provide an in-person examination of the patient before issuing a prescription except as specifically prescribed by federal law. A physical or mental health status examination may be conducted during a telehealth encounter. Schedule II drugs may be prescribed only after an in-person or audio-visual examination and only to the extent allowed by federal and state law.

Services provided through telehealth are subject to this state’s laws and rules governing the health care provider’s scope of practice and the practice guidelines adopted by the telehealth advisory committee on telehealth best practices established by section 36-3607.

SOURCE: Arizona Revised Statute Sec. 36-3602 (Accessed Oct. 2022).

Naturopathic Physicians

Prescribing, dispensing or furnishing a prescription medication or a prescription-only device as defined in section 32-1901 to a person unless the licensee first conducts a physical examination of that person or has previously established a doctor-patient relationship. The physical examination may be conducted during a real-time telemedicine encounter with audio and video capability unless the examination is for the purpose of obtaining a written certification from the physician for the purposes of title 36, chapter 28.1. This subdivision does not apply to:

  • A licensee who provides temporary patient supervision on behalf of the patient’s regular treating licensed health care professional.
  • An emergency medical situation as defined in section 41-1831.
  • Prescriptions written to prepare a patient for a medical examination.
  • Prescriptions written or prescription medications issued for use by a county or tribal public health department for immunization programs or emergency treatment or in response to an infectious disease investigation, a public health emergency, an infectious disease outbreak or an act of bioterrorism. For the purposes of this item, “bioterrorism” has the same meaning prescribed in section 36-781.
  • Prescriptions written or antimicrobials dispensed to a contact as defined in section 36-661 who is believed to have had significant exposure risk as defined in section 36-661 with another person who has been diagnosed with a communicable disease as defined in section 36-661 by the prescribing or dispensing physician.
  • Prescriptions written by a licensee through a telemedicine program that is covered by the policies and procedures adopted by the administrator of a hospital or outpatient treatment center.
  • If medical treatment is considered experimental or investigational, failing to include in a patient’s record a consent to treatment document that is signed by the patient or the patient’s parent or legal guardian and that indicates that the patient or the patient’s parent or legal guardian has been informed of the risk of any treatment to be provided and the expected cost of that treatment.
  • When issuing a written certification (see regulation for more details).

SOURCE: Arizona Revised Statute Sec. 32-1501, (Accessed Jul. 2022).

Pharmacy

Unprofessional conduct includes knowingly dispensing a drug on a prescription order that was issued in the course of the conduct of business of dispensing drugs pursuant to diagnosis by mail or the internet, unless the order was any of the following: …

  • Written by a licensee through a telehealth program that is covered by the policies and procedures adopted by the administrator of a hospital or outpatient treatment center.
  • Written pursuant to a physical or mental health status examination that was conducted through telehealth as defined in section 36-3601 and consistent with federal law.

SOURCE: Arizona Revised Statute Sec. 1901.01.01  (Accessed Oct. 2022).

A health care provider shall not use telehealth to provide an abortion.

SOURCE: Arizona Revised Statute Sec. 36-3604  (Accessed Oct. 2022).

If a health professional believes that a patient requires more than ninety morphine milligram equivalents per day and the patient is not exempt from the limit pursuant to subsection B of this section, the health professional shall first consult with a physician who is licensed pursuant to chapter 13 or 17 of this title and who is board-certified in pain, or an opioid assistance and referral call service, if available, that is designated by the department of health services. The consultation may be done by telephone or through telehealth.

SOURCE: Arizona Revised Statute Sec. 32-3248.01, (Accessed Oct. 2022).

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Arkansas

Last updated 10/17/2022

A distant site provider will not utilize telemedicine to treat …

A distant site provider will not utilize telemedicine to treat a patient located in Arkansas unless a professional relationship exists between the healthcare provider and the patient or as otherwise meets the definition of a professional relationship as defined in Section 17-80-402.  Existence of a professional relationship is not required in the following circumstances:

  • Emergency situations where life or health of the patient is in danger or imminent danger or
  • Simply providing information in a generic nature not meant to be specific to an individual patient.

“Professional relationship” means at a minimum a relationship established between a healthcare professional and a patient when:

  • The healthcare professional has previously conducted an in-person examination of the patient and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals;
  • The healthcare professional personally knows the patient and the patient’s relevant health status through an ongoing personal or professional relationship and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals;
  • The treatment is provided by a healthcare professional in consultation with, or upon referral by, another healthcare professional who has an ongoing professional relationship with the patient and who has agreed to supervise the patient’s treatment, including follow-up care;
  • An on-call or cross-coverage arrangement exists with the patient’s regular treating healthcare professional or another healthcare professional who has established a professional relationship with the patient;
  • A relationship exists in other circumstances as defined by rule of the Arkansas State Medical Board for healthcare professionals under its jurisdiction and their patients.
  • A relationship established under rules of the Arkansas State Medical Board may be utilized for telehealth certification;
  • A relationship exists in other circumstances as defined by rule of a licensing or certification board for other healthcare professionals under the jurisdiction of the appropriate board and their patients if the rules are no less restrictive than the rules of the Arkansas State Medical Board; or
  • The healthcare professional who is licensed in Arkansas has access to a patient’s personal health record maintained by a healthcare professional and uses any technology deemed appropriate by the healthcare professional, including the telephone, with a patient located in Arkansas to diagnose, treat, and if clinically appropriate, prescribe a noncontrolled drug to the patient.
  • For purposes of this subchapter, a health record may be created with the use of telemedicine and consists of relevant clinical information required to treat a patient, and is reviewed by the healthcare professional who meets the same standard of care for a telemedicine visit as an in-person visit

A professional relationship cannot be established only through:

  • An internet questionnaire
  • Email message
  • Patient generated medical history
  • Text messaging
  • Facsimile machine
  • Any combination of means listed above

See statute for additional avenues to establish the professional relationship.

SOURCE: AR Code 17-80-402 & 403 (Accessed Oct. 2022).

A physician-patient relationship must be established in accordance with Regulation 2.8 before the delivery of services via telemedicine. A patient completing a medical history online and forwarding it to a physician is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology. See regulation for additional requirements.

A physician using telemedicine may NOT issue a prescription for any controlled substances defined as any scheduled medication under schedules II through V unless the physician has seen the patient for an in-person exam or unless a relationship exists through consultation or referral; on-call or cross-coverage situations; or through an ongoing personal or professional relationship.

SOURCE: AR Rules and Regulation. Sec. 060.00.16-005 (Accessed Oct. 2022).

When abortion-inducing drugs are used, the initial administration must occur in the same room and in the physical presence of the prescribing physician who prescribed, dispensed, or otherwise provided the drug or chemical to the patient.

SOURCE:  AR Code Annotated Section 20-16-603(b)(1). (Accessed Oct. 2022). 

When mifepristone or another drug or chemical regimen is used to induce an abortion, the initial administration of the drug or chemical shall occur in the same room and in the physical presence of the physician who prescribed, dispensed, or otherwise provided the drug or chemical to the patient.

SOURCE: AR Medical Board: Rule 36 – Abortion Procedures, (Accessed Oct. 2022).

Without a prior and proper patient-provider relationship, providers are prohibited from issuing prescriptions solely in response to an Internet questionnaire, an Internet consultation, or a telephone consultation.

“Proper practitioner-patient relationship” means that before the issuance of a prescription, a practitioner, physician, or other prescribing health professional performs a history and in-person physical examination of the patient adequate to establish a diagnosis and to identify underlying conditions or contraindications to the treatment recommended or provided unless:

  • The prescribing practitioner is consulting at the specific request of another practitioner who:
    • Maintains an ongoing relationship with the patient
    • Has performed an in-person physical examination of the patient; and
    • Has agreed to supervise the patient’s ongoing care and use of prescribed medications;
  • The prescribing practitioner interacts with the patient through an on-call or cross-coverage situation; or
  • The relationship is established through telemedicine pursuant to the Telemedicine Act, § 17-80-401 et seq.

SOURCE: AR Code Annotated Sec. 17-92-1003(14)(B). (Accessed Oct. 2022).

Medical Board

A Provider exhibits gross negligence if he provides and/or recommends any form of treatment, including prescribing legend drugs, without first establishing a proper Patient/Provider relationship.

For purposes of this regulation, a proper Patient/Provider relationship, at a minimum requires that:

  1. The Provider performs a history and an “in person” physical examination of the patient adequate to establish a diagnosis and identify underlying conditions and/or contraindications to the treatment recommended/provided, OR
  2. The Provider has access to a patient’s personal health record, as relevant clinical information required to treat a patient, that is maintained by a provider and uses any technology deemed appropriate by the provider, including telephone, with a patient located in Arkansas to diagnose, treat and if clinically appropriate, prescribe a noncontrolled drug to the patient.
    1. A proper professional relationship does not include one established only be internet questionnaire, email message, patient-generated medical history, text message, facsimile, or any combination of these means.
  3. The Provider personally knows the patient and the patient’s general health status through an “ongoing” personal or professional relationship;
    1. Appropriate follow-up care provided or arrange, when necessary, at medically necessary intervals
    2. A health record may be created with the use of telemedicine and consists of relevant clinical information required to treat a patient, and is reviewed by a healthcare professional who meets the same standard of care for a telemedicine visit as an in-person visit.

SOURCE:  Medical Board Regulations, Rule 2.8: Requiring Minimum Standards for Establishing Provider/Patient Relationships. (Accessed Oct. 2022).

A Patient/Provider relationship must be established in accordance with Rule 2.8 before the delivery of services via telemedicine. Provider is defined as a person licensed by the Arkansas State Medical Board. A patient completing a medical history online and forwarding it to a Provider is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology.

A physician shall not issue a written medical marijuana certification to a patient based on an assessment performed through telemedicine. A Patient/Provider relationship established under Rule 2.8 may be utilized for medical marijuana recertification by telehealth. “Telehealth certification” means the electronic assessment of a patient by a provider in connection with an application for a registry identification card under the Arkansas Medical Marijuana Amendment of 2016.

Telemedicine does not include the use of audio-only electronic technology by a provider to renew a written certification that was previously issued to the same patient.

SOURCE:  Medical Board Regulations, Rule 38: Requirement for all services provided by Providers using telemedicine. (Accessed Oct. 2022).

Medical Marijuana Certification

“Telehealth certification” means the electronic assessment of a patient by a practitioner in connection with an application for a registry identification card under § 5 of the Arkansas Medical Marijuana Amendment of 2016, Arkansas Constitution, Amendment 98.

SOURCE: AR Code 17-80-402 (Accessed Oct. 2022)

Drug-induced, chemical and surgical abortions shall not be performed by telemedicine.

SOURCE: AR Admin Code 007 05 CARR 004 (Accessed Oct. 2022).

When a physician or other licensed prescriber authorizes or provides new prescriptions or refill medications to a pharmacy that is not physically located in this state or to a pharmacy that utilizes common carriers to deliver medications through the mail for a new patient who has not previously received pharmacist services or prescriptions filled through that pharmacy, that pharmacy shall:

  • Establish a professional relationship between a pharmacist and the patient by telephone or telemedicine consult…

SOURCE: AR Code 17-92-120  (Accessed Oct. 2022).

Social Work

A social worker/client relationship must be established in accordance with Ark. Code Ann. §§17-80-402 & 403 and Rule XIV before the delivery of services via telemedicine. A client completing a psychosocial history online and forwarding it to a social worker is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology. A social worker exhibits gross negligence if he or she provides and/or recommends any form of treatment via telemedicine without first establishing a proper social worker/client relationship.

“Professional relationship” does not include a relationship between a social worker and a client established only by the following:

  • An internet questionnaire;
  • An email message;
  • Patient-generated medical history;
  • Text messaging;
  • A facsimile machine; or
  • Any combination thereof.

See regulations for further requirements.

SOURCE: Rules and Regulations, Social Work Licensing Board, Sec. XIV (120 00 CARR 001), (Accessed Oct. 2022).

Licensed Counselor or Marriage Family Therapist

A licensed counselor or marriage and family therapists/client relationship must be established in accordance with Ark. Code Ann. §§ 17-80-402 & 403 and Section 12.3 & 12.4 before the delivery of services via telemedicine. A client’s completing a psychosocial history online and forwarding it to a licensed counselor or marriage and family therapist is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology. A licensed counselor or marriage and family therapist exhibits gross negligence if he or she provides and/or recommends any form of treatment via telemedicine without first establishing a proper licensed counselor or marriage and family therapist/client relationship.

“Professional relationship” does not include a relationship between a licensed counselor or marriage and family therapist and a client established only by the following:

  • An internet questionnaire;
  • An email message;
  • Patient-generated medical history;
  • Text messaging;
  • A facsimile machine; or
  • Any combination thereof.

See regulations for further requirements.

SOURCE: Rules and Regulations, Board of Examiners in Counseling, Rule XII, Sec. 12.2 (122 00 CARR 001), (Accessed Oct. 2022)

Dietitians

“Professional relationship” does not include a relationship between a licensed dietitian and a client established only by the following:

  • An internet questionnaire;
  • An email message;
  • Patient-generated medical history;
  • Text messaging;
  • A facsimile machine; or
  • Any combination thereof.

SOURCE: Rules and Regulations, Dietetics Licensing Board Sec. 239.00.22-002 (007 33 CARR 045), (Accessed Oct. 2022).

APRN

The APRN shall establish a proper APRN/patient relationship prior to providing any patient care. A proper APRN/patient relationship, at a minimum requires that:

  • The APRN perform a history and an “in person” physical examination of the patient adequate to establish a diagnosis and identify underlying conditions and/or contraindications to the treatment recommended/provided;
  • The APRN perform a face-to-face examination using real-time audio or visual telemedicine technology that provides information at least equal to such information as would have been obtained by an in-person examination; AND
  • Appropriate follow-up be provided or arranged, when necessary, at medically necessary intervals.

A proper APRN/patient relationship is also deemed to exist in the following situations:

  • When treatment is provided in consultation with, or upon referral by another health care provider who has an ongoing relationship with the patient, and who has agreed to supervise the patient‘s treatment, including follow-up care and the use of any prescribed medications.
  • On-call or cross-coverage situations arranged by the patient‘s health care provider.
Recognizing a Providers duty to adhere to the applicable standard of care, the following situations are hereby excluded from the requirement of this regulation:
  • Emergency situations where the life or health of the patient is in danger or imminent danger.
  • Providing information of a generic nature not meant to be specific to an individual.
  • Providing prescriptions written or medications issued for use in expedited heterosexual partner therapy for the sexually transmitted diseases of gonorrhea and/or chlamydia.
  • Administration of vaccines containing tetanus toxoid (e.g., DTaP, DTP, DT, Tdap, TD, or TT) or inactive influenza vaccines.

An APRN/patient relationship shall be established in accordance with Chapter 4, Section XIII before the delivery of services via telemedicine. A patient completing a medical history online and forwarding it to an APRN is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology.

An APRN using telemedicine may NOT issue a prescription for any controlled substances defined as any scheduled medication under schedules III through V and only hydrocodone combination products which were reclassified from Schedule III to Schedule II as of October 6, 2014 unless the APRN has seen the patient for an in-person exam or unless a relationship exists through consultation or referral; or on-call or cross-coverage situations.

SOURCE: Rule 007.34.22-003, Sec XV (067 00 CARR 004) (Accessed Oct. 2022).

Physical Therapy

“Professional relationship” means at a minimum a relationship established between a licensee and a patient when:

  • The licensee has previously conducted an in-person examination of the patient and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals;
  • The licensee personally knows the patient and the patient’s relevant health status through an ongoing personal or professional relationship and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals;
  • The treatment is provided by a licensee in consultation with, or upon referral by, another healthcare professional who has an ongoing professional relationship with the patient and who has agreed to supervise the patient’s treatment, including follow-up care;
  • An on-call or cross-coverage arrangement exists with the patient’s regular treating healthcare professional or another healthcare professional who has established a professional relationship with the patient;
  • A relationship exists in other circumstances as defined by rule of the Arkansas State Medical Board for healthcare professionals under its jurisdiction and their patients; or
  • The licensee has access to a patient’s personal health record maintained by a licensee and uses any technology deemed appropriate by the licensee, including the telephone, with a patient located in Arkansas to diagnose and treat the patient.

A licensee at a distant site shall not utilize telehealth with respect to a patient located in Arkansas unless a professional relationship exists between the licensee and the patient or the licensee otherwise meets the requirements of a professional relationship as defined in Section 1.(5) of this rule.

The existence of a professional relationship is not required in the following circumstances: (A) Emergency situations where the life or health of the patient is in danger or imminent danger; or(B) Simply providing information of a generic nature, not meant to be specific to an individual patient.

“Professional relationship” does not include a relationship between a licensee and a patient established only by the following:

  • An internet questionnaire;
  • An email message;
  • Patient-generated medical history;
  • Text messaging;
  • A facsimile machine; or
  • Any combination thereof.

SOURCE: Rule 007.33.22-017. (Accessed Jul. 2022).

Psychology

A psychologist/psychological examiner exhibits gross negligence if he provides and/or recommends any form of treatment/service, without first establishing a proper psychologist/psychological examiner-patient/client relationship.

For purposes of this rule, a proper psychologist/psychological examiner- patient/client relationship, at a minimum requires that:

  • The psychologist/psychological examiner performs a history and an “in person” interview of the patient/client adequate to establish a diagnosis and identify underlying conditions and/or contraindications to the treatment/service recommended/provided,
  • The psychologist/psychological examiner has access to a patient/client’s personal health record, as defined by A.C.A. §17-80-401 et seq., maintained by a psychologist/psychological examiner and uses any technology deemed appropriate by the psychologist/psychological examiner, including the telephone, with a patient/client located in Arkansas to diagnose or treat the patient/client; or
  • The psychologist/psychological examiner personally knows the patient/client and the patient/client’s general health status through an “ongoing” personal or professional relationship;19.1.A. (2) Appropriate follow-up be provided or arranged, when necessary, at necessary intervals.

For the purposes of this rule, a proper psychologist/psychological examiner-patient/client relationship is deemed to exist in the following situations:

  • When treatment/service is provided in consultation with, or upon referral by, another provider who has an ongoing relationship with the patient/client, and who has agreed to supervise the patient/client’s treatment/service, including follow up care.
  • On-call or cross-coverage situations arranged by the patient/client’s treating psychologist/psychological examiner.

Exceptions — Recognizing a psychologist/psychological examiner’s duty to adhere to the applicable standard of care, the following situations are hereby excluded from the requirement of this rule:

  • Emergency situations where the life or health of the patient/client is in danger or imminent danger.
  • Simply providing information of a generic nature not meant to be specific to an individual patient/client.

A Patient/client/Provider relationship must be established before the delivery of services via telepsychology. Provider is defined as a person licensed by the Arkansas Psychology Board who has documented training in telepsychology. A patient/client completing a history online and forwarding it to a Provider is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology.

SOURCE: Rules and Regulations Board of Psychology, Sec. 007.00.22-001, (074 00 CARR 001), (Accessed Oct. 2022).

Speech-Language Pathology and Audiology

“Professional relationship” means at a minimum a relationship established between a licensee and a patient when:

  • The licensee has previously conducted an in-person examination of the patient and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals;
  • The licensee personally knows the patient and the patient’s relevant health status through an ongoing personal or professional relationship and is available to provide appropriate follow-up care, when necessary, at therapeutically necessary intervals;
  • The treatment is provided by a licensee in consultation with, or upon referral by, another healthcare professional who has an ongoing professional relationship with the patient and who has agreed to supervise the patient’s treatment, including follow-up care;
  • An on-call or cross-coverage arrangement exists with the patient’s regular treating healthcare professional or another healthcare professional who has established a professional relationship with the patient;
  • A relationship established under rules of the Arkansas State Medical Board may be utilized for telepractice certification; or
  • The licensee has access to a patient’s personal health record maintained by a healthcare professional and uses any technology deemed appropriate by the licensee, including the telephone, with a patient located in Arkansas to diagnose and treat the patient.  For purposes of this subchapter, a health record may be created with the use of telepractice and consists of relevant clinical information required to treat a patient, and is reviewed by the licensee who meets the same standard of care for a telepractice visit as an in-person visit;

“Professional relationship” does not include a relationship between a licensee and a patient established only by the following:

  • An internet questionnaire;
  • An email message;
  • Patient-generated medical history;
  • Text messaging;
  • A facsimile machine; or
  • Any combination of means listed in subdivisions (c)(1)-(5) of this section.

SOURCE:  AR Board of Examiners in Speech-Language Pathology and Audiology Rules, Section 12: Telepractice, (Accessed Oct. 2022).

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California

Last updated 09/06/2022

Prescribing, dispensing, or furnishing dangerous drugs as defined in Section …

Prescribing, dispensing, or furnishing dangerous drugs as defined in Section 4022 without an appropriate prior examination and a medical indication, constitutes unprofessional conduct. An appropriate prior examination does not require a synchronous interaction between the patient and the licensee and can be achieved through the use of telehealth, including, but not limited to, a self-screening tool or a questionnaire, provided that the licensee complies with the appropriate standard of care.

SOURCE: CA Business & Professions Code Sec. 2242.1(a). (AB 1264 – 2019 Legislative Session). (Accessed Sept. 2022).

Remote Dispensing Site Pharmacies

Remote dispensing site pharmacies are permitted to dispense or provide pharmaceutical care services in medically underserved areas. A supervising pharmacy must provide telepharmacy services to the remote dispensing site pharmacy and shall not be located greater than 150 road miles from the remote dispensing site pharmacy.

SOURCE: CA Business & Professions Code Sec. 4130-4135 (Accessed Sept. 2022).

Occupational Therapy

An occupational therapist shall determine whether an in-person evaluation or in-person interventions are necessary considering: the complexity of the patient’s/client’s condition; his or her own knowledge, skills, and abilities; the nature and complexity of the intervention; the requirements of the practice setting; and the patient’s/client’s context and environment.

SOURCE: CA Code of Regulations, Title 16, Div. 39, Art. 8, Sec. 4172(c). (Accessed Sept. 2022).

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Colorado

Last updated 10/20/2022

Colorado Medical Board

Provider-patient relationships may be established using telehealth …

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 Oct. 2022).

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 Oct. 2022).

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.

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 under the following conditions:

    1. The opiate antagonist is not a controlled substance; and
    2. The opiate antagonist 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 Oct. 2022).

Workers’ Compensation

The physician-patient relationship/psychologist-patient relationship can be established through live audio/video services.

SOURCE: 7 CO Regs. Rule 1101-3, 18-5(I)(3), p. 30. (Accessed Oct. 2022).

“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 assessment of the patient’s medical history, including reviewing a previous diagnosis for a debilitating or disabling medical condition, and current medical condition, including an appropriate personal physical examination. “Appropriate personal physical examination” may not be performed by remote means, including telemedicine.

SOURCE: 5 CO Regs. Rule 1006-2. (Accessed Oct. 2022).

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Connecticut

Last updated 08/10/2022

Effective Now Until June 30, 2024

Notwithstanding the provisions of …

Effective Now Until June 30, 2024

Notwithstanding the provisions of this section or title 20 of the general statutes, no telehealth provider shall, during the period beginning on May 10, 2021 and ending on June 30, 2024, prescribe any schedule I, II or III controlled substance through the use of telehealth, except a schedule II or III controlled substance other than an opioid drug, as defined in section 20-14o of the general statutes, in a manner fully consistent with the Ryan Haight Online Pharmacy Consumer Protection Act, 21 USC 829(e), as amended from time to time, for the treatment of a person with a psychiatric disability or a person with a substance use disorder, as defined in section 17a-458 of the general statutes, including, but not limited to, medication-assisted treatment. A telehealth provider using telehealth to prescribe a schedule II or III controlled substance pursuant to this subsection shall electronically transmit the prescription pursuant to section 21a-249 of the general statutes, as amended by public act 21-9.

SOURCE: HB 5596 (2021 Session), Sec. 1 & SB 2 (2022 Session), Sec. 32. (Accessed Aug. 2022).

Effective Now Until June 30, 2023

Notwithstanding the provisions of sections 21a-408 to 21a-408n, inclusive, of the general statutes, as amended by this act, or any other section, regulation, rule, policy or procedure concerning the certification of medical marijuana patients, a physician, physician assistant, or advanced practice registered nurse may issue a written certification to a qualifying patient and provide any follow-up care using telehealth services during the period beginning on the effective date of this section and ending on June 30, 2023, provided all other requirements for issuing the written certification to the qualifying patient and all recordkeeping requirements are satisfied.

SOURCE: HB 5596 (2021 Session), Sec. 7 & HB 5329 (2022 Session), Sec. 20. (Accessed Aug. 2022).

Permanent Statute

No telehealth provider shall prescribe any schedule I, II or III controlled substance through the use of telehealth, except a schedule II or III controlled substance other than an opioid drug, in a manner consistent with federal law, for the treatment of a person with a psychiatric disability or substance use disorder, including but not limited to medication assisted treatment. A telehealth provider using telehealth to prescribe a schedule II or III controlled substance pursuant to this subsection shall electronically submit the prescription pursuant to section 21a-249 of the general statutes, as amended by this act.

SOURCE: CT General Statute 19a, Sec. 906(c). (Accessed Aug. 2022).

A licensed practitioner shall not be required to electronically transmit a prescription when:

  • Electronic transmission is not available due to a temporary technological or electrical failure. In the event of a temporary technological or electrical failure, the practitioner shall, without undue delay, reasonably attempt to correct any cause for the failure that is within his or her control. A practitioner who issues a prescription, but fails to electronically transmit the prescription, as permitted by this subsection, shall document the reason for the practitioner’s failure to electronically transmit the prescription in the patient’s medical record as soon as practicable, but in no instance more than seventy-two hours following the end of the temporary technological or electrical failure that prevented the electronic transmittal of the prescription. For purposes of this subdivision, “temporary technological or electrical failure” means failure of a computer system, application or device or the loss of electrical power to such system, application or device, or any other service interruption to such system, application or device that reasonably prevents the practitioner from utilizing his or her certified application to electronically transmit the prescription in accordance with subsection (b) of this section;
  • The practitioner reasonably determines that it would be impractical for the patient to obtain substances prescribed by an electronically transmitted prescription in a timely manner and that such delay would adversely impact the patient’s medical condition, provided if such prescription is for a controlled substance, the quantity of such controlled substance does not exceed a five-day supply for the patient, if the controlled substance was used in accordance with the directions for use. A practitioner who issues a prescription, but fails to electronically transmit the prescription, as permitted by this subsection, shall document the reason for the practitioner’s failure to electronically transmit the prescription in the patient’s medical record;
  • The prescription is to be dispensed by a pharmacy located outside this state. A practitioner who issues a prescription, but fails to electronically transmit the prescription, as permitted by this subsection, shall document the reason for the practitioner’s failure to electronically transmit the prescription in the patient’s medical record;
  • Use of an electronically transmitted prescription may negatively impact patient care, such as a prescription containing two or more products to be compounded by a pharmacist, a prescription for direct administration to a patient by parenteral, intravenous, intramuscular, subcutaneous or intraspinal infusion, a prescription that contains long or complicated directions, a prescription that requires certain elements to be included by the federal Food and Drug and Administration, or an oral prescription communicated to a pharmacist by a health care practitioner for a patient in a chronic and convalescent nursing home, licensed pursuant to chapter 368v; or
  • The practitioner demonstrates, in a form and manner prescribed by the commissioner, that such practitioner does not have the technological capacity to issue an electronically transmitted prescription. For the purposes of this subsection, “technological capacity” means possession of a computer system, hardware or device that can be used to electronically transmit controlled substance prescriptions consistent with federal law. The provisions of this subdivision shall not apply to a practitioner when such practitioner is prescribing as a telehealth provider, as defined in section 19a-906, as amended by this act, section 1 of public act 20-2 of the July special session* or section 1 of public act 21-9*, as amended by this act, as applicable, pursuant to subsection (c) of section 19a-906, subsection (c) of section 1 of public act 20-2 of the July special session* or subsection (c) of section 1 of public act 21-9*, as amended by this act, as applicable. 

SOURCE: CT General Statute 21a-249 (c). As amended by HB 5596 (2021 Session)& proposed to be amended by SB 2 (2022 Session), sec. 34. (Accessed Aug. 2022).

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Delaware

Last updated 08/24/2022

Health-care providers may not deliver health-care services by telehealth and …

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:

  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.

SOURCE: Title 24, Ch. 60, Sec. 6003 & 6005. (Accessed Aug. 2022).

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).

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District of Columbia

Last updated 09/03/2022

A physician shall perform a patient evaluation to establish diagnoses …

A physician shall perform a patient evaluation to establish diagnoses and identify underlying conditions or contraindications to recommended treatment options before providing treatment or prescribing medication for a patient utilizing the appropriate standards of care, except when performing interpretive services.

If a physician-patient relationship does not include a prior in-person interaction with a patient, the physician may use real-time telemedicine to allow a free exchange of protected health information between the patient and the physician to establish the physician-patient relationship and perform the patient evaluation.

SOURCE: DC Reg Sec. 17-4618.3 & 4 (Accessed Sept. 2022).

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Florida

Last updated 10/26/2022

A telehealth provider may use telehealth to perform a patient …

A telehealth provider may use telehealth to perform a patient evaluation. If a telehealth provider conducts a patient evaluation sufficient to diagnose and treat the patient, the telehealth provider is not required to research a patient’s medical history or conduct a physical examination of the patient before using telehealth to provide health care services to the patient.

A telehealth provider may not use telehealth to prescribe a controlled substance listed in Schedule II of s. 893.03 unless the controlled substance is prescribed for the following:

  1. The treatment of a psychiatric disorder;
  2. Inpatient treatment at a hospital licensed under chapter 395;
  3. The treatment of a patient receiving hospice services as defined in s. 400.601; or
  4. The treatment of a resident of a nursing home facility as defined in s. 400.021.

SOURCE: FL Statute 456.47. (Accessed Oct. 2022).

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Georgia

Last updated 10/22/2022

In order for a physician to practice within the minimum …

In order for a physician to practice within the minimum standards of practice while providing treatment and/or consultation recommendations by electronic or other such means, all the following conditions must be met:

  • All treatment and/or consultations must be done by Georgia licensed practitioners;
  • A history of the patient shall be available to the Georgia licensed physician, physician assistant or advanced practice registered nurse who is providing treatment or consultation via electronic or other such means;
  • Georgia licensed physician, physician assistant or advanced practice registered nurse either: (a) Has personally seen and examined the patient and provides ongoing or intermittent care by electronic or other such means; or (b) Is providing medical care by electronic or other such means at the request of a physician, physician assistant or advanced practice registered nurse licensed in Georgia who has personally seen and examined the patient; or (c) Is providing medical care by electronic or other such means at the request of a Public Health Nurse, a Public School Nurse, the Department of Family and Children’s Services, law enforcement, community mental health center or through an established child advocacy center for the protection for a minor, and the physician, physician assistant or advanced practice registered nurse is able to examine the patient using technology and peripherals that are equal or superior to an examination done personally by a provider within that provider’s standard of care; or (d) Is able to examine the patient using technology and peripherals that are equal or superior to an examination done personally by a provider within that provider’s standard of care.
  • The Georgia licensed physician, physician assistant or advanced practice registered nurse providing treatment or consultations by electronic or other means must maintain patient records on the patient and must document the evaluation and treatment along with the identity of the practitioners providing the service by electronic or other means, and if there is a referring practitioner, a copy of this record must also be provided to the referring physician, physician assistant or advanced practice registered nurse.
  • To delegate to a nurse practitioner or to supervise a physician assistant doing telemedicine, the physician must document to the board that the provision of care by telemedicine is in his or her scope of practice and that the NP or PA has demonstrated competence in the provision of care by telemedicine.
  • Patients treated by electronic or other such means or patient’s agent must be given the name, credentials and emergency contact information for the Georgia licensed physician, physician assistant and/or advanced practice registered nurse providing the treatment or consultation. Emergency contact information does not need to be provided to those treated within the prison system while incarcerated but should be provided to the referring provider. For the purposes of this rule, “credentials” is defined as the area of practice and training for physicians, and for physician assistants and advanced practice registered nurses, “credentials” shall mean the area of licensure and must include the name of the delegating physician or supervising physician.
  • The patient being treated via electronic or other means or the patient’s agent must be provided with clear, appropriate, accurate instructions on follow-up in the event of needed emergent care related to the treatment. In the case of prison patients, prison staff will be provided this information if the consult is provided to an inmate.
  • The physician, physician assistant or nurse practitioner who provides care or treatment for a patient by electronic or other such means must make diligent efforts to have the patient seen and examined in person by a Georgia licensed physician, physician assistant or nurse practitioner at least annually.

This rule should not be interpreted to interfere with care and treatment by telephonic communication in an established physician-patient relationship, call coverage for established physician-patients relationships, or telephone and internet consultations between physicians, nurse practitioners, physician assistants, other health care providers or child protection agencies.

This rule does not authorize the prescription of controlled substances for the treatment of pain or chronic pain by electronic or other such means. All treatment of pain or chronic pain must be in compliance with Rule 360-3-.06.

SOURCE: GA Rules & Regulations revised 360-3-.07. (Accessed Oct. 2022). 

Unprofessional conduct shall include but not be limited to prescribing controlled substances and/or dangerous drugs for a patient based solely on a consultation via electronic means with the patient, patient’s guardian or patient’s agent. This shall not prohibit a licensee from prescribing a dangerous drug for a patient pursuant to a valid physician­ patient relationship in accordance with O.C.G.A. 33-24-56.4 or a licensee who is on-call or covering for another licensee from prescribing up to a 30-day supply of medications for a patient of such other licensee nor shall it prohibit a licensee from prescribing medications when documented emergency circumstances exist.

This shall also not prevent a licensed physician from prescribing Schedule II sympathomimetic amine drugs for the treatment of attention deficit disorder to a patient in the physical presence of a licensed nurse, provided the initial diagnosis was made and an initial prescription was issued in accordance with 21 U .S .C. § 829(e), as amended from time to time, including but not limited to the following:

  • The physician has conducted at least one in-person medical evaluation of the patient; or
  • The physician is covering for a licensee who is temporarily unavailable and has conducted at least one in-person medical evaluation of the patient; or
  • The physician is engaged in the practice of telemedicine in accordance with Board Rule 360-3-.07 and with 21 U.S.C. §§ 802(54) and 829(e)(3)(A), including, but not limited to:
    • Where the patient is being treated by, and physically located in, a hospital or clinic registered with the U.S. Drug Enforcement Agency (“DEA”), the physician is registered with the DEA, and all other requirements of 21 U.S.C. § 802(54)(A) are met; or
    • Where the patient is being treated by, and physically in the presence of, a licensee who is registered with the DEA, and all other requirements of 21 U.S.C. § 802(54)(B) are met; or
    • Where the physician has obtained from the U.S. Attorney General a special registration for telemedicine in accordance with 21 U.S.C. §§ 802(54)(E) and 831(h).

Providing treatment via electronic or other means is considered unprofessional conduct unless a history and physical examination of the patient has been performed by a Georgia licensee.  This shall not prohibit a licensee who is on call or covering for another licensee from treating and/or consulting a patient of such other licensee. Also, this paragraph shall not prohibit a patient’s attending physician from obtaining consultations or recommendations from other licensed health care providers.

SOURCE: GA Rules & Regulations revised 360-3-.02. (Accessed Oct. 2022).

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Hawaii

Last updated 10/29/2022

Prescribing providers must have a provider-patient relationship prior to prescribing. …

Prescribing providers must have a provider-patient relationship prior to prescribing. This includes:

  • A face-to-face history and appropriate physical exam to make a diagnosis and therapeutic plan;
  • Discussion of diagnosis or treatment with the patient; including the benefits of other treatment options; and
  • Ensure the availability of appropriate follow-up care.

SOURCE: HI Revised Statutes § 329-1. (Accessed Oct. 2022)

Treatment recommendations made via telehealth, including issuing a prescription via electronic means, shall be held to the same standards of practice as traditional settings that do not include a face-to-face visit but in which prescribing is appropriate, including on-call telephone encounters and encounters for which a follow-up visit is arranged.

Issuing a prescription based solely on an online questionnaire is not treatment for the purposes of this section and does not constitute an acceptable standard of care.

A physician-patient relationship may be established via a telehealth interaction; provided that the physician has a license to practice medicine in the State.  Once a physician-patient relationship is established, a patient or physician licensed in this State may use telehealth for any authorized purpose, including consultation with a medical provider licensed in another state, authorized by this section or as otherwise provided by law.

For the purposes of prescribing opiates or medical cannabis, a physician-patient relationship shall only be established after an in-person consultation between the prescribing physician and the patient.

SOURCE: HI Revised Statutes § 453-1.3. (Accessed Oct. 2022).

For purposes of prescribing medical cannabis, a bona fide physician-patient relationship may be established via telehealth, and a nurse-patient relationship can be established via telehealth; provided that treatment recommendations that certify a patient for the medical use of cannabis via telehealth shall be allowed only after an initial in-person consultation between the certifying physician or advanced practice registered nurse and the patient.

SOURCE: HI Revised Statutes § 329-126. (Accessed Oct. 2022).

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Idaho

Last updated 08/22/2022

Prescribers must have prescriber-patient relationship, which includes a documented patient …

Prescribers must have prescriber-patient relationship, which includes a documented patient evaluation adequate to establish diagnoses and identify underlying conditions and/or contraindications to the treatment.

Prescriptions based solely on online questionnaires or consultation outside of an ongoing clinical relationship does not constitute a legitimate medical purpose.

SOURCE: ID Code § 54-1733. (Accessed Aug. 2022).

If a provider offering telehealth services does not have an established provider-patient relationship with a person seeking such services, the provider shall take appropriate steps to establish a provider-patient relationship by use of two-way audio or audio-visual interaction; provided however, that the applicable Idaho community standard of care must be satisfied.

A provider with an established provider-patient relationship, including a relationship established pursuant to section 54-5705, Idaho Code, may issue prescription drug orders using telehealth services within the scope of the provider’s license and according to any applicable laws, rules and regulations, including the Idaho community standard of care; provided however, that the prescription drug shall not be a controlled substance unless prescribed in compliance with title 21 U.S.C.

SOURCE: ID Code Sec. 54-5705 & 5707 (Accessed Aug. 2022).

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Illinois

Last updated 11/18/2022

An optometrist treating a patient through telehealth must perform at …

An optometrist treating a patient through telehealth must perform at least a minimum eye examination as required by 68 Ill. Adm. Code 1320.90 before prescribing eyeglasses or contact lenses to the patient. Nothing in this Section authorizes an eye examination that:

  • does not assess the ocular health and visual status of a patient, or
  • consists solely of objective refractive data or information generated by an automated testing device, including an autorefractor, in order to establish a medical diagnosis or to determine a refractive error.

SOURCE: Illinois Consolidated Statute 225, 80/15.4. (Accessed Nov. 2022).

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Indiana

Last updated 10/30/2022

A documented patient evaluation, including history and physical evaluation adequate …

A documented patient evaluation, including history and physical evaluation adequate to establish diagnoses and identify underlying conditions or contraindications to the treatment recommended or provided, must be obtained prior to issuing prescriptions electronically or otherwise.

SOURCE: IN Admin. Code, “Article 5” Title 844, 5-3-2. p. 9 (Accessed Oct. 2022). 

Telehealth may not be used to provide any abortion, including the writing or filling of a prescription for any purpose that is intended to result in an abortion.

SOURCE: IN code, 16-34-1-11 & 25-1-9.5-8(a)(r) & 25-1-9.5-0.5. (Accessed Oct. 2022).

A practitioner who:

  • Provides health care services through telehealth; or
  • Directs an employee of the practitioner to perform a health care service listed in the chapter;

shall be held to the same standards of appropriate practice as those standards for health care services provided at an in-person setting.

A practitioner who uses telehealth shall, if such action would otherwise be required in the provision of the same health care services in a manner other than telehealth, ensure that a proper provider-patient relationship is established. The provider-patient relationship by a  practitioner who uses telehealth must at a minimum include the following:

  1. Obtain the patient’s name and contact information (see regulation for other related requirements);
  2. Disclose the practitioner’s name and practitioner’s licensure, certification or registration;
  3. Obtain informed consent from the patient;
  4. Obtain the patient’s medical history and information necessary to establish a diagnosis;
  5. Discuss with the patient the diagnosis, evidence for the diagnosis and risks and benefits of the various treatment options;
  6. Create and maintain a medical record for the patient. If a prescription is issued for the patient, and subject to the consent of the patient, the prescriber shall notify the patient’s primary care provider of any prescriptions the provider has issued (see regulation for other related requirements);
  7. Issue proper instructions for appropriate follow-up care
  8. Provide a telehealth visit summary to the patient, including information that indicates any prescriptions that is being prescribed.

SOURCE: IN Code, 25-1-9.5-7. (Accessed Oct. 2022)

A prescription for a controlled substance can be issued for a patient the prescriber has not previously examined if the following conditions are met:

  1. The prescriber has satisfied the applicable standard of care in the treatment of the patient.
  2. The issuance of the prescription is within the prescriber’s scope of practice and certification
  3. The prescription meets the requirements outline in the following section and it is not an opioid.  However, opioids may be prescribed if the opioid is a partial agonist that is used to treat or manage opioid dependence.
  4. The prescription is not for an abortion inducing drug

If the prescription is for a medical device, including an ophthalmic device, the prescriber must use telehealth technology that is sufficient to allow the provider to make an informed diagnosis and treatment plan that includes the medical device being prescribed.

Additionally, the following conditions must be met for a prescription for a controlled substance:

  • The prescriber maintains a valid controlled substance registration under IC 35-48-3.
  • The prescriber meets the conditions set forth in 21 U.S.C. 829 et seq.
  • A practitioner acting in the usual course of the practitioner’s professional practices issues the prescription for a legitimate medical purpose.
  • The telehealth communication is conducted using an audiovisual, real time, two-way interactive communication system.
  • The prescriber complies with the requirements of the INSPECT program (IC 35-48-7).
  • All other applicable federal and state laws are followed.

SOURCE: IN Code 25-1-9.5-8. (Accessed Oct. 2022).

A pharmacy does not violate this chapter if the pharmacy fills a prescription for an opioid and the pharmacy is unaware that the prescription was written or electronically transmitted by a prescriber providing telehealth services under this chapter.

SOURCE: IN Code 25-1-9.5-11. (Accessed Oct 2022)

A prescriber may not issue a prescription for an ophthalmic device unless the following conditions are met:

  • If the prescription is for contact lenses or eyeglasses, the patient must be at least eighteen (18) years of age but not more than fifty-five (55) years of age.
  • The patient must have completed a medical eye history that includes information concerning the following:
    • Chronic health conditions.
    • Current medications.
    • Eye discomfort.
    • Blurry vision.
    • Any prior ocular medical procedures.
  • The patient must have had a prior prescription from a qualified eye care professional that included a comprehensive in person exam that occurred within two (2) years before the initial use of telehealth for a refraction under subdivision (5)(A).
  • If the patient desires a contact lens prescription, at the discretion of the eye care professional, that patient must have had a prior contact lens fitting or evaluation by a qualified eye care professional that occurred within two (2) years before the initial use of telehealth for a refraction under subdivision (5)(A).
  • The patient:
    • May not use telehealth more than two (2) consecutive times within two (2) years from the date of the examination that occurred under subdivision (3) for a refraction without a subsequent in person comprehensive eye exam; and
    • Must acknowledge that the patient has had a comprehensive eye exam as required under clause (A) before receiving an online prescription.
  • The patient may allow the prescriber to access the patient’s medical records using an appropriate HIPAA compliant process.
  • The prescriber must ensure that the transfer of all information, including the vision test and prescription, comply with HIPAA requirements.
  • The prescriber must use technology to allow the patient to have continuing twenty-four (24) hour a day online access to the patient’s prescription as soon as the prescription is signed by the prescriber.

SOURCE: IN Code 25-1-9.5-13. (Accessed Oct. 2022)

If a veterinarian is required to establish a veterinarian-client-patient relationship to perform a health care service, the veterinarian shall ensure that a proper veterinarian-client-patient relationship is established, when providing the service using telehealth.

SOURCE: IN Code 25-1-9.5-15. (Accessed Oct. 2022)

Telehealth Services Pilot Program

Prescriptions may not be issued for a controlled substance or an abortifacient.

Telehealth shall not include any encounter in which the patient is assured that any outcome, including the issuance of a prescription, will be issued as a quid pro quo for the payment of the provider’s consultation fee or solely on the basis of an online questionnaire.

SOURCE: IN Code, 844-Article 5-8-3, p. 27-28. (Accessed Oct. 2022).

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Iowa

Last updated 07/21/2022

Pharmacists are prohibited from dispensing prescription drugs if the pharmacist …

Pharmacists are prohibited from dispensing prescription drugs if the pharmacist knows or should have known that the prescription was issued solely on the basis of an Internet-based questionnaire, an Internet-based consult, or a telephone consult.

SOURCE: IA Admin. Code, 657 8.19(5). (Accessed Oct. 2022). 

A physician must be physically present with a woman at the time an abortion-inducing drug is provided.

SOURCE: IA Admin. Code, 653 13.10(3) (Accessed Oct. 2022). 

Generally, a licensee shall perform an in-person medical interview and physical examination for each patient. However, the medical interview and physical examination may not be in-person if the technology utilized in a telemedicine encounter is sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed in-person. Prior to providing treatment, including issuing prescriptions, electronically or otherwise, a licensee who uses telemedicine shall interview the patient to collect the relevant medical history and perform a physical examination, when medically necessary, sufficient for the diagnosis and treatment of the patient. An Internet questionnaire that is a static set of questions provided to the patient, to which the patient responds with a static set of answers, in contrast to an adaptive, interactive and responsive online interview, does not constitute an acceptable medical interview and physical examination for the provision of treatment, including issuance of prescriptions, electronically or otherwise, by a licensee.

Under certain circumstances, whether or not such circumstances involve the use of telemedicine, a licensee may treat a patient who has not been personally interviewed, examined and diagnosed by the licensee.  See rule.

SOURCE: Iowa Admin Code, Sec. 653-13.11, (Accessed Oct. 2022).

Specific requirements apply for mental health professionals establishing a provider-patient relationship in a school-based setting. See full law text for details.

A mental health professional with prescribing authority who provides telehealth services in accordance with this section shall not prescribe any new medication to a student during a telehealth session. However, a mental health professional with prescribing authority may initiate new prescriptions, alter the dosage of an existing medication, or discontinue an existing medication for the treatment of the student’s behavioral health condition after consultation with the student’s parent or guardian.

SOURCE: IA Code Chapter 280A.4 (Accessed Oct. 2022).

A mental health professional with prescribing authority who provides telehealth services shall not alter the dosage of an existing medication or prescribe any new medication during a telehealth session without prior consultation with the student’s parent or guardian.

SOURCE: IA Code 281.14.24, (Accessed Oct. 2022).

Physician Assistant-Patient Relationship

A licensee who uses telemedicine shall establish a valid physician assistant-patient relationship with the person who receives telemedicine services. The physician assistant-patient relationship begins when:

  • The person with a health-related matter seeks assistance from a licensee;
  • The licensee agrees to undertake diagnosis and treatment of the person; and
  • The person agrees to be treated by the licensee whether or not there has been an in-person encounter between the physician assistant and the person.

A valid physician assistant-patient relationship may be established by:

  • In-person encounter. Through an in-person medical interview and physical examination where the standard of care would require an in-person encounter;
  • Consultation with another licensee. Through consultation with another licensee (or other health care provider) who has an established relationship with the patient and who agrees to participate in, or supervise, the patient’s care; or
  • Telemedicine encounter. Through telemedicine, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

Medical history and physical examination may be done through telemedicine if the technology utilized in a telemedicine encounter is sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed in person.

An Internet questionnaire that is a static set of questions provided to the patient, to which the patient responds with a static set of answers, in contrast to an adaptive, interactive and responsive online interview, does not constitute an acceptable medical interview and physical examination for the provision of treatment, including issuance of prescriptions, electronically or otherwise, by a licensee.

See rule for circumstances where the standard of care may not require a licensee to personally interview or examine a patient.

Prescribing to a patient based solely on an Internet request or Internet questionnaire (i.e., a static questionnaire provided to a patient, to which the patient responds with a static set of answers, in contrast to an adaptive, interactive and responsive online interview) is prohibited. Absent a valid physician assistant-patient relationship, a licensee’s prescribing to a patient based solely on a telephonic evaluation is prohibited, with the exception of the circumstances described in subrule 327.9(21).

SOURCE: Iowa Admin Code, Sec. 645-327.9, (Accessed Oct. 2022).

Nursing – APRNs

Prior to providing services through telehealth, the licensee shall first establish a practitioner-patient relationship. A practitioner-patient relationship is established when:

  • The person with a health-related matter seeks assistance from the licensee;
  • The licensee agrees to provide services; and
  • The person agrees to be treated, or the person’s legal guardian or legal representative agrees to the person’s being treated, by the licensee regardless of whether there has been a previous in-person
    encounter between the licensee and the person.

A practitioner-patient relationship can be established through an in-person encounter, consultation with another licensee or health care provider, or telehealth encounter.

Notwithstanding paragraphs 7.9(5)“a” and “b,” services may be provided through telehealth without first establishing a practitioner-patient relationship in the following settings or circumstances:

  1. Institutional settings;
  2. Licensed or certified nursing facilities, residential care facilities, intermediate care facilities, assisted living facilities, and hospice settings;
  3. In response to an emergency or disaster;
  4. Informal consultations with another health care provider performed by a licensee outside of the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  5. Episodic consultations by a specialist located in another jurisdiction who provides consultation services upon request to a licensee;
  6. A substitute licensee acting on behalf and at the designation of an absent licensee or other health care provider in the same specialty on an on-call or cross-coverage basis; or
  7. When a sexually transmitted disease has been diagnosed in a patient, a licensee prescribes or dispenses antibiotics to the patient’s named sexual partner(s) for the treatment of the sexually transmitted disease as recommended by the U.S. Centers for Disease Control and Prevention.

A licensee providing services through telehealth may issue a prescription to a patient as long as the issuance of such prescription is consistent with the standard of care applicable to the in-person setting.

SOURCE: IA Admin Code Sec. 655-7.9(152), (Accessed Oct. 2022).

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Kansas

Last updated 08/18/2022

The same laws and regulations that apply to the prescribing …

The same laws and regulations that apply to the prescribing of drugs, including controlled substances, by means of in-person contact shall apply to the prescribing of drugs, including controlled substances, by means of telemedicine.

SOURCE: KS Admin. Regs., Sec. 100-77-3. (Accessed Aug. 2022). 

Physicians must have a pre-existing patient-prescriber relationship.  Physicians are prohibited from prescribing drugs on the basis of an internet-based questionnaire, internet-based consult, or telephonic consultation.

SOURCE: KS Admin. Regs., Sec. 68-2-20(2). (Accessed Aug. 2022).

Telemedicine may be used to establish a valid provider-patient relationship.

SOURCE:  KS Statute Ann. § 40-2,212(b). (Accessed Aug. 2022).

“Telepharmacy” means the practice of pharmacy by a pharmacist located in Kansas using telecommunications or other automations and technologies to deliver personalized, electronically documented, real-time pharmaceutical care to patients or their agents, who are located at sites other than where the pharmacist is located, including prescription dispensing and counseling and to oversee and supervise telepharmacy outlet operations.

A pharmacist shall be in attendance at the telepharmacy outlet by connecting to the telepharmacy outlet via computer link, video link and audio link or other functionally equivalent telecommunications equipment and shall be available to consult with and assist the pharmacy technician in performing activities.

Not later than January 1, 2023, the board shall adopt rules and regulations necessary to specify additional criteria for a managing pharmacy and telepharmacy outlet under this section, including, but not limited to:

Application requirements;

  • structural, security, technology and equipment requirements;
  • staffing, training and electronic supervision requirements;
  • inventory record keeping and storage requirements;
  • labeling requirements;
  • establishment of policies and procedures;
  • the number of telepharmacy outlets that may be operated by a supervising pharmacy;
  • use of automated dispensing machines; and
  • criteria for requesting exemptions or waivers from the requirements set forth in rules and regulations adopted under this subsection.

SOURCE: KS Statute Sec. 65-16, 130, (Accessed Aug. 2022).

A physician may issue a prescription for or order the administration of medication, including a controlled substance, for a patient without conducting an in-person examination of such patient.

A physician practicing telemedicine in accordance with this section shall conduct an appropriate assessment and evaluation of the patient’s current condition and document the appropriate medical indication for any prescription issued.

SOURCE: KS Statute Ann. Sec. 48-963, (Accessed Aug. 2022).

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Kentucky

Last updated 11/02/2022

As used in KRS 311.595(9), “dishonorable, unethical, or unprofessional conduct

As used in KRS 311.595(9), “dishonorable, unethical, or unprofessional conduct of a character likely to deceive, defraud, or harm the public or any member thereof” shall include but not be limited to the following acts by a licensee:

Prescribes or dispenses any medication:

  • In response to any communication transmitted or received by computer or other electronic means, when the licensee fails to take the following actions to establish and maintain a proper physician-patient relationship:
    • Verification that the person requesting medication is in fact who the patient claims to be;
    • Establishment of a documented diagnosis through the use of accepted medical practices; and
    • Maintenance of a current medical record.

For the purposes of this paragraph, an electronic, on-line, or telephonic evaluation by questionnaire is inadequate for the initial evaluation of the patient or for any follow-up evaluation.

SOURCE: KY Revised Statutes § 311.597. (Accessed Nov. 2022).

A “good faith prior examination” (needed to establish a physician-patient relationship) can be done through telehealth. Not applicable to hospice providers.

SOURCE: KY Revised Statute § 218A.010(18). (Accessed Nov. 2022).

A practitioner-patient relationship may commence via telehealth. An in-person initial meeting shall not be required unless the provider determines it is medically necessary to perform those services in person as set forth in KRS 211.336(2)(a). A licensed health care practitioner may represent the licensee at the initial meeting.

See rule for additional requirements.

SOURCE: KY 201 KAR 17:110. (Accessed Nov. 2022).

A physician performing or inducing an abortion shall be present in-person and in the same room with the patient. The use of telehealth shall not be allowed in the performance of an abortion.

SOURCE: KY Revised Statute Sec. 311.728. (Accessed Nov. 2022).

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Louisiana

Last updated 11/08/2022

Physicians utilizing telemedicine shall establish a proper physician-patient relationship by:…

Physicians utilizing telemedicine shall establish a proper physician-patient relationship by:

  • Verify the identity of the patient.  Appropriate contact and identifying information shall be made part of the medical record;
  • Conduct an appropriate exam. The examination does not require an in-person visit if the technology is sufficient to provide the physician the pertinent clinical information reasonably necessary to practice at an acceptable level of skill and safety;
  • Establish a proper diagnosis through the use of accepted medical practices; e.g., history, mental status, appropriate diagnostic and laboratory testing;
  • Discuss the diagnosis and risks and benefits of various treatment options;
  • ·Ensure the availability of appropriate follow up care;
  • Create and/or maintain a medical record.

SOURCE: LA Admin. Code 46: XLV.7503. p. 249 (Accessed Nov. 2022). 

Telemedicine, including the issuance of any prescription via electronic means, shall be held to the same prevailing and usually accepted standards of medical practice as those in traditional, face-to-face settings.

An online, electronic or written mail message, or a telephonic evaluation by questionnaire or otherwise, does not satisfy the standards of appropriate care.

No physician shall utilize telemedicine:

  1. for the treatment of non-cancer related chronic or intractable pain, as set forth in §§6915-6923 of the board’s rules;
  2. for the treatment of obesity, as set forth in §§6901-6913 of the board’s rules;
  3. to authorize or order the prescription, dispensation or administration of any controlled substance unless;
    1. the physician has had at least one in-person visit with the patient within the past year; provided, however, the requirement for an in-person visit shall not apply to a physician who holds an unrestricted license to practice medicine in LA and who practices telemedicine upon any patient being treated at a healthcare facility that is required to be licensed pursuant to the laws of LA and which holds a current registration with the U.S. Drug Enforcement Administration;
    2. the prescription is issued for a legitimate medical purpose;
    3. the prescription is in conformity with the standard of care applicable to an in-person visit; and
    4. the prescription is permitted by and in conformity with all applicable state and federal laws and regulations.

The Board may grant an exception if the physician submits a written application.

SOURCE: LA Admin. Code 46: XLV.7503,7505 & 7513. p. 251 (Accessed Nov. 2022).

All of the following restrictions and authorizations apply to a physician who holds an unrestricted license to practice medicine from the board and who practices telemedicine upon any patient who is being treated at a healthcare facility that is required to be licensed pursuant to the laws of this state and which holds a current registration with the United States Drug Enforcement Administration:

  • The physician shall use the same standard of care as if the healthcare services were provided in person.
  • The physician shall be authorized to prescribe any controlled dangerous substance without necessity of conducting an appropriate in-person patient history or physical examination of the patient as otherwise would be required by R.S. 37:1271(B)(2).
  • The physician shall not be subject to any regulatory prohibition or restriction on the practice of telemedicine, including prohibitions or restrictions related to prescribing controlled dangerous substances, which are in any manner more restrictive than the prohibitions and restrictions that are otherwise applicable to the entire practice of medicine.

SOURCE: LA Statute Sec. 37:1271.1. (Accessed Nov 2022). 

No physician practicing telemedicine can prescribe a controlled dangerous substance prior to conducting an appropriate in-person patient history or physical examination of the patient as determined by the Board.

SOURCE: LA Revised Statutes 37:1271(B)(3). (Accessed Nov. 2022).

Teledentistry

Controlled substances may not be prescribed via teledentistry except in emergency situations where the dentist determines:

  • That immediate administration of the controlled substance is necessary for proper treatment of the intended ultimate user, and
  • That no appropriate alternate treatment is available, including administration of a drug that is not a controlled substance.

In an emergency situation the prescription for a controlled substance must be limited to the amount adequate to treat the patient during the emergency period.

SOURCE: LA Admin. Code LAC 46:XXXIII.203 (Accessed Nov. 2022)

Board of Optometry

Evaluation, treatment, and consultation recommendations made in an optometric telemedicine setting, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional in-person clinical settings.

SOURCE: LA Admin Code LAC 46:LI.509, (Accessed Nov. 2022).

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Maine

Last updated 10/19/2022

Insurers may not place any restriction on the prescribing of …

Insurers may not place any restriction on the prescribing of medication through telehealth by a provider whose scope of practice includes prescribing medication that is more restrictive than any requirement in state and federal law for prescribing medication through in-person consultation.

The carrier shall require that a clinical evaluation is conducted either in person or through telehealth before a provider may write a prescription that is covered.

SOURCE: Maine Revised Statutes Annotated, Title 24-A, Sec. 4316 (Accessed Oct. 2022).

Recently Adopted Rule 

Board of Licensure in Medicine, State Board of Nursing, & Board of Osteopathic Licensure

A licensee who uses telehealth in providing health care shall establish a valid licensee-patient relationship with the person who receives telehealth services. The licensee-patient relationship begins when:

  • The person with a health-related matter seeks assistance from the licensee;
  • The licensee agrees to undertake examination, diagnosis, nursing assessment, consultation or treatment of the person; and
  • The person agrees to receive health care services from the licensee whether or not there has been an in-person encounter between the licensee and the person.

A valid licensee-patient relationship may be established between a licensee who uses telehealth in providing health care and a patient who receives telehealth services through any of the following circumstances:

  • Consultation with another licensee. Through consultation with another licensee (or other health care provider) who has an established relationship with the patient upon agreement to participate in, or supervise, the patient’s care; or
  • Telehealth encounter. Through telehealth, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telehealth practice guidelines that address the clinical and technological aspects of telehealth.

Medical History and Physical Examination

Generally a physician, physician assistant, and advanced practice registered nurse shall perform an in-person clinical interview and physical examination for each patient. However, the clinical interview and physical examination may not be in-person if the technology utilized in a telehealth encounter is sufficient to establish an informed diagnosis as though the clinical interview and clinician examination had been performed in-person. Prior to providing treatment, including issuing prescriptions, electronically or otherwise, a licensee who uses telehealth in providing health care shall interview the patient to collect the relevant medical history and perform a pertinent physical examination as defined by the standard of care for the purpose of the visit, when clinically necessary, sufficient for the diagnosis and treatment of the patient. An internet questionnaire that is a static set of questions provided to the patient, to which the patient responds with a static set of answers, in contrast to an adaptive interactive and responsive online interview, does not constitute an acceptable clinical interview and physical examination for the provision of treatment, including issuance of prescriptions, electronically or otherwise, by the licensee.

Prescribing Based Solely on an Internet Request, Internet Questionnaire or a Telephonic Interview Prohibited

Prescribing to a patient based solely on an Internet request or Internet questionnaire (i.e. static questionnaire provided to a patient, to which the patient responds with a static set of answers, in contrast to an adaptive, interactive and responsive online interview) is prohibited. Absent a valid licensee-patient relationship, a licensee’s prescribing to a patient based solely on a telephonic evaluation is prohibited, with the exception of the circumstances described in Section 3, subsection 20, subparagraph A(3) of this rule.

Telehealth technologies, where prescribing may be contemplated, must implement measures to uphold patient safety in the absence of traditional physical examination. Such measures should guarantee that the identity of the patient and provider is clearly established and that detailed documentation for the clinical evaluation and resulting prescription is required. Measures to assure informed, accurate and error prevention prescribing practices (e.g. integration with e-Prescription systems) are encouraged. All applicable law shall be complied with.

Prescribing medications, in-person or via telehealth, is at the professional discretion of the licensee. The licensee prescribing via telehealth must ensure that the clinical evaluation, indication, appropriateness, and safety consideration for the resulting prescription are appropriately documented and meet the applicable standard of care. Consequently, prescriptions via telehealth carry the same 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, licensees may exercise their judgment and prescribe medications as part of telehealth encounters.

Circumstances Where the Standard of Care May Not Require A Licensee to Personally Interview or Conduct a Nursing Assessment or Physical Examination of a Patient

Under the following circumstances, whether or not such circumstances involve the use of telehealth in providing health care, a licensee may treat a patient who has not been personally interviewed, examined, assessed and diagnosed by the licensee:

  • Situations in which the licensee prescribed medications on a short-term basis for a new patient and has scheduled an appointment to personally examine the patient;
  • For institutional settings, including writing initial admission orders for a newly hospitalized patient;
  • Call situations in which a licensee is taking call for another licensee who has an established licensee-patient relationship with the patient;
  • Cross-coverage situations in which a licensee is taking call for another licensee who has an established licensee-patient relationship with the patient;
  • Situations in which the patient has been examined in person by an advanced practice registered nurse or a physician assistant or other licensed practitioner with whom the licensee has a supervisory or collaborative relationship;
  • Emergency situations in which the life or health of the patient is in imminent danger;
  • Emergency situations that constitute an immediate threat to the public health including, but not limited to, empiric treatment or prophylaxis to prevent or control an infectious disease outbreak;
  • Situations in which the licensee has diagnosed a sexually transmitted disease in a patient and the licensee prescribes or dispenses antibiotics to the patient’s named sexual partner(s) for the treatment of the sexually transmitted disease as recommended by the U.S. Centers for Disease Control and Prevention;
  • Situations where the patients are in a licensed or certified long term care facility, nursing facility, residential care facility, intermediate care facility, assisted living facility or hospice setting and doing so is within the practice standards for that setting; and
  • Circumstances in which a patient’s treating clinician determines that a radiology or pathology consultation is warranted

SOURCE: ME Regulation Sec. 02-373 Ch. 11, 02-380 Ch. 11, 02-383 Ch. 11. (Accessed Oct. 2022).

Recently Adopted Rule 

Teledentistry

Prior to establishing a patient relationship as defined by Board Rules, Chapter 1(I)(N) and prior to providing teledentistry services, a dentist, denturist, or a dental hygienist (when the dental hygienist is providing services as an independent practice dental hygienist, public health dental hygienist, dental therapist, or and provisional dental therapist) must take reasonable steps to verify the patient’s physical location.

Practice Requirements Specific to Prescribing Medications

  • The validity when prescribing medication to a patient as a result of a teledentistry service is determined by the same standards that would apply when prescribing medication to a patient in an in-person setting.
  • This section does not limit the professional judgment, discretion or decision-making authority when prescribing medication to a patient. It is the expectation that the standard of care is met with demonstrated professional practice standards and judgment, consistent with all applicable statutes and rules when prescribing medication as a result of a teledentistry service.
  • Prescribing medication must be for a legitimate dental purpose as part of an established patient relationship and must meet all other applicable laws and rules governing prescribing practices, including the use of controlled substances.

SOURCE: ME Regulation Sec. 02-313 Ch. 15,  (Accessed Oct. 2022).

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Maryland

Last updated 11/22/2022

A health care practitioner may establish a practitioner-patient relationship through …

A health care practitioner may establish a practitioner-patient relationship through either a synchronous telehealth interaction or an asynchronous telehealth interaction, if the health care practitioner:

  • Verifies the identity of the patient receiving health care services through telehealth;
  • Discloses to the patient the health care practitioner’s name, contact information, and type of health occupation license held by the health care practitioner; and
  • Obtains oral or written consent from the patient or from the patient’s parent or guardian.

A health care practitioner shall perform a clinical evaluation that is appropriate for the patient and the condition with which the patient presents before providing treatment or issuing a prescription through telehealth. Synchronous or asynchronous telehealth interaction may be used for the clinical evaluation.

A health care practitioner may not prescribe a Schedule II controlled substance that is an opiate for the treatment of pain through telehealth unless:

  • The individual receiving the prescription is a patient in a health care facility; or
  • The governor has declared a state of emergency due to a catastrophic health emergency

A health care practitioner who prescribes a controlled substance through telehealth is subject to federal and state prescribing laws.

SOURCE: MD Code Health Occupations Sec. 1-1002, Section 1-1003. (Accessed Nov. 2022).

Before performing telehealth services, a telehealth practitioner shall develop and follow a procedure to:

  • Verify the identification of the patient receiving telehealth services;
  • Except for interpretive services, obtain oral or written acknowledgement from a patient or person in interest as defined by Health-General Article, §4-301(m), Annotated Code of Maryland, to perform telehealth services;
  • Prevent access to data by unauthorized persons through encryption or other means;
  • Notify patients in the event of a data breach;
  • Ensure that the telehealth practitioner provides a secure and private telehealth connection that complies with federal and state privacy laws; and
  • Establish safety protocols to be used in the case of an emergency.

Except when providing store and forward telehealth services, remote patient monitoring, or other asynchronous telehealth services, a telehealth practitioner shall:

  • Obtain or confirm an alternative method of contacting the patient in case of a technological failure;
  • Confirm whether the patient is in Maryland and identify the practice setting in which the patient is located;
  • For an initial patient-telehealth practitioner interaction only, disclose the telehealth practitioner’s name, contact information, and medical specialty; and
  • Identify all individuals present at each location and confirm they are allowed to hear personal health information.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.32.05.04. (Accessed Nov. 2022).

 A telehealth practitioner shall perform a synchronous, audio-visual patient evaluation adequate to establish diagnoses and identify underlying conditions or contraindications to recommended treatment options before providing treatment or prescribing medication. A telehealth practitioner may use surrogate examiner; or a patient evaluation performed by another licensed health care practitioner providing coverage.

These requirements do not apply to:

  • Interpretive services where a prior patient evaluation was performed by another provider;
  • Remote patient monitoring; or
  • Asynchronous telehealth services for a patient who has had a prior synchronous, audio-visual telehealth patient evaluation or in-person patient evaluation that complies with the requirements of this regulation.

SOURCE:  Code of Maryland Admin. Regs. Sec. 10.32.05.05. (Accessed Nov. 2022).

A telehealth practitioner may not treat a patient or prescribe medication based solely on an online questionnaire.

A telehealth practitioner may not prescribe opioids for the treatment of pain through telehealth except if the patient is in a health care facility as defined in Health-General Article, §19-114(d)(1), Annotated Code of Maryland.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.32.05.06. (Accessed Nov. 2022).

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Massachusetts

Last updated 11/18/2022

The practice of medicine shall not require a face-to-face encounter …

The practice of medicine shall not require a face-to-face encounter between the physician and the patient prior to health care delivery via telemedicine.  The standard of care applicable to the physician is the same whether the patient is seen in-person or through telemedicine.

SOURCE: “Policy on Telemedicine,” Board of Registration in Medicine.  Feb. 3, 2022. (Accessed Nov. 2022).

To be valid, a prescription must be issued in the usual course of the physician’s professional practice, and within a physician-patient relationship that is for the purpose of maintaining the patient’s well-being. In addition, the physician must conform to certain minimum standards of patient care, such as taking an adequate medical history, doing a physical and/or mental status examination and document the findings. This rule applies to any prescription, issued by any means, including the Internet or other electronic process.

SOURCE: “Internet Prescribing,” MA Board of Registration in Medicine.  Dec. 17, 2003 & Prescribing Practices Policy and Guidelines Policy 15-05 (Adopted Oct. 8, 2015), (Amended January 14, 2021). (Accessed Nov. 2022).

Cannabis Control Commission

Clinical Visit means an in-person or telehealth visit during which a Certifying Healthcare Provider establishes a Bona Fide Healthcare Provider Patient Relationship and conducts a full assessment of the Patient’s medical history and current medical condition, including the Debilitating Medical Condition, and explains the potential benefits and risks of Marijuana use. A Clinical Visit for an initial Certificate of Registration shall be performed in-person.

SOURCE: MA Regulations, Cannabis Control Commission, Ch. 935 CMR 501.002. (Accessed Nov. 2022).

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Michigan

Last updated 11/22/2022

Providers must have an existing physician-patient or dentist-patient relationship.  See …

Providers must have an existing physician-patient or dentist-patient relationship.  See statute for additional requirements.

SOURCE: MI Compiled Laws Sec. 333.17751(2)(a).  (Accessed Nov. 2022).

Schedule 2 to 5 controlled substances cannot be prescribed unless the prescribing is in a bona fide prescriber-patient relationship with the patient.  If a licensed prescriber prescribes a controlled substance under this subsection, the prescriber shall provide follow-up care to the patient to monitor the efficacy of the use of the controlled substance as a treatment of the patient’s medical condition. If the licensed prescriber is unable to provide follow-up care, he or she shall refer the patient to the patient’s primary care provider for follow-up care or, if the patient does not have a primary care provider, he or she shall refer the patient to another licensed prescriber who is geographically accessible to the patient for follow-up care.

SOURCE:  MI Compiled Laws Sec. 333.7303a. (Accessed Nov. 2022). 

A health professional providing telehealth service to a patient may prescribe the patient a drug if both the following are met:

  • The health professional is a prescriber who is acting within the scope of his or her practice; and
  • If the health professional is prescribing a controlled substance, the health professional must meet the requirements of this act applicable to that health professional for prescribing a controlled substance.

If the health professional considers it medically necessary, he or she shall provide the patient with a referral for other health care services that are geographically accessible to the patient, including, but not limited to, emergency services. After providing a telehealth service, the health professional, or a health professional who is acting under the delegation of the delegating health professional, shall make himself or herself available to provide follow-up health care services to the patient or refer the patient to another health professional for follow-up health care services.

SOURCE:  MI Compiled Laws, Sec. 333.16285. (Accessed Nov. 2022).

Genetic Counseling, Optometry, Medicine, Podiatric Medicine & Surgery

A licensee providing a telehealth service may prescribe a drug if the licensee is a prescriber acting within the scope of his or her practice and in compliance with section 16285 of the code, MCL 333.16285, and if he or she does both of the following:

If medically necessary, refers the patient to a provider that is geographically accessible to the patient.

Makes himself or herself available to provide follow-up care services to the patient, or to refer the patient to another provider, for follow-up care.

A licensee providing any telehealth service shall do both of the following:

  • Act within the scope of his or her practice.
  • Exercise the same standard of care applicable to a traditional, in-person health care service.

SOURCE: MI Administrative Code 338.2455. MI Administrative Code 338.306, MI Administrative Code 338.2407, & MI Administrative Code 338.8145, (Accessed Nov. 2022).

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Minnesota

Last updated 10/27/2022

A physician-patient relationship may be established through telehealth.

“Telehealth” has …

A physician-patient relationship may be established through telehealth.

“Telehealth” has the meaning given in section 62A.673, subdivision 2, paragraph (h).

SOURCE: MN Statute 147.033. (Accessed Oct. 2022).

A prescription drug order for the following drugs is not valid, unless it can be established that the prescription drug order was based on a documented patient evaluation, including an examination, adequate to establish a diagnosis and identify underlying conditions and contraindications to treatment:

  • Controlled substance drugs listed in section 152.02, subdivisions 3 to 5;
  • Drugs defined by the Board of Pharmacy as controlled substances under section 152.02, subdivisions 7, 8, and 12;
  • Muscle relaxants;
  • Centrally acting analgesics with opioid activity;
  • Drugs containing butalbital; or
  • Phosphodiesterase type 5 inhibitors when used to treat erectile dysfunction.

The requirement for an examination shall be met if:

An in-person examination has been completed in any of the following circumstances:

  • The prescribing practitioner examines the patient at the time the prescription or drug order is issued;
  • The prescribing practitioner has performed a prior examination of the patient;
  • Another prescribing practitioner practicing within the same group or clinic as the prescribing practitioner has examined the patient;
  • A consulting practitioner to whom the prescribing practitioner has referred the patient has examined the patient; or
  • The referring practitioner has performed an examination in the case of a consultant practitioner issuing a prescription or drug order when providing services by means of telehealth; or

The prescription order is for a drug listed in paragraph (d), clause (6), or for medication-assisted therapy for a substance use disorder, and the prescribing practitioner has completed an examination of the patient via telehealth as defined in section 62A.673, subdivision 2, paragraph (h).

SOURCE: MN Statute Sec. 151.37 Subd. 2(d) & (e).(Accessed Oct. 2022).

For purposes of a provider prescribing ophthalmic goods, the provider must establish a provider-patient relationship through one of the following methods:

  1. In person;
  2. Face-to-face interactive, two-way, real-time communication; or
  3. Through store-and-forward technologies when all of the following conditions are met: The provider obtains an updated medical history and makes a diagnosis at the time of prescribing; the provider conforms to the standard of care expected of in-person care as appropriate to the patient’s age and presenting condition, including when the standard of care requires the use of diagnostic testing and performance of a physical examination, which may be carried out through the use of peripheral devices appropriate to the patient’s condition; the ophthalmic prescription is not determined solely by use of an online questionnaire; the provider is licensed and authorized to issue an ophthalmic prescription in MN; and upon request, the provider provides patient records in a timely manner.

SOURCE:  MN Statute Sec. 145.713, Subd. 4, (Accessed Oct. 2022). 

Medical Cannabis

For issuing a written certification of qualifying condition, an in-person physical examination of the patient must take place an cannot be performed by remote means, including telehealth or via the Internet.

SOURCE: MN Administrative Rule. 4770.4014, Subpart 2(B)(1). (Accessed Oct. 2022).

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Mississippi

Last updated 11/17/2022

A prescription for a controlled substance based solely on a …

A prescription for a controlled substance based solely on a consumer’s completion of an online medical questionnaire is not a valid prescription.

SOURCE: MS Code Annotated 41-29-137. (Accessed Nov. 2022).

Patients with Terminal Disease Pain 

The medical director of a licensed hospice, in his or her discretion, may prescribe controlled substances for a patient of the hospice for terminal disease pain without having an in-person face-to-face visit with the patient before issuing the prescription. The provisions of this section supersede the provisions of any rule or regulation of a licensing agency to the contrary.

SOURCE: MS Code Sec. 41-29-137.1 (Accessed Nov. 2022).

Subject to the limitations of the license under which the individual is practicing, a health care practitioner licensed in this state may prescribe, dispense, or administer drugs or medical supplies, or otherwise provide treatment recommendations to a patient after having performed an appropriate examination of the patient either in person or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically. Treatment recommendations made via electronic means, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional provider-patient settings.

SOURCE: MS Code Sec. 41-127-1, (Accessed Nov. 2022).

Practice of Medicine

In order to practice telemedicine a valid “physician patient relationship” must be established. The elements of this valid relationship are:

  • verify that the person requesting the medical treatment is in fact who they claim to be;
  • conducting an appropriate history and physical examination of the patient that meets the applicable standard of care;
  • establishing a diagnosis through the use of accepted medical practices, i.e., a patient history, mental status exam, physical exam and appropriate diagnostic and laboratory testing;
  • discussing with the patient the diagnosis, risks and benefits of various treatment options to obtain informed consent;
  • insuring the availability of appropriate follow-up care; and
  • maintaining a complete medical record available to patient and other treating health care providers.

Providers using telemedicine technologies to provide medical care to patients located in Mississippi must provide an appropriate examination prior to diagnosis and treatment of the patient. However, this exam need not be in person if the technology is sufficient to provide the same information to the physician as if the exam had been performed face to face.

Store-and-Forward Transfer Technology may be used to enhance, but never replace, real-time provider-patient interaction. Provider-patient interaction may be audio-visual or audio only where medically appropriate.

Other exams may be appropriate if a licensed health care provider is on site with the patient and is able to provide various physical findings that the physician needs to complete an adequate assessment. However, a simple questionnaire without an appropriate exam is in violation of this policy and may subject the physician to discipline by the Board.

Any physician utilizing the automated dispensary will be responsible for the proper maintenance and inventory/accountability requirements as if the physician were personally dispensing the medications to the patient from his or her stock in their personal practice, as required in Rule 1.9 of Part 2640. An automated dispensary may not dispense controlled substances, and refills of medications may not be issued without a follow-up visit with the physician.

Any telemedicine service devices or systems which contain automated dispensaries, containing medications ordered and maintained by physician licensees, shall be subject to the oversight of the Board and the Mississippi Board of Pharmacy, as stated in Part 2640, Rule 1.9, and may not operate in this state until approved by both Boards.

SOURCE: MS Admin. Code Title 30, Part 2635, Rule 5.4 to 5, & 9. (Accessed Nov. 2022).

Prescriptions may not be written outside of a valid licensee-patient relationship. While not all of the elements in subsection A are necessary each time a prescription is authorized (e.g., via appropriate telemedicine as defined in Rule 5.5 of Part 2635, calling in refills, taking call for a practice partner for short term care, etc.), all initial encounters, and at reasonable intervals thereafter, should conform to this rule and be done pursuant to a valid licensee-patient relationship. The elements of this valid relationship are: …

  • Conducting an appropriate history and physical examination of the patient that meets the applicable standard of care, which as previously stated may also be accomplished through appropriate telemedicine as defined in Part 2635 Rule 5.5.

SOURCE: MS Admin Code Title 30, Part 2640, Rule 1.11, (Accessed Nov. 2022).

Optometry

The use of eye and vision telehealth services is not appropriate for establishing the doctor-patient relationship, for an initial diagnosis, as a replacement for recommended face-to-face interactions. It is therefore mandated that the doctor-patient relationship begin with an initial face-to-face encounter.

The standard of care must remain the same regardless of whether eye and vision telehealth services are provided in-person, remotely, via telehealth, or through any combination thereof. Doctors of optometry may not waive this obligation, or require patients to waive their right to receive the established standard of care in the state of Mississippi.

Eye and vision telehealth services cannot, based on current technologies and uses, replace an in-person comprehensive eye examination provided by an eye doctor. Eye and vision telehealth services provided must be consistent with and in compliance with existing rules and regulations of practice established in the State of Mississippi. In order to protect and insure patient safety, the Board recommends the use of only technology approved by the Food and Drug Administration, designed specifically for use in optometric care.

During telehealth encounters the patient must be in the presence of an onsite health provider.

An Established Treatment Site or distant site Mississippi licensed health care provider means a person licensed to provide health care to patients in Mississippi.

During telehealth encounters a Mississippi licensed optometrist must be present either onsite or distant site or both.  See regulation for more on definitions on the treatment site and distant site.

SOURCE: MS Rules and Regulations, Title 30 Part 2901 Chapters 1-11.6 to 8, (Accessed Nov. 2022).

Bona-fide practitioner-patient relationship”means:

  • A certifying practitioner and patient have a treatment or consulting relationship, during the course of which the certifying practitioner, within his or her scope of practice, has completed an in-person assessment of the patient’s medical history and current mental health and medical condition and has documented their certification in the patient’s medical records;
  • The certifying practitioner has consulted in person with the patient with respect to the patient’s debilitating medical condition; and
  • The certifying practitioner is available to or offers to provide follow-up care and treatment to the patient.

SOURCE: MS Rules and Regulations, Title 30 Part 2901 Chapters 12, (Accessed Nov. 2022).

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Missouri

Last updated 08/22/2022

Prescribing or dispensing drugs without sufficient examination is prohibited including …

Prescribing or dispensing drugs without sufficient examination is prohibited including failing to establish a valid physician-patient relationship pursuant to section 334.108. See statute for additional information.

SOURCE: MO Revised Statutes § 334.100(4)(h). (Accessed Aug. 2022).

A telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

  • In order to establish a physician-patient relationship through telemedicine:
    • The technology utilized shall be sufficient to establish an informed diagnosis as though the medical interview and physical examination has been performed in person; and
    • Prior to providing treatment, including issuing prescriptions or physician certifications under Article XIV of the Missouri Constitution, a physician who uses telemedicine shall interview the patient, collect or review relevant medical history, and perform an examination sufficient for the diagnosis and treatment of the patient. A questionnaire completed by the patient, whether via the internet or telephone, does not constitute an acceptable medical interview and examination for the provision of treatment by telehealth.

SOURCE: MO Revised Statute Ch. 191 Sec. 191.1146. (Accessed Aug. 2022).

In addition, in order to prescribe, the relationship includes:

  1. Obtaining a reliable medical history and performing a physical examination of the patient, adequate to establish the diagnosis for which the drug is being prescribed and to identify underlying conditions or contraindications to the treatment recommended or provided;
  2. Having sufficient dialogue with the patient regarding treatment options and the risks and benefits of treatment or treatments;
  3. If appropriate, following up with the patient to assess the therapeutic outcome;
  4. Maintaining a contemporaneous medical record that is readily available to the patient and, subject to the patient’s consent, to the patient’s other health care professionals; and
  5. Maintaining the electronic prescription information as part of the patient’s medical record.

The requirements of subsection 1 (see above) may be satisfied by the prescribing physician’s designee when treatment is provided in:

  • A hospital;
  • A hospice program;
  • Home health services provided by a home health agency;
  • Accordance with a collaborative practice agreement;
  • Conjunction with a physician assistant licensed;
  • Conjunction with an assistant physician;
  • Consultation with another physician who has an ongoing physician-patient relationship with the patient, and who has agreed to supervise the patient’s treatment, including use of any prescribed medications; or
  • On-call or cross-coverage situations.

No health care provider shall prescribe any drug, controlled substance, or other treatment to a patient based solely on an evaluation over the telephone; except that, a physician or such physician’s on-call designee, or an advanced practice registered nurse, a physician assistant, or an assistant physician in a collaborative practice arrangement with such physician may prescribe any drug, controlled substance, or other treatment that is within his or her scope of practice to a patient based solely on a telephone evaluation if a previously established and ongoing physician-patient relationship exists between such physician and the patient being treated.

No health care provider shall prescribe any drug, controlled substance, or other treatment to a patient based solely on an internet request or an internet questionnaire.

SOURCE: MO Revised Statute Sec. 334.108. (Accessed Aug. 2022).

 “Remote dispensing site pharmacy”, any location in this state where the practice of pharmacy occurs and that is licensed as a pharmacy to dispense prescription drugs and is staffed by one or more qualified pharmacy technicians, as defined by the board, or intern pharmacists, whose activities are supervised by a pharmacist at a supervising pharmacy through a continuous real-time audio and video link.  “Remote dispensing site pharmacy” does not include the office of a dispensing prescriber or an automated device.

A remote dispensing site pharmacy shall be located at least ten miles from an existing retail pharmacy unless:

  • The remote dispensing site pharmacy is part of a community mental health center, federally qualified health center, rural health clinic, or outpatient clinic setting; or
  • An applicant of a proposed remote dispensing site pharmacy demonstrates to the board how the proposed remote dispensing site pharmacy will promote public health.

SOURCE: MO Revised Statutes Sec. 338.215, (Accessed Aug. 2022).

Recently Adopted Rule

In order to establish a provider-patient relationship through telemedicine—

  • The technology utilized shall be sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed in person; and
  • Prior to providing treatment, including issuing prescriptions and physician certifications under Article XIV of the Missouri Constitution, a physician who uses telemedicine shall interview the patient, collect or review relevant medical history, and perform an examination sufficient for diagnosis and treatment of the patient. A questionnaire completed by the patient, whether via the telephone or internet, does not constitute a medical interview and examination for provision of treatment via telemedicine.

SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330, (Accessed Aug. 2022). 

Mental Health – Division of Behavioral Health Community Treatment Program

For purposes of the provision of all services via telemedicine and audio-only, the provider-patient relationship may be established by the following:

  • An in-person encounter through a medical interview and physical examination; or
  • Consultation with another health care professional, or that health care professional’s delegate, who has an established relationship with the patient and an agreement with the health care professional to participate in the individual’s care; or
  • A telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

In order to establish a provider-patient relationship via telemedicine and/oraudio-only for all services:

  • The technology utilized shall be sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed in person; and
  • Prior to providing treatment, including issuing prescriptions and physician certifications under Article XIV of the Missouri Constitution, a physician who uses telemedicine shall interview the patient, collect or review relevant medical history, and perform an examination sufficient for diagnosis and treatment of the patient. A questionnaire completed by the patient, whether via the telephone or internet, does not constitute a medical interview and examination for provision of treatment via telemedicine.

In-Person Requirements Post Federal Declaration of Public Health Emergency (PHE)Individuals who have only received telemedicine and/or audio-only services must receive an in person service within 6 months of their last service. After the initial 6-month in-person visit, all individuals must be seen in person, at minimum, once every 12 months. All new individuals being served via telemedicine and/or audio-only require an in-person service within 6 months of beginning services and then every 12 months following.

SOURCE:  MO Division of Behavioral Health, Community Treatment Program, July 8, 2022, (Accessed Aug. 2022).

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Montana

Last updated 11/01/2022

The licensee using telemedicine in the treatment and care of …

The licensee using telemedicine in the treatment and care of patients in Montana shall adhere to the same standards of care required for in-person medical care settings.

A physician-patient relationship may be established for purposes of telemedicine:

  • by an in-person medical interview and physical examination when the standard of care requires an in-person encounter;
  • by consultation with another licensee or health care provider who has a documented relationship with the patient and who agrees to participate in, or supervise, the patient’s care; or
  • through telemedicine if the standard of care does not require an in-person encounter.

The licensee using telemedicine in patient care may prescribe Schedule II drugs to a patient only after first establishing a physician-patient relationship through an in-person encounter which includes a medical interview and physician examination.

The licensee using telemedicine in patient care shall:

  • make available to the patient verification of the licensee’s identity and credentials;
  • verify the identity of the patient;
  • establish a physician-patient relationship prior to initiating care;
  • obtain a medical history sufficient for diagnosis and treatment in keeping with the applicable standard of care prior to providing treatment, issuing prescriptions, or delegating the patient’s medical services to other health care providers;
  • delegate the patient’s medical care only to health care providers:
    • who are known by the licensee to be qualified and competent to perform the delegated services;
    • with whom the patient has an established provider-patient relationship; or
    • who have physical or electronic access to the licensee for consultation and follow-up while the patient is under the licensee’s or the delegee’s care;
  • securely maintain and make timely available:
    • to the patient or the patient’s representative all relevant medical and billing records received or produced in connection with the patient’s care; and
    • to other health care providers all medical records received or produced in connection with the patient’s care.

SOURCE: Montana State Board of Medical Examiners. Administrative Rules of MT. Rule 24.156.813 Practice Requirements for Physicians Using Telemedicine. (Accessed Nov. 2022).

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Nebraska

Last updated 11/18/2022

Any credential holder under the Uniform Credentialing Act may establish …

Any credential holder under the Uniform Credentialing Act may establish a provider-patient relationship through telehealth.

Any credential holder under the Uniform Credentialing Act who is providing a telehealth service to a patient may prescribe the patient a drug if the credential holder is authorized to prescribe under state and federal law.

This section does not apply to a credential holder under the Cosmetology, Electrology, Esthetics, Nail Technology, and Body Art Practice Act, the Dialysis Patient Care Technician Registration Act, the Environmental Health Specialists Practice Act, the Funeral Directing and Embalming Practice Act, the Massage Therapy Practice Act, the Medical Radiography Practice Act, the Nursing Home Administrator Practice Act, the Perfusion Practice Act, the Surgical First Assistant Practice Act, or the Veterinary Medicine and Surgery Practice Act.

SOURCE: NE Revised Statute 38-1,143. (Accessed Nov. 2022).

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Nevada

Last updated 11/04/2022

Before a provider of health care who is located at …

Before a provider of health care who is located at a distant site may use telehealth to direct or manage the care or render a diagnosis of a patient who is located at an originating site in this State or write a treatment order or prescription for such a patient, the provider must hold a valid license or certificate to practice his or her profession in this State, including, without limitation, a special purpose license issued pursuant to NRS 630.261. The requirements of this subsection do not apply to a provider of health care who is providing services within the scope of his or her employment by or pursuant to a contract entered into with an urban Indian organization, as defined in 25 U.S.C. § 1603.

A provider of health care may establish a relationship with a patient using telehealth when it is clinically appropriate to establish a relationship with a patient in that manner. The State Board of Health may adopt regulations governing the process by which a provider of health care may establish a relationship with a patient using telehealth.

SOURCE: NV Revised Statutes Sec. 629.515, (Accessed Nov. 2022).

A bona fide relationship between the patient and the person prescribing the controlled substance shall be deemed to exist if the patient was examined in person, electronically, telephonically or by fiber optics, including, without limitation, through telehealth, within or outside this State or the United States by the person prescribing the controlled substances within the 6 months immediately preceding the date the prescription was issued.

SOURCE: NV Revised Statutes Sec. 639.235(4). (Accessed Nov. 2022).

Before issuing an initial prescription for a controlled substance listed in schedule II, III or IV for the treatment of pain, a practitioner, other than a veterinarian, must:

  • Have established a bona fide relationship, as described in subsection 4 of NRS 639.235, with the patient;
  • Perform an evaluation and risk assessment of the patient that meets the requirements of subsection 1 of NRS 639.23912;
  • Establish a preliminary diagnosis of the patient and a treatment plan tailored toward treating the pain of the patient and the cause of that pain;
  • Document in the medical record of the patient the reasons for prescribing the controlled substance instead of an alternative treatment that does not require the use of a controlled substance; and
  • Obtain informed consent to the use of the controlled substance.

If a practitioner, other than a veterinarian, prescribes a controlled substance listed in schedule II, III or IV for the treatment of pain, the practitioner shall not issue more than one additional prescription that increases the dose of the controlled substance unless the practitioner meets with the patient, in person or using telehealth, to reevaluate the treatment plan.

SOURCE: NV Revised Statutes Sec. 639.23911. (Accessed Nov. 2022).

Before prescribing a schedule II, III, or IV controlled substance to continue the treatment of pain of a patient who has used the controlled substance for 90 consecutive days or more, a practitioner, other than a veterinarian must (among other requirements) meet with the patient in-person or through telehealth to review the treatment plan and determine whether continuation of treatment using the controlled substance is medically appropriate.

SOURCE: NV Revised Statutes Sec. 639.23913. (Accessed Nov. 2022).

An advanced practice registered nurse authorized to prescribe controlled substances may do so electronically, telephonically or by fiber optics, including telehealth, from within or outside Nevada or the United States.

SOURCE: NV Revised Statutes Sec. 632.237(4). (Accessed Nov. 2022).

Veterinarians

A veterinarian-client-patient relationship is not established solely through veterinary telemedicine. However, once established, a veterinarian-client-patient relationship may be maintained via veterinary telemedicine between:

  • Medically necessary examinations; or
  • Visits, within periods of time that are appropriate for the medical issue in question, to the premises where the animal is kept.

Advice and recommendations may be provided via veterinary telemedicine in an emergency, but only until the animal can be examined in person by a licensed veterinarian.  See statute for additional requirements related to a veterinarian-client-patient relationship.

SOURCE: NV Revised Statutes Sec. 638.1521(4), (Accessed Nov. 2022).

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New Hampshire

Last updated 11/10/2022

“Physician-patient relationship” means a medical connection between a licensed physician …

“Physician-patient relationship” means a medical connection between a licensed physician and a patient that includes an in-person [or face-to-face 2-way real-time interactive communication] exam or an exam using telemedicine, as defined in RSA 310-A:1-g, I-b, provided the physician:

  • Verifies the identity of the patient receiving health care services through telemedicine;
  • Discloses to the patient the physician’s name, contact information, and the type of health occupation license held by the physician;
  • Obtains oral or written consent from the patient or from the patient’s parent or guardian, if state law requires the consent of a parent or guardian for use of telemedicine services; and
  • Meets the standard of care. A physician shall complete or review a history, a diagnosis, a treatment plan appropriate for the licensee’s medical specialty, and documentation of all prescription drugs including name and dosage.

A licensee may prescribe for a patient whom the licensee does not have a physician-patient relationship under the following circumstances: writing admission orders for a newly hospitalized patient; for a patient of another licensee for whom the prescriber is taking call; for a patient examined by a physician assistant, nurse practitioner, or other licensed practitioner; or for medication on a short-term basis for a new patient prior to the patient’s first appointment or when providing limited treatment to a family member in accordance with the American Medical Association Code of Medical Ethics. Prescribing drugs to individuals without a physician-patient relationship shall be unprofessional conduct subject to discipline under RSA 329:17, VI. The definition of a physician-patient relationship shall not apply to a physician licensed in another state who is consulting to a New Hampshire licensed physician with whom the patient has a relationship.

SOURCE: NH Revised Statutes Annotated, Sec. 329:1-c as amended by NH SB 390 (2022 Session).  (Accessed Nov. 2022).

It is unlawful to prescribe through telemedicine a controlled drug classified in schedule II through IV, except substance use disorder (SUD) treatment as permitted in locations enumerated in paragraph IV. Methadone hydrochloride, as defined in RSA 318-B:10, VII(d)(2) shall not be included in the exemption.

(IV) The prescribing of a non-opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a), who are treating a patient with whom the prescriber has an in-person practitioner-patient relationship, for purposes of monitoring or follow-up care. A provider shall not be required to establish care via face-to-face in-person service when:

  • The provider is a Department of Veteran Affairs (VA) practitioner or VA-contracted practitioner not required to obtain a special registration
  • The patient is being treated by, and is physically located in a correctional facility administered by the state of New Hampshire or a New Hampshire county;
  • The patient is being treated by, and is physically located in a Doorway as defined in RSA 167:4-d, II(c);
  • The patient is being treated by and is physically located in a state designated community mental health center pursuant to RSA 135; or
  • The patient is being treated by, and physically located in, a hospital or clinic registered in a manner fully consistent with 21 U.S.C. section 823(f).

Subsequent in-person exams shall be by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and drug, but not less than annually.

The prescribing of an opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a).

A provider shall not be required to establish care via face-to-face in-person service when:

  • The provider is a Department of Veteran Affairs (VA) practitioner or VA-contracted practitioner not required to obtain a special registration
  • The patient is being treated by, and is physically located in a correctional facility administered by the state of New Hampshire or a New Hampshire county;
  • The patient is being treated by, and is physically located in a Doorway as defined in RSA 167:4-d, II(c);
  • The patient is being treated by and is physically located in a state designated community mental health center pursuant to RSA 135; or
  • The patient is being treated by, and physically located in, a hospital or clinic registered in a manner fully consistent with 21 U.S.C. section 823(f).

Subsequent in-person exams shall be by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and opioid, but not less than annually.

See Statute for specific requirements for physicians providing services via telemedicine, and those issuing a prescription for spectacle lenses, or contact lenses by means of telemedicine.

The prescription authority under this paragraph shall be limited to a practitioner licensed to prescribe the drug and in compliance with all federal laws, including the United States Drug Enforcement Agency registration or waiver when required. An initial face-to-face in person exam shall be required with the exception of the locations enumerated in this paragraph.

SOURCE: NH Revised Statutes Annotated, 329:1-d, (Accessed Nov. 2022).

An individual providing services by means of telemedicine or telehealth directly to a patient shall:

  • Use the same standard of care as used in an in-person encounter;
  • Maintain a medical record; and
  • Subject to the patient’s consent, forward the medical record to the patient’s primary care or treating provider, if appropriate.

SOURCE: NH Revised Statutes Annotated Sec. 310-A:1-g, (Accessed Nov. 2022).

The prescribing of a non-opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a), who are treating a patient with whom the prescriber has an in-person practitioner-patient relationship, for purposes of monitoring or follow-up care. A provider shall not be required to establish care via face-to-face in-person service when:

  • The provider is a Department of Veteran Affairs (VA) practitioner or VA-contracted practitioner not required to obtain a special registration pursuant to 21 U.S.C. section 831(h);
  • The patient is being treated by, and is physically located in a correctional facility administered by the state of New Hampshire or a New Hampshire county;
  • The patient is being treated by, and is physically located in a doorway as defined in RSA 167:4-d, II(c);
  • The patient is being treated by and is physically located in a state designated community mental health center pursuant to RSA 135; or (E) The patient is being treated by, and physically located in, a hospital or clinic registered in a manner fully consistent with 21 U.S.C. section 823(f)

Subsequent in-person exams must be by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and drug, but not less than annually.

The prescribing of an opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a), who are treating a patient with whom the prescriber has an in-person practitioner-patient relationship, for purposes of monitoring or follow-up care.

SOURCE: NH Revised Statutes Annotated 318-B:2(XVI). (Accessed Nov. 2022).

A physician issuing a prescription for spectacle lenses, as defined in RSA 327-A:1, III, or a prescription for contact lenses, as defined in RSA 327-A:1, IV, by means of telemedicine directly to a patient shall:

  • Obtain an updated medical history at the time of prescribing;
  • Make a diagnosis at the time of prescribing;
  • Conform to the standard of care expected of in-person care as appropriate to the patient’s age and presenting condition, including when the standard of care requires the use of diagnostic testing and performance of a physical examination, which may be carried out through the use of peripheral devices appropriate to the patient’s condition;
  • Not determine an ophthalmic prescription solely by use of an online questionnaire; and
  • Upon request, provide patient records in a timely manner in accordance with the provisions of RSA 332-I and all other state and federal laws and regulations.

SOURCE: NH Revised Statutes Annotated, 329:1-d(VI), (Accessed Nov. 2022).

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New Jersey

Last updated 09/06/2022

Unless specifically prohibited or limited by federal or State law, …

Unless specifically prohibited or limited by federal or State law, a health care provider who establishes a proper provider-patient relationship with a patient may remotely provide health care services to a patient through the use of telemedicine.  A health care provider may also engage in telehealth as may be necessary to support and facilitate the provision of health care services to patients.  Nothing in this section shall be construed to allow a provider to require a patient to use telemedicine or telehealth in lieu of receiving services from an in-network provider.

Any health care provider who uses telemedicine or engages in telehealth while providing health care services to a patient, shall: (1) be validly licensed, certified, or registered, pursuant to Title 45 of the Revised Statutes, to provide such services in the State of New Jersey; (2) remain subject to regulation by the appropriate New Jersey State licensing board or other New Jersey State professional regulatory entity; (3) act in compliance with existing requirements regarding the maintenance of liability insurance; and (4) remain subject to New Jersey jurisdiction.

Telemedicine services may be provided using interactive, real-time, two way communication technologies or, subject to the requirements of below, asynchronous store-and-forward technology.

A health care provider engaging in telemedicine or telehealth may use asynchronous store-and-forward technology to provide services with or without the use of interactive,r eal-time, two-way audio if, after accessing and reviewing the patient’s medical records, the provider determines that the provider is able to meet to meet the same standard of care as if the health care services were being provided in person and informs the patient of this determination at the outset of the telemedicine or telehealth encounter.

A health care provider engaging in telemedicine or telehealth shall review the medical history and any medical records provided by the patient. For an initial encounter with the patient, the provider shall review the patient’s medical history and medical records prior to initiating contact with the patient. In the case of a subsequent telemedicine or telehealth encounter conducted pursuant to an ongoing provider-patient relationship, the provider may review the information prior to initiating contact with the patient or contemporaneously with the telemedicine or telehealth encounter.

Diagnosis, treatment, and consultation recommendations, including discussions regarding the risk and benefits of the patient’s treatment options, which are made through the use of telemedicine or telehealth, including the issuance of a prescription based on a telemedicine or telehealth encounter, shall be held to the same standard of care or practice standards as are applicable to in-person settings. Unless the provider has established a proper provider-patient relationship with the patient, a provider shall not issue a prescription to a patient based solely on the responses provided in an online static questionnaire.

In the event that a mental health screener, screening service, or screening psychiatrist determines that an in-person psychiatric evaluation is necessary to meet standard of care requirements, or in the event that a patient requests an in-person psychiatric evaluation in lieu of a psychiatric evaluation performed using telemedicine or telehealth, the mental health screener, screening service, or screening psychiatrist may nevertheless perform a psychiatric evaluation using telemedicine and telehealth if it is determined that the patient cannot be scheduled for an in-person psychiatric evaluation within the next 24 hours. Nothing in this paragraph shall be construed to prevent a patient who receives a psychiatric evaluation using telemedicine and telehealth as provided in this paragraph from receiving a subsequent, in-person psychiatric evaluation in connection with the same treatment event, provided that the subsequent in-person psychiatric evaluation is necessary to meet standard of care requirements for that patient.

The prescription of Schedule II controlled dangerous substances through the use of telemedicine or telehealth shall be authorized only after an initial in-person examination of the patient, as provided by regulation, and a subsequent in-person visit with the patient shall be required every three months for the duration of time that the patient is being prescribed the Schedule II controlled dangerous substance.  However, the provisions of this subsection shall not apply, and the in-person examination or review of a patient shall not be required, when a health care provider is prescribing a stimulant which is a Schedule II controlled dangerous substance for use by a minor patient under the age of 18, provided that the health care provider is using interactive, real-time, two-way audio and video technologies when treating the patient and the health care provider has first obtained written consent for the waiver of these in-person examination requirements from the minor patient’s parent or guardian.

SOURCE: NJ Statute C.45:1-62. (Accessed Sept. 2022).

A provider patient relationship shall include:

  • Properly identifying the patient, using at minimum the patient’s name, date of birth, phone number, and address.
  • Disclosing and validating the provider’s identity and credentials, such as license, title, specialty, and board certifications.
  • Review of patient’s medical history and available medical records, prior to initiating contact and initial encounter.
  • Determining whether the provider will be able to meet the same standard of care as care provided in-person, using telehealth or telemedicine, prior to initiating contact, for each unique patient encounter.

See statute for exceptions.

SOURCE: NJ Statute C.45:1-63(3). (Accessed Sept. 2022).

A health care practitioner may initially authorize any qualifying patient for the medical use of cannabis using telemedicine or telehealth, provided that the use of telemedicine or telehealth, rather than an in-person visit, is consistent with the standard of care required for assessment and treatment of the patient’s condition. Following the initial authorization, the practitioner may provide continued authorization for the use of medical cannabis via telemedicine or telehealth if the practitioner determines that an in-person visit is not required, consistent with the standard of care. The practitioner may require in-office consultations if additional consultations are necessary to continue to authorize the patient’s use of medical cannabis.

See statute for additional requirements.

SOURCE:  NJ Statute C.24:6I-5.1, (Accessed (Sept. 2022).

Licensee-client relationship

Board of Marriage and Family Therapy Examiners

Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-client relationship by:

  •  Identifying the client with, at a minimum, the client’s name, date of birth, phone number, and address. A licensee may also use a client’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the client; and
  • Disclosing and validating the licensee’s identity, license, title, and, if applicable, specialty and board certifications.

Prior to initiating contact with a client for the purpose of providing services to the client using telemedicine or telehealth, a licensee shall:

  • Review the client’s medical history and any available medical records that are relevant to the provision of marriage and family services;
  • Determine, as to each unique client encounter, whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in-person; and
  • Provide the client the opportunity to sign a consent form that authorizes the licensee to release client records of the encounter to the client’s primary care licensee or other healthcare provider identified by the client.

Notwithstanding (a) and (b) above, marriage and family therapy services may be provided through telemedicine or telehealth without a proper licensee-client relationship if the provision of marriage and family therapy services is:

  • For informal consultations with another healthcare provider performed by a licensee outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • During episodic consultations by a healthcare specialist located in another jurisdiction who provides consultation services, upon request, to a licensee in this State;
  • Related to healthcare assistance provided in response to an emergency or disaster, provided that there is no charge for the medical assistance; or
  • Provided by a substitute licensee acting on behalf and at the designation of an absent licensee in the same specialty on an on-call or cross-coverage basis.

SOURCE: NJ Administrative Code 13:34-6A.4. (Accessed Sept. 2022).

Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-client relationship by:

  • Identifying the client with, at a minimum, the client’s name, date of birth, phone number, and address. A licensee may also use a client’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the client; and
  • Disclosing and validating the licensee’s identity, license, title, and, if applicable, specialty and Committee certifications.

Prior to initiating contact with a client for the purpose of providing services to the client using telemedicine or telehealth, a licensee shall:

  • Review the client’s history, including medical history, provided by the client and any other records provided by the client;
  • Determine as to each unique client encounter whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in-person; and
  • Provide the client the opportunity to sign a consent form that authorizes the licensee to release client records of the encounter to the client’s primary care licensee or other healthcare provider identified by the client.

Notwithstanding (a) and (b) above, professional counseling or rehabilitation counseling, as applicable, may be provided through telemedicine or telehealth without a proper licensee-client relationship if the provision of professional counseling or rehabilitation counseling, as applicable, is:

  • For informal consultations with another healthcare provider performed by a licensee outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • During episodic consultations by a healthcare specialist located in another jurisdiction who provides consultation services, upon request, to a licensee in this State;
  • Related to healthcare assistance provided in response to an emergency or disaster, provided that there is no charge for the medical assistance; or
  • Provided by a substitute licensee acting on behalf and at the designation of an absent licensee in the same specialty on an on-call or cross-coverage basis.

SOURCE: NJ Administrative Code  13:34-32.4. (Accessed Sept. 2022).

Board of Medical Examiners-Electrologists

Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-client relationship by:

  • Identifying the client with, at a minimum, the client’s name, date of birth, phone number, and address. A licensee may also use a client’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the client; and
  • Disclosing and validating the licensee’s identity, license, title, and, if applicable, specialty and board certifications.

Prior to initiating contact with a client for the purpose of providing services to the client using telemedicine or telehealth, a licensee shall:

  • Review the client’s medical history and any available medical records, to the extent they relate to the practice of electrology;
  • Determine, as to each unique client encounter, whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in-person; and
  • Provide the client the opportunity to sign a consent form which authorizes the licensee to release client records of the encounter to the client’s primary care licensee or other healthcare provider identified by the client.

Notwithstanding (a) and (b) above, electrology services may be provided through telemedicine or telehealth without a proper licensee-client relationship if the provision of electrology services is:

  • For informal consultations with another health care provider performed by a licensee outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • During episodic consultations by a health care specialist located in another jurisdiction who provides consultation services, upon request, to a licensee in this State;
  • Related to health care assistance provided in response to an emergency or disaster, provided that there is no charge for the medical assistance; or
  • Provided by a substitute licensee acting on behalf and at the designation of an absent licensee in the same specialty on an on-call or cross-coverage basis.

SOURCE: NJ Administrative Code 13:35-12A.4. (Accessed Sept. 2022).

Board of Medical Examiners

Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-patient relationship by:

  • Identifying the patient with, at a minimum, the patient’s name, date of birth, phone number, and address. A licensee may also use a patient’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the patient; and
  • Disclosing and validating the licensee’s identity, license, title, and, if applicable, specialty and board certifications.

Prior to initiating contact with a patient for the purpose of providing services to the patient using telemedicine or telehealth, a licensee shall:

  • Review the patient’s medical history and any available medical records;
  • Determine as to each unique patient encounter, whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in-person; and
  • Provide the patient the opportunity to sign a consent form that authorizes the licensee to release medical records of the encounter to the patient’s primary care provider or other healthcare provider identified by the patient.

Notwithstanding (a) and (b) above, health care services may be provided through telemedicine or telehealth without a proper licensee-patient relationship if the provision of health care services is:

  • For informal consultations with another healthcare provider performed by a licensee outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • During episodic consultations by a medical specialist located in another jurisdiction who provides consultation services, upon request, to a licensee in this State;
  • Related to medical assistance provided in response to an emergency or disaster, provided that there is no charge for the medical assistance; or
  • Provided by a substitute licensee acting on behalf of, and at the designation of, an absent licensee in the same specialty on an on-call or cross-coverage basis.

SOURCE: NJ Administrative Code 13:35-6B.4 & 13:35-2C.4. (Accessed Sept. 2022).

Board of Medical Examiners- Acupuncturists

Prior to providing services through telemedicine or telehealth, an acupuncturist shall establish an acupuncturist-patient relationship by:

  • Identifying the patient with, at a minimum, the patient’s name, date of birth, phone number, and address. An acupuncturist may also use a patient’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the patient; and
  • Disclosing and validating the acupuncturist’s identity, license, title, and, if applicable, specialty and board certifications.

Prior to an initial contact with a patient for the purpose of providing services to the patient using telemedicine or telehealth, an acupuncturist shall review the patient’s history and any available records.

Prior to initiating contact with a patient for the purpose of providing services through telemedicine or telehealth, an acupuncturist shall determine whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in-person. The acupuncturist shall make this determination prior to each unique patient encounter.

Notwithstanding (a), (b), and (c) above, services may be provided through telemedicine or telehealth without a proper provider-patient relationship if:

  • The provision of services is for informal consultations with another healthcare provider performed by an acupuncturist outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • The provision of services is during episodic consultations by a specialist located in another jurisdiction who provides consultation services, upon request, to an acupuncturist in this State;
  • An acupuncturist furnishes assistance in response to an emergency or disaster, provided that there is no charge for the medical assistance; or
  • A substitute acupuncturist, who is acting on behalf of an absent acupuncturist in the same specialty, provides health care services on an on-call or cross-coverage basis, provided that the absent acupuncturist has designated the substitute acupuncturist as an on-call acupuncturist or cross-coverage service provider.

SOURCE: NJ Administrative Code 13:35-9.24. (Accessed Sept. 2022).

Board of Medical Examiners-Limited Licenses Midwifery

Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-patient relationship by:

  • Identifying the patient with, at a minimum, the patient’s name, date of birth, phone number, and address. A licensee may also use a patient’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the patient; and
  • Disclosing and validating the licensee’s identity, license, title, and, if applicable, specialty and board certifications.

Prior to an initial contact with a patient for the purpose of providing services to the patient using telemedicine or telehealth, a licensee shall review the patient’s history and any available records.

Prior to initiating contact with a patient for the purpose of providing services through telemedicine or telehealth, a licensee shall determine whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in person. The licensee shall make this determination prior to each unique patient encounter.

Notwithstanding (a), (b), and (c) above, service may be provided through telemedicine or telehealth without a proper licensee-patient relationship if:

  • The provision of services is for informal consultations with another healthcare provider performed by a licensee outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • The provision of services is during episodic consultations by a medical specialist located in another jurisdiction who provides consultation services, upon request, to a licensee in this State;
  • A licensee furnishes medical assistance in response to an emergency or disaster, provided that there is no charge for the medical assistance; or
  • A substitute licensee, who is acting on behalf of an absent licensee in the same specialty, provides health care services on an on-call or cross-coverage basis, provided that the absent licensee has designated the substitute licensee as an on-call licensee or cross-coverage service provider.

SOURCE: NJ Administrative Code 13:35-2A.21. (Accessed Sept. 2022).

Board of Medical Examiners – Licensed Genetic Counselor

Prior to providing services through telemedicine or telehealth, a licensed genetic counselor shall establish a licensed genetic counselor-patient relationship by:

  • Identifying the patient with, at a minimum, the patient’s name, date of birth, phone number, and address. A licensed genetic counselor may also use a patient’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the patient; and
  • Disclosing and validating the licensed genetic counselor’s identity, license, title, and, if applicable, specialty and board certifications.

Prior to an initial contact with a patient for the purpose of providing services to the patient using telemedicine or telehealth, a licensed genetic counselor shall review the patient’s history and any available records.

Prior to initiating contact with a patient for the purpose of providing services through telemedicine or telehealth, a licensed genetic counselor shall determine whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in person. The licensed genetic counselor shall make this determination prior to each unique patient encounter.

Notwithstanding (a), (b), and (c) above, service may be provided through telemedicine or telehealth without a proper licensed genetic counselor-patient relationship if:

  • The provision of services is for informal consultations with another healthcare provider performed by a licensed genetic counselor outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • The provision of services is during episodic consultations by a medical specialist located in another jurisdiction who provides consultation services, upon request, to a licensed genetic counselor in this State;
  • A licensed genetic counselor furnishes medical assistance in response to an emergency or disaster, provided that there is no charge for the medical assistance; or
  • A substitute licensed genetic counselor, who is acting on behalf of an absent licensed genetic counselor, provides health care services on an on-call or cross-coverage basis, provided that the absent licensed genetic counselor has designated the substitute licensed genetic counselor as an on-call licensed genetic counselor or cross-coverage service provider.

SOURCE: NJ Administrative Code 13:35-14.22. (Accessed Sept. 2022). 

Board of Medical Examiners – Hearing and Dispensers

Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-patient relationship by:

  • Identifying the patient with, at a minimum, the patient’s name, date of birth, phone number, and address. A licensee may also use a patient’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the patient; and
  • Disclosing and validating the licensee’s identity, license, title, and, if applicable, specialty and board certifications.

Prior to an initial contact with a patient for the purpose of providing services to the patient using telemedicine or telehealth, a licensee shall review the patient’s history and any available records.

Prior to initiating contact with a patient for the purpose of providing services through telemedicine or telehealth, a licensee shall determine whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in person. The licensee shall make this determination prior to each unique patient encounter.

Prior to initiating contact with a patient, a licensee shall provide the patient the opportunity to sign a consent form that authorizes the licensee to release records of the encounter to the patient’s primary care provider or other health care provider identified by the patient.

Notwithstanding (a), (b), and (c) above, service may be provided through telemedicine or telehealth without a proper provider-patient relationship if:

  • The provision of services is for informal consultations with another healthcare provider performed by a licensee outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • The provision of services is during episodic consultations by a specialist located in another jurisdiction who provides consultation services, upon request, to a licensee in this State;
  • A licensee furnishes assistance in response to an emergency or disaster, provided that there is no charge for the assistance; or
  • A substitute licensee, who is acting on behalf of an absent licensee in the same specialty, provides health care services on an on-call or cross-coverage basis, provided that the absent licensee has designated the substitute licensee as an on-call licensee or cross-coverage service provider.

SOURCE: NJ Administrative Code 13:35-8.24, (Accessed Sept. 2022).

NJ Board of Nursing

Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-patient relationship by:

  • Identifying the patient with, at a minimum, the patient’s name, date of birth, phone number, and address. A licensee may also use a patient’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the patient; and
  • Disclosing and validating the licensee’s identity, license, title, and, if applicable, specialty and board certifications.

Prior to initiating contact with a patient for the purpose of providing services to the patient using telemedicine or telehealth, a licensee shall:

  • Review the patient’s medical history and any available medical records;
  • Determine as to each unique patient encounter whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in-person; and
  • Provide the patient the opportunity to sign a consent form which authorizes the licensee to release medical records of the encounter to the patient’s primary care provider or other health care provider identified by the patient.

Notwithstanding (a) and (b) above, health care services may be provided through telemedicine or telehealth without a proper licensee-patient relationship if the provision of health care services is:

  • For informal consultations with another healthcare provider performed by a licensee outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • During episodic consultations by a medical specialist located in another jurisdiction who provides consultation services, upon request, to a licensee in this State;
  • Related to medical assistance provided in response to an emergency or disaster, provided that there is no charge for the medical assistance; or
  • Provided by a substitute licensee acting on behalf and at the designation of an absent licensee in the same specialty on an on-call or cross-coverage basis.

SOURCE: NJ Administrative Code 13:37-8A.4. (Accessed Sept. 2022).

Board of Physical Therapy

Prior to providing services through telemedicine or telehealth, a licensed physical therapist or licensed physical therapist assistant shall establish a licensed physical therapist or licensed physical therapist assistant-patient relationship by:

  • Identifying the patient with, at a minimum, the patient’s name, date of birth, phone number, and address. A licensed physical therapist or licensed physical therapist assistant may also use a patient’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the patient; and
  • Disclosing and validating the licensed physical therapist or licensed physical therapist assistant’s identity, license, title, and, if applicable, specialty and board certifications.

Prior to an initial contact with a patient for the purpose of providing services to the patient using telemedicine or telehealth, a licensed physical therapist or licensed physical therapist assistant shall review the patient’s history and any available records.

Prior to initiating contact with a patient for the purpose of providing services through telemedicine or telehealth, a licensed physical therapist or licensed physical therapist assistant shall determine whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in-person. The licensed physical therapist or licensed physical therapist assistant shall make this determination prior to each unique patient encounter.

Prior to initiating contact with a patient, a licensed physical therapist or licensed physical therapist assistant shall provide the patient the opportunity to sign a consent form that authorizes the licensed physical therapist or licensed physical therapist assistant to release records of the encounter to the patient’s primary care licensed physical therapist or other health care provider identified by the patient.

Notwithstanding (a), (b), and (c) above, service may be provided through telemedicine or telehealth without a proper provider-patient relationship if:

  • The provision of services is for informal consultations with another healthcare provider performed by a licensed physical therapist or licensed physical therapist assistant outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • The provision of services is during episodic consultations by a specialist located in another jurisdiction who provides consultation services, upon request, to a licensed physical therapist or licensed physical therapist assistant in this State;
  • A licensed physical therapist or licensed physical therapist assistant furnishes assistance in response to an emergency or disaster, provided that there is no charge for the assistance; or
  • A substitute licensed physical therapist or licensed physical therapist assistant, who is acting on behalf of an absent licensed physical therapist or licensed physical therapist assistant in the same specialty, provides health care services on an on-call or cross-coverage basis, provided that the absent licensed physical therapist or licensed physical therapist assistant has designated the substitute licensed physical therapist or licensed physical therapist assistant as an on-call licensed physical therapist or licensed physical therapist assistant or cross-coverage service provider.

SOURCE: NJ Administrative Code 13:39A-10.4. (Accessed Sept. 2022).

Board of Psychological Examiners

Prior to providing psychological services through telemedicine or telehealth, a licensee shall establish a licensee-client relationship by:

  • Identifying the client with, at a minimum, the client’s name, date of birth, phone number, and address. A licensee may also use a client’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the client; and
  • Disclosing and validating the licensee’s identity, license, title, and, if applicable, specialty and board certifications.

Prior to an initial contact with a client for the purpose of providing psychological services to the client using telemedicine or telehealth, a licensee shall review the client’s history and any available records.

Prior to initiating contact with a client for the purpose of providing psychological services through telemedicine or telehealth, a licensee shall determine whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the psychological services were provided in person. The licensee shall make this determination prior to each unique client encounter.

Notwithstanding (a), (b), and (c) above, psychological service may be provided through telemedicine or telehealth without a proper provider-client relationship if:

  • The provision of psychological services is for informal consultations with another healthcare provider performed by a licensee outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • The provision of psychological services is during episodic consultations by a medical and/or psychological specialist located in another jurisdiction who provides consultation psychological services, upon request, to a licensee in this State;
  • A licensee furnishes assistance in response to an emergency or disaster, provided that there is no charge for the assistance; or
  • A substitute licensee, who is acting on behalf of an absent licensee in the same specialty, provides psychological services on an on-call or cross-coverage basis, provided that the absent licensee has designated the substitute licensee as an on-call licensee or cross-coverage psychological service provider.

SOURCE: NJ Administrative Code 13:42-13.4. (Accessed Sept. 2022). 

Audiology and Speech Language Pathology  Advisory Committee

Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-patient relationship by:

  • Identifying the patient with, at a minimum, the patient’s name, date of birth, phone number, and address. A licensee may also use a patient’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the patient; and
  • Disclosing and validating the licensee’s identity, license, title, and, if applicable, specialty and board certifications.

Prior to an initial contact with a patient for the purpose of providing services to the patient using telemedicine or telehealth, a licensee shall review the patient’s history and any available records.

Prior to initiating contact with a patient for the purpose of providing services through telemedicine or telehealth, a licensee shall determine whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in person. The licensee shall make this determination prior to each unique patient encounter.

Prior to initiating contact with a patient, a licensee shall provide the patient the opportunity to sign a consent form that authorizes the licensee to release records of the encounter to the patient’s primary care licensee or other health care provider identified by the patient.

Notwithstanding (a), (b), and (c) above, services may be provided through telemedicine or telehealth without a proper licensee-patient relationship if:

  • The provision of services is for informal consultations with another healthcare provider performed by a licensee outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • The provision of services is during episodic consultations by a specialist located in another jurisdiction who provides consultation services, upon request, to a licensee in this State;
  • A licensee furnishes assistance in response to an emergency or disaster, provided that there is no charge for the assistance; or
  • A substitute licensee, who is acting on behalf of an absent licensee in the same specialty, provides health care services on an on-call or cross-coverage basis, provided that the absent licensee has designated the substitute licensee as an on-call licensee or cross-coverage service provider.

SOURCE: NJ Administrative Code 13:44C-11.4. (Accessed Sept. 2022).

Board of Social Work Examiners

Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-client relationship by:

  • Identifying the client with, at a minimum, the client’s name, date of birth, phone number, and address. A licensee may also use a client’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the client; and
  • Disclosing and validating the licensee’s identity, license, title, and, if applicable, specialty and board certifications.

Prior to an initial contact with a client for the purpose of providing services to the client using telemedicine or telehealth, a licensee shall review the client’s history provided by the client and any records provided by the client.

Prior to initiating contact with a client for the purpose of providing services through telemedicine or telehealth, a licensee shall determine whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in-person. The licensee shall make this determination prior to each unique client encounter.

Notwithstanding (a), (b), and (c) above, service may be provided through telemedicine or telehealth without a proper licensee-client relationship if:

  • The provision of services is for informal consultations with another healthcare provider performed by a licensee outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • The provision of services is during episodic consultations by a specialist located in another jurisdiction who provides consultation services, upon request, to a licensee in this State;
  • A licensee furnishes assistance in response to an emergency or disaster, provided that there is no charge for the assistance; or
  • A substitute licensee, who is acting on behalf of an absent licensee in the same specialty, provides health care services on an on-call or cross-coverage basis, provided that the absent licensee has designated the substitute licensee as an on-call licensee or cross-coverage service provider.

SOURCE: NJ Administrative Code 13:44G-15.4. (Sept. 2022).

Alcohol and Drug Counselor Committee

Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-client relationship by:
  • Identifying the client with, at a minimum, the client’s name, date of birth, phone number, and address. A licensee may also use a client’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the client; and
  • Disclosing and validating the licensee’s identity, license, title, and, if applicable, specialty and Committee certifications.
Prior to initiating contact with a client for the purpose of providing services to the client using telemedicine or telehealth, a licensed clinical alcohol and drug counselor shall:
  • Review the client’s medical history and any available medical records that are relevant to substance use and addictive disorders and mental health history;
  • Determine, as to each unique client encounter, whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in-person; and
  • Provide the client the opportunity to sign a consent form that authorizes the licensed clinical alcohol and drug counselor or the agency employing the licensee to release client records of the encounter to the client’s primary care licensed clinical alcohol and drug counselor or other healthcare provider identified by the client.
Prior to initiating contact with a client for the purpose of providing services to the client using telemedicine or telehealth, a certified alcohol and drug counselor shall:
  • Have his or her supervising licensed clinical alcohol and drug counselor comply with (b)1, 2, and 3 above; and
  • After the supervising licensed clinical alcohol and drug counselor conducts the review and makes the determination required at (b) above, satisfy the requirements of (b)1 and 2.
Notwithstanding (a), (b), and (c) above, alcohol and drug counseling may be provided through telemedicine or telehealth without a proper licensee-client relationship if the provision of alcohol and drug counseling is:
  • For informal consultations with another healthcare provider performed by a licensee outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • During episodic consultations by a healthcare specialist located in another jurisdiction who provides consultation services, upon request, to a licensee in this State;
  • Related to health care assistance provided in response to an emergency or disaster, provided that there is no charge for the mental health assistance; or
  • Provided by a substitute licensee acting on behalf, and at the designation, of an absent licensee in the same specialty on an on-call or cross-coverage basis.

SOURCE: NJ Administrative Code 13:34C-7.4. (Accessed Sept. 2022).

Occupational Therapy Advisory Council

Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-client relationship by:

  • Identifying the client with, at a minimum, the client’s name, date of birth, phone number, and address. A licensee may also use a client’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the client; and
  • Disclosing and validating the licensed occupational therapist or occupational therapy assistant’s identity, license, title, and, if applicable, specialty and board certifications.

Prior to initiating contact with a client for the purpose of providing services to the client using telemedicine or telehealth, a licensee shall:

  • Review the client’s medical history, any available medical records, and any other relevant client records including, but not limited to, educational, vocational, or social records;
  • Determine as to each unique client encounter whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in-person; and
  • Provide the client the opportunity to sign a consent form that authorizes the licensee to release client records of the encounter to the client’s primary care licensee or other health care provider identified by the client.

Notwithstanding (a) and (b) above, occupational therapy services may be provided through telemedicine or telehealth without a proper licensee-client relationship if the provision of occupational therapy services is:

  • For informal consultations with another health care provider performed by a licensee outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • During episodic consultations by a health care specialist located in another jurisdiction who provides consultation services, upon request, to a licensee in this State;
  • Related to health care assistance provided in response to an emergency or disaster, provided that there is no charge for the medical assistance; or
  • Provided by a substitute licensee acting on behalf, and at the designation, of an absent licensee in the same specialty on an on-call or cross-coverage basis.

SOURCE: NJ Administrative Code 13:44K-7.4. (Accessed Sept. 2022).

New Jersey Board of Dentistry

Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-patient relationship by:

  • Identifying the patient with, at a minimum, the patient’s name, date of birth, phone number, and address. A licensed dentist may also use a patient’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the patient; and
  • Disclosing and validating the licensee’s identity, license, title, and, if applicable, professional certifications.

Prior to initiating contact with a patient for the purpose of providing services to the patient using telemedicine or telehealth, a licensed dentist shall:

  • Review the patient’s medical and dental history and any available dental records;
  • Determine as to each unique patient encounter whether the licensee will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in-person; and
  •  Provide the patient the opportunity to sign a consent form that authorizes the licensed dentist to release dental records of the encounter to the patient’s primary care licensed dentist or other healthcare provider identified by the patient.

Notwithstanding (a) and (b) above, health care services may be provided through telemedicine or telehealth without a proper licensed dentist-patient relationship if the provision of health care services is:

  • For informal consultations with another healthcare provider performed by a licensee outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • During episodic consultations by a medical or dental specialist located in another jurisdiction who provides consultation services, upon request, to a licensee in this State;
  • Related to dental assistance provided in response to an emergency or disaster, provided that there is no charge for the dental assistance; or
  • Provided by a substitute licensee acting on behalf, and at the designation of, an absent licensee in the same specialty on an on-call or cross-coverage basis.

SOURCE: NJ Administrative Code 13:30-9.4. (Accessed Sept. 2022).

Board of Respiratory Care

Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-patient relationship by:

  • Identifying the patient with, at a minimum, the patient’s name, date of birth, phone number, and address. A licensee may also use a patient’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the patient; and
  • Disclosing and validating the licensee’s identity, license, title, and, if applicable, specialty and board certifications.

Prior to initiating contact with a patient for the purpose of providing services to the patient using telemedicine or telehealth, a licensee shall:

  • Review the patient’s medical history and any available medical records;
  • Determine as to each unique patient encounter whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in-person; and
  • Provide the patient the opportunity to sign a consent form that authorizes the licensee to release medical records of the encounter to the patient’s primary care licensee or other healthcare provider identified by the patient.

Notwithstanding (a) and (b) above, health care services may be provided through telemedicine or telehealth without a proper licensee-patient relationship if the provision of health care services is:

  • For informal consultations with another healthcare provider performed by a licensee outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • During episodic consultations by a medical specialist located in another jurisdiction who provides consultation services, upon request, to a licensee in this State;
  • Related to medical assistance provided in response to an emergency or disaster, provided that there is no charge for the medical assistance; or
  • Provided by a substitute licensee acting on behalf, and at the designation, of an absent licensee in the same specialty on an on-call or cross-coverage basis.

SOURCE: NJ Administrative Code 13:44F-11.4. (Accessed Sept. 2022).

Certified Psychoanalysts Advisory Committee 

Prior to providing services through telemedicine or telehealth, a State-certified psychoanalyst shall establish a State-certified psychoanalyst-patient relationship by:

  • Identifying the patient with, at a minimum, the patient’s name, date of birth, phone number, and address. A State-certified psychoanalyst may also use a patient’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the patient; and
  • Disclosing and validating the State-certified psychoanalyst’s identity, license, and title.

Prior to an initial contact with a patient for the purpose of providing services to the patient using telemedicine or telehealth, a State-certified psychoanalyst shall review the patient’s history and any available records.

Prior to initiating contact with a patient for the purpose of providing services through telemedicine or telehealth, a State-certified psychoanalyst shall determine whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in person. The State-certified psychoanalyst shall make this determination prior to each unique patient encounter.

Notwithstanding (a), (b), and (c) above, service may be provided through telemedicine or telehealth without a proper provider-patient relationship if:

  • The provision of services is for informal consultations with another healthcare provider performed by a State-certified psychoanalyst outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  • The provision of services is during episodic consultations by a specialist located in another jurisdiction who provides consultation services, upon request, to a State-certified psychoanalyst in this State;
  • A State-certified psychoanalyst furnishes assistance in response to an emergency or disaster, provided that there is no charge for the assistance; or
  • A substitute State-certified psychoanalyst, who is acting on behalf of an absent State-certified psychoanalyst in the same specialty, provides health care services on an on-call or cross-coverage basis, provided that the absent State-certified psychoanalyst has designated the substitute State-certified psychoanalyst as an on-call State-certified psychoanalyst or cross-coverage service provider.

SOURCE: NJ Administrative Code 13:42A-8.4. (Accessed Sept. 2022).

Prescriptions

Board of Medical Examiners- Physician Assistants

Notwithstanding requirements for in-person interaction at N.J.A.C. 13:35-7, a licensee providing services through telemedicine or telehealth may issue a prescription to a patient, as long as the issuance of such a prescription is consistent with the standard of care or practice standards applicable to the in-person setting.

A licensee shall not issue a prescription based solely on responses provided in an online questionnaire, unless the licensee has established a proper licensee-patient relationship pursuant to N.J.A.C. 13:35-2C.4.

Notwithstanding (a) above, and except as provided at (d) below, a licensee shall not issue a prescription for a Schedule II controlled dangerous substance, unless the licensee has had an initial in-person examination of the patient and a subsequent in-person visit with the patient at least every three months for the duration of the time the patient is prescribed the Schedule II controlled dangerous substance.

The prohibition of (c) above shall not apply when a licensee prescribes a stimulant for a patient under the age of 18 years, as long as the licensee is using interactive, real-time, two-way audio and video technologies and the licensee has obtained written consent for a waiver of in-person examination requirements from the patient’s parent or guardian.

SOURCE: NJ Administrative Code 13:35-2C.6. (Accessed Sept. 2022).

Board of Medical Examiners

Notwithstanding the requirements for in-person interaction in N.J.A.C. 13:35-7 , a licensee providing services through telemedicine or telehealth may issue a prescription to a patient, if the issuance of such a prescription is consistent with the standard of care or practice standards applicable to the in-person setting.

A licensee shall not issue a prescription based solely on responses provided in an online questionnaire, unless the licensee has established a proper licensee-patient relationship pursuant to N.J.A.C. 13:35-6B.4 .

Notwithstanding (a) above, and except as provided in (d) below, a licensee shall not issue a prescription for a Schedule II controlled dangerous substance unless the licensee has had an initial in-person examination of the patient and a subsequent in-person visit with the patient at least every three months for the duration of the time the patient is prescribed the Schedule II controlled dangerous substance.

The prohibition of (c) above shall not apply when a licensee prescribes a stimulant for a patient under the age of 18 years, as long as the licensee is using interactive, real-time, two-way audio and video technologies and the licensee has obtained written consent for a waiver of in-person examination requirements from the patient’s parent or guardian.

SOURCE: NJ Administrative Code 13:35-6B.6. (Accessed Sept. 2022).

Board of Veterinary Medical Examiners

A licensee providing services through telemedicine or telehealth may issue a prescription to a patient, as long as the issuance of such a prescription is consistent with the standard of care or practice standards applicable to the in-person setting.

A licensee shall not issue a prescription based solely on responses provided in an online questionnaire, unless the licensee has established a proper licensee-client-patient relationship pursuant to N.J.A.C. 13:44-4A.4.

Notwithstanding (a) above, a licensee shall not issue a prescription for a Schedule II controlled dangerous substance unless the licensee has had an initial in-person examination of the patient and a subsequent in-person visit with the patient at least every three months for the duration of the time the patient is prescribed the Schedule II controlled dangerous substance.

SOURCE: NJ Administrative Code 13:44-4A.6. (Accessed Sept. 2022).

Board of Medical Examiners-Limited Licenses Midwifery

Notwithstanding requirements for in-person interaction in N.J.A.C. 13:35-7 , a certified nurse midwife (CNM) with prescriptive authority pursuant to N.J.A.C. 13:35-2A.14 providing services through telemedicine or telehealth may issue a prescription to a patient, as long as the issuance of such a prescription is consistent with the standard of care or practice standards applicable to the in-person setting.

A CNM with prescriptive authority pursuant to N.J.A.C. 13:35-2A.14 shall not issue a prescription based solely on responses provided in an online questionnaire, unless the CNM has established a proper licensee-patient relationship pursuant to N.J.A.C. 13:35-2A.21 .

Notwithstanding (a) above, and except as provided in (d) below, a CNM with prescriptive authority pursuant to N.J.A.C. 13:35-2A.14 shall not issue a prescription for a Schedule II controlled dangerous substance unless the CNM has had an initial in-person examination of the patient and a subsequent in-person visit with the patient at least every three months for the duration of the time the patient is prescribed the Schedule II controlled dangerous substance.

The prohibition of (c) above shall not apply when a CNM with prescriptive authority pursuant to N.J.A.C. 13:35-2A.14 prescribes a stimulant for a patient under the age of 18 years, as long as the CNM is using interactive, real-time, two-way audio and video technologies and the CNM has obtained written consent for a waiver of in-person examination requirements from the patient’s parent or guardian.

SOURCE: NJ Administrative Code 13:35-2A.23. (Accessed Sept. 2022).

NJ Board of Nursing

An advanced practice nurse providing services through telemedicine or telehealth may issue a prescription to a patient, as long as the issuance of such a prescription is consistent with the standard of care or practice standards applicable to the in-person setting.

An advanced practice nurse shall not issue a prescription based solely on responses provided in an online questionnaire, unless the advanced practice nurse has established a proper licensee-patient relationship pursuant to N.J.A.C. 13:37-8A.4.

Notwithstanding (a) above, and except as provided in (d) below, an advanced practice nurse shall not issue a prescription for a Schedule II controlled dangerous substance unless the advanced practice nurse has had an initial in-person examination of the patient and a subsequent in-person visit with the patient at least every three months for the duration of the time the patient is prescribed the Schedule II controlled dangerous substance.

The prohibition of (c) above shall not apply when an advanced practice nurse prescribes a stimulant for a patient under the age of 18 years, as long as the advanced practice nurse is using interactive, real-time, two-way audio and video technologies and the advanced practice nurse has obtained written consent for a waiver of in-person examination requirements from the patient’s parent or guardian.

SOURCE: NJ Administrative Code 13:37-8A.6. (Accessed Sept. 2022).

State Board of Polysomnography

Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-patient relationship by:

  • Identifying the patient with, at a minimum, the patient’s name, date of birth, phone number, and address. A licensee may also use a patient’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the patient; and
  • Disclosing and validating the licensee’s identity, license, title, and, if applicable, specialty and board certifications.

SOURCE: NJ Admin Code 13:44L-7.4. (Accessed Sept. 2022).

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New Mexico

Last updated 10/28/2022

Prescribing, dispensing or administering drugs or medical supplies to a …

Prescribing, dispensing or administering drugs or medical supplies to a patient when there is no established physician-patient relationship, including prescribing over the internet or via other electronic means that is based solely on an on-line questionnaire is unprofessional conduct, except for:

  • Physicians and physician assistants on call for another practitioner, or responsible for another practitioner’s patients in an established clinic or office, or acting as locum tenens where a physician-patient relationship has previously been established and documented in the practitioner’s or clinic’s record;
  • Physicians and physician assistants in emergency room or urgent care settings;
  • Prescriptions written to prepare a patient for special examination(s) or laboratory testing;
  • Prescribing or dispensing for immunization programs;
  • The provision of treatment for partners of patients with sexually transmitted diseases when this treatment is conducted in accordance with the expedited partner therapy guidelines and protocol published by the New Mexico department of health; and
  • The provision of consultation, recommendation, or treatment during a face-to-face telehealth encounter online, using standard videoconferencing technology, where a medical history and informed consent are obtained and a medical record generated by the practitioner, and a physical examination is:
    • Recorded as appropriate by the practitioner, or a practitioner such as a physician, a physician or anesthesiologist assistant, or an advanced practice nurse, with the results communicated to the telehealth practitioner; or
    • Waived when a physical examination would not normally be part of a typical physical face-to-face encounter with the patient for the specific services being provided.

SOURCE: NM Administrative Code 16.10.8.8(L). (Accessed Oct. 2022).

Related to Medical Cannabis

Qualified patient means a resident of New Mexico who has been diagnosed by a practitioner as having a debilitating medical condition and has received written certification and a registry identification card pursuant to the Lynn and Erin Compassionate Use Act on the basis of having been diagnosed, in person or via telemedicine, by a practitioner as having a debilitating medical condition.

SOURCE: NM Administrative Code 7.34.3.7 & 7.34.2.7. (Accessed Oct. 2022).

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New York

Last updated 08/25/2022

Office of Alcoholism and Substance Abuse Services (OASAS)

Buprenorphine requires …

Office of Alcoholism and Substance Abuse Services (OASAS)

Buprenorphine requires a preliminary face-to-face evaluation by the Drug Addiction Treatment Act (DATA) 2000 waived prescribing professional, unless otherwise authorized.  See OASAS Telepractice Standards outlines practitioner requirements for prescribing buprenorphine.

SOURCE: NY Office of Alcoholism and Substance Abuse Services. Telepractice Standards for OASAS Designated Providers. (Dec. 2019), p. 3 (Accessed Aug. 2022).

Induction and prescribing of addiction medications must be done in accordance any and all applicable Federal rules and regulations; guidance may be found in the Telepractice Standards for OASAS Designated Providers posted on the OASAS website.

SOURCE: NY Codes, Rules and Regulations, Title 14, Chapter XXI, Part 830.5. (Accessed Aug. 2022).

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North Carolina

Last updated 11/04/2022

Teledentistry

The indication, appropriateness, and safety considerations for each prescription …

Teledentistry

The indication, appropriateness, and safety considerations for each prescription for medication, laboratory services, or dental laboratory services provided through the use of teledentistry shall be evaluated by the licensed dentist in accordance with applicable law and current standards of care, including those for appropriate documentation. A licensed dentist’s use of teledentistry carries the same professional accountability as a prescription issued in connection with an in-person encounter. A licensed dentist who prescribes any type of analgesic or pain medication as part of the provision of teledentistry services shall comply with all applicable North Carolina Controlled Substance Reporting System requirements.”

SOURCE: NC Statute Sec. 90-30.2. (Accessed Nov. 2022).

 

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North Dakota

Last updated 11/09/2022

“In-person medical evaluation” means a medical evaluation that is conducted …

“In-person medical evaluation” means a medical evaluation that is conducted with the patient in the physical presence of the practitioner, without regard to whether portions of the evaluation are conducted by other practitioners, and must include one of the following actions: … The referring practitioner has performed an examination in the case of a consultant practitioner issuing a prescription or drug order when providing services by means of telemedicine.

“Valid prescription” means a prescription that is issued for a legitimate medical purpose in the usual course of professional practice by a practitioner who has conducted an in-person medical evaluation of the patient.

SOURCE: ND Century Code Sec. 19-02.1-15.1.(c) & (f) (Accessed Oct. 2022).

A licensee practicing telemedicine shall establish a bona fide relationship with the patient before the diagnosis or treatment of a patient. A licensee practicing telemedicine shall verify the identity of the patient seeking care and shall disclose, and ensure the patient has the ability to verify, the identity and licensure status of any licensee providing medical services to the patient.

Before initially diagnosing or treating a patient for a specific illness or condition, an examination or evaluation must be performed. An examination or evaluation may be performed entirely through telemedicine, if the examination or evaluation is equivalent to an in-person examination.

  • An examination utilizing secure videoconferencing or store-and-forward technology for appropriate diagnostic testing and use of peripherals that would be deemed necessary in a like in-person examination or evaluation meets this standard, as does an examination conducted with an appropriately licensed intervening health care provider, practicing within the scope of the provider’s profession, providing necessary physical findings to the licensee. An examination or evaluation consisting only of a static online questionnaire or an audio conversation does not meet the standard of care.
  • Once a licensee conducts an acceptable examination or evaluation, whether in-person or by telemedicine, and establishes a patient-licensee relationship, subsequent followup care may be provided as deemed appropriate by the licensee, or by a provider designated by the licensee to act temporarily in the licensee’s absence. In certain types of telemedicine utilizing asynchronous store-and-forward technology or electronic monitoring, such as teleradiology or intensive care unit monitoring, it is not medically necessary for an independent examination of the patient to be performed.
A licensee practicing telemedicine is subject to all North Dakota laws governing the adequacy of medical records and the provision of medical records to the patient and other medical providers treating the patient.
A licensee must have the ability to make appropriate referrals of patients not amenable to diagnosis or complete treatment through a telemedicine encounter, including a patient in need of emergent care or complementary in-person care.

SOURCE: ND Century Code Sec. 43-17-44, (Accessed Oct. 2022).

A controlled substance that is a prescription drug may not be delivered, distributed, or dispensed by means of the internet without a valid prescription, but nothing in this subsection may be construed to imply that one in-person medical evaluation by itself demonstrates that a prescription has been validly issued for a legitimate medical purpose within the usual course of professional practice.

This section applies to the delivery, distribution, and dispensing of a controlled substance by means of the internet from a location whether within or outside this state to a person or an address in this state.

Nothing in this section applies to the delivery, distribution, or dispensing of a controlled substance by a practitioner engaged in the practice of telemedicine in accordance with applicable federal and state laws.

“Valid prescription” means a prescription that is issued for a legitimate medical purpose in the usual course of professional practice by a:

  • Practitioner who has conducted at least one in-person medical evaluation of the patient; or
  • Covering practitioner.
“Covering practitioner” means, with respect to a patient, a practitioner who conducts a medical evaluation, other than an in-person medical evaluation, at the request of a practitioner who:
  • Has conducted at least one in-person medical evaluation of the patient or an evaluation of the patient through the practice of telemedicine, within the previous twenty-four months; and
  • Is temporarily unavailable to conduct the evaluation of the patient.

A licensee who has performed a telemedicine examination or evaluation meeting the requirements of this chapter may prescribe medications according to the licensee’s professional discretion and judgment. Opioids may only be prescribed through telemedicine if done so as a federal food and drug administration-approved medication-assisted treatment for opioid use disorder. Opioids may not be prescribed through a telemedicine encounter for any other purpose.

Licensees who prescribe controlled substances, as defined by North Dakota law, in circumstances allowed under this rule, must comply with all state and federal laws regarding the prescribing of controlled substances, and must participate in the North Dakota prescription drug monitoring program.

SOURCE: ND Admin Code Sec. 50-02-15-02, (Accessed Oct. 2022).

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Ohio

Last updated 09/07/2022

A physician shall not prescribe, personally furnish or otherwise provide, …

A physician shall not prescribe, personally furnish or otherwise provide, or cause to be provided any controlled substance or non-controlled substance to a person on whom the physician has never conducted a physical examination, with the exceptions listed below.

Non-Controlled Substances Exceptions

Prescribing is allowed when a patient is remote from the physician by complying with the following:

  • Establish the patient’s identity and physical location;
  • Obtain the patient’s informed consent;
  • Forward medical record to patient’s primary care provider (upon consent);
  • Conduct an appropriate evaluation;
  • Establish or confirm a diagnosis and treatment plan;
  • Document information in patient’s medical record;
  • Provide or recommend appropriate follow-up care;
  • Make medical record of the visit available to patient; and
  • Use appropriate technology sufficient to conduct all steps.

Separate exceptions exist for prescribing controlled substances when the patient is remote from the physician.  See regulation.

SOURCE: OH Admin. Code 4731-11-09. (Accessed Sept. 2022).

A patient evaluation performed within the previous twenty-four months via telemedicine by a healthcare provider acting within the scope of their professional license is acceptable for satisfying the criteria to be an “active patient”.

SOURCE: OAC 4731-11-01(D). (Accessed Sept. 2022).

An optometrist who holds a therapeutic pharmaceutical agents certificate issued under this chapter may provide telehealth services in accordance with section 4743.09 of the Revised Code.

SOURCE: OH Revised Code Section 4725.35. (Accessed Sept. 2022).

A pharmacist may provide telehealth services in accordance with section 4743.09 of the Revised Code, except that in the case of dispensing a dangerous drug, a pharmacist shall not use telehealth mechanisms or other virtual means to perform any of the actions involved in dispensing the dangerous drug unless the action is authorized by the state board of pharmacy through rules it adopts under this chapter or section 4743.09 of the Revised Code.

SOURCE: OH Revised Code Section 4729.285.(Accessed Sept. 2022).

Certificate to recommend medical use of marijuana

For purposes of recommending use of marijuana, a physician who holds a certificate to recommend may recommend that a patient be treated with medical marijuana if all of the following conditions are met:

  • The patient has been diagnosed with a qualifying medical condition;
  • A bona fide physician-patient relationship has been established through all of the following:
    • An examination of the patient by the physician either in person or through the use of telehealth services in accordance with section 4743.09 of the Revised Code;
    • A review of the patient’s medical history by the physician;
    • An expectation of providing care and receiving care on an ongoing basis.

See Code for additional requirements.

SOURCE: OH Revised Code Section 4731.30, (Accessed Sept. 2022).

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Oklahoma

Last updated 09/05/2022

A valid physician-patient relationship may be established by an allopathic …

A valid physician-patient relationship may be established by an allopathic or osteopathic physician with a patient located in this state through telemedicine, provided that the physician:

  • Holds a license to practice medicine in this state;
  • Confirms the patient’s identity and physical location; and
  • Provides the patient with the treating physician’s identity and professional credentials.

Telemedicine encounters shall comply with the Health Insurance Portability and Accountability Act of 1996 and ensure that all patient communications and records are secure and confidential.  Telemedicine encounters in this state shall not be used to establish a valid physician-patient relationship for purpose of prescribing opiates, synthetic opiates, semisynthetic opiates, benzodiazepine or carisprodol, but may be used to prescribe opioid antagonists or partial agonists.

The relationship shall not be based solely on the receipt of patient health information by a physician.  The duties and obligations created by a physician-patient relationship shall not apply until the physician affirmatively:

  • Undertakes to diagnose and treat the patient; or
  • Participates in the diagnosis and treatment of the patient.

SOURCE: OK Statutes, Title 59, Ch. 11 Sec. 478.1. (Accessed Sept. 2022).

Unprofessional Conduct includes prescribing or administering a drug or treatment without sufficient examination and the establishment of a valid physician-patient relationship and not prescribing in a safe, medically accepted manner.

SOURCE: OK Statute, Title 59, Sec. 509.(12), (Accessed Sept. 2022).

A physician/patient relationship is established when a physician agrees by direct or indirect contact with a patient to diagnose or treat any condition, illness or disability presented by a patient to that physician, whether or not such a presenting complaint is considered a disease by the general medical community. The physician/patient relationship shall include a medically appropriate, timely-scheduled, face-to-face encounter with the patient, subject to any supervisory responsibilities established elsewhere in these rules except the following providers are not subject to the face-to-face encounter:

  • Providers covering the practice of another provider may approve refills of previously ordered medications if they have access to the medical file of the patient.
  • Hospice medical directors may initiate prescriptions based on requests from licensed health care providers and on information from Hospice records.
  • Providers ordering appropriate medications for persons with laboratory-proven, sexually transmitted diseases and persons who have been in contact with certain infectious diseases.
  • Telemedicine physicians who meet the criteria set out in OAC 435:10-7-13 of this Subchapter.
  • Licensed healthcare providers providing medical immunizations, which may be implemented by means of standing order(s) and/or policies.
  • Licensed providers ordering opioid antagonists pursuant to 63 O.S. §1-2506.2.

SOURCE: OK Admin. Code Sec. 435:10-7-12. (Accessed Sept. 2022).

Abortion-inducing drugs shall not be provided directly to the patient through the mail, telemedicine or otherwise outside of the parameters of the Oklahoma Abortion-Inducing Drug Certification Program.

NOTE: This law is being challenged in court, and may be temporarily blocked.

SOURCE: OK Statute, Title 63, Ch. 1, Sec.1-757.4, (Accessed Sept. 2022).

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Oregon

Last updated 11/10/2022

“Telepharmacy” means the delivery of pharmacy services by a pharmacist, …

“Telepharmacy” means the delivery of pharmacy services by a pharmacist, through the use of a variety of electronic and telecommunications technologies, to a patient at a remote location staffed by a pharmacy technician.

The pharmacy services for which a pharmacist may use telepharmacy include the supervision of the dispensation of prescription drugs to a patient.

The remote location at which a patient receives pharmacy services through the use of telepharmacy must be affiliated with the pharmacy where the pharmacist providing the pharmacy services through telepharmacy regularly engages in the practice of pharmacy.

The State Board of Pharmacy shall adopt rules to carry out this section. The rules adopted under this section must include rules:

  • Regarding remote supervision of a pharmacy technician in order to facilitate the use of telepharmacy; and
  • Describing the pharmacy services that a pharmacist may provide through telepharmacy.

In adopting rules under this section, the board may not establish standards for telephar- macy that are more restrictive than standards for the delivery of in-person pharmacy services, including standards regarding prescription and dispensation of drugs. This paragraph may not be construed to limit the authority of the board to adopt rules to require compliance with any applicable federal law.

SOURCE: OR Revised Statutes 689.700 as amended by HB 4034 (2022 Session). (Accessed Nov. 2022). 

“Telepharmacy” means the delivery of pharmacy services by an Oregon licensed Pharmacist through the use of a telepharmacy system to a patient at a remote location staffed by a Certified Oregon Pharmacy Technician.

“Telepharmacy system” means a system of telecommunications technologies that enables monitoring, documenting and recording of the delivery of pharmacy services at a remote location by an electronic method which must include the use of audio and video, still image capture, and store and forward.

SOURCE: OAR 855-139-0005. (Accessed Nov. 2022).

Remote Dispensing Site Pharmacy

A location in Oregon where the practice of pharmacy occurs by an Oregon licensed Pharmacist through the use of a telepharmacy system to a patient at a remote location staffed by a Certified Oregon Pharmacy Technician or Pharmacy Technician must be registered by the board in Oregon as a Retail Drug Outlet RDSP.

SOURCE: OAR 855-139-0010. (Accessed Nov. 2022).

Non-Resident Affiliated Pharmacies

A non-resident pharmacy includes a RDSP Affiliated Pharmacy located outside of Oregon and providing pharmacy services through a telepharmacy system to a Retail Drug Outlet RDSP located in Oregon.

Each non-resident RDSP Affiliated Pharmacy must be registered with the Oregon Board of Pharmacy.

To qualify for registration under these rules, every non-resident RDSP Affiliated Pharmacy must be registered and in good standing with the Board of Pharmacy in the pharmacy’s state of residence.

Each out-of-state non-resident RDSP Affiliated Pharmacy must designate an Oregon licensed Pharmacist-in-Charge (PIC), who is responsible for all pharmacy services and to provide supervision and control of the RDSP. To qualify for this designation, the person must:

  • Hold a license to practice pharmacy in the resident state;
  • Be normally working for the RDSP Affiliated Pharmacy a minimum of 20 hours per week;
  • Complete the annual RDSP PIC self-inspection report prior to February 1 each year; and
  • Provide the PIC self-inspection report as requested by the board.
  • Every non-resident RDSP Affiliated Pharmacy will have a Pharmacist-in-Charge (PIC) who is licensed in Oregon prior to initial registration of the RDSP.

SOURCE: OAR 855-139-0030. (Accessed Nov. 2022).

The Oregon licensed Pharmacist-in-charge of the RDSP Affiliated Pharmacy is responsible for all operations at the RDSP including responsibility for the telepharmacy system and enforcing policies and procedures.

SOURCE: OAR 855-139-0050. (Accessed Nov. 2022).

Technology

A RDSP and its RDSP Affiliated Pharmacy must:

  • Utilize a shared telepharmacy system and have appropriate technology or interface to allow access to information required to process and fill a prescription drug order;
  • Use still image capture or store and forward for verification of prescriptions with a camera that is of sufficient quality and resolution so that the Oregon licensed Pharmacist from the RDSP Affiliated Pharmacy can visually identify each

Please see rule for additional requirements.

SOURCE: OAR 855-139-0205. (Accessed Nov. 2022).

Chiropractic Physician

The use of telehealth as described in subsection (2) of this section is not an expansion of the scope of practice of chiropractic physicians. The use of telehealth establishes a doctor-patient relationship.

SOURCE: OAR 811-015-0066. (Accessed Aug. 2022).

A physician granted a license to practice medicine across state lines has the same duties and responsibilities and is subject to the same penalties and sanctions as any other provider licensed in Oregon, including but not limited to: …

  • Refrain from writing prescriptions based only from a sale or consultation over the internet.

SOURCE: OR Admin. Rules, 847-025-0000. (Accessed Nov. 2022).

Optometry

“Telehealth prescription” may only be issued on an intial spectacle or contact lens prescription only after conducting an in-person eye exam prior to delivering telemedicine.

SOURCE: OAR 852-001-0002. (Accessed Nov. 2022). 

A physician licensed under ORS 677.100 to 677.228, a physician assistant licensed under ORS 677.505 to 677.525 or a physician or physician assistant licensed under ORS 677.139 may use telemedicine to provide health care services, including the establishment of a patient-provider relationship, the diagnosis or treatment of a medical condition or the prescription of drugs, to a patient physically located in this state. The physician or physician assistant is not required to be physically located in this state when providing health care services through telemedicine.

SOURCE: OR Revised Statutes Chapter 677 as amended by HB 4034 (2022 Session). (Accessed Nov. 2022). 

Emergency Rule (Expires Dec. 27, 2022)

A pharmacist receiving a prescription is responsible for:

  • Using professional judgment in dispensing only pursuant to a valid prescription. A pharmacist shall not dispense a prescription if the pharmacist, in their professional judgment, believes that the prescription was issued without a valid patient-practitioner relationship. In this rule, the term practitioner shall include a clinical associate of the practitioner or any other practitioner acting in the practitioner’s absence. The prescription must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of their professional practice and issued pursuant to a valid patient-practitioner relationship.

See statute for additional requirements.

SOURCE: OAR 855-019-0210. (Accessed Nov. 2022).

A telemedicine licensee [physicians practicing medicine across state lines] must not:

  • Act as a dispensing physician as described in ORS 677.010(5) or dispensing physician assistant as described in ORS 677.511;
  • Prescribe controlled substances for the management of chronic pain to a person located in Oregon;
  • Provide written documentation for purposes of ORS 475C.783;
  • Employ a physician assistant as defined in ORS 677.495 to treat a person located within Oregon…
  • Prescribe medication based only on a sale or form over the Internet, unless an appropriate provider-patient relationship is established and the standard of care described in ORS 677.095 and 677.265 is met.

SOURCE: OR Admin Rules, 847-025-0030. (Accessed Nov. 2022).

A telemedicine licensee [physicians practicing medicine across state lines] has the same duties and responsibilities and is subject to the same penalties and sanctions as any other physician or physician assistant licensed under ORS Chapter 677, including but not limited to the following:

  • The telemedicine licensee must establish an appropriate provider-patient relationship

SOURCE: OR Admin. Rules, 847-025-0000. (Accessed Nov. 2022).

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Pennsylvania

Last updated 09/06/2022

No Reference Found

No Reference Found

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Puerto Rico

Last updated 09/08/2022

No reference found.

No reference found.

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Rhode Island

Last updated 10/21/2022

Treatment and consultation recommendations made in an online setting, including …

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 face-to-face settings. Treatment, including issuing a prescription, based solely on an online questionnaire without an appropriate evaluation does not constitute an acceptable standard of care and is considered unprofessional conduct.

SOURCE: RI Department of Health. Telemedicine. (Accessed Oct. 2022).

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 face-to-face settings. Therefore, consistent with the definition of telemedicine, provided in § 1.2(A)(25) of this Part, treatment, including issuing a prescription, based solely on an online questionnaire without an appropriate evaluation does not constitute an acceptable standard of care and is considered unprofessional conduct. Asynchronous evaluation of a patient, without contemporaneous real-time, interactive exchange between the physician and patient, is not appropriate.

SOURCE: Code of RI Rules, 216-40-05-1, (Accessed Oct. 2022).

Life-Saving Allergy Medication – Emergency Administration

An authorized entity that acquires a stock supply of epinephrine auto-injectors pursuant to a prescription issued in accordance with this chapter, may make such epinephrine auto-injectors available to individuals other than those trained individuals described in § 23-6.4-6, and such individuals may administer such epinephrine auto-injector to any individual believed in good faith to be experiencing anaphylaxis, if the epinephrine auto-injectors are stored in a locked, secure container and are made available only upon remote authorization by an authorized healthcare provider after consultation with the authorized healthcare provider by audio, televideo, or other similar means of electronic communication. Consultation with an authorized healthcare provider for this purpose shall not be considered the practice of telemedicine or otherwise be construed as violating any law or rule regulating the authorized healthcare provider’s professional practice.

SOURCE: RI Gen. Laws 23-6.4-5, (Accessed Oct. 2022).

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South Carolina

Last updated 08/12/2022

A licensee who establishes a physician-patient relationship solely via telemedicine …

A licensee who establishes a physician-patient relationship solely via telemedicine shall adhere to the same standard of care as a licensee employing more traditional in-person medical care and be evaluated according to the standard of care applicable to the licensee’s area of specialty. A licensee shall not establish a physician-patient relationship by telemedicine for the purpose of prescribing medication when an in-person physical examination is necessary for diagnosis.

Schedule II and Schedule III prescriptions are not permitted except for those Schedule II and Schedule III medications specifically authorized by the board, which may include, but not be limited to, Schedule II-nonnarcotic and Schedule III-nonnarcotic medications.

To establish a physician-patient relationship via telemedicine, the provider must:

    • Comply with state and federal laws on patient confidentiality
    • Adhere to current standards of practice improvement and monitoring of outcomes and provide reports containing such information upon request of the board;
    • Provide an appropriate evaluation prior to diagnosing and/or treating the patient, which need not be done in-person if the licensee employs technology sufficient to accurately diagnose and treat the patient in conformity with the applicable standard of care; provided, that evaluations in which a licensee is at a distance from the patient, but a practitioner is able to provide various physical findings the licensee needs to complete an adequate assessment, is permitted; further, provided, that a simple questionnaire without an appropriate evaluation is prohibited;
    • Verify the identity and location of the patient and be prepared to inform the patient of the licensee’s name, location and professional credentials;
    • Establish a diagnosis through the use of accepted medical practices, which may include patient history, mental status evaluation, physical examination, and appropriate diagnostic and laboratory testing in conformity with the applicable standard of care;
    • Ensure availability of follow-up care and maintain a complete medical record that is available to the patient and other treating health care practitioners, to be distributed to other treating health care practitioners only with patient consent and in accordance with applicable law and regulation;
    • Prescribe within a practice setting fully in compliance with the law and during an encounter in which threshold information necessary to make an accurate diagnosis has been obtained in a medical history interview conducted by the prescribing licensee. See Code for specific information on controlled substances.
    • Maintain a complete record of the patient’s care according to prevailing medical record standards that reflects an appropriate evaluation of the patient’s presenting symptoms; provided that relevant components of the telemedicine interaction be documented as with any other encounter;
    • Maintain the patient’s records’ confidentiality and disclose the records to the patient consistent with state and federal law; provided, that licensees practicing telemedicine shall be held to the same standards of professionalism concerning medical records transfer and communication with the primary care provider and medical home as licensees practicing via traditional means; further, provided, that if a patient has a primary care provider and a telemedicine provider for the same ailment, then the primary care provider’s medical record and the telemedicine provider’s record constitute one complete medical record;
    • Be licensed to practice in South Carolina provided, however, a licensee need not reside in South Carolina so long as he or she has a valid, current South Carolina medical license; further, provided, that a licensee residing in South Carolina who intends to practice medicine via telemedicine to treat or diagnose patients outside of South Carolina shall comply with other state licensing boards; and
    • Discuss with the patient the value of having a primary care medical home and, if the patient requests, provide assistance in identifying available options for a primary care medical home.

A licensee, practitioner, or any other person involved in a telemedicine encounter must be trained in the use of the telemedicine equipment and competent in its operation.

Schedule II and III prescriptions are not permitted except as specifically authorized by the board.

Prescribing abortion-inducing drugs is not permitted; as used in this article “abortion-inducing drug” means a medicine, drug, or any other substance prescribed or dispensed with the intent of terminating the clinically diagnosable pregnancy of a woman, with knowledge that the termination will with reasonable likelihood cause the death of the unborn child.

SOURCE: SC Code Annotated Sec. 40-47-37. (Accessed Aug. 2022).

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South Dakota

Last updated 11/10/2022

Any health care professional who utilizes telehealth shall ensure that …

Any health care professional who utilizes telehealth shall ensure that a proper health provider-patient relationship is established and includes:

  • Verifying and authenticating the location and, to the extent reasonable, identifying the requesting patient;
  • Disclosing and validating the health care professional’s identity and applicable credentials, as appropriate;
  • Obtaining appropriate consent for treatment from a requesting patient after disclosure regarding the delivery models and treatment methods or limitations;
  • Establishing a diagnosis through the use of acceptable medical practices, including patient history, mental status examination, physical examination, and appropriate diagnostic and laboratory testing;
  • Discussing with the patient the diagnosis and its evidentiary basis and the risks and benefits of various treatment options;
  • Ensuring appropriate follow-up care for the patient;
  • Providing a visit summary to the patient or consult note; and
  • Utilizing technology sufficient to evaluate or diagnose and appropriately treat a patient for the condition as presented in accordance with the applicable standard of care.

Exceptions to the requirements of this section include on-call, cross coverage situations, and consultation with another health care professional who has an ongoing health care provider relationship with the patient and agrees to supervise the patient’s care and emergency treatment.

SOURCE: SD Codified Laws Sec. 34-52-3  (Accessed Nov. 2022).

A health care professional using telehealth to provide medical care to any patient located in the state shall provide an appropriate face-to-face examination using real-time audio and visual technology prior to diagnosis and treatment of the patient, if a face-to-face encounter would otherwise be required in the provision of the same service not delivered via telehealth.

SOURCE: SD Codified Laws Sec. 34-52-5. (Accessed Nov. 2022).

Without a proper provider-patient relationship, a health care professional using telehealth may not prescribe a controlled drug or substance, as defined by § 34-20B-3, solely in response to an internet questionnaire or consult, including any encounter via telephone.

SOURCE: SD Codified Laws Sec. 34-52-6. (Accessed Nov. 2022).

Recently Passed Legislation

Mifepristone and Misoprostol must be prescribed and dispensed by a licensed physician in a licensed abortion facility consistent with chapter 34-23A and in compliance with the applicable requirements in chapter 36-4.

SOURCE: SD Codified Laws Sec. 36-4-8 & Ch. 36-4 as amended by HB 1318 (2022 Session). (Accessed Nov. 2022).

 

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Tennessee

Last updated 09/04/2022

For the purposes of this section, a healthcare provider-patient relationship …

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: (1) Affirmatively undertakes to diagnose or treat the patient; or (2) Affirmatively participates in the diagnosis or treatment.

SOURCE:  TN Code Sec. 63-1-155, (Accessed Sept. 2022).

Prerequisites to Issuing Prescriptions or Dispensing Medications – In Person, Electronically, and Over the Internet

(a) 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:

  • Perform an appropriate history and physical examination;
  • Make a diagnosis, consistent with good medical care;
  • Formulate a therapeutic plan and discuss it with the patient;
  • Ensure the availability for appropriate follow-up care.

SOURCE: TN Rule Annotated, 0880-02-.14(7)(a). (Accessed Sept. 2022).

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: Certain conditions apply in each case. See rule for details.

SOURCE: TN Rule Annotated, 0880-02.-16(6)(a). (Accessed Sept. 2022).

Optometry

Optometrist-patient relationship. Pursuant to T.C.A. § 63-1-155(b), an optometrist- 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 optometrist. The consent by the patient may be expressed or implied consent; however, the optometrist-patient relationship is not created simply by the receipt of patient health information by an optometrist unless a prior optometrist-patient relationship exists. The duties and obligations created by the relationship do not arise until the optometrist:

  • Affirmatively undertakes to diagnose or treat the patient; or
  • Affirmatively participates in the diagnosis or treatment.

The optometrist-patient relationship established via telehealth, shall at a minimum, meet the requirements of T.C.A. § 63-1-155(b).

SOURCE: TN Code 1045-02-.18, (Accessed Sept. 2022). 

Recently Passed Legislation 

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 63-1-155. as amended by SB  NO. 2240 (2022 Session), (Accessed Sept. 2022).

 

 

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Texas

Last updated 09/07/2022

A valid practitioner-patient relationship is present between a practitioner providing …

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 same standard of care as would apply in an in-person setting, and complies with one of the following scenarios:

  • Has a preexisting practitioner-patient relationship with the patient established;
  • 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 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 follow-up requirements and the method allows the practitioner to have access to the relevant clinical information that would be required to meet the standard of care.
  • Synchronous audiovisual interaction between the practitioner and the patient in another location
  • Asynchronous store-and-forward technology, including in conjunction with synchronous audio interaction, as long as practitioner uses relevant clinical information from clinically relevant photographic or video 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 appropriate standard of care

A practitioner who provides telemedicine medical services to a patient shall provide the patient with guidance on appropriate follow up care and with the patient’s consent, forward the report of the encounter to the patient’s primary care physician within 72 hours.

A practitioner-patient relationship is not present for purposes of prescribing an abortifacient or other drug or device to terminate a pregnancy.

The Texas Medical Board, Texas Board of Nursing, Texas Physician Assistant Board, and the Texas Pharmacy Board are required to adopt joint rules that establish the determination of a valid prescription, which must allow for the establishment of the practitioner-patient relationship through telemedicine if it meets the standards outlined above.

This section does not apply to mental health 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.

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.

SOURCE: TX Occupations Code 111.005-.009, (Accessed Sept. 2022).

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.

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 dental health professional providing a dental health care service or procedure as a teledentistry dental service:

  • must establish a practitioner-patient relationship

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.

SOURCE: TX Administrative Code Title 22, Part 5, Ch. 108, Rule 108.16. (Accessed Sept. 2022).

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.

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: TX Admin. Code, Title 22, Part 9, Ch. 174.5 & Title 22, Part 11, Ch. 217.24, (Accessed Sept. 2022).

APRNs Treating Chronic Pain

An APRN, when determining whether to utilize telemedicine medical services for the treatment of chronic pain with controlled substances, 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, 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 Sept. 2022).

Establishing a practitioner-patient relationship is not required for prescription of medication to treat for sexually transmitted disease for partners of the physician’s established patient, if the physician determines that the patient may have been infected; or drugs or vaccines for after close contact with an infectious disease (see list of applicable diseases in regulation).

SOURCE: TX Admin. Code, Title 22, Part 9, Ch. 190.8(1)(L). (Accessed Sept. 2022).

An outpatient chemical dependency treatment program provided by a treatment facility 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 Sept. 2022).

Physicians who treat and prescribe through communications technology are practicing medicine and must possess a full Texas medical license when treating residents of Texas. An out-of-state physician may provide episodic consultations without a Texas medical license, as provided in Texas Occupations Code, §151.056, §172.2(g)(4) of this title (relating to Construction and Definitions), and §172.12(f) of this title (relating to Out-of-State Telemedicine License).

SOURCE: TX Admin. Code, Title 22, Part 9, Sec. 174.8. (Accessed Sept. 2022).

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Utah

Last updated 08/23/2022

A provider offering telehealth services shall at all times:

  • act

A provider offering telehealth services shall at all times:

  • act within the scope of the provider’s license; and
  • be held to the same standards of practice as those applicable in traditional health care settings

If the provider does not already have a provider-patient relationship with the patient, establish a provider-patient relationship during the patient encounter in a manner consistent with the standards of practice, including providing the provider’s licensure and credentials to the patient;

Before providing treatment or prescribing a prescription drug, establish a diagnosis and identify underlying conditions and contraindications to a recommended treatment after:

  • obtaining from the patient or another provider the patient’s relevant clinical history; and
  • documenting the patient’s relevant clinical history and current symptoms;

Be available to a patient who receives telehealth services from the provider for subsequent care related to the initial telemedicine services, in accordance with community standards of practice.

Be familiar with available medical resources, including emergency resources near the originating site, in order to make appropriate patient referrals when medically indicated.

Make available to each patient receiving telehealth services the patient’s medical records; and

If the patient has a designated health care provider who is not the telemedicine provider:

  • Consult with the patient regarding whether to provide the patient’s designated health care provider a medical record or other report containing an explanation of the treatment provided to the patient and the telemedicine provider’s evaluation, analysis, or diagnosis of the patient’s condition;
  • Collect from the patient the contact information of the patient’s designated health care provider; and
  • Within two weeks after the day on which the telemedicine provider provides services to the patient, and to the extent allowed under HIPAA as that term is defined in Section 26-18-17, provide the medical record or report to the patient’s designated health care provider, unless the patient indicates that the patient does not want the telemedicine provider to send the medical record or report to the patient’s designated health care provider.

Unless a provider has established a provider-patient relationship with a patient, a provider offering telemedicine services may not diagnose a patient, provide treatment, or prescribe a prescription drug based solely on one of the following:

  • an online questionnaire;
  • an email message; or
  • a patient-generated medical history.

A provider may not offer telehealth services if:

  • the provider is not in compliance with applicable laws, rules, and regulations regarding the provider’s licensed practice; or
  • the provider’s license under Title 58, Occupations and Professions, is not active and in good standing.

SOURCE: UT Code, 26-60-103. (Accessed Aug. 2022).

It is considered unprofessional conduct to issue, or aid and abet in the issuance of, an order or prescription for a drug or device:

  • without first obtaining information in the usual course of professional practice, that is sufficient to establish a diagnosis, to identify conditions, and to identify contraindications to the proposed treatment; or
  • with prescriptive authority conferred by an exception issued under this title, or a multi-state practice privilege recognized under this title, if the prescription was issued without first obtaining information, in the usual course of professional practice, that is sufficient to establish a diagnosis, to identify underlying conditions, and to identify contraindications to the proposed treatment.

SOURCE: UT Code, 58-1-501(2(m)). (Accessed Aug. 2022).

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Vermont

Last updated 10/27/2022

Providers may prescribe, dispense, or administer drugs or medical supplies, …

Providers may prescribe, dispense, or administer drugs or medical supplies, or otherwise provide treatment recommendations to a patient after having performed an appropriate examination of the patient in person, through telemedicine, or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically. Treatment recommendations made via electronic means, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional provider-patient settings.

SOURCE: VT Statutes Annotated, Title 18 Sec. 9361(b)  (Accessed Oct. 2022).

Recently Passed Legislation

A physician shall not be subject to any civil or criminal liability or professional disciplinary action if the physician prescribes to a patient with a terminal condition medication to be self-administered for the purpose of hastening the patient’s death and the physician affirms by documenting in the patient’s medical record that all of the following occurred:

  • The patient made an oral request to the physician in the physician’s physical presence or by telemedicine, if the physician determines the use of telemedicine to be clinically appropriate, for medication to be self- administered for the purpose of hastening the patient’s death.
  • Not fewer than 15 days after the first oral request, the patient made a second oral request to the physician in the physician’s physical presence or by telemedicine, if the physician determines the use of telemedicine to be clinically appropriate, for medication to be self- administered for the purpose of hastening the patient’s death.

No physician, nurse, pharmacist, or other person licensed, certified, or otherwise authorized by law to deliver health care services in this State shall be subject to civil or criminal liability or professional disciplinary action for acting in good faith compliance with the provisions of this chapter.

SOURCE: VT S. 74 (No. 97). (2022 Session), (Accessed Oct. 2022).

 

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Virgin Islands

Last updated 09/08/2022

The Board of Medical Examiners shall establish by rules and …

The Board of Medical Examiners shall establish by rules and regulations the requirements for telemedicine licensure in accordance with this subchapter, provided that the rules and regulations include the following: …

The physician, when examining a patient by telemedicine, shall establish a bona fide physician-patient relationship by:

  • Establishing a relationship and coordinating with the patient’s Virgin Islands-licensed healthcare professional.
  • Establishing a diagnosis through the use of accepted medical practices including, but not limited to, patient history, mental status and appropriate diagnostic and laboratory testing.
  • Discussing with the patient any diagnosis as well as the risks and benefits of various treatment options.
  • Ensuring the availability for appropriate follow-up care.
  • Fulfilling any other requirements as deemed appropriate and necessary by the Board of Medical Examiners.

SOURCE:  27 V.I. Code Section 45d(c)(2)  (Accessed Sept. 2022).

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Virginia

Last updated 11/23/2022

The practitioner-patient relationship is fundamental to the provision of acceptable …

The practitioner-patient relationship is fundamental to the provision of acceptable medical care. It is the expectation of the Board that practitioners recognize the obligations, responsibilities, and patient rights associated with establishing and maintaining a practitioner-patient relationship. Where an existing practitioner-patient relationship is not present, a practitioner must take appropriate steps to establish a practitioner-patient relationship consistent with the guidelines identified in this document, with Virginia law, and with any other applicable law.  While each circumstance is unique, such practitioner-patient relationships may be established using telemedicine services provided the standard of care is met.

A practitioner is discouraged from rendering medical advice and/or care using telemedicine services without (1) fully verifying and authenticating the location and, to the extent possible, confirming the identity of the requesting patient; (2) disclosing and validating the practitioner’s identity and applicable credential(s); and (3) obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations, including any special informed consents regarding the use of telemedicine services. An appropriate practitioner-patient relationship has not been established when the identity of the practitioner may be unknown to the patient.

A documented medical evaluation and collection 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 must be obtained prior to providing treatment, which treatment includes the issuance of 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, in-person encounters. Treatment, including issuing a prescription based solely on an online questionnaire, does not constitute an acceptable standard of care.

Prescribing controlled substances requires the establishment of a bona fide practitioner-patient relationship in accordance with § 54.1-3303 (A) of the Code of Virginia. Prescribing controlled substances, in-person or via telemedicine services, is at the professional discretion of the prescribing practitioner. The indication, appropriateness, and safety considerations for each prescription provided via telemedicine services must be evaluated by the practitioner in accordance with applicable law and current standards of practice and consequently carries the same professional accountability as prescriptions delivered during an in-person encounter. Where such measures are upheld, and the appropriate clinical consideration is carried out and documented, the practitioner may exercise their judgment and prescribe controlled substances as part of telemedicine encounters in accordance with applicable state and federal law.

Prescriptions must comply with the requirements set out in Virginia Code §§ 54.1-3408.01 and 54.1-3303(A). Prescribing controlled substances in Schedule II through V via telemedicine also requires compliance with federal rules for the practice of telemedicine. Practitioners issuing prescriptions as part of telemedicine services should include direct contact for the prescriber or the prescriber’s agent on the prescription. This direct contact information ensures ease of access by pharmacists to clarify prescription orders, and further facilitates the prescriber-patient-pharmacist relationship.

SOURCE: Telemedicine Guidance. Doc. # 85-12. VA Board of Medicine. P. 2-4 (Aug. 19, 2021). (Accessed Nov. 2022).

A practitioner who has established a bona fide practitioner-patient relationship with a patient in accordance with the provisions of this subsection may prescribe Schedule II through VI controlled substances to that patient via telemedicine if such prescribing is in compliance with federal requirements for the practice of telemedicine and, in the case of the prescribing of a Schedule II through V controlled substance the prescriber maintains a practice at a physical location in the Commonwealth or is able to make appropriate referral of patients to a licensed practitioner located in the Commonwealth in order to ensure an in-person examination of the patient when required by the standard of care.

Adds to the conditions a prescriber must meet for a bona fide practitioner-patient relationship for the purpose of prescribing Schedule II through VI controlled substances by an examination through face-to-face interactive, two-way, real-time communications services or store-and-forward technologies. Includes:

  • The establishment of a bona fide practitioner-patient relationship via telemedicine is consistent with the standard of care, and the standard of care does not require an in-person examination for the purpose of diagnosis; and
  • The establishment of a bona fide practitioner patient relationship via telemedicine is consistent with federal law and regulations and any waiver thereof.

SOURCE: VA Code Annotated 54.1-3303, (Accessed Nov. 2022).

Teledentistry

No person shall practice dentistry unless a bona fide dentist-patient relationship is established in person or through teledentistry. A bona fide dentist-patient relationship shall exist if the dentist has:

  • Obtained or caused to be obtained a health and dental history of the patient;
  • Performed or caused to be performed an appropriate examination of the patient, either physically, through use of instrumentation and diagnostic equipment through which digital scans, photographs, images, and dental records are able to be transmitted electronically, or through use of face-to-face interactive two-way real-time communications services or store-and-forward technologies;
  • Provided information to the patient about the services to be performed; and
  • Initiated additional diagnostic tests or referrals as needed. In cases in which a dentist is providing teledentistry, the examination required by clause (ii) shall not be required if the patient has been examined in person by a dentist licensed by the Board within the six months prior to the initiation of teledentistry and the patient’s dental records of such examination have been reviewed by the dentist providing teledentistry.

SOURCE: VA Statute 54.1-2711.  (Accessed Nov. 2022).

Certification for use of cannabis oil for treatment.

The practitioner shall use his professional judgement to determine the manner and frequency of patient care and evaluation and may employ the use of telemedicine provided that the use of telemedicine includes the delivery of patient care through real-time interactive audio-visual technology. Such telemedicine use shall be consistent with federal requirements for the prescribing of Schedule II through V controlled substances.

SOURCE: VA Code Annotated Sec. 54.1-3408.3. (Accessed Nov. 2022).

The practitioner shall use his professional judgment to determine the manner and frequency of patient care and evaluation, which may include the use of telemedicine, provided that the use of telemedicine:

  • Includes the delivery of patient care through real-time interactive audio-visual technology;
  • Conforms to the standard of care expected for in-person care; and
  • Transmits information in a manner that protects patient confidentiality.

Such telemedicine use shall be consistent with federal requirements for the prescribing of Schedules II through V controlled substances.

SOURCE: 18VAC110-60-30(C). (Accessed Nov. 2022).

A pharmacist may initiate treatment with, dispense, or administer drugs, devices, controlled paraphernalia, and other supplies and equipment pursuant to this section through telemedicine services, as defined in § 38.2-3418.16, in compliance with all requirements of § 54.1-3303 and consistent with the applicable standard of care.

SOURCE: VA Code 54.1-3303.1. (Accessed Nov. 2022).

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Washington

Last updated 08/27/2022

The WA Medical Quality Assurance Commission has issued guidance on …

The WA Medical Quality Assurance Commission has issued guidance on the use telemedicine.  Guidance does not have the force of law, but can be considered by the Commission to be the standard of practice in the state.

A practitioner who uses telemedicine must establish a valid practitioner-patient relationship with the person who receives telemedicine services. The relationship is established when the practitioner agrees to undertake diagnosis or treatment of the patient and the patient agrees that the practitioner will diagnose or treat the patient. A valid practitioner-patient relationship may be established through telemedicine if the standard of care does not require an initial in- person encounter.

Prior to providing treatment, including issuing prescriptions, a practitioner who uses telemedicine should interview the patient to collect the relevant medical history and perform a physical examination, when medically necessary, sufficient for the diagnosis and treatment of the patient. A practitioner may not delegate an appropriate history and physical examination to an unlicensed person or to a licensed individual for whom that function would be out of the scope of the license.

Once a practitioner has obtained a relevant medical history and performed a physical examination, it is within the practitioner’s judgment to determine whether it is medically necessary to obtain a history or perform a physical examination at subsequent encounters. The technology used in a telemedicine encounter must be sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed inperson by the practitioner. An on-line questionnaire does not constitute an acceptable medical interview for the provision of treatment, including issuance of prescriptions, by a practitioner. The standard of care requires direct interaction with a licensed practitioner.

SOURCE: Washington Medical Commission, Defining and Providing Guidance on Telemedicine Usage, p. 4 (November 19, 2021). (Accessed Aug. 2022).

For purposes of authorizing the medical use of marijuana, a physician must complete an in-person physical exam or a remote physical exam when certain conditions are met. Following an in-person physical examination to authorize the use of marijuana for medical purposes, the health care professional may determine and note in the patient’s medical record that subsequent physical examinations for the purposes of renewing an authorization may occur through the use of telemedicine technology if the health care professional determines that requiring the qualifying patient to attend a physical examination in person to renew an authorization would likely result in severe hardship to the qualifying patient because of the qualifying patient’s physical or emotional condition.

SOURCE: Revised Code Washington Sec. 69.51A.030. (Accessed Aug. 2022).

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West Virginia

Last updated 08/31/2022

Each health care board is required to propose an emergency …

Each health care board is required to propose an emergency rule for telehealth regulation. The rule must include a prohibition of prescribing any controlled substance listed in Schedule II of the Uniform Controlled Substance Act, unless authorized by another section: Provided, That the prescribing limitations contained in this section do not apply to a physician or a member of the same group practice with an established patient.

The standard of care shall require that with respect to the established patient, the patient shall visit an in-person health care practitioner within 12 months of using the initial telemedicine service or the telemedicine service shall no longer be available to the patient until an in-person visit is obtained. This requirement may be suspended, in the discretion of the health care practitioner, on a case-by-case basis, and it does not apply to the following services: acute inpatient care, post-operative follow-up checks, behavioral medicine, addiction medicine, or palliative care.

SOURCE: WV Statute Sec. 30-1-26. (Accessed Aug. 2022).

A “valid patient-practitioner relationship” can be established through telemedicine in a manner approved by the appropriate practitioner board.

SOURCE: WV Code Sec. 30-5-4. (Accessed Aug. 2022).

A physician-patient relationship may not be established through:

  • Text-based communications such as e-mail, Internet questionnaires, text-based messaging, or other written forms of communication.
If an existing physician-patient relationship is not present prior to the utilization to telemedicine technologies, or if services are rendered solely through telemedicine technologies, a physician-patient relationship may only be established:
  • Through the use of telemedicine technologies which incorporate interactive audio using store and forward technology, real-time videoconferencing, or similar secure video services during the initial physician-patient encounter;
  • For the practice of pathology and radiology, a physician-patient relationship may be established through store and forward telemedicine or other similar technologies; or
  • Through the use of audio-only calls or conversations that occur in real time. Patient communication though audio-visual communication is preferable, if available or possible. Audio-only calls or conversations that occur in real time may be used to establish the physician-patient relationship.

Once a physician-patient relationship has been established, either through an in-person encounter or in accordance with the above, the physician may utilize any telemedicine technology that meets the standard of care and is appropriate for the patient presentation.

A physician or podiatrist who practices medicine to a patient solely through the utilization of telemedicine technologies may not prescribe to that patient any controlled substances listed in Schedule II of the Uniform Controlled Substances Act: Provided, That the prescribing limitations contained in this section do not apply to a physician or a member of the same group practice with an established patient.

The prescribing limitations do not apply when a physician is providing treatment to patients who are minors, or if 18 years of age or older, who are enrolled in a primary or secondary education program and are diagnosed with intellectual or developmental disabilities, neurological disease, Attention Deficit Disorder, Autism, or a traumatic brain injury in accordance with guidelines as set forth by organizations such as the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, or the American Academy of Pediatrics. The physician must maintain records supporting the diagnosis and the continued need of treatment.

The prescribing limitations do not apply to a hospital, excluding the emergency department, when a physician submits an order to dispense a controlled substance, listed in Schedule II of the Uniform Controlled Substances Act, to a hospital patient for immediate administration in a hospital.

A physician or podiatrist may not prescribe any pain-relieving controlled substance listed in Schedule II of the Uniform Controlled Substance Act as part of a course of treatment for chronic nonmalignant pain solely based upon a telemedicine encounter: Provided, That the prescribing limitations contained in this section do not apply to a physician or a member of the same group practice with an established patient.

A physician or health care provider may not prescribe any drug with the intent of causing an abortion.

These provisions do not prohibit the use of audio-only or text-based communications by a physician who is:

  • Responding to a call for patients with whom a physician-patient relationship has been established through an in-person encounter by the physician;
  • Providing cross coverage for a physician who has established a physician-patient or relationship with the patient through an in-person encounter; or
  • Providing medical assistance in the event of an emergency.

SOURCE: WV Statute Sec. 30-14-12d & 30-3-13a, (Accessed Aug. 2022).

“Dishonorable, unethical or unprofessional conduct of a character likely to deceive, defraud or harm the public or any member thereof” includes practice of providing treatment recommendations relating to issuing prescriptions, via electronic or other means, for persons without establishing an on-going physician-patient relationship wherein the physician has obtained information adequate to support the prescription: Provided, That this definition does not apply: in a documented emergency; or in an on-call or cross coverage situation; or where patient care is rendered in consultation with another physician who has an ongoing relationship with the patient, and who has agreed to supervise the patient’s treatment, including use of any prescribed medications.

SOURCE: WV Code of State Rules Sec. 11-1A-12.2(k) p. 19. (Accessed Aug. 2022).

A practitioner providing medication-assisted treatment may perform certain aspects of telehealth if permitted under his or her scope of practice.

SOURCE: WV Code Sec. 16-5Y-5(r). (Accessed Aug. 2022).

Veterinarians

A veterinarian-client-patient relationship is required for providing veterinary care in the State of West Virginia via telehealth services. The veterinary care professional shall perform an in person exam within the 12 months prior, and at least every 12 months thereafter, or the telehealth service shall no longer be available to the patient. Such relationship exists when:

  • A veterinarian assumes responsibility for medical judgments regarding the health of an animal and the client who is the owner or owner’s advocate of the animal consents to the veterinarian’s treatment plan; and 
  • A veterinarian, through personal examination of an animal or a representative sample of a herd or flock, obtains sufficient information to make at least a general or preliminary diagnosis of the medical condition of the animal, herd or flock, which diagnosis is expanded through medically appropriate visits to the premises where the animal, herd or flock is kept,
  • In the event of an imminent, life-threatening emergency veterinary care may be provided in this State via telehealth services without an existing veterinarian-client-patient relationship or an in-person visit within 12 months.

A registrant shall not prescribe any controlled substance listed in Schedule II of the Uniform Controlled Substance Act via interstate telehealth services.

SOURCE: WV Statute Sec. 30-10-24, as added by HB 4570 (2022 Session). (Accessed Aug. 2022).

Final Rule (Effective until August 1st, 2027) – Dentistry

No person shall practice teledentistry unless a bona fide practitioner-patient relationship is established. A bona fide practitioner-patient relationship shall exist if the dentist has:

  • obtained or caused to be obtained a health and dental history of the patient
  • performed or caused to be performed an appropriate examination of the patient, either physically, through use of instrumentation and diagnostic equipment by which digital scans, photographs, images, and dental records are able to be transmitted electronically, or through use of face-to-face interactive two-way real-time communications services or store-and-forward technologies
  • provided information to the patient about the services to be performed
  • initiated additional diagnostic tests or referrals as needed; or
  • through audio only calls or conversations that occur in real time

In cases in which a dentist is providing teledentistry, the examination required shall not be required if the patient has been examined in person by a dentist licensed by the board within the twelve months prior to the initiation of teledentistry and the patient’s dental records of such examination have been reviewed by the practitioner providing teledentistry.

SOURCE: WV Admin Law 5-16-4. (Accessed Aug. 2022).

Final Rule (Effective until August 1st, 2027) – Medical Board

Among other ways, a provider-patient relationship is formed when a provider serves a patient’s medical needs, examines, diagnoses or treats a patient, or agrees to examine, diagnose or treat a patient.

A provider-patient relationship may be established through:

  • An in-person patient encounter;
  • Store and forward telemedicine or other similar technologies for the practice of pathology and radiology;
  • Telemedicine technologies which incorporate interactive audio using store and forward technology, real-time videoconferencing, or similar secure video services during the initial provider-patient encounter; or
  • Audio-only calls or conversations that occur in real time.

While real-time audio-only communications may be utilized to establish the provider-patient relationship, patient communication though audio-visual communication is preferable, if available or possible.  Real-time audio-only communications may not be utilized when its use does not conform to the standard of care.

The provider-patient relationship may not be established through text-based communications such as email, internet questionnaires, text-based messaging, or other written forms of communication.

A telehealth provider’s selection of telemedicine technologies for a patient encounter must permit the provider to meet the standard of care for the patient’s particular health issue and presentation.  Treatment, including issuing a prescription, based solely on an online questionnaire, does not conform to the standard of care.

When prescribing to a patient via telemedicine, a telehealth provider shall prescribe within the prescriptive authority of the provider’s profession in West Virginia.

A telehealth provider who provides health care to a patient solely through the use of telemedicine technologies is prohibited from prescribing a controlled substance listed in Schedule II of the Uniform Controlled Substance Act except under the following circumstances:

  • The patient is an established patient of the prescribing telehealth provider’s group practice;
  • The provider submits an order to dispense a Schedule II controlled substance to a hospital patient, other than in the emergency department, for immediate administration in a hospital
  • The telehealth provider is treating patients who are minors, or if 18 years of age or older, who are emolled in a primary or secondary education program and are diagnosed with intellectual or developmental disabilities, neurological disease, Attention Deficit Disorder, Autism, or a traumatic brain injury in accordance with guidelines as set forth by organizations such as the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, or the American Academy of Pediatrics. The provider must maintain records supporting the diagnosis and the continued need of treatment.

See rule for additional requirements for prescribing controlled substances.

A telehealth provider may not, based solely upon a telemedicine encounter, prescribe any drug with the intent of causing an abortion.

SOURCE: WV Admin Law 11-15-6, 7 & 8. (Accessed Aug. 2022).

Final Rule (Effective until August 1st, 2027) – Board of Nursing

A practitioner-patient relationship may be established through:

  • An in-person patient encounter;
  • Telemedicine technologies which incorporate interactive audio using store and forward technology, real-time videoconferencing, or similar secure video services during the initial provider-patient encounter; or
  • Audio-only calls or conversations that occur in real time.

While real-time audio-only communications may be utilized to establish the practitioner-patient relationship, patient communication through audio-visual communication is preferable, if available or possible.  Real-time audio-only communications may not be utilized when its use does not conform to the standard of care.

The practitioner-patient relationship may not be established through text-based communications such as email, internet questionnaires, text-based messaging, or other written forms of communication.

After a practitioner-patient relationship has been established, a practitioner may utilize any telemedicine technology that meets the standard of care and is appropriate for the patient presentation.

A telehealth provider’s selection of telemedicine technologies for a patient encounter must permit the provider to meet the standard of care for the patient’s particular health issue and presentation.  Treatment, including issuing a prescription if the nurse has prescriptive authority, based solely on an online questionnaire, does not conform to the standard of care.

The standard of care requires a telehealth provider to verify that a patient has visited an in-person health care practitioner within twelve months of an initial telehealth service by the provider or the provider’s telehealth service or company. Continued treatment of a patient solely through telemedicine technologies after an initial telehealth encounter, with no intervening in-person health services, violates the standard of care. The provisions of this subsection do not apply to acute inpatient care, post-operative follow-up checks, behavioral medicine, addiction medicine, or palliative care; and may be suspended, in the discretion of the telehealth provider, on a case-by-case basis. If suspended, the telehealth provider must document the reason for suspending the in-person visit requirement in the patient medical record.

APRNs:  When prescribing to a patient via telemedicine, a telehealth provider shall prescribe within the prescriptive authority of the provider’s profession in the state of West Virginia pursuant to qualified advanced practice registered nurses to prescribe prescription drugs in accordance with the provisions of W. Va. Code § 60A-9-5a and the requirements set forth in §30-7-15a, 15b, and 15c and 19 CSR 08.

See rule for requirements for controlled substances.

SOURCE: WV Admin Law 19-16-6, 7, 8 (Accessed Aug. 2022).

Final Rule (Effective until August 1st, 2027) – Board of Osteopathic Medicine

A provider-patient relationship may be established through:

  • An in-person patient encounter;
  • Store and forward telemedicine or other similar technologies for the practice of pathology and radiology;
  • Telemedicine technologies which incorporate interactive audio using store and forward technology, real-time videoconferencing, or similar secure video services during the initial provider-patient encounter; or
  • Audio-only calls or conversations that occur in real time.

The provider-patient relationship may not be established through text-based communications such as email, internet questionnaires, text-based messaging, or other written forms of communication. After a provider-patient relationship has been established, a provider may utilize any telemedicine technology that meets the standard of care and is appropriate for the patient presentation.

It is the standard of care in this state for health care practitioners to complete an appropriate controlled substance prescribing course prior to prescribing controlled substances to patients located in West Virginia.  The Board maintains a list of Board-approved courses in drug diversion training and best practice prescribing controlled substances training on its website.  Registrants may comply with the standard of care by completing a Board-approved course or a controlled substance continuing education course required by the registrant’s state of licensure.

When prescribing to a patient via telemedicine, a telehealth provider shall prescribe within the prescriptive authority of the provider’s profession in this state.

A telehealth provider who provides health care to a patient solely through the use of telemedicine technologies is prohibited from prescribing a controlled substance listed in Schedule II of the Uniform Controlled Substance Act except under the following circumstances:

  • The patient is an established patient of the prescribing telehealth provider’s group practice;
  • The provider submits an order to dispense a Schedule II controlled substance to a hospital patient, other than in the emergency department, for immediate administration in a hospital; or
  • The telehealth provider is treating patients who are minors, or if 18 years of age or older, who are enrolled in a primary or secondary education program and are diagnosed with intellectual or developmental disabilities, neurological disease, Attention Deficit Disorder, Autism, or a traumatic brain injury in accordance with guidelines as set forth by organizations such as the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, or the American Academy of Pediatrics. The provider must maintain records supporting the diagnosis and the continued need of treatment.

See additional requirements for providers who prescribe controlled substances.

A telehealth provider may not, based solely upon a telemedicine encounter, prescribe any drug with the intent of causing an abortion.

SOURCE: WV Admin Law 24-10-6, 7, 8 (Accessed Aug. 2022).

Final Rule (Effective until August 1, 2030) – Social Workers

The practitioner-client relationship is established at the time informed consent is obtained.

SOURCE: WV Admin Law 25-1-5. (Accessed Aug. 2022).

Final Rule (Effective until August 1, 2030) – Speech Language Pathology and Audiology

Established patient means a patient who has, within the last three years, received professional services, face-to-face, from the physician, qualified health care professional, or another physician or qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice.

The standard of care requires that with respect to the established patient, the patient shall visit an in-person health care practitioner within 12 months of using the initial telepractice service or the telepractice service shall no longer be available to the patient until an in-person visit is obtained. This requirement may be suspended, in the discretion of the health care practitioner, on a case-by-case basis, but it does not apply to the following services: acute inpatient care, post-operative follow-up checks, behavioral medicine, addiction medicine, or palliative care.

SOURCE: WV Rule 29-01-16. (Accessed Aug. 2022).

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Wisconsin

Last updated 11/21/2022

When a physician uses a website to communicate with a …

When a physician uses a website to communicate with a patient located in this state, the physician may not provide treatment recommendations, including issuing a prescription unless the following requirements are met:

  • The physician shall be licensed in the state;
  • The physician’s name and contact information must be made available to the patient;
  • Informed consent is required;
  • A documented patient evaluation performed;
  • A patient health care record is prepared and maintained.

Prescribing based on a static electronic questionnaire does not meet the minimum standard of competent medical practice.

SOURCE: WI Admin. Code MED Ch. 24.07 (Accessed Nov. 2022).

A physician-patient relationship may be established through telemedicine.

SOURCE: WI Admin. Code MED Ch. 24.03 (Accessed Nov. 2022).

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Wyoming

Last updated 10/20/2022

Initially prescribing a controlled substance through the Internet, World Wide …

Initially prescribing a controlled substance through the Internet, World Wide Web or any similar proprietary or common carrier electronic system without a documented physician-patient relationship is subject to review, discipline and consequences to license.

SOURCE: WY Statutes Annotated Sec. 33-26-402(a(xxxiii)). (Accessed Oct. 2022).

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Professional Requirements

Online Prescribing

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