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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Federal

Last updated 02/28/2021

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 Feb. 2021).

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 Feb. 2021).

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 Feb. 2021).

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Alabama

Last updated

The Alabama Board of Medical Examiners holds the position that, …

The Alabama Board of Medical Examiners holds the position that, when prescribing medications to an individual, the prescriber, when possible, should personally examine the patient.  Prescribing medications for patients the physician has not personally examined may be suitable for certain circumstances, including telemedicine.

Licensees are expected to adhere to federal and state statute regarding prescribing of controlled substances.

SOURCE: AL Admin. Code. r. 540-X-9-.11(2) & (3), (Accessed Feb. 2021).

Board of Optometry

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 Feb. 2021).

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Alaska

Last updated 02/28/2021

The guiding principles for telemedicine practice in the American Medical …

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.

During a disaster emergency declared by the Governor, 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 treatment for opioid use disorder and the physician or physician assistant:

  • Is a Drug Addiction Treatment Act (DATA) waivered practitioner;
  • Documents all attempts to conduct a physical examination and the reason why the examination cannot be performed; 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 & Emergency Regulations made permanent (Accessed Feb. 2021).

A physician is not subject to disciplinary sanctions for rendering a diagnosis, treatment or prescribing a prescription drug (except a controlled substance) without a physical examination if the physician or another health care provider or physician in the physician’s group practice is available for follow up care and the physician requests that the person consent to sending a copy of all records of the encounter to the person’s primary care provider.

If the above requirements are met, a physician may also prescribe a controlled substance or botulinum toxin when an appropriate licensed health care provider is present with the patient to assist the physician with examination, diagnosis and treatment.

SOURCE: Alaska Department of Commerce, Medical Statutes and Regulations Sept. 2020. (Accessed Feb. 2021).

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

SOURCE: AK Admin. Code, Title 12, Sec. 40.967(27). (Accessed Feb. 2021).

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Arizona

Last updated 02/28/2021

Physicians are prohibited from issuing a prescription to patients without …

Physicians are prohibited from issuing a prescription to patients without having a physical or mental health status examination to establish a provider-patient relationship.

The physical or mental health status examination can be conducting during a real-time telemedicine encounter, unless the examination is for purpose of obtaining a written certification from the physician for medical marijuana.

SOURCE: Arizona Revised Statute Sec. 32-1401(tt) (Accessed Feb. 2021).

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Arkansas

Last updated 02/28/2021

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.

SOURCE: AR Code 17-80-403 (Accessed Feb. 2021). 

A proper physician or physician assistant/patient relationship can be established via real time audio and video telemedicine if it provides information at least equal to such information as would have been obtained by an in-person examination.

SOURCE: AR Rules and Regulation. Sec. 060.00.16. (Accessed Feb. 2021).

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.

A physician may not use telemedicine to issue a prescription for a controlled substance under schedules II through V unless they have seen the patient in-person or 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.  Reg. 38.  (Accessed Feb. 2021). 

When abortion inducing drugs are used, the initial administration must occur in the same room and in the physical presence of the prescribing physician.

SOURCE:  AR Code Annotated Section 20-16-603(b)(1). (Accessed Feb. 2021). 

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.

SOURCE: AR Code Annotated Sec. 17-92-1003(14)(B). (Accessed Feb. 2021). 

A professional relationship cannot be established only through:

  • An internet questionnaire
  • Email message
  • Patient generated medical history
  • Audio only communication, including without limitation interactive audio
  • Text messaging
  • Facsimile machine
  • Any combination thereof

SOURCE: AR Code 17-80-403(c). (Accessed Feb. 2021). 

A written medical marijuana certification is not allowed when an assessment is performed through telemedicine.

SOURCE: AR  Constitution, Amendment 98 Sec. 2(19)(c). (Accessed Feb. 2021).

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California

Last updated 02/28/2021

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 Feb. 2021).

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 & Professionals Code Sec. 4130-4135 (Accessed Feb. 2021).

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Colorado

Last updated 02/28/2021

A pharmacist shall not dispense a prescription drug if the …

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. 7. (Accessed Feb. 2021).

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)(a), p. 34. (Accessed Feb. 2021).

“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 Feb. 2021).

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Connecticut

Last updated 02/28/2021

No telehealth provider shall prescribe any schedule I, II or …

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.

SOURCE: CT General Statute 19a, Sec. 906(c) (Accessed Feb. 2021).

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Delaware

Last updated 02/28/2021

Pharmacists are prohibited from dispensing prescription drug orders through an …

Pharmacists 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.

SOURCE: DE Code, Title 16 Sec. 4744(d)(1)(a). (Accessed Feb. 2021)

APRNs and Physicians

Establishing a proper provider-patient relationship includes:

  • Verifying the location of and to the extent possible, the identity of the requesting patient;
  • Disclosing the provider’s identity and credentials;
  • Obtaining consent;
  • Establishing a diagnosis through acceptable medical practices, including a physical exam;
  • Discuss with patient the diagnosis;
  • Ensure availability of distant site provider or coverage of patient for follow up care; and
  • Provide written visit summary to patient.

Without a prior patient-provider relationship, providers are prohibited from issuing prescriptions based on internet questionnaire, internet consult or a telephone consult.

Prescriptions through telemedicine and under a physician-patient relationship may include controlled substances, subject to limitations set by the Board.

SOURCE: Title 24, Sec. 1769D(b) & DE Code Title 24, Sec. 1933(b)(4)(g). (Accessed Feb. 2021).

Physicians

Prior to a diagnosis and treatment, a physician using telemedicine must either provide:

  • An appropriate in-person exam;
  • Have another DE licensed practitioner at the originating site with the patient at the time of diagnosis;
  • Diagnosis must be based using both audio and visual communication; or
  • The service meets standards of establishing a patient-physician relationship included as part of evidenced-based clinical practice guidelines in telemedicine developed by major medical specialty societies.

After a relationship has been established, subsequent treatment of the same patient with the same physician need not satisfy the limitations of this section.

This section shall not limit the practice of radiology or pathology.

SOURCE: Title 24, Sec. 1769D(h)(i)(j). (Accessed Feb. 2021). 

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. Sec. 1700.  Sec. 19. (Accessed Feb. 2021).

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District of Columbia

Last updated 02/28/2021

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.

A physician-patient relationship can be established through real-time telemedicine.

SOURCE: DC Code Sec. 17-4618.3 & 4 (Accessed Feb. 2021).

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Florida

Last updated 02/28/2021

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 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 Feb. 2021).

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Georgia

Last updated 02/28/2021

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 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.

SOURCE: GA Rules & Regulations revised 360-3-.07. (Accessed Feb. 2021). 

Physicians are prohibited from prescribing controlled substances or dangerous drugs based solely on an electronic consult, unless the physician is on-call or covering for another provider and prescribing up to a 72-hour supply of medications for a patient of the other provider.

There is also an exception for 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), 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.

SOURCE: GA Rules & Regulations revised 360-3-.02. (Accessed Feb. 2021).

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Hawaii

Last updated 02/28/2021

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;
  • Ensure the availability of appropriate follow-up care.

SOURCE: HI Revised Statutes § 329-1. (Accessed Feb. 2021)

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 prohibited.

A physician-patient relationship may be established via telehealth if the patient is referred to the telehealth provider by another health care provider who has conducted an in-person consultation and has provided all pertinent patient information to the telehealth provider. Once a provider-patient relationship is established, a patient or physician licensed in Hawaii may use telehealth for any purpose, including consultation with a medical provider 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 Feb. 2021).

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 Feb. 2021).  

 

 

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Idaho

Last updated 02/28/2021

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

Prescribing physicians 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 are prohibited.

SOURCE: ID Code § 54-1733. (Accessed Feb. 2021).

Recently Amended (Effective Now)

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 technologies sufficient to conduct a patient evaluation and appropriate to diagnose and treatment the patient, 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 21 U.S.C. section 802(54)(A).

SOURCE: ID Code Sec. 54-5705 & 5707 & HB 342 (2020 Session). (Accessed Feb. 2021).

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Illinois

Last updated 02/28/2021

No Reference Found

No Reference Found

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Indiana

Last updated 02/28/2021

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, Title 844, 5-3-2. (Accessed Feb. 2021). 

A provider may not issue a prescription unless they have established a provider-patient relationship.  At a minimum that includes:

  1. Obtain the patient’s name and contact information (see regulation for other related requirements);
  2. Disclose the prescriber’s name and credentials;
  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, and with consent 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 telemedicine visit summary to the patient, including information that indicates any prescriptions that is being prescribed.

SOURCE: IN Code, 25-1-9.5-7. (Accessed Feb. 2021).

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 telemedicine 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.
  • The patient has been examined in-person by a licensed Indiana health care provider and the licensed health care provider has established a treatment plan to assist the prescriber in the diagnosis of the patient.
  • The prescriber has reviewed and approved the treatment plan described in subdivision (3) and is prescribing for the patient pursuant to the treatment plan.
  • The prescriber complies with the requirements of the INSPECT program (IC 35-48-7).

SOURCE: IN Code 25-1-9.5-8. (Accessed Feb. 2021).

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Iowa

Last updated 02/28/2021

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, and was completed without a pre-existing patient-provider relationship.

SOURCE: IA Admin. Code, 657 8.19(5). (Accessed Feb. 2021). 

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 Feb. 2021). 

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.

SOURCE: IA Admin. Code, 653 13.11(8) (Accessed Feb. 2021).

Recently Passed Legislation

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: Senate File 2261 (2020 Session).  (Accessed Feb. 2021).

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Kansas

Last updated 02/28/2021

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 Feb. 2021). 

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 Feb. 2021).

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

SOURCE:  KS Statute Ann. § 40-2,212(b). (Accessed Feb. 2021).

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Kentucky

Last updated 02/28/2021

Prior to prescribing in response to any communication transmitted or …

Prior to prescribing in response to any communication transmitted or received by computer or other electronic means, physicians must establish a proper physician-patient relationship. This includes:

  • 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;
  • Maintenance of a current medical record.

An electronic, online, or telephone evaluation by questionnaire are inadequate for the initial or any follow-up evaluation.

SOURCE: KY Revised Statutes § 311.597. (Accessed Feb. 2021).

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 Feb. 2021).

The Board of Speech Language Pathology and Audiology does not allow for the establishment of a practitioner-patient relationship via telehealth. They require an in-person meeting to occur first.

SOURCE: KY 201 KAR 17:110. (Accessed Feb. 2021).

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 Feb. 2021).

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Louisiana

Last updated 02/28/2021

Louisiana law requires that a physician who uses telemedicine establish …

Louisiana law requires that a physician who uses telemedicine establish a proper physician-patient relationship.  Physicians must:

  • 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;
  • Discuss the diagnosis and risks and benefits of various treatment options;
  • ·Ensure the availability of follow up care;
  • Create and/or maintain a medical record.

SOURCE: LA Admin. Code 46: XLV.7503. (Accessed Feb. 2021). 

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.

To establish a physician-patient relationship an in-person visit is not required 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.

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. (Accessed Feb. 2021).

For physicians practicing telemedicine and treating a patient at a healthcare facility that is required to be licensed according to the laws of LA and holds a current registration with the US Drug Enforcement Administration:

  • Physician must use the same standard of care as in-person.
  • Physician must be authorized to prescribe any controlled dangerous substance without necessity of conducting an appropriate in-person patient history or physical examination.
  • Physician shall not be subject to any regulation prohibition or restriction on the use of telemedicine that is more restrictive than those that are otherwise applicable to their entire profession.

SOURCE: LA Statute Sec. 37:1271.1. (Accessed Feb. 2021). 

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 Feb. 2021).

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Maine

Last updated 02/28/2021

Board of Licensure in Medicine & Board of Osteopathic Licensure

Board of Licensure in Medicine & Board of Osteopathic Licensure

Prior to providing treatment, including issuing prescriptions, electronically or otherwise, a licensee who uses telemedicine in providing health care 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 the licensee.

A valid physician-patient relationship may be established between a licensee who uses telemedicine in providing health care and a patient who receives telemedicine services through consultation with another licensee or through a telemedicine encounter if the standard of care does not require an in-person encounter and in accordance with evidence-based standards for practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

SOURCE: ME Regulation Sec. 02-373-6 & 02-383-6. (Accessed Feb. 2021). 

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Maryland

Last updated 02/28/2021

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: HB 448 & SB 402. (2020 Session). (Accessed Feb. 2021).

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

  • Verify the identification of the patient receiving telehealth services;
  • xcept 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.

See rule for additional requirements when the service is not an asynchronous telehealth service.

SOURCE:  Code of Maryland Admin. Regs. Sec. 10.32.05.04 (Accessed Feb. 2021).

  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.

SOURCE:  Code of Maryland Admin. Regs. Sec. 10.32.05.05 (Accessed Feb. 2021).

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 Feb. 2021).

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Massachusetts

Last updated 02/28/2021

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.  June 25, 2020. (Accessed Feb. 2021).

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 03-06 (Adopted Oct. 8, 2015). (Accessed Feb. 2021).

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 501.111. (Accessed Feb. 2021).

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Michigan

Last updated 02/28/2021

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

SOURCE: …

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

SOURCE: MI Compiled Laws Sec. 333.17751(2)(a).  (Accessed Feb. 2021).

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 Feb. 2021). 

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. 16285. (Accessed Feb. 2021).

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Minnesota

Last updated 02/28/2021

A physician-patient relationship may be established through telemedicine.

SOURCE: MN

A physician-patient relationship may be established through telemedicine.

SOURCE: MN Statute 147.033.  (Accessed Feb. 2021). 

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

The requirement for an examination shall be met if 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.

SOURCE: MN Statute Sec. 151.37 Subd. 2(d)(5). (Accessed Feb. 2021).

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; 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 Feb. 2021). 

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Mississippi

Last updated 02/28/2021

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 Sec. 41-29-137(f)(3). (Accessed Feb. 2021).

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.

Physicians 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.

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.

 SOURCE: MS Admin. Code Title 30, Sec. 2635, Rule 5.4 & 5.5. (Accessed Feb. 2021).

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Missouri

Last updated 02/28/2021

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.

SOURCE: MO Revised Statutes § 334.100(4)(h) (2018). (Accessed Feb. 2021).

A telemedicine encounter can establish a physician-patient relationship 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 Feb. 2021).

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 Feb. 2021).

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Montana

Last updated 04/27/2021

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

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 appropriate health care providers (see regulation)
  • securely maintain and make timely available medical and billing records to patient or patient’s representative and to other health care providers.

SOURCE: Montana State Board of Medical Examiners. Administrative Rules of MT. Rule 24.156.813 Practice Requirements for Physicians Using Telemedicine. (Accessed Apr. 2021).

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Nebraska

Last updated 02/28/2021

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 and may prescribe while using 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.

SOURCE: NE Revised Statute 38-1,143. (Accessed Feb. 2021).

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Nevada

Last updated 02/28/2021

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.

SOURCE: NV Revised Statutes Sec. 629.515(1) (Accessed Feb. 2021).

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 Feb. 2021).

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 Feb. 2021).

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 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 Feb. 2021).

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 Feb. 2021).

 

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New Hampshire

Last updated 02/28/2021

“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, 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. 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. (Accessed Feb. 2021).

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.

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, (NH HB 1623, 2020 Session). (Accessed Feb. 2021).

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 (HB 1620 – 2020 Session), (Accessed Feb. 2021).

A prescription of a non-opioid controlled drug classified in schedule II through IV via telemedicine shall be limited to certain practitioners 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).

SOURCE: NH Revised Statutes Annotated 318-B:2(XVI). (Accessed Feb. 2021).

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New Jersey

Last updated 02/28/2021

The prescription of Schedule II controlled substances through telemedicine or …

The prescription of Schedule II controlled substances through telemedicine or telehealth is authorized only after an initial in-person examination, and subsequent in-person visit with the patient is required every three months for the duration of prescription.  Does not apply when prescribing stimulant which is a Schedule II controlled dangerous substance for use by a minor under the age of 18 provided 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 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(e). (Accessed Feb. 2021).

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 Feb. 2021).

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New Mexico

Last updated 02/28/2021

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 Feb. 2021).

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New York

Last updated 02/28/2021

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 Feb. 2021).

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 Feb. 2021).

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North Carolina

Last updated 02/28/2021

No Reference Found

No Reference Found

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North Dakota

Last updated 02/28/2021

A valid prescription via e-prescribing means a prescription has been …

A valid prescription via e-prescribing means a prescription has been issued for a legitimate medical purpose, in the usual course of professional practice, by a practitioner who has first conducted an in-person medical evaluation of the patient.   An in-person medical evaluation can include the referring practitioner having performed the exam, in the case of a consultant practitioner issuing a prescription or drug order when providing services by means of telemedicine.

SOURCE: ND Century Code Sec. 19-02.1-15.1.(c) & (f) (Accessed Feb. 2021).

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Ohio

Last updated 02/28/2021

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 Feb. 2021).

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 Feb. 2021).

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Oklahoma

Last updated 02/28/2021

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 and store and forward technology 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 and encounters involving store-and-forward technology 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 Feb. 2021).

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 Feb. 2021).

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.  Telemedicine physicians who meet certain criteria are not subject to the face-to-face requirement to establish a physician-patient relationship.

A physician-patient relationship includes a medically appropriate, timely-scheduled, actual face-to-face encounter with the patient.

SOURCE: OK Admin. Code Sec. 435:10-7-12. (Accessed Feb. 2021).

 

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Oregon

Last updated 02/28/2021

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Pennsylvania

Last updated 02/28/2021

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Rhode Island

Last updated 02/28/2021

An established in-person physician-patient relationship is required prior to prescribing …

An established in-person physician-patient relationship is required prior to prescribing controlled substances. However, a covering physician may prescribe a controlled substance if an established coverage agreement is in place and the quantity reflects the prescription is only for a short duration.

SOURCE: RI Department of Health. Telemedicine. (Accessed Feb. 2021).

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South Carolina

Last updated 02/28/2021

A licensee shall not establish a physician-patient relationship by telemedicine …

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.

SOURCE: SC Code Annotated Sec. 40-47-37. (Accessed Feb. 2021).

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South Dakota

Last updated 04/29/2021

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 & Senate Bill 96 (2021 Session). (Accessed Apr. 2021).

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 Apr. 2021).

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 Apr. 2021).

 

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Tennessee

Last updated 02/28/2021

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 & HB 8002 (2020 Session). (Accessed Feb. 2021). 

Prior to online or telephone prescribing, providers must complete and document 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 Feb. 2021).

A physician-patient relationship can be established via telemedicine with or without a facilitator present. Certain conditions apply in each case. See rule for details.

SOURCE: TN Rule Annotated, 0880-02.-16(6)(a). (Accessed Feb. 2021).

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Texas

Last updated 02/28/2021

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 and a patient receiving the telemedicine medical 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
  • Provides the telemedicine medical 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
  • 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 medical records
  • 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.

SOURCE: TX Occupations Code 111.005-.008. (Accessed Feb. 2021).

A valid prescription must be issued for a legitimate medical purpose and meet all other applicable laws before prescribing.

Treatment of chronic pain with scheduled drugs through use of telemedicine is prohibited unless otherwise allowed under federal and state law.  Treatment of acute pain with scheduled drugs through telemedicine is allowed unless otherwise prohibited under federal and state law.

SOURCE: TX Admin. Code, Title 22, Part 9, Ch. 174.5. (Accessed Feb. 2021).

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 Feb. 2021).

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Utah

Last updated 02/28/2021

Before providing treatment or prescribing a prescription drug, provider must:…

Before providing treatment or prescribing a prescription drug, provider must:

  • Obtain and document patient’s relevant clinical history and current symptoms

Except as specifically provided in Title 58, Chapter 83, Online Prescribing, Dispensing, and Facilitation Licensing Act, and 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.

See statute for requirements if the patient has a designated health care provider who is not the telemedicine provider.

SOURCE: UT Code, 26-60-103(1(c) & 3). (Accessed Feb. 2021).

Providers must first obtain 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 Feb. 2021).

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Vermont

Last updated 02/28/2021

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 if they first examine 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 Feb. 2021).

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Virginia

Last updated 02/28/2021

Practitioners prescribing controlled substances must have a “bona fide” relationship …

Practitioners prescribing controlled substances must have a “bona fide” relationship with the patient.

Requirements:

Obtaining a medical or drug history;

  • Informing the patient about the benefits and risks of the drug;
  • Conducting a patient exam, either physically or by the use of instrumentation and diagnostic equipment, through which images and medical records may be transmitted electronically; and
  • Initiated additional interventions and follow-up care, if necessary, especially if a prescribed drug may have serious side effects.

Practitioners can also prescribe Schedule II-V controlled substances under certain circumstances and in compliance with federal requirements.  Additional requirements apply for the prescription of Schedule VI controlled substances via telemedicine.

An examination is not required in cases in which the practitioner is an employee or contracted by the Department of Health or local health department and is providing expedited partner therapy.  Cases in which the practitioner is an employee of or contracted by the Department of Health or a local health department, a “bona-fide” practitioner-patient relationship is not required for purposes of prescribing Schedule VI antibiotics and antiviral agents.

SOURCE: VA Board of Medicine. Telemedicine Guidance Document: 85-12. p. 4 (Oct. 2018) & VA Code Annotated Sec. 54.1-3303. (HB – 1914). (Accessed Feb. 2021).

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 (SB 122 – 2020 Session).  (Accessed Feb. 2021).

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 consistent with federal requirements for the prescribing of Schedule II through V controlled substances.

SOURCE: VA Code Annotated Sec. 54.1-3408. (SB 976 & HB 1460 – 2020 Session). (Accessed Feb. 2021).

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. 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 Feb. 2021).

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Washington

Last updated 02/28/2021

The WA Medical Quality Assurance Commission has issued guidelines on …

The WA Medical Quality Assurance Commission has issued guidelines on the use of the Internet in medical practices.  A guideline does not have the force of law, but can be considered by the Commission to be the standard of practice in the state.

An appropriate history and evaluation of the patient must precede the rendering of any care, including provision of prescriptions.

Patient completion of a questionnaire does not, by itself, establish a practitioner-patient relationship, and therefore treatment, including prescriptions, based solely on a questionnaire does not constitute an acceptable standard of care.

Careful consideration should apply before prescribing DEA-controlled substances, and compliance with all laws and regulations pertaining to such prescriptions is expected.

Treatment, including issuing a prescription, based solely on an online questionnaire or consultation does not constitute an acceptable standard of care.

SOURCE: Washington Medical Quality Assurance Commission, Guidelines for Appropriate Use of the Internet in Medical Practice, p. 3-4, Oct. 3, 2014, (Accessed Feb. 2021).

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 Feb. 2021).

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West Virginia

Last updated 02/28/2021

A “valid patient-practitioner relationship” can be established through telemedicine in …

A “valid patient-practitioner relationship” can be established through telemedicine in a manner approved by the appropriate board.

SOURCE: WV Code Sec. 30-5-4.(67) (Accessed Feb. 2021).

A physician-patient relationship cannot be established through audio only communication, text communications or any combination thereof.

A physician-patient relationship can 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; or for the practice of pathology and radiology, a physician-patient relationship may be established through store and forward telemedicine or other similar technologies.

A physician or podiatrist may not prescribe any pain-relieving controlled substance listed in Schedules II through V of the Uniform Controlled Substance Act as part of a course of treatment for chronic nonmalignant pain solely based upon a telemedicine encounter.

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.  Certain exceptions apply.

A physician or health care provider may not prescribe any drug with the intent of causing an abortion.

SOURCE: WV Code 30-14-12d. (Accessed Feb. 2021).

Prohibits providers from issuing prescriptions, via electronic or other means, for persons without establishing an ongoing physician-patient relationship, wherein the physician has obtained information adequate to support the prescription.

Exceptions:

  • Documented emergencies;
  • On-call or cross-coverage situations;
  • 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) (Accessed Feb. 2021).

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) (SB 273 – 2018).  (Accessed Feb. 2021).

 

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Wisconsin

Last updated 02/28/2021

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 Feb. 2021).

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Wyoming

Last updated 02/28/2021

Prescribing a controlled substance through the Internet, World Wide Web …

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 Feb. 2021).

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Professional Requirements

Online Prescribing

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