Can the pre-treatment exam be done by telehealth, state by state
The same question, answered for 51 states from each state’s own law. States disagree on this, which is the point — an answer that is right in one is wrong next door. Every entry below is a statute or board rule we verified, most recently Sep 8, 2026.
Intake · part of The Practice Perimeter
| State | What its rule says | Cited to |
|---|---|---|
| Alabama | Yes — a physician may form the patient relationship and reach a diagnosis by telemedicine without a prior in-person exam, so long as it uses acceptable medical practices, including any history, physical, or testing the in-person service would require. | Ala. Code § 34-24-703(b)(1), (d) Sep 8, 2026 |
| Alaska | The board may not impose disciplinary sanctions on a physician or physician assistant for rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug that is not a controlled substance to a person without conducting a physical examination if | AS 08.64.364(a) (Prescription of drugs without physical examination) Sep 5, 2026 |
| Arizona | Yes — Arizona telehealth law lets the provider-patient relationship be established and prescribing done remotely with documented informed consent; no prior in-person exam may be required except for Schedule II drugs, which Botox and fillers are not. | A.R.S. §36-3602 Jul 26, 2026 |
| Arkansas | The cited rules do not settle this — the physician must personally diagnose and prescribe the laser treatment, and telemedicine is held to in-person standards of care and needs an established patient/provider relationship, but remote exams aren't addressed. | 17 CAR § 140-3201(a) (Telemedicine — patient/provider relationship) Sep 4, 2026 |
| California | Yes — the appropriate prior exam can be done by telehealth and need not be synchronous; even a self-screening tool or questionnaire can suffice if the standard of care is met. It still can't be delegated to an RN — a physician, NP, or PA must do it. | Cal. Bus. & Prof. Code §2242(a) Sep 8, 2026 |
| Colorado | The cited rules do not settle this — Article 240 imposes no pre-treatment exam duty at all, and telemedicine is itself the practice of medicine, judged against generally accepted standards; nothing cited expressly permits or bars a remote exam. | Colo. Rev. Stat. § 12-240-107(1)(g); § 12-240-121(1)(aa) Sep 2, 2026 |
| Connecticut | No — a cosmetic medical procedure at a medical spa requires an initial in-person physical assessment by the spa's employed or contracted physician, PA, or APRN; the general telehealth standard-of-care rule does not displace that requirement. | Conn. Gen. Stat. §19a-906(b)(1) Sep 8, 2026 |
| Delaware | Yes — the provider-patient relationship may be formed by telehealth, but before diagnosis or treatment you must either examine in person, have a Delaware-licensed provider with the patient, diagnose by audio or visual link, or meet society guidelines. | 24 Del. C. §6003(a) Sep 3, 2026 |
| District of Columbia | Yes — a practitioner-patient relationship may be established by telehealth if it meets the applicable standard of care and the practitioner's scope of practice; the cited rules impose no in-person exam, though the Mayor may add one by rulemaking. | D.C. Code §3-1201.05(b) Sep 3, 2026 |
| Florida | Yes — a telehealth evaluation is allowed if it meets the same standard of care as an in-person visit and is sufficient to diagnose and treat; no prior in-person exam is required, and the prescribing must still sit inside the physician's course of practice. | Fla. Stat. §456.47(2) Jul 26, 2026 |
| Georgia | The cited rules do not settle this — Georgia's telemedicine rule lets a Georgia-licensed physician, PA or APRN treat remotely with history available and technology equal to an in-person exam, but the cosmetic-laser exam rule says nothing about mode. | Ga. Comp. R. & Regs. 360-3-.07(a)(1)-(3) (Practice through electronic or other such means) Sep 8, 2026 |
| Hawaii | Yes — a Hawaii-licensed physician may establish the patient relationship and do the exam by telehealth, if it includes a documented history and symptom discussion adequate to diagnose and identify contraindications; phone, fax or email alone doesn't count. | Haw. Rev. Stat. § 453-1.3(e)-(f) Sep 8, 2026 |
| Idaho | Yes — Idaho allows a provider-patient relationship to be established by virtual care technology, so the pre-treatment exam can be done by telehealth provided the applicable Idaho community standard of care for that treatment is satisfied. | Idaho Code §54-5705 Sep 3, 2026 |
| Illinois | The cited rules do not settle this — they only let the on-site physician exam be skipped for non-ablative laser when an APRN does the exam under a delegation protocol, an RN/LPN trained on the device performs it, and a physician is reachable electronically. | 225 ILCS 60/54.2(e) Aug 17, 2026 |
| Indiana | Only for prescribing — a prescription may issue without a prior in-person exam if standard of care is met, it's in scope, and a valid provider-patient relationship exists (ID/location, consent, history, risks). Remote exams for laser work aren't addressed. | Ind. Code §25-1-9.5-7, §25-1-9.5-8 Jul 26, 2026 |
| Iowa | Iowa's rules cited here don't say whether the exam may be remote, but they exclude care given only by audio-only phone, email, fax or mail from what counts as telemedicine. | Iowa Admin. Code r. 481—655.9(1) (Standards of practice — telemedicine) Sep 4, 2026 |
| Kansas | The cited rules do not settle this — telemedicine may establish a valid provider-patient relationship, and remote care is held to the same standards of practice and conduct as in-person care, but no cited rule addresses the pre-treatment exam itself. | Kan. Stat. Ann. §40-2,212(b) Sep 3, 2026 |
| Kentucky | Kentucky regulates telehealth rather than banning it: the physician must get the patient's informed consent first, and prescribing by electronic means requires verifying identity, a documented diagnosis and a current medical record. | Ky. Rev. Stat. §311.5975(1) Sep 3, 2026 |
| Louisiana | The cited rules do not settle this — they only establish that practicing medicine in Louisiana requires a state license except as allowed under the Louisiana Telehealth Access Act, whose terms for a pre-treatment exam are not reproduced here. | La. Rev. Stat. §37:1271 Sep 3, 2026 |
| Maine | Yes — a licensee under the medical practice chapter may do the exam by telehealth, synchronous or asynchronous, provided it stays within that licensee's scope and meets the same standards of practice and professional conduct rules that apply in person. | 32 M.R.S. §3300-BB Sep 3, 2026 |
| Maryland | Yes — the pre-treatment evaluation may be done by telehealth, synchronously or asynchronously, if it is appropriate for the patient and the presenting condition; the practitioner must refer to in-person care where that is clinically appropriate. | Md. Code Regs. 10.32.05.05(A) (Patient Evaluation) Sep 3, 2026 |
| Massachusetts | The cited rules do not settle this — Massachusetts defines telehealth broadly enough to cover evaluating, diagnosing and prescribing, including audio-only, but no statute sets a pre-treatment exam requirement; that standard sits in Board rules not cited here. | Mass. Gen. Laws ch. 112, § 5O(a) Sep 1, 2026 |
| Michigan | The cited rules do not settle this — they set no pre-treatment exam rule for botulinum toxin or fillers, impose a consent duty when care is delivered remotely, and require a bona fide prescriber-patient relationship plus follow-up for Schedule 2–5 drugs. | Mich. Comp. Laws § 333.16284 Sep 2, 2026 |
| Minnesota | Only for ED drugs and opioid use disorder medications — for the other drugs on the examination list, the exam must have happened in person: by the prescriber, at a prior visit, or by another practitioner in the same group or clinic, or a consultant. | Minn. Stat. § 151.37, subd. 2(e) Sep 2, 2026 |
| Mississippi | Yes — if the technology gives the physician the same information as a face-to-face exam and a physician-patient relationship is established (ID check, history and exam, diagnosis, consent, follow-up); a questionnaire alone won't do. | Miss. Admin. Code Title 30, Part 2635, Rule 5.4 Sep 8, 2026 |
| Missouri | Yes — a telemedicine encounter can establish the physician-patient relationship if the standard of care doesn't require an in-person exam and the technology allows an informed diagnosis as if in person; a patient questionnaire alone isn't enough. | Mo. Rev. Stat. §191.1146.1 Sep 3, 2026 |
| Montana | Yes — if the standard of care for that treatment doesn't require an in-person encounter; the exam must use interactive, audio-only, or store-and-forward technology (not email or fax) and meet the same standard of care as an in-person visit. | Mont. Code Ann. § 37-3-102(14)(a)-(b) Sep 8, 2026 |
| Nebraska | The cited rules do not settle this — Nebraska's Telehealth Act only covers Medicaid-enrolled practitioners, so a cash-pay med spa falls outside it, and nothing cited says whether a pre-treatment exam may be done remotely. | Neb. Rev. Stat. § 71-8503(2)-(3) (Nebraska Telehealth Act — terms defined) Sep 8, 2026 |
| Nevada | Yes — a Nevada-licensed provider may establish the patient relationship by telehealth where doing so is clinically appropriate for that treatment; telehealth does not expand scope of practice or lower the standard of care that would apply in person. | Nev. Rev. Stat. §629.515(4) Sep 3, 2026 |
| New Hampshire | Yes — a telemedicine exam can replace the in-person exam if the physician verifies patient identity, discloses name, contact info and license type, obtains consent, and meets the standard of care; an APRN's exam may also be by telemedicine. | N.H. Rev. Stat. §329:1-c (Physician-Patient Relationship) Sep 3, 2026 |
| New Jersey | Only if the licensee first determines that delivering that exam remotely meets the same standard of care as in person — that call is made for each patient encounter, and if it can't be met before or during the visit, the patient must be told to come in. | N.J.A.C. 13:35-6B.3 (Telemedicine and telehealth — standard of care) Sep 8, 2026 |
| New Mexico | Yes — an APRN or other licensed independent practitioner may use telemedicine for the required face-to-face exam, provided video quality doesn't compromise the assessment or diagnosis and state and federal law is met; it still can't be delegated. | 16.12.14.10(D) NMAC (Patient care — telemedicine) Sep 4, 2026 |
| New York | Yes — a physician, PA, or nurse practitioner may do the pre-treatment assessment and diagnosis remotely, as both sit inside New York's telehealth definition, but only by two-way audio-video, store-and-forward, remote monitoring, or audio-only phone. | N.Y. Pub. Health Law § 2999-cc(2), (4)-(5) (Telehealth — definitions) Sep 8, 2026 |
| North Carolina | Yes — the Board does not require the pre-treatment evaluation to be in person, so a physician, PA or NP may do it by synchronous or asynchronous telemedicine provided the technology is sufficient to accurately diagnose and treat at the standard of care. | NCMB Position Statement 5.1.4 (Telemedicine — licensee-patient relationship; evaluations and examinations) Sep 8, 2026 |
| North Dakota | Yes — an exam by telemedicine is held to the same standard of care as an in-person one; it must establish a bona fide relationship and be performed before any first diagnosis or treatment, and a compliant telemedicine exam supports prescribing. | N.D.C.C. § 43-17-44 (Standard of care — telemedicine and in-person alike) Sep 5, 2026 |
| Ohio | “A health care professional may provide telehealth services to a patient located in this state”, and “The standard of care for a telehealth visit is the same as the standard of care for an in-person visit.” Synchronous or asynchronous technology may be used “provided that the standard of care for an in-person visit… | Ohio Admin. Code 4731-37-01(B) (Telehealth — standard of care) Sep 8, 2026 |
| Oklahoma | The cited rules do not settle this — an Oklahoma-licensed physician may form the patient relationship by telemedicine unless otherwise prohibited (not for opiates or benzodiazepines), but nothing says a remote encounter is a sufficient exam. | Okla. Stat. tit. 59, § 478.1(A), (C) (Establishment of physician-patient relationship through telemedicine) Sep 8, 2026 |
| Oregon | Yes — a licensed physician or physician associate may use telemedicine, synchronous or asynchronous, to establish the provider-patient relationship, diagnose, treat and prescribe; the cited rules do not extend this to nurse practitioners or RNs. | Or. Rev. Stat. §677.494(2) Sep 3, 2026 |
| Pennsylvania | Yes — the pre-treatment exam may be done remotely, including by real-time audio or video, but it is held to the same standard of care as an in-person visit; there is no cosmetic-specific exam rule, so whatever applies in the room applies remotely. | 2024 Pa. Act 42, §§ 4702, 4705 (Telemedicine — definitions; standard of care) Sep 8, 2026 |
| Rhode Island | Yes — a remote exam is allowed but is held to the same standards as a face-to-face visit; treating on an online questionnaire alone is unprofessional conduct, and asynchronous review without a contemporaneous real-time, interactive exchange is not appropriate. | 216-RICR-40-05-1 § 1.5.9(H)(2) (Licensure and Discipline of Physicians — telemedicine standard of care) Sep 8, 2026 |
| South Carolina | Yes — telemedicine is held to the same standard of care as an in-person exam, so a pre-treatment exam may be done remotely only if it meets that standard; the licensee must hold a current South Carolina medical license. Falling short is unprofessional conduct. | S.C. Code §40-47-37(A)(1) Sep 3, 2026 |
| South Dakota | The cited rules do not settle this — they allow telehealth care only by a provider fully licensed in South Dakota (or employed by a listed facility) and subject to the licensing board's rules, but say nothing specific about the pre-treatment exam. | S.D. Codified Laws §34-52-2 Sep 3, 2026 |
| Tennessee | Only if it meets the same bar as an in-person visit — telemedicine rules don't relax the standard of care or the requirements for establishing a physician-patient relationship, and a remote evaluation requires a facilitator physically present with the patient. | Tenn. Comp. R. & Regs. 0880-02-.16 (scope) Sep 2, 2026 |
| Texas | The cited rules do not settle this — telemedicine establishes a valid practitioner-patient relationship for prescribing when the standard of care is met, but the cosmetic delegation rule requires a relationship before treatment without addressing modality. | Tex. Occ. Code §111.005(a) Sep 8, 2026 |
| Utah | Yes — for nonablative cosmetic procedures, the evaluation before a treatment protocol or series may be in person or by live telemedicine, done by an unrestricted-licensed physician, nurse practitioner, or PA acting under the Utah Physician Assistant Act. | Utah Code § 58-1-506(3)(a) (Supervision of cosmetic medical procedures) Sep 4, 2026 |
| Vermont | Yes — a Vermont-licensed provider may perform the required appropriate exam in person, by telemedicine, or by diagnostic equipment transmitting images and records, within that license's limits; treatment recommendations meet the same standards as in person. | 18 V.S.A. § 9361(b) Sep 8, 2026 |
| Virginia | A bona fide practitioner-patient relationship may be established via telemedicine when, among other conditions, the patient has provided a medical history available for review, the prescriber obtains an updated medical history and makes a diagnosis at the time of prescribing, the prescriber conforms to the standard… | Va. Code § 54.1-3303(B)(d), (h) Sep 8, 2026 |
| Washington | The cited rules do not settle this — they only require a non-physician clinician who provides clinical services by telemedicine to complete telemedicine training and keep a signed attestation; physicians are exempt. No cited rule sets the exam's modality. | Wash. Rev. Code § 43.70.495(1)-(2) (Telemedicine training for health care professionals) Sep 8, 2026 |
| West Virginia | If an existing physician-patient or podiatrist-patient relationship does not exist prior to the utilization to telemedicine technologies, or if services are rendered solely through telemedicine technologies, a physician-patient or podiatrist-patient relationship may only be established through the use of… | W. Va. Code §30-3-13a(c)(2)(A) Sep 3, 2026 |
| Wisconsin | The cited rules do not settle this — a Wisconsin-licensed physician may establish the relationship by telemedicine, but the same standard of practice applies as in person, so whether a remote exam suffices turns on that standard and your written protocol. | Wis. Stat. § 448.30(2)–(5) Sep 2, 2026 |
| Wyoming | The cited rules do not settle this — Wyoming defines telemedicine as practicing medicine electronically to a patient in another location and lets boards adopt telehealth rules, but set no in-person requirement for a pre-treatment exam. | Wyo. Stat. Ann. §33-26-102(a)(xxix) Sep 3, 2026 |
Every state, in its own words
Alabama
A physician practicing telemedicine shall establish a diagnosis through the use of acceptable medical practices, which may include taking a patient history, a mental status examination, a physical examination, disclosure and evaluation of underlying conditions, and diagnostic and laboratory testing, if that would otherwise be required in the provision of the same service delivered in person; and the physician-patient relationship may be formed without a prior in-person examination.
Ala. Code § 34-24-703(b)(1), (d) · verified Sep 8, 2026
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The board may not impose disciplinary sanctions on a physician or physician assistant for rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug that is not a controlled substance to a person without conducting a physical examination if
AS 08.64.364(a) (Prescription of drugs without physical examination) · verified Sep 5, 2026
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Arizona’s telehealth statute allows the provider-patient relationship to be established and prescribing to occur via telehealth with documented informed consent; a board may not require a prior in-person exam except for Schedule II drugs (which Botox and fillers are not).
A.R.S. §36-3602 · verified Jul 26, 2026
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(a)(1) A patient/provider relationship must be established in accordance with 17 CAR § 140-202(b)(8) before the delivery of services via telemedicine. (2) “Provider” means a person licensed by the Arkansas State Medical Board. (3) A patient completing a medical history online and forwarding it to a provider is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology.
17 CAR § 140-3201(a) (Telemedicine — patient/provider relationship) · verified Sep 4, 2026
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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.
Cal. Bus. & Prof. Code §2242(a) · verified Sep 8, 2026 · read at Public.Law — California Codes
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TELEMEDICINE IS INSIDE THE DEFINITION AND OUTSIDE ANY DISCOUNT. “The delivery of telemedicine” is itself the practice of medicine, and separately “ANY ACT OR OMISSION IN THE PRACTICE OF TELEMEDICINE THAT FAILS TO MEET GENERALLY ACCEPTED STANDARDS OF MEDICAL PRACTICE” is its own ground for unprofessional conduct. The remote consult is medicine and is held to the same standard.
Colo. Rev. Stat. § 12-240-107(1)(g); § 12-240-121(1)(aa) · verified Sep 2, 2026
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A telehealth provider shall only provide telehealth services to a patient when the provider is communicating through real-time, interactive, two-way communication technology or store and forward technologies; has access to or knowledge of the patient's medical history and health record; and conforms to the standard of care applicable to the provider's profession and expected for in-person care, except that when the standard of care requires diagnostic testing and a physical examination, such testing or examination may be carried out through the use of peripheral devices appropriate to the patient's condition.
Conn. Gen. Stat. §19a-906(b)(1) · verified Sep 8, 2026
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Except for the instances listed in this chapter, health-care providers may not deliver health-care services by telehealth and telemedicine in the absence of a health-care provider-patient relationship. A health-care provider-patient relationship may be established either in-person or through telehealth and telemedicine.
24 Del. C. §6003(a) · verified Sep 3, 2026
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A practitioner-patient or practitioner-client relationship may be established through telehealth in accordance with the appropriate standard of care and the practitioner’s competence and scope of practice; provided, that the Mayor may through rulemaking issue additional requirements for specific health professionals to establish a practitioner-client relationship, including an initial in-person physical examination.
D.C. Code §3-1201.05(b) · verified Sep 3, 2026
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A remote (telehealth) evaluation must meet the same standard of care as an in-person visit; a telehealth provider who conducts a patient evaluation sufficient to diagnose and treat is not separately required to perform a prior in-person exam.
Fla. Stat. §456.47(2) · verified Jul 26, 2026
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GEORGIA ALLOWS THE REMOTE ENCOUNTER BUT NAMES FOUR WAYS TO EARN IT, AND ONE OF THEM IS THE TECHNOLOGY. A physician, physician assistant or APRN providing treatment or consultation by electronic means must be Georgia licensed, must have the patient’s history available, and must EITHER have “personally seen and examined the patient” and be providing ongoing or intermittent care, OR be acting at the request of a Georgia licensed practitioner who has, OR be acting at the request of certain public health and child-protection referrers, OR be “able to examine the patient using technology or peripherals that are equal or superior to an examination done personally by a provider within that provider’s standard of care.” That last route is what makes a first remote visit possible; it is a standard about the equipment, not a waiver.
Ga. Comp. R. & Regs. 360-3-.07(a)(1)-(3) (Practice through electronic or other such means) · verified Sep 8, 2026
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A physician-patient relationship may be established via a telehealth interaction; provided that the physician has a license to practice medicine in the State. (f) Once a physician-patient relationship is established, a patient or physician licensed in this State may use telehealth for any authorized purpose, including consultation with a medical provider licensed in another state, authorized by this section or as otherwise provided by law.
Haw. Rev. Stat. § 453-1.3(e)-(f) · verified Sep 8, 2026
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A provider may provide virtual care to a patient if such provider has first established a provider-patient relationship with the patient, the patient has a provider-patient relationship with another provider in the provider group, the provider is covering calls for a provider with an established relationship with the patient, or the provider is performing any activities set forth in section 54-1733(3), Idaho Code.
Idaho Code §54-5705 · verified Sep 3, 2026
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Effective January 1, 2025, an on-site physician examination before a non-ablative laser procedure is not required where four conditions are met: the facility follows a physician delegation protocol available to the Department on request; the examination is performed by an advanced practice registered nurse; the procedure is delegated by a physician and performed by an RN or LPN with documented training in each system; and a physician is available remotely by telephone or other electronic means to respond promptly to questions or complications.
225 ILCS 60/54.2(e) · verified Aug 17, 2026
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A prescriber may issue a prescription without a prior in-person exam only if the applicable standard of care is satisfied, the prescription is within the prescriber’s scope, and a valid provider-patient relationship has been established — including identity/location verification, informed consent, a medical history sufficient to establish a diagnosis, and discussion of the diagnosis and risks/benefits.
Ind. Code §25-1-9.5-7, §25-1-9.5-8 · verified Jul 26, 2026
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Telemedicine shall not include the provision of medical services only through an audio-only telephone, email messages, facsimile transmissions, or U.S. mail or other parcel service, or any combination thereof.
Iowa Admin. Code r. 481—655.9(1) (Standards of practice — telemedicine) · verified Sep 4, 2026
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Telemedicine may be used to establish a valid provider-patient relationship.
Kan. Stat. Ann. §40-2,212(b) · verified Sep 3, 2026
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A treating physician who provides or facilitates the use of telehealth shall ensure that the informed consent of the patient, or another appropriate person with authority to make the health care treatment decision for the patient, is obtained before services are provided through telehealth; and that the confidentiality of the patient's medical information is maintained as required by this chapter and other applicable law.
Ky. Rev. Stat. §311.5975(1) · verified Sep 3, 2026
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Except as provided in the Louisiana Telehealth Access Act, R.S. 40:1223.1 et seq., no person shall practice medicine as defined in this Part until the person possesses a duly recorded license issued pursuant to this Part, a permit or registration as provided for in this Part, or a certificate issued pursuant to Part I-D of this Chapter.
La. Rev. Stat. §37:1271 · verified Sep 3, 2026
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A person licensed under this chapter may provide telehealth services as long as the licensee acts within the scope of practice of the licensee’s license, in accordance with any requirements and restrictions imposed by this subchapter and in accordance with standards of practice.
32 M.R.S. §3300-BB · verified Sep 3, 2026
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A telehealth practitioner shall perform a synchronous or asynchronous clinical patient evaluation that is appropriate for the patient and the condition with which the patient presents before providing treatment or issuing a prescription through telehealth.
Md. Code Regs. 10.32.05.05(A) (Patient Evaluation) · verified Sep 3, 2026
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Massachusetts defines telehealth expressly widely: synchronous OR asynchronous audio, video, electronic media or other telecommunications technology — including interactive audio-video, remote patient monitoring devices, AUDIO-ONLY TELEPHONE, and online adaptive interviews — used for evaluating, diagnosing, consulting, PRESCRIBING, treating or monitoring a patient. Prescribing is named in the definition, and so is audio-only.
Mass. Gen. Laws ch. 112, § 5O(a) · verified Sep 1, 2026
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Where care is delivered remotely Michigan does impose a consent duty by statute rather than leaving it to the standard of care, and it sits in the same article as the delegation rule — which is where a reader looking for a pre-treatment requirement would find it if one existed. (Complete through PA 38 of 2025.)
Mich. Comp. Laws § 333.16284 · verified Sep 2, 2026 · read at Internet Archive snapshot — evidence of a page, not the current rule
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WHAT SATISFIES THE EXAMINATION IS BROADER THAN “SEE THE PATIENT TODAY”: it is met where the prescribing practitioner examines the patient at the time the prescription is issued, where “THE PRESCRIBING PRACTITIONER HAS PERFORMED A PRIOR EXAMINATION OF THE PATIENT”, where “ANOTHER PRESCRIBING PRACTITIONER PRACTICING WITHIN THE SAME GROUP OR CLINIC AS THE PRESCRIBING PRACTITIONER HAS EXAMINED THE PATIENT”, or where a consulting practitioner the patient was referred to has examined them. ⚠️ TELEHEALTH ALONE SATISFIES IT FOR ONLY TWO THINGS — ED drugs and medications for opioid use disorder. For every other listed drug the examination must have happened in person, by someone.
Minn. Stat. § 151.37, subd. 2(e) · verified Sep 2, 2026
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In order to practice any form of telemedicine, as defined in R.5.1 , a valid “physician patient relationship” must be established. The elements of this valid relationship are: A. verify that the person requesting the medical treatment is in fact who they claim to be; B. conducting an appropriate history and physical examination of the patient that meets the applicable standard of care; C. 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; D. discussing with the patient the diagnosis, risks and benefits of various treatment options to obtain informed consent; E. insuring the availability of appropriate follow-up care; and F. maintaining a complete medical record available to patient and other treating health care providers.
Miss. Admin. Code Title 30, Part 2635, Rule 5.4 · verified Sep 8, 2026
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Physicians licensed under chapter 334 who use telemedicine shall ensure that a properly established physician-patient relationship exists with the person who receives the telemedicine services. The physician-patient relationship may be established by: an in-person encounter through a medical evaluation and physical examination; consultation with another physician, or that physician's delegate, who has an established relationship with the patient and an agreement with the physician to participate in the patient's care; or a telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.
Mo. Rev. Stat. §191.1146.1 · verified Sep 3, 2026
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"Telemedicine" means the practice of medicine using interactive electronic communications, information technology, audio-only conversations, or other means between a licensee in one location and a patient in another location with or without an intervening health care provider. Telemedicine includes the application of secure videoconferencing or store-and-forward technology. (b) The term does not mean an e-mail or instant messaging conversation or a message sent by facsimile transmission.
Mont. Code Ann. § 37-3-102(14)(a)-(b) · verified Sep 8, 2026
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READ THE SCOPE BEFORE THE RULE: NEBRASKA’S TELEHEALTH ACT DEFINES ITS PRACTITIONERS AS MEDICAID-ENROLLED. “Health care practitioner means a Nebraska medicaid-enrolled provider who is licensed, registered, or certified to practice in this state”, and “Telehealth means the use of medical information electronically exchanged from one site to another, whether synchronously or asynchronously, to aid a health care practitioner in the diagnosis or treatment of a patient”, expressly including “services originating from a patient’s home or any other location where such patient is located” and asynchronous store-and-forward. A cash-pay med spa outside the medical assistance program is therefore outside THIS Act; what governs it is the ordinary practice-of-medicine standard, which these claims do not survey.
Neb. Rev. Stat. § 71-8503(2)-(3) (Nebraska Telehealth Act — terms defined) · verified Sep 8, 2026
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A provider of health care may establish a relationship with a patient using telehealth when it is clinically appropriate to establish a relationship with a patient in that manner. The State Board of Health may adopt regulations governing the process by which a provider of health care may establish a relationship with a patient using telehealth.
Nev. Rev. Stat. §629.515(4) · verified Sep 3, 2026
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Physician-patient relationship means a medical connection between a licensed physician and a patient that includes an in-person exam or an exam using telemedicine, provided the physician: verifies the identity of the patient receiving health care services through telemedicine; discloses to the patient the physician’s name, contact information, and the type of health occupation license held by the physician; obtains oral or written consent from the patient or from the patient’s parent or guardian, if state law requires the consent of a parent or guardian for use of telemedicine services; and meets the standard of care.
N.H. Rev. Stat. §329:1-c (Physician-Patient Relationship) · verified Sep 3, 2026
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NEW JERSEY PUTS THE DECISION BEFORE THE VISIT, AND MAKES IT THE LICENSEE’S. “Prior to providing services through telemedicine or telehealth, a licensee shall determine whether providing those services through telemedicine or telehealth would be consistent with the standard of care applicable for those services when provided in-person.” If it would not — “either before or during the provision of health care services” — “the licensee shall not provide services through telemedicine or telehealth” and “shall advise the patient to obtain services in-person.” There is no lower bar for the remote encounter: a licensee giving a diagnosis, treatment or consultation recommendation this way “shall be held to the same standard of care or practice standards as are applicable to in-person settings.”
N.J.A.C. 13:35-6B.3 (Telemedicine and telehealth — standard of care) · verified Sep 8, 2026 · read at Cornell Legal Information Institute
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Telemedicine may be used by an APRN or other licensed independent healthcare providers for assessment and face-to-face examinations provided that such use complies with any applicable state and federal law and that the quality of the video examination does not adversely affect the face-to-face assessment or diagnosis.
16.12.14.10(D) NMAC (Patient care — telemedicine) · verified Sep 4, 2026
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NEW YORK PUTS THE ASSESSMENT AND THE DIAGNOSIS INSIDE THE DEFINITION OF TELEHEALTH ITSELF. “Telehealth” means “the use of electronic information and communication technologies by telehealth providers to deliver health care services, which shall include the assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient”, and “Telemedicine” means “the use of synchronous, two-way electronic audio visual communications to deliver clinical health care services, which shall include the assessment, diagnosis, and treatment of a patient, while such patient is at the originating site and a telehealth provider is at a distant site.” THE MODALITY LIST IS CLOSED AND SHORT: “telehealth shall be limited to telemedicine, store and forward technology, remote patient monitoring and audio-only telephone communication”, and “Telehealth shall not include delivery of health care services by means of facsimile machines, or electronic messaging alone”. A “telehealth provider” is enumerated by license: “a physician licensed pursuant to article one hundred thirty-one of the education law” is (a), “a physician assistant licensed pursuant to article one hundred thirty-one-B of the education law” is (b), and “a nurse practitioner licensed pursuant to article one hundred thirty-nine of the education law” is (d) — so the remote encounter is authorized for exactly the clinicians a med spa would use.
N.Y. Pub. Health Law § 2999-cc(2), (4)-(5) (Telehealth — definitions) · verified Sep 8, 2026 · read at Internet Archive snapshot — evidence of a page, not the current rule
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It is the Board's position that a licensee-patient relationship may be established via either synchronous or asynchronous telemedicine technologies without any requirement of a prior in-person meeting, so long as the standard of care is met; licensees are encouraged to provide, or rely upon, an appropriate evaluation prior to diagnosing or treating the patient, and that evaluation need not be in-person if the licensee employs technology sufficient to accurately diagnose and treat the patient in conformity with the applicable standard of care.
NCMB Position Statement 5.1.4 (Telemedicine — licensee-patient relationship; evaluations and examinations) · verified Sep 8, 2026
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A licensee is held to the same standard of care and same ethical standards, whether practicing traditional in - person medicine or telemedicine.
N.D.C.C. § 43-17-44 (Standard of care — telemedicine and in-person alike) · verified Sep 5, 2026
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OHIO PERMITS THE REMOTE VISIT AND THEN REFUSES TO LOWER THE BAR, INCLUDING FOR THE TECHNOLOGY CHOSEN. “A health care professional may provide telehealth services to a patient located in this state”, and “The standard of care for a telehealth visit is the same as the standard of care for an in-person visit.” Synchronous or asynchronous technology may be used “provided that the standard of care for an in-person visit can be met for the patient and the patient's medical condition through the use of the technology selected.” AND THE TELEPHONE IS SINGLED OUT: calls “may only be used for telehealth services when all of the elements of a bona fide health care visit meeting the standard of care are performed”, and calls “that are routine or simply involve communication of information do not constitute” a telehealth service.
Ohio Admin. Code 4731-37-01(B) (Telehealth — standard of care) · verified Sep 8, 2026
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Unless otherwise prohibited by law, a valid physician-patient relationship may be established by an allopathic or osteopathic physician with a patient located in Oklahoma through telemedicine, provided that the physician holds a license to practice medicine in the state, confirms with the patient the patient's identity and physical location, and provides the patient with the treating physician's identity and professional credentials; telemedicine encounters shall not be used to establish a valid physician-patient relationship for the purpose of prescribing opiates, synthetic opiates, semisynthetic opiates, or benzodiazepines.
Okla. Stat. tit. 59, § 478.1(A), (C) (Establishment of physician-patient relationship through telemedicine) · verified Sep 8, 2026
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A physician licensed under ORS 677.100 to 677.228, a physician associate licensed under ORS 677.505 to 677.525 or a physician or physician associate licensed under ORS 677.139 may use telemedicine to engage in the practice of medicine and provide health care services, including the establishment of a provider-patient relationship, the diagnosis or treatment of a medical condition or the prescription of drugs.
Or. Rev. Stat. §677.494(2) · verified Sep 3, 2026
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PENNSYLVANIA ANSWERS IT IN ONE SENTENCE AND SETS NO LOWER BAR FOR THE REMOTE VISIT. “A health care provider providing health care services through telemedicine shall be subject to the same standard of care that would apply to the health care services in an in-person setting.” Telemedicine is defined as delivering care to a “patient by a health care provider who is at a different location, through synchronous interactions, asynchronous interactions or remote patient monitoring”, and a synchronous interaction is “A two-way or multiple-way exchange of information between a patient and a health care provider that occurs in real time via audio or video conferencing.” The Act carries no separate examination rule for cosmetic medicine — what governs the remote encounter is whatever would govern it in the room.
2024 Pa. Act 42, §§ 4702, 4705 (Telemedicine — definitions; standard of care) · verified Sep 8, 2026
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RHODE ISLAND ALLOWS THE REMOTE VISIT, REFUSES TO LOWER THE BAR, AND THEN RULES OUT TWO SHORTCUTS BY NAME. “Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in face-to-face settings.” THE QUESTIONNAIRE IS NOT AN EXAM: “treatment, including issuing a prescription, based solely on an online questionnaire without an appropriate evaluation does not constitute an acceptable standard of care and is considered unprofessional conduct.” AND NEITHER IS STORE-AND-FORWARD ON ITS OWN: “Asynchronous evaluation of a patient, without contemporaneous real-time, interactive exchange between the physician and patient, is not appropriate.” The rule sits inside the Board of Medical Licensure and Discipline’s unprofessional-conduct section, so the consequence of getting it wrong is a disciplinary one.
216-RICR-40-05-1 § 1.5.9(H)(2) (Licensure and Discipline of Physicians — telemedicine standard of care) · verified Sep 8, 2026
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A licensee who provides care, renders a diagnosis, or otherwise engages in the practice of medicine via telemedicine shall adhere to the same standard of care as in-person medical care and be evaluated according to the standard of care applicable to the licensee’s area of specialty. The failure of a licensee to conform to the appropriate standard of care is considered unprofessional conduct under Section 40-47-110(B)(9).
S.C. Code §40-47-37(A)(1) · verified Sep 3, 2026
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Any health care professional treating a patient in the state through telehealth shall be fully licensed to practice in the state or employed by a licensed health care facility, an accredited prevention or treatment facility, a community support provider, a nonprofit mental health center, or a licensed child welfare agency under §36-32-76; and subject to any rule adopted by the applicable South Dakota licensing body.
S.D. Codified Laws §34-52-2 · verified Sep 3, 2026
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Tennessee’s telemedicine rules disclaim any effect on the underlying duty: they are not meant to alter or amend the applicable standard of care in any particular field of medicine, NOR TO AMEND ANY REQUIREMENT FOR THE ESTABLISHMENT OF A PHYSICIAN-PATIENT RELATIONSHIP. Remote delivery changes the channel, not the threshold.
Tenn. Comp. R. & Regs. 0880-02-.16 (scope) · verified Sep 2, 2026
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For purposes of the requirement of a practitioner-patient relationship for a valid prescription, a valid practitioner-patient relationship is present between a practitioner providing a telemedicine medical service and a patient receiving the service as long as the practitioner complies with the standard of care described in Section 111.007 and has a preexisting relationship with the patient, communicates under a call coverage agreement, or provides the service through synchronous audiovisual interaction, asynchronous store and forward technology using clinically relevant images or the relevant clinical records, or another method that allows the practitioner to use the clinical information the standard of care requires.
Tex. Occ. Code §111.005(a) · verified Sep 8, 2026
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a physician who has an unrestricted license to practice medicine, a nurse practitioner who has an unrestricted license for advanced practice registered nursing, or a physician assistant acting in accordance with Chapter 70a, Utah Physician Assistant Act, who has an unrestricted license to practice as a physician assistant, shall: (i) develop a treatment plan for the nonablative cosmetic medical procedure; and (ii) conduct an evaluation of the patient either in-person or utilizing a live telemedicine visit before the initiation of a treatment protocol or series of treatments;
Utah Code § 58-1-506(3)(a) (Supervision of cosmetic medical procedures) · verified Sep 4, 2026
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Subject to the limitations of the license under which the individual is practicing, a health care provider licensed in the State may prescribe, dispense, or administer drugs or medical supplies, or otherwise provide treatment recommendations to a patient, after having performed an appropriate examination of the patient in person, through telemedicine, or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically; and treatment recommendations made via electronic means, including issuing a prescription via electronic means, are held to the same standards of appropriate practice as those in traditional provider-patient settings.
18 V.S.A. § 9361(b) · verified Sep 8, 2026
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A bona fide practitioner-patient relationship may be established via telemedicine when, among other conditions, the patient has provided a medical history available for review, the prescriber obtains an updated medical history and makes a diagnosis at the time of prescribing, the prescriber conforms to the standard of care expected of in-person care, including when the standard of care requires diagnostic testing and a physical examination, which may be carried out through peripheral devices appropriate to the patient's condition, and the establishment of the relationship via telemedicine is consistent with the standard of care and the standard of care does not require an in-person examination for the purpose of diagnosis.
Va. Code § 54.1-3303(B)(d), (h) · verified Sep 8, 2026
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WASHINGTON PUTS A TRAINING REQUIREMENT ON EVERYONE DOING TELEMEDICINE EXCEPT THE PHYSICIAN, WHICH IS THE OPPOSITE OF WHAT MOST OPERATORS ASSUME. Beginning January 1, 2021, “a health care professional who provides clinical services through telemedicine, other than a physician licensed under chapter 18.71 RCW or an osteopathic physician licensed under chapter 18.57 RCW, shall complete a telemedicine training.” The training “Must include information on current state and federal law, liability, informed consent” and other criteria set by the telemedicine collaborative, and “If a health care professional completes the training, the health care professional shall sign and retain an attestation.” In a med spa that reaches the nurse, the advanced practice nurse and the physician assistant, and leaves the supervising physician out.
Wash. Rev. Code § 43.70.495(1)-(2) (Telemedicine training for health care professionals) · verified Sep 8, 2026
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If an existing physician-patient or podiatrist-patient relationship does not exist prior to the utilization to telemedicine technologies, or if services are rendered solely through telemedicine technologies, a physician-patient or podiatrist-patient relationship may only be established through the use of telemedicine technologies which incorporate interactive audio using store and forward technology, real-time videoconferencing, or similar secure video services during the initial physician-patient or podiatrist-patient encounter.
W. Va. Code §30-3-13a(c)(2)(A) · verified Sep 3, 2026
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The statute also names what the duty does NOT require, which is where a practice usually over- or under-discloses: detailed technical information a patient would in all probability not understand; risks apparent or already known to the patient; extremely remote possibilities that might falsely or detrimentally alarm them; and information in emergencies where withholding treatment would be more harmful.
Wis. Stat. § 448.30(2)–(5) · verified Sep 2, 2026
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"Telemedicine" means the practice of medicine by electronic communication or other means from a physician in a location to a patient in another location, with or without an intervening health care provider.
Wyo. Stat. Ann. §33-26-102(a)(xxix) · verified Sep 3, 2026
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