Is an exam required before a patient can be treated in Hawaii?

Short answer
Yes for telehealth — the visit must include a documented evaluation with history and symptoms adequate to diagnose and flag contraindications, and a questionnaire alone doesn't count; a Hawaii-licensed physician may form the relationship by telehealth.

The sections cited here govern the pre-treatment encounter through Hawaii’s telehealth statute. Telehealth services must include a documented patient evaluation, including a history and a discussion of physical symptoms adequate to establish a diagnosis and to identify underlying conditions or contraindications to the treatment recommended. Treatment recommendations made by telehealth, including an electronic prescription, are held to the same standards as traditional physician-patient settings, and a prescription issued on an online questionnaire alone is not treatment and is not an acceptable standard of care. A physician-patient relationship may be established through a telehealth interaction by a physician licensed in Hawaii, and once established, telehealth may be used for any authorized purpose. Telehealth is defined by its modalities and excludes standard telephone, facsimile, or e-mail contact except through an interactive telecommunications system. The pharmacy act defines the practice of pharmacy to include the compounding, dispensing, and labeling of drugs, and defines a prescription as a practitioner’s order for the compounding or dispensing of drugs; neither cited pharmacy definition names a drug or mentions office stock.