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

Short answer
Yes for telemedicine — before treating, the physician must establish the patient relationship, review relevant history, and perform an exam sufficient for diagnosis; an in-person physical exam is needed only where the standard of care requires it.

Missouri answers the online-intake question directly, and the answer is conditional. a physician using telemedicine must ensure a properly established physician-patient relationship exists, and the statute names the three ways it may be established: an in-person encounter through a medical evaluation and physical examination; consultation with another physician who has an established relationship with the patient and an agreement to participate in that patient’s care; or a telemedicine encounter, IF the standard of care does not require an in-person encounter. To establish the relationship through telemedicine the technology must be sufficient to reach an informed diagnosis as though the evaluation, and any physical examination the standard of care requires, had been performed in person. A questionnaire — internet or telephone — must be reviewed by the treating health care professional and must itself carry information sufficient to serve as though the medical evaluation had been performed in person; otherwise the statute says in terms that it DOES NOT constitute an acceptable medical evaluation and examination for providing treatment by telehealth. Before prescribing through telemedicine or the internet, the physician must obtain a reliable medical history and, if the standard of care requires, perform a physical examination adequate to establish the diagnosis and identify underlying conditions or contraindications.