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

Short answer
The cited rules do not settle this — none of them impose a pre-treatment exam. What they establish is narrower: a physician-patient relationship cannot be created through e-mail, internet questionnaires, text messaging, or other written communication.

West Virginia legislates the telemedicine encounter in detail, and the detail is restrictive at the front end. A physician-patient relationship MAY NOT be established through text-based communications such as e-mail, Internet questionnaires, text-based messaging or other written forms of communication. Where no relationship existed beforehand, or where services are rendered solely by telemedicine, it may be established only through interactive audio using store and forward technology, real-time videoconferencing or similar secure video services at the initial encounter — or through real-time audio-only calls, with the statute stating that audio-visual communication is preferable if available or possible. Once the relationship exists, whether in person or by those routes, the physician may use any telemedicine technology that meets the standard of care and suits the presentation. The Act also fixes jurisdiction: the practice of medicine occurs where the PATIENT is located when the technology is used.