Establishing the Patient-Practitioner Relationship by Telehealth: Synchronous, Asynchronous and the Online Questionnaire
A prescription without a real evaluation is the single most common telehealth compliance failure. The standard is the same as for in-person care: a documented evaluation and history before treatment. The rules differ on how that evaluation can be done.
Key Highlights
- A relationship can generally be established by telehealth without a prior in-person visit, so long as the standard of care is met, though state rules differ.
- A documented evaluation and history must come before treatment, including any prescription.
- Evaluation done solely by completing an online questionnaire does not meet an acceptable standard of care under the model policy Vermont adopted.
- Texas, California and Florida illustrate three different statutory approaches.
The Baseline Standard
The Federation of State Medical Boards' 2022 model policy, as adopted nearly verbatim by Vermont, says a patient-practitioner relationship is established when the physician agrees to diagnose and treat and the patient agrees, whether or not there has been an in-person encounter. It can be established through synchronous or asynchronous technology without a prior in-person meeting, so long as the standard of care is met. A documented evaluation and history must precede treatment, including prescriptions, and video or images must be used where the standard of care would require a physical exam. The same text states that an evaluation done solely through an online questionnaire does not meet an acceptable standard of care.
How Three States Approach It
- term: text
- term: text
- term: text
Why a Questionnaire Is Not an Exam
Many consumer-facing telehealth flows collect a questionnaire and a photo and issue a prescription. That model is the one regulators and the model policy single out. A questionnaire can be part of an evaluation, but the clinician has to review the history, decide whether more information or a live encounter is needed, and document the reasoning. Our own position is that a live synchronous encounter is the stronger legal and clinical standard, and it is the only one that is accepted wherever telehealth is allowed at all.
Building the Workflow
- term: text
- term: text
- term: text
- term: text
Disclaimer
This article is general educational information, not legal advice. Telehealth rules differ by state and change often, so confirm specifics with health care regulatory counsel in each state where you treat patients.
MedGrid MSO provides management services to independently owned practices; it does not practise medicine and does not direct clinical decisions. Requirements vary by state and by service, and change over time — nothing on this page is legal or medical advice. Talk to us or your own counsel before making a structural decision for your clinic.