Virginia Telehealth Compliance for Cash-Pay Clinics: Licensure, the Bona Fide Relationship Rule and Prescribing
Virginia's statute defines the bona fide practitioner-patient relationship and allows it to be established by real-time video or store-and-forward under conditions, including that the prescriber is actively licensed in Virginia. Virginia is not a member of the interstate licensure compact.
Key Highlights
- Virginia requires licensure in the patient's state under Board guidance, with an exemption for out-of-state consultation with Virginia-licensed practitioners, and no special license or registration route.
- Virginia is not a member of the Interstate Medical Licensure Compact according to the state code index and the FSMB list.
- A bona fide relationship requires a history, risk and benefit information, an exam and follow-up, and for Schedule II to VI may be established by real-time video or store-and-forward if conditions are met.
- Board guidance says prescribing based solely on an online questionnaire is not an acceptable standard of care.
Licensure
The Virginia Board's telemedicine guidance, effective in 2021, says the practice of medicine occurs where the patient is, so the practitioner must be licensed in the patient's state. The Virginia Code exempts out-of-state consultation with Virginia-licensed practitioners. We found no special license or registration route. Virginia does not appear on the Virginia Code's compact index or on the Federation of State Medical Boards' September 2026 member list, so it is not an Interstate Medical Licensure Compact member.
The Bona Fide Relationship
Virginia's prescribing statute requires a bona fide practitioner-patient relationship, which includes a history, information about risks and benefits, an examination (physical or through instrumentation that transmits images and records) and follow-up. For Schedule II through VI drugs, the relationship may be established by real-time video or store-and-forward technology if listed conditions are met, which include the prescriber being actively licensed in Virginia and the standard of care not requiring an in-person exam. The Board's guidance adds that a documented evaluation is required and that prescribing based solely on an online questionnaire is not an acceptable standard of care.
Consent
Board guidance requires documented consent. The baseline covers patient and practitioner identification and credentials, permitted activities, security risks, a hold-harmless clause and consent to share data.
Prescribing
Prescribing Schedule II through VI by telemedicine requires compliance with federal rules. For Schedule II through V, the prescriber must have a practice location in Virginia or be able to refer the patient to a Virginia-licensed practitioner for an in-person exam. Prescribers of covered substances must register with the prescription monitoring program, and the mandatory query covers opioids for more than seven days. Nonresident pharmacies shipping Schedule II through VI drugs into Virginia must register with the Board of Pharmacy. We found no Virginia-specific testosterone or ketamine telehealth rule.
NPs and PAs
Nurse practitioners practice under an agreement with a patient care team physician until they have three years of full-time experience and an attestation, and collaboration by telemedicine is allowed. A 2026 law allows PA practice without an agreement after three years but carries a contingent effective date, so confirm its status.
Corporate Practice
We found no Virginia authority on corporate practice that is specific to telehealth or management companies. The general professional corporation statute allows shares to be held only by people licensed in the same service, so a physician-owned PC with a flat-fee management agreement is the conservative design.
Disclaimer
This article is general educational information, not legal advice. Telehealth rules change often and differ by state, and parts of this summary rest on secondary sources, so confirm specifics with health care regulatory counsel in the state before you rely on them.
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.