| (a) Evaluation of the Patient. Distant site providers
who utilize telemedicine medical services must ensure that a defined
physician-patient relationship is established which at a minimum
includes:
(1) establishing that the person requesting the treatment
is in fact who the person claims to be;
(2) establishing a diagnosis through the use of acceptable
medical practices, including documenting and performing patient history,
mental status examination, and physical examination that must be performed
as part of a face-to-face or in-person evaluation as defined in §174.2(3)
and (4) of this title (relating to Definitions). The requirement for
a face-to-face or in-person evaluation does not apply to mental health
services, except in cases of behavioral emergencies, as defined by
25 TAC §415.253 (relating to Definitions), and appropriate diagnostic
and laboratory testing to establish diagnoses, as well as identify
underlying conditions or contra-indications, or both, to treatment
recommended or provided;
(3) discussing with the patient the diagnosis and the
evidence for it, the risks and benefits of various treatment options;
and
(4) ensuring the availability of the distant site provider
or coverage of the patient for appropriate follow-up care.
(b) Treatment. Treatment and consultation recommendations
made in an online setting, including issuing a prescription via electronic
means, will be held to the same standards of acceptable medical practices
as those in traditional in-person clinical settings.
(c) An online questionnaire or questions and answers
exchanged through email, electronic text, or chat or telephonic evaluation
of or consultation with a patient are inadequate to establish a defined
physician-patient relationship.
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