§ 334.108 — Telemedicine or internet prescriptions and treatment, establishment of physician-patient relationship required.

Missouri § 334.108

• Jurisdiction: Missouri
• Title XXII: OCCUPATIONS AND PROFESSIONS
• Ch. 334: Physicians and Surgeons — Therapists — Athletic Trainers — Health Care Providers

Text

1.  Prior to prescribing any drug, controlled substance, or other treatment through telemedicine, as defined in section 191.1145 , or the internet, a physician shall establish a valid physician-patient relationship as described in section 191.1146 .  This relationship shall include:

(1)  Obtaining a reliable medical history and performing a physical examination of the patient, adequate to establish the diagnosis for which the drug is being prescribed and to identify underlying conditions or contraindications to the treatment recommended or provided;

(2)  Having sufficient dialogue with the patient regarding treatment options and the risks and benefits of treatment or treatments;

(3)  If appropriate, following up with the patient to assess the therapeutic outcome;

(4)  Maintaining a contemporaneous medical record that is readily available to the patient and, subject to the patient's consent, to the patient's other health care professionals; and

(5)  Maintaining the electronic prescription information as part of the patient's medical record.

2.  The requirements of subsection 1 of this section may be satisfied by the prescribing physician's designee when treatment is provided in:

(1)  A hospital as defined in section 197.020 ;

(2)  A hospice program as defined in section 197.250 ;

(3)  Home health services provided by a home health agency as defined in section 197.400 ;

(4)  Accordance with a collaborative practice agreement as defined in section 334.104 ;

(5)  Conjunction with a physician assistant licensed pursuant to section 334.738 ;

(6)  Conjunction with an assistant physician licensed under section 334.036 ;

(7)  Consultation with another physician who has an ongoing physician-patient relationship with the patient, and who has agreed to supervise the patient's treatment, including use of any prescribed medications; or

(8)  On-call or cross-coverage situations.

3.  No health care provider, as defined in section 376.1350 , shall prescribe any drug, controlled substance, or other treatment to a patient based solely on an evaluation over the telephone; except that, a physician or such physician's on-call designee, or an advanced practice registered nurse, a physician assistant, or an assistant physician in a collaborative practice arrangement with such physician, may prescribe any drug, controlled substance, or other treatment that is within his or her scope of practice to a patient based solely on a telephone evaluation if a previously established and ongoing physician-patient relationship exists between such physician and the patient being treated.

4.  No health care provider shall prescribe any drug, controlled substance, or other treatment to a patient based solely on an internet request or an internet questionnaire.

Legislative History

(L. 2011 H.B. 265, A.L. 2016 S.B. 579, A.L. 2019 S.B. 514)