Establishing the Patient-Provider Relationship Through Telemedicine

Our healthcare and business law firm advises many physicians and medical practices on compliantly using telemedicine to provide medical care to patients.  Not only are there parameters around practicing medicine via telemedicine and prescribing via telemedicine (often called teleprescribing), there always remains the requirement to establish a patient-provider relationship before providing care or prescribing for any patient.  Each state has different telemedicine rules, in addition to Federal tele-prescribing rules, so it is important for providers to consult their states’ requirements, including requirements on establishing a patient-provider relationship via telemedicine (if permitted).  This post discusses considerations around establishing a patient-provider relationship through telemedicine. If you would like to discuss using telemedicine in a medical practice or this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

Some initial questions that should be answered when considering using telemedicine are:

1. Can a patient-provider relationship be established via telemedicine?
2. If so, does that require a synchronous, audio-visual visit?
3. If no, is an asynchronous tool, like a questionnaire or screening tool, sufficient to establish a patient-provider relationship?

Many states now permit a patient-provider relationship to be established via telemedicine, so that typically requires answering questions two and three.  Often, states use broader language about what a telemedicine visit must include for different situations. For instance, in California, to tele-prescribe, the provider must complete an “appropriate prior examination,” which may or may not include synchronous communication provided that the provider “complies with the appropriate standard of care.”  Ca. Business and Professions Code, Section 2242.  In Georgia, telemedicine is appropriate as long as the provider “is able to examine the patient using technology or peripherals that are equal or superior to an examination done personally by a provider within that provider’s standard of care.”  Georgia Rule 360-3-.07(a).  This, however, still does not answer the question of what is required to establish the patient-provider relationship in the first place.  Once a patient-provider relationship is established, then an asynchronous tool may be appropriate under the standard of care depending on the circumstance.  But is that asynchronous tool sufficient to establish the relationship?

Fortunately for Georgia providers, the Georgia Composite Medical Board has provided its input on this topic.

For many years, the only information with the Georgia Medical Board meeting minutes on this topic was the following question and answer:

Aaron Chase, LLC: “As a practical matter, what does a doctor’s office need to do in order to establish a provider-patient relationship via telehealth?” For example, can the doctor’s office establish the relationship using an online questionnaire? Or is a real-time audio-visual (e.g. Zoom call) experience required? After discussion, the Board would like to refer to the existing rules concerning this matter (Rule 360-3-.07). Specifically, subsection (a)(3) addresses four scenarios for how a Georgia licensed physician, physician assistant, or advanced practice registered nurse would practice through electronic or other such means. https://rules.sos.state.ga.us/GAC/360-3-.07.

In September of 2025, the Medical Board further clarified its stance on this point, as follows:

Correspondence from Jackie Gomez, Life RX Telemed -Does GA law permit the use of asynchronous telehealth methods to establish a valid patient-provider relationship for prescribing non-controlled medications such as PDE5 inhibitors. If not, is synchronous audio-video consultation required?

Response: No, asynchronous telehealth does not meet requirements. Synchronous telehealth may be permitted. Please see Board Rule 360-3-.07 Practice through Electronic or Other Such Means.

The Georgia Medical Board made it clear that a patient-provider relationship cannot be established via asynchronous means.  This may require certain telehealth platforms to modify their business model.

If you would like to discuss using telemedicine in a medical practice or this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

 

 

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