Telemedicine

Physicians who engage in the provision of telehealth medical services to any individual in Alabama must possess a full and active license to practice medicine in Alabama.
The provision of telehealth medical services is deemed to occur at the patient’s physical location within Alabama at the time telehealth medical services are provided.
Telehealth services that may not require an Alabama license:
- The physician is licensed in another state or D.C.; and services are irregular or infrequent (telehealth medical services occurring fewer than ten days in a calendar year or involving fewer than ten patients in a calendar year); or
- Services are provided in consultation with an Alabama licensed physician, limited to ten days in a calendar year, or necessary medical care is provided to a patient being transported into Alabama.
- Practitioners should consult an attorney with questions about when a license is required.

A physician has the same duty to exercise reasonable care, diligence, and skill whether providing services in-person or via telehealth, including when appropriate, to:
- Establish a diagnosis.
- Disclose the diagnosis and evidence for it.
- Discuss the risks and benefits of treatment options.
- Provide a visit summary to the patient and information how to obtain appropriate follow-up and emergency care if needed.
- A physician-patient relationship must be established either at the initiation of the patient or referral by the patient’s established physician.
Before providing telehealth medical services, the physician must:
- Verify the patient’s identity;
- Require the patient to identify his or her physical location, including city and state;
- Disclose the identity and credentials of the physician and any other personnel; and
- Obtain the patient’s consent for the use of telehealth and document it in the patient’s medical record.

If a physician or practice group provides telehealth services more than four times in a 12-month period to the same patient for the same medical condition without resolution, the physician shall either:
- See the patient in person within a reasonable amount of time, which shall not exceed 12 months; or
- Appropriately refer the patient to a physician who can provide the in-person care within a reasonable amount of time, which shall not exceed 12 months.
The provision of telehealth services that includes video communication to a patient at an originating site with the in-person assistance of a licensed physician, physician assistant, certified registered nurse practitioner, certified nurse midwife, or other person licensed by the Alabama Board of Nursing shall constitute an in-person visit for this purpose.
This requirement does not apply to the provision of mental health services as defined in state law (Ala. Code § 22-50-1).

A prescriber may prescribe a legend drug, medical supplies, or a controlled substance via telehealth if the prescriber is authorized to do so under state and federal law.
A prescription for a controlled substance may only be issued via telehealth if:
- The telehealth visit includes synchronous audio or audio-visual communication using HIPAA-compliant equipment with the prescriber;
- The prescriber has had at least one in-person encounter with the patient within the preceding 12 months; and
- The prescriber has established a legitimate medical purpose for issuing the prescription within the preceding 12 months.
- The in-person encounter may be satisfied by the in-person assistance of personnel licensed by the Board of Medical Examiners or Board of Nursing at the originating site when the prescriber is evaluating the patient from a distant site using video communication.

A physician who provides telehealth services must maintain complete and accurate medical records, must have access to the patient’s medical records, and must be able to produce records upon demand by the patient, the Board of Medical Examiners, or the Medical Licensure Commission.