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

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

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, if required to meet the standard of care, 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 exchange 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 described 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 through telemedicine; 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 telemedicine 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 in the absence of a proper provider-patient relationship, as described in section 191.1146.

5.  Medical records of any drug, controlled substance, or other treatment prescribed through telemedicine, as defined in section 191.1145, shall be collected, stored, and maintained in accordance with the Health Insurance Portability and Accountability Act of 1996, which allows for the sharing of protected health information for continuity of care between health care providers for treatment, payment, and health care operations.

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(L. 2011 H.B. 265, A.L. 2016 S.B. 579, A.L. 2019 S.B. 514, A.L. 2026 H.B. 2372)

---- end of effective  28 Aug 2026 ----

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