Physician-Patient Relationship
The foundation of every virtual visit.
Before care can be delivered remotely, a valid practitioner-patient relationship has to be established. That relationship is the cornerstone of safe, compliant virtual care — and every state governs it a little differently.
AMA Guidelines
Three ways to establish a valid relationship
The American Medical Association advises that a valid practitioner-patient relationship be established before telemedicine services begin. It can be established through any of three methods:
Face-to-face examination
If an in-person encounter is typically required for the service in question, a face-to-face examination may be necessary before telemedicine services begin.
Consultation with a physician
A physician who already holds an ongoing relationship with the patient — and who agrees to supervise their care — can bring the telemedicine practitioner into that established relationship.
Evidence-based guidelines
The relationship can also be established in line with evidence-based clinical practice guidelines developed by medical specialty societies, such as those in radiology and pathology.
What States Require
Established before treatment
All states allow physicians to form a practitioner-patient relationship via telemedicine, but the conditions vary — some regulate the patient's location, others the modalities used. In most states, the relationship must be formally established before any diagnosis or treatment can occur.
- Initial consultation — a synchronous video or audio visit to establish the relationship before prescribing or treatment.
- Patient consent — informed consent so patients understand the risks, benefits, and limitations of telehealth.
- Documentation — proper record-keeping of the virtual visit for continuity of care and state compliance.
Beyond the First Visit
Sustaining a compliant relationship
Informed Consent
Many states require explicit consent before a telehealth visit — including an explanation of how virtual care differs from in-person care.
Prescribing Laws
Under the Ryan Haight Act, an in-person visit is generally required before prescribing controlled substances — with evolving telehealth exceptions.
Learn moreContinuity of Care
Integrating telehealth with in-person care, keeping comprehensive records, and coordinating follow-up, referrals, and care teams.
Trust is built one visit at a time.
Get the state-by-state requirements.
CTeL members access the consent, prescribing, and relationship rules for all 50 states.