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Florida Board of Medicine Addresses Telemedicine Prescribing
From the Florida Medical Association
A recent article appeared in the Florida Times-Union titled "Doctoring Over Phone Rising Trend." But there are important things to know before you prescribe for a patient either by phone or by Internet. After taking input from the FMA and all state specialty societies, the Florida Board of Medicine issued a rule last year, 64B8-9.014 FAC, that addresses the prescribing of drugs for patients by phone, by Internet, or by other electronic means. The rule requires a physician to perform a patient evaluation before writing any prescription. The evaluation must include a history and physical examination. The rule provides for the following exceptions:
1. a history and physical need not be performed if the physician determines that the immediate administration of the medication is necessary for the proper treatment of the patient, and it is not reasonably possible for the prescribing physician to first perform a history and physical and;
2. a history and physical need not be performed if the prescribing physician is in consultation with another physician, or is in an on-call or cross-coverage relationship with the patient's physician.
A copy of the rule is provided below:
64B8-9.014 Standards for Telemedicine Prescribing Practice.
(1) Prescribing medications based solely on an electronic medical questionnaire constitutes the failure to practice medicine with that level of care, skill, and treatment which is recognized by reasonably prudent physicians as being acceptable under similar conditions and circumstances, as well as prescribing legend drugs other than in the course of a physician's professional practice.
(2) Physicians and physician assistants shall not provide treatment recommendations, including issuing a prescription, via electronic or other means, unless the following elements have been met:
(a) A documented patient evaluation, including history and physical examination to establish the diagnosis for which any legend drug is prescribed.
(b) Discussion between the physician or the physician assistant and the patient regarding treatment options and the risks and benefits of treatment.
(c) Maintenance of contemporaneous medical records meeting the requirements of Rule 64B8-9.003, F.A.C. - 312
(3) The provisions of this rule are not applicable in an emergency situation. For purposes of this rule an emergency situation means those situations in which the prescribing physician or physician assistant determines that the immediate administration of the medication is necessary for the proper treatment of the patient, and that it is not reasonably possible for the prescribing physician or physician assistant to comply with the provision of this rule prior to providing such prescription.
(4) The provisions of this rule shall not be construed to prohibit patient care in consultation with another physician who has an ongoing relationship with the patient, and who has agreed to supervise the patient's treatment, including the use of any prescribed medications, nor on-call or cross-coverage situations in which the physician has access to patient records.
(5) For purposes of this rule, the term "telemedicine" shall include, but is not limited to, prescribing legend drugs to patients through the following modes of communication:
(a) Internet;
(b) Telephone; and
(c) Facsimile.