The Ohio State Medical Board has approved a new interpretation for Rule 4731-11-09 of the Ohio Administrative Code, which requires a physician to personally examine and diagnose a patient prior to initially prescribing medications.
The interpretative guideline applies solely to cases that involve prescribing or personally furnishing non-controlled substances and recognizes that with advances in medical technology it may be possible for the personal and physical examination to occur through the use of the internet or other forms of telecommunication when the provider and patient are in remote locations. The interpretation states:
When personally physically examining a patient who is located at a remote location, the physician or authorized prescriber should obtain a reliable medical history and perform a physical examination of the patient, adequate to establish the diagnosis for which the drug is being prescribed and to identify underlying conditions and/or contraindications to the treatment recommended/provided and conform to minimal standards of care. Prior to initially prescribing non-controlled substances the physician or authorized prescriber should:
(a) establish or have previously established a valid provider patient relationship;
(b) have appropriate diagnostic medical equipment capable of transmitting in real-time the patient’s vital signs and other physical data;
(c) have appropriate diagnostic medical equipment capable of transmitting in real-time images of the patients symptoms and that also has the ability to be adjusted for better image quality and definition;
(d) have sufficient dialogue with the patient regarding treatment options and the risks and benefits of treatment(s);
(e) as appropriate, follow up with the patient to assess the therapeutic outcome;
(f) maintain a contemporaneous medical record that is readily available to the patient and, subject to the patient’s consent, to his or her other health care professionals; and
(g) include the electronic prescription information as part of the patient medical record.