4.1.1: Contact With Patients Before Prescribing

It is the position of the Board that prescribing drugs to an individual the prescriber has not examined to the extent necessary for an accurate diagnosis is inappropriate except as noted in the paragraphs below.  Before prescribing a drug, a licensee should make an informed medical judgment based on the circumstances of the situation and on his or her training and experience.  Ordinarily, this will require that the licensee perform an appropriate history and physical examination, establish a working diagnosis, and formulate a therapeutic plan, a component of which might be a prescription.  This process must be documented appropriately.

Prescribing for a patient whom the licensee has not personally examined may be suitable under certain circumstances.  These may include:

• Admission orders for a newly hospitalized patient;
• Interim medication orders or prescriptions, including pain management, from a hospice licensee for a patient admitted to a certified hospice program;
• Prescribing for a patient of another licensee for whom the prescriber is providing call coverage;
• Continuing previously prescribed medication on a short-term basis for a new patient prior to the patient’s first appointment;
• An appropriate prescription in a telemedicine encounter where the threshold information to make a reasonably presumptive treatment plan has been obtained;
• Prescribing an opiate antagonist to someone in a position to assist a person at risk of an opiate-related overdose;
• Providing expedited partner therapy (see 4.1.4: Expedited Partner Therapy); or
• An appropriate prescription in anticipation of a diagnostic test consistent with the standard of care in that particular specialty.

Established patients may not require a new history and physical examination for each new prescription, depending on reasonable medical practice. 

It is the position of the Board that prescribing drugs to individuals the licensee has never met based solely on answers to a set of questions, as is common in Internet or toll-free telephone prescribing, is inappropriate and unprofessional.