Section 34-24-703 Duties of Physicians Providing Telehealth Medical Services or Practicing Telemedicine; Location of Service; Physician-Patient Relationship.

(a) A physician providing telehealth medical services shall owe to the patient the same duty to exercise reasonable care, diligence, and skill as would be applicable if the service or procedure were provided in person. Telehealth medical services shall be governed by the Medical Liability Act of 1987, codified in Sections 6-5-540 through 6-5-552, and shall be subject to the exclusive jurisdiction and venue of the circuit courts of the State of Alabama, regardless of the citizenship of the parties. (b) A physician practicing telemedicine shall do all of the following, if the action would otherwise be required in the provision of the same service if delivered in-person: (1) Establish a diagnosis through the use of acceptable medical practices, which may include, but not be limited to, taking a patient history, a mental status examination, a physical examination, disclosure and evaluation of underlying conditions, and any diagnostic and laboratory testing. (2) Disclose any diagnosis and the evidence for the diagnosis, and discuss the risks and benefits of treatment options. (3) Provide a visit summary to the patient and, if needed, inform the patient of the availability of, or how to obtain, appropriate follow-up and emergency care. (c) The provision of telehealth medical services is deemed to occur at the patient’s originating site within this state. A licensed physician providing telehealth medical services may do so at any distant site. (d) Telehealth medical services may only be provided following the patient’s initiation of a physician-patient relationship, or pursuant to a referral made by a patient’s licensed physician with whom the patient has an established physician-patient relationship, in the usual course of treatment of the patient’s existing health condition. The physician-patient relationship may be formed without a prior in-person examination. (e) Prior to providing any telehealth medical service, the physician, to the extent possible, shall do all of the following: (1) Verify the identity of the patient. (2) Require the patient to identify his or her physical location, including the city and state. (3) Disclose to the patient the identity and credentials of the physician and any other applicable personnel. (4) Obtain the patient’s consent for the use of telehealth as an acceptable mode of delivering health care services, including, but not limited to, consent for the mode of communication used and its limitations. Acknowledgment of consent shall be documented in the patient’s medical record. (f)(1) If a physician or practice group provides telehealth medical services more than four times in a 12-month period to the same patient for the same medical condition without resolution, the physician shall do either of the following: a. See the patient in person within a reasonable amount of time, which shall not exceed 12 months. b. Appropriately refer the patient to a physician who can provide the in-person care within a reasonable amount of time, which shall not exceed 12 months. (2)a. For the purposes of this section, for a woman, each pregnancy is considered a separate or new condition. b. For the purposes of this subsection, the term “practice group” means, at a minimum, a group of providers who have access to the same medical records. c. The Board of Medical Examiners, by rule or otherwise, may provide for exemptions to the requirement contained in subdivision (1) that are no more restrictive than the provisions of this article. (3) The provision of telehealth medical services that includes video communication to a patient at an originating site with the in-person assistance of a person licensed by the Board of Medical Examiners or by the Board of Nursing pursuant to Chapter 21 of Title 34, shall constitute an in-person visit for the purposes of this subsection. (4) This section does not apply to the provision of telehealth medical services provided by a physician in active consultation with another physician who is providing in-person care to a patient. (5) This section shall not apply to the provision of mental health services as defined in Section 22-50-1.