Telehealth Laws by State (2026): Prescribing Rules for All 50 States and DC

Last reviewed: [November 10, 2026]. General information, not legal advice. Each state entry below is a summary, so check the current statute or board rule before relying on it.

Say a client trains with you in Portland but lives ten minutes away in Vancouver, Washington. If a physician reviews them by video while they're sitting at home, Washington's rules apply, and the physician needs a Washington license. If the same client takes the call from your studio, it's Oregon. Same client, same physician, different state law.

That's the part of telehealth prescribing most practices miss. In most cases a physician is treated as practicing medicine where the patient is located during the visit, as one Pennsylvania health law attorney summarized in March 2026, not where the physician sits or where your practice is.

Almost every state now lets a physician start care and prescribe through telehealth if the care meets the same standard as an in-person visit. Where states split is on three narrower questions: whether a questionnaire alone can support a prescription, whether certain treatments need a live video visit or an in-person exam first, and how controlled substances are handled. The state section further down covers all three, plus each state's status in the Interstate Medical Licensure Compact.

What changes from one state to the next

Questionnaires. This is the line states draw most often. According to the Center for Connected Health Policy (CCHP), most states treat an online questionnaire alone as inadequate to establish the relationship a prescription needs. A physician can use a questionnaire as part of an evaluation in many states. They just can't let it be the whole evaluation. There are two clear exceptions. California allows a self-screening tool or questionnaire to support treatment if the physician meets the standard of care. Missouri changed its law in 2026 to allow questionnaires that the treating provider reviews, with extra conditions.

Live visits. A smaller group of states expects a real-time interaction for some or all care. Georgia's medical board has said asynchronous telehealth doesn't meet its requirements. South Dakota requires a live audio-video exam whenever an in-person visit would otherwise be needed. Louisiana lifted its ban on treating obesity by telehealth in 2026, but only with a synchronous interaction. Utah requires an in-person or live telemedicine evaluation before cosmetic procedures, which matters for med spas. Minnesota goes further for a short list of drugs: muscle relaxants, butalbital products, and most controlled substances need an in-person exam, which matters for physical therapy and chiropractic clients.

Controlled substances. These sit under a federal rule as well as a state one, and when the two differ, the stricter rule wins. Many states add their own limits on Schedule II drugs, opioids, or pain treatment by telehealth.

Licensing. The physician needs a license in the patient's state, or a pathway that state recognizes. Florida, for example, lets out-of-state providers register to treat Florida patients by telehealth. The Interstate Medical Licensure Compact (IMLC) makes it faster for a physician to collect licenses in member states, and it added North Carolina, Connecticut, and Alaska in 2026. It doesn't change any state's prescribing rules.

The federal rule on controlled substances

Under the Ryan Haight Act, the default federal rule requires at least one in-person evaluation before a practitioner prescribes a controlled substance remotely. Temporary rules have waived that since 2020.

The current extension, the fourth, lets DEA-registered practitioners keep prescribing Schedule II through V controlled substances by telemedicine without a prior in-person visit through December 31, 2026. The DEA sent a final rule creating "special registrations" for telemedicine prescribing to White House review on August 25, 2026. As of this writing, the text hasn't been made public.

None of this affects non-controlled medications. Those are entirely a matter of state law.

Telehealth prescribing rules by state

Most readers come here with one of two questions: "which states have rule X?" or "what's the rule in my state?" The first part below answers the first question by grouping states by rule. The second part has short notes on every state, A to Z.

"Not addressed" in the notes means our source didn't cover it. It doesn't mean questionnaires are fine there, because the general standard of care still applies.

States grouped by rule

A questionnaire alone can't support a prescription (states that say so in writing): Alaska, Arizona, Arkansas, Colorado, Delaware, Hawaii, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Mississippi, New Jersey, New Mexico, North Carolina, North Dakota, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Vermont, Virginia, West Virginia, Wisconsin. The wording varies. Some states name questionnaires directly, while others say "internet-only" prescribing isn't enough without a proper relationship. A few, including Iowa, Maine, and Wisconsin, ban a static questionnaire but treat an adaptive, interactive online interview differently.

Questionnaire-only limits written specifically for controlled substances: Georgia, South Dakota.

A questionnaire can support treatment if conditions are met: California (standard of care) and Missouri (reviewed by the treating provider, with added requirements as of August 2026). Texas also allows store-and-forward (asynchronous) care when the physician has enough clinical information.

A live (real-time) visit is expected for most prescribing, at least in some situations: Georgia, New Mexico, South Dakota.

A live or in-person visit is required for specific kinds of care: Louisiana (weight management, live interaction), Minnesota (in-person exam before muscle relaxants, butalbital products, and most controlled substances), Utah (cosmetic procedures, in person or live video).

An in-person exam is required before some controlled substances: Alabama, Arkansas, Hawaii, Louisiana, Mississippi, New Hampshire, New Jersey, New York, North Dakota, Ohio (Schedule II, new patients), Oklahoma, Rhode Island.

Certain controlled substances are barred or tightly limited by telehealth: Connecticut, Florida, Georgia, Oklahoma, Oregon, South Carolina, West Virginia.

Interstate Medical Licensure Compact (IMLC) status, as of October 2026:

• Members issuing licenses: Alabama, Arizona, Arkansas, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Dakota, Tennessee, Texas, Utah, Vermont, Washington, West Virginia, Wisconsin, Wyoming. (Hawaii and Vermont issue licenses but can't be a physician's home state for the compact.)
• Joined, not yet issuing licenses: Alaska, New Mexico, Rhode Island.
• Not members: California, Massachusetts, New York, Oregon, South Carolina, Virginia.

State notes, A to Z

Alabama: Telehealth can start care. Controlled substances need an in-person encounter in the prior 12 months, which licensed staff at the patient's site can satisfy, and more than four telehealth visits for the same condition in 12 months triggers an in-person visit or referral. The relationship must start at the patient's request or on referral from the patient's own physician. IMLC member.

Alaska: Telehealth can start care with no in-person visit first. Prescribing from a questionnaire alone is prohibited without a prior relationship. IMLC member, not yet issuing licenses.

Arizona: Telehealth can satisfy the exam required before prescribing. The medical board's policy says a physician can't rely on an internet questionnaire to prescribe, and Schedule II drugs need an in-person or audio-video exam. IMLC member.

Arkansas: Telehealth can start care, with conditions on how the relationship is formed. A questionnaire, email, text, or fax alone doesn't count, and Schedule II to V by telemedicine generally needs a prior in-person exam. IMLC member.

California: Telehealth can start care, including through a self-screening tool or questionnaire, as long as the physician meets the standard of care. Not an IMLC member.

Colorado: Telehealth can start care with identity verification, disclosure, and consent. Questionnaire-only prescribing is prohibited, and out-of-state providers on Colorado's telehealth registration can't prescribe controlled substances. IMLC member.

Connecticut: Telehealth is allowed under the state statute's consent and disclosure rules. No Schedule I to III by telehealth, except for medication-assisted treatment and certain psychiatric or substance use conditions. IMLC member.

Delaware: Telehealth can start care with identity verification, a diagnosis, and a written visit summary. Prescribing from a questionnaire or an internet or phone consult alone is prohibited. IMLC member.

District of Columbia: Real-time telemedicine can be used for the initial evaluation. Questionnaires not addressed. IMLC member.

Florida: A telehealth evaluation sufficient to diagnose and treat is enough. Schedule II by telehealth is limited to psychiatric care, inpatients, hospice, and nursing home residents, and out-of-state providers can register to treat Florida patients. IMLC member.

Georgia: Limited. A Georgia licensee generally must have done a history and physical, with exceptions, and the board has said asynchronous telehealth doesn't meet its requirements. No controlled substances for pain by telehealth, and physicians should try to see patients in person at least once a year. IMLC member.

Hawaii: Telehealth can start care with a Hawaii-licensed physician. Questionnaire-only prescribing is prohibited, and opioids and medical cannabis need an in-person consult first. The opioid exception for a short supply was revised by Act 65 in 2025. IMLC member.

Idaho: Telehealth can start care if the Idaho community standard of care is met. Questionnaire-only prescribing is prohibited, and providers must verify identity and location and disclose credentials at first contact. IMLC member.

Illinois: No physician-specific telehealth prescribing rule in our source, so the general standard of care applies. Questionnaires not addressed. IMLC member.

Indiana: Telehealth can start care with history, diagnosis, and consent. By statute, an internet questionnaire, email, instant message, or fax doesn't count as telehealth unless a relationship already exists. Controlled substances by telehealth need real-time audio-video and a prescription monitoring check, and opioids are generally excluded. IMLC member.

Iowa: Telehealth can start care unless the standard of care requires in-person care. Prescribing from a static questionnaire is prohibited, though the rule treats an adaptive, interactive online interview differently. IMLC member.

Kansas: Telehealth can start care and establish the physician-patient relationship. A state pharmacy rule says a questionnaire alone doesn't create a valid relationship, and controlled substances follow the same rules as in-person care. IMLC member.

Kentucky: Telehealth can start care unless an in-person visit is medically necessary. Questionnaire-only prescribing is prohibited. IMLC member.

Louisiana: Telehealth can start care if the technology provides the clinical information needed. Weight-management care requires a live interaction under Act 345 (effective May 22, 2026), controlled substances generally need an in-person visit in the past year, and telemedicine isn't allowed for non-cancer chronic pain. IMLC member.

Maine: Telehealth can start care unless the standard of care requires in-person care. Prescribing from a static questionnaire, or a phone evaluation without an existing relationship, is prohibited. An adaptive, interactive online interview is treated differently. IMLC member.

Maryland: Telehealth can start care through either a live or an asynchronous interaction, but an appropriate evaluation comes before any prescription. Prescribing from a static online questionnaire is prohibited, and opioids for pain are restricted. IMLC member.

Massachusetts: No face-to-face visit is required first. Prescribing without an adequate history and exam, online included, is unlawful. Not an IMLC member.

Michigan: Telehealth can start care within scope of practice. Schedule 2 to 5 need a bona fide relationship and available follow-up care. IMLC member.

Minnesota: Telehealth can start care. State law requires an in-person exam before prescribing muscle relaxants, butalbital products, centrally acting opioid-type pain relievers, and most controlled substances. A telehealth exam counts only for erectile dysfunction drugs and opioid use disorder treatment. IMLC member.

Mississippi: Telehealth can start care if the technology allows an appropriate exam. A questionnaire without an appropriate exam violates board rules, and controlled substances generally need at least one in-person evaluation. IMLC member.

Missouri: Telehealth can start care. Since HB 2372 (signed July 2026), a questionnaire can support treatment if the treating provider reviews it, it gathers what an in-person visit would, the provider works with a Missouri-licensed health care entity, and a report goes to the patient's primary care physician within 14 days. IMLC member.

Montana: Telehealth can start care unless the standard of care requires in-person care. A history sufficient for diagnosis is required. IMLC member.

Nebraska: Telehealth can start care. No added rules beyond general state and federal law. IMLC member.

Nevada: Telehealth can start care when clinically appropriate. Schedule II to IV for pain need a bona fide relationship and an evaluation first. IMLC member.

New Hampshire: Telehealth can start care through a telemedicine exam that meets listed conditions. Schedule II to IV by telemedicine need an in-person exam at least once a year. IMLC member.

New Jersey: Telehealth can start care after identity, history, and standard-of-care checks. Questionnaire-only prescribing is prohibited without a proper relationship. Schedule II generally needs an initial in-person exam plus in-person visits every 3 months. A 2026 law (P.L. 2026, c.40) lets adult Schedule II stimulant care start by live audio-video if an in-person visit follows within 30 days and yearly after that, and adds exceptions for cancer, hospice, and palliative care. IMLC member.

New Mexico: Limited. A face-to-face video encounter with history, consent, and a medical record can support treatment, so plan on a live visit. Questionnaire-only prescribing is unprofessional conduct. IMLC member, not yet issuing licenses.

New York: Telehealth can start care under the standard of care. Controlled substances generally need an in-person evaluation unless the telemedicine exception applies. Not an IMLC member.

North Carolina: Medical Board position statements allow telehealth prescribing, though some situations call for an initial in-person visit. The Board says a simple questionnaire without an appropriate evaluation falls short. IMLC member.

North Dakota: Telehealth can start care with a bona fide relationship and an equivalent exam. A questionnaire or audio-only conversation doesn't meet the standard of care, and opioids are allowed only for opioid use disorder treatment. IMLC member.

Ohio: Telehealth can start care, and non-controlled drugs can be prescribed after a medical evaluation appropriate for the patient, with no in-person visit first. A new patient needs an in-person physical exam before a Schedule II drug, with listed exceptions. IMLC member.

Oklahoma: Telehealth can start care with an Oklahoma licensee. The statute says a website questionnaire, email, text, or audio-only call isn't telemedicine. Telehealth can't start care for opioids, benzodiazepines, or carisoprodol (limited exceptions). Controlled drug renewals by telemedicine are allowed if the first prescription was written in person. IMLC member.

Oregon: Telehealth can start care. Internet-only prescribing is barred without a proper relationship, and telemedicine licensees can't prescribe controlled substances for chronic pain. Not an IMLC member.

Pennsylvania: No telehealth-specific rule for non-controlled prescribing, so the standard of care applies. IMLC member.

Rhode Island: Telehealth care is held to in-person standards. Questionnaire-only prescribing is prohibited, and controlled substances need an established in-person relationship. IMLC member, not yet issuing licenses.

South Carolina: Telehealth can start care if the standard of care can be met remotely. State law calls prescribing to someone the physician has never examined, based only on answers to a set of questions, unprofessional conduct. Schedule II and III narcotics by telemedicine are limited to specific settings. Not an IMLC member.

South Dakota: Telehealth can start care, but a live audio-video exam is required when an in-person visit would otherwise be needed. Controlled drugs can't be prescribed from a questionnaire, internet consult, or phone call alone. IMLC member.

Tennessee: The history and physical can be done by telemedicine. A facilitator is required for patients under 18. IMLC member.

Texas: Telehealth can start care, including store-and-forward when the physician has adequate clinical information. Scheduled drugs for chronic pain need audio-video unless the patient is established and was seen within 90 days. IMLC member.

Utah: Telehealth can start care, but a diagnosis comes before any prescription. Prescribing from a questionnaire, email, or patient-generated history alone is prohibited, and cosmetic procedures need an in-person or live telemedicine evaluation. IMLC member.

Vermont: A physician can prescribe after an appropriate exam in person, by telemedicine, or with diagnostic equipment. The statute says a questionnaire-based evaluation isn't adequate for the initial evaluation. IMLC member.

Virginia: Telehealth can start care if the standard of care is met and the evaluation is documented. Questionnaire-only prescribing is prohibited, and Schedule II to V by telemedicine need a Virginia practice location or a referral when an in-person exam is needed. Not an IMLC member.

Washington: Telehealth can start care. Email, instant messaging, text, or fax can't establish the relationship. Questionnaires aren't addressed directly. IMLC member.

West Virginia: Telehealth can start care by audio-video or real-time audio-only. Questionnaire-only prescribing is prohibited, and telemedicine-only Schedule II prescribing is barred, with exceptions. IMLC member.

Wisconsin: Telehealth can start care with a documented evaluation. Questionnaire-only prescribing is prohibited. IMLC member.

Wyoming: General telehealth care isn't addressed in our source. Initially prescribing listed controlled substances online without a documented relationship is grounds for discipline. IMLC member.

State notes are based on CCHP's state summaries on online prescribing and professional board standards (accessed May to October 2026) and the state sources listed at the end of this page. IMLC status as of October 2026.

Three situations that trip practices up

The traveling client. A client who normally lives in Texas messages you from a work trip in Maryland asking for a review. The visit happens in Maryland, so Maryland's rules and licensing apply for that encounter. In practice, it's often simpler to wait until they're home.

The client who moved. Clients who relocate often keep training with you online. Their new address changes which physician can review them, and it may change what that physician can prescribe. Update their location on file before the next request.

The multi-state clinic. A recovery clinic with locations in Kansas City, Missouri, and Overland Park, Kansas, is dealing with two sets of rules a few miles apart. Kansas doesn't let a questionnaire alone create the relationship, while Missouri now allows a reviewed questionnaire with conditions attached. Build one intake process that meets the stricter state's rule, so staff don't have to switch processes by location.

How this plays out on Doc Connect

Doc Connect is physician oversight infrastructure for wellness practices. The state rules above are why every request is matched to a physician licensed where your client is, not where you are. That physician does their own evaluation in whatever form that state requires and decides whether to prescribe. [Counsel to confirm wording: describe the evaluation format used in live-visit states once confirmed.]

Controlled substances are blocked at submission, so the DEA rule doesn't affect requests on the platform. If you're weighing this kind of service against launching your own telehealth brand, we compare the two in White-Label Telehealth vs. Physician Review. For the scope side, see our guides for personal trainers, physical therapists, and chiropractors.

Frequently asked questions

Can a doctor prescribe medication without seeing you in person?

In most states, yes, if the physician establishes a valid relationship by telehealth and meets the same standard of care as an in-person visit. Some states require a live video visit or an in-person exam for certain treatments, and controlled substances have extra rules.

Can a doctor prescribe based on an online questionnaire alone?

In most states, no. Many states say so in writing, and CCHP reports that most states consider a questionnaire alone inadequate to establish a prescribing relationship. California and Missouri are the main exceptions, and both attach conditions.

Which state's rules apply if my client and the physician are in different states?

The client's. Care is generally treated as happening where the patient is located during the visit, so the physician needs a license there and follows that state's prescribing rules.

Which states are in the Interstate Medical Licensure Compact in 2026?

44 states plus DC and Guam are members. California, Massachusetts, New York, Oregon, South Carolina, and Virginia are not. Alaska, New Mexico, and Rhode Island have joined but weren't issuing licenses as of October 2026.

Can controlled substances be prescribed by telehealth in 2026?

Federally, yes, without a prior in-person visit, through December 31, 2026, under the DEA's temporary rule. Many states set stricter limits. A permanent federal rule is under review.

Is asynchronous (store-and-forward) telehealth allowed for prescribing?

It depends on the state. Texas and California allow it in some form when the physician has enough clinical information. Georgia's board has said asynchronous care doesn't meet its rules, Louisiana requires a live interaction for weight-management care, and Minnesota requires an in-person exam before muscle relaxants.

Disclaimer: This page summarizes state telehealth prescribing rules for wellness practice owners. It is not legal, medical, or compliance advice. Summaries are drawn from secondary sources and may not reflect the latest changes, so confirm any state's rule with the statute, the state board, or a healthcare attorney.

Changelog

• November 2026: Page published. Primary-source checks before launch corrected Maryland, Mississippi, Missouri, and Washington, then moved Arizona, Indiana, Oklahoma, South Carolina, and Vermont into the questionnaire-ban group, added Minnesota's in-person exam rule, and updated New Jersey, Hawaii, Ohio, and Kansas.

Sources: Center for Connected Health Policy: Online Prescribing (state-by-state); Center for Connected Health Policy: Professional Board Standards; Telehealth.org: Telehealth Prescribing Laws in 2026; Holland & Knight via JD Supra: DEA and HHS Extend Telemedicine Prescribing Flexibilities Through 2026; Becker's: DEA extends telemedicine prescribing flexibilities through 2026; Gordon Rees: HHS and DEA Extend Telemedicine Flexibilities; Frier Levitt: DEA Telemedicine Special Registration Final Rule Reaches White House Review; McDermott: DEA appears close to finalizing telemedicine special registration; CompHealth: IMLC States List and Guide for 2026; North Carolina Medical Board: IMLC; Connecticut DPH: IMLC; Louisiana Legislature: Act 345 (SB 30) of 2026; NC Medical Board: Telemedicine Position Statement; Ward and Smith: North Carolina Telehealth; Pullman & Comley: DEA Extension and Connecticut Practitioners; Wheel: Pennsylvania Telehealth Regulations; LexBlog: PBI Health Law Institute Recap; Hooper Lundy: California AB 1264 and B&P Code 2242; Maryland Board of Physicians: Telehealth FAQs; Maryland HB 448 (2020); Georgia Rules 360-3; Georgia Composite Medical Board minutes, Sept. 11, 2025; South Dakota Codified Laws ch. 34-52; New Mexico Medical Board: 16.10.8 NMAC; Utah HB 365 (2024); 30 Miss. Code R. 2635-5.5; Missouri Governor: HB 2372 signed; MSMA: Unpacking HB 2372; Texas Occupations Code ch. 111; RCW 18.134.030; Florida Statutes 456.47; Massachusetts Telehealth Task Force Report (June 2026); Minnesota Statutes 151.37; South Carolina Code 40-47-113; South Carolina Board of Medical Examiners: Physician-Patient Relationship; Ohio Admin. Code 4731-37-01; Ohio Admin. Code 4731-11-09; New York DOH controlled substance rule (Nixon Peabody, June 2025)