(a) Under O.C.G.A. §§
43-34-8 and
43-1-19, the Board is authorized to take disciplinary action against licensees for
unprofessional conduct, and in connection therewith, to establish standards of
practice. Except as otherwise provided, in order for a physician to practice
within the minimum standards of practice while providing treatment and/or
consultation recommendations by electronic or other such means, all the
following conditions must be met:
(1) All
treatment and/or consultations must be done by Georgia licensed
practitioners;
(2) A history of the
patient shall be available to the Georgia licensed physician, physician
assistant or advanced practice registered nurse who is providing treatment or
consultation via electronic or other such means;
(3) A Georgia licensed physician, physician
assistant or advanced practice registered nurse either:
3.a. Has personally seen and examined the
patient and provides ongoing or intermittent care by electronic or other such
means; or
3.b. Is providing medical
care by electronic or other such means at the request of a physician, physician
assistant or advanced practice registered nurse licensed in Georgia who has
personally seen and examined the patient; or
3.c. Is providing medical care by electronic
or other such means at the request of a Public Health Nurse, a Public School
Nurse, the Department of Family and Children's Services, law enforcement,
community mental health center or through an established child advocacy center
for the protection for a minor, and the physician, physician assistant or
advanced practice registered nurse is able to examine the patient using
technology and peripherals that are equal or superior to an examination done
personally by a provider within that provider's standard of care; or
3.d. Is able to examine the patient using
technology or peripherals that are equal or superior to an examination done
personally by a provider within that provider's standard of care.
(4) The Georgia licensed
physician, physician assistant or advanced practice registered nurse providing
treatment or consultations by electronic or other means must maintain patient
records on the patient and must document the evaluation and treatment along
with the identity of the practitioners providing the service by electronic or
other means, and if there is a referring practitioner, a copy of this record
must also be provided to the referring physician, physician assistant or
advanced practice registered nurse;
(5) To delegate to a nurse practitioner or to
supervise a physician assistant doing telemedicine, the physician must document
to the board that that the provision of care by telemedicine is in his or her
scope of practice and that the NP or PA has demonstrated competence in the
provision of care by telemedicine.
(6) Patients treated by electronic or other
such means or patient's agent must be given the name, credentials and emergency
contact information for the Georgia licensed physician, physician assistant
and/or advanced practice registered nurse providing the treatment or
consultation. Emergency contact information does not need to be provided to
those treated within the prison system while incarcerated but should be
provided to the referring provider. For the purposes of this rule,
"credentials" is defined as the area of practice and training for physicians,
and for physician assistants and advanced practice registered nurses,
"credentials" shall mean the area of licensure and must include the name of the
delegating physician or supervising physician;
(7) The patient being treated via electronic
or other means or the patient's agent must be provided with clear, appropriate,
accurate instructions on follow-up in the event of needed emergent care related
to the treatment. In the case of prison patients, prison staff will be provided
this information if the consult is provided to an inmate; and
(8) The physician, physician assistant or
nurse practitioner who provides care or treatment for a patient by electronic
or other such means must make diligent efforts to have the patient seen and
examined in person by a Georgia licensed physician, physician assistant or
nurse practitioner at least annually.
(b) This rule should not be interpreted to
interfere with care and treatment by telephonic communication in an established
physician-patient relationship, call coverage for established
physician-patients relationships, or telephone and internet consultations
between physicians, nurse practitioners, physician assistants, other healthcare
providers or child protection agencies.
(c) This rule does not authorize the
prescription of controlled substances for the treatment of pain or chronic pain
by electronic or other such means. All treatment of pain or chronic pain must
be in compliance with Rule
360-3-.06.
(d) Nothing in this rule shall excuse a
physician, nurse practitioner or physician assistant from ordering appropriate
laboratory or other diagnostic tests needed to make diagnoses within the
minimum standard of care.
(e)
Nothing in this rule shall supersede any requirements provided for by other
rules or laws.
(f) Licensees
practicing by electronic or other means will be held to the same standard of
care as licensees employing more traditional in-person medical care. A failure
to conform to the appropriate standard of care, whether that care is rendered
in person or via electronic or other such means, may subject the licensee to
disciplinary action by the Board.
