(a) Definitions. As used in this section:

1. (1) “Distant site” means the location of the healthcare professional delivering services through telemedicine at the time the services are provided (Arkansas Code § 17-80-402(1));
2. (2) “Originating site” means a site at which a patient is located at the time healthcare services are provided to him or her by means of telemedicine, including the home of a patient (Arkansas Code § 17-80-402(3));
3. (3) “Remote patient monitoring” means the use of synchronous or asynchronous electronic information and communication technology to collect personal health information and medical data from a patient at an originating site that is transmitted to a healthcare professional at a distant site for use in the treatment and management of medical conditions that require frequent monitoring (Arkansas Code § 17-80-402(5));
4. (4) “Store-and-forward technology” means the asynchronous transmission of a patient’s medical information from a healthcare professional at an originating site to a healthcare professional at a distant site (Arkansas Code § 17-80-402(6)); and

5. (5)

   1. (A) “Telemedicine” means the use of electronic information and communication technology to deliver healthcare services, including without limitation the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient.
   2. (B) Telemedicine includes store-and-forward technology and remote patient monitoring (Arkansas Code § 17-80-402(7)).

(b) Establishing a licensed dietitian-client relationship.

1. (1) A licensed dietitian-client relationship must be established in accordance with Arkansas Code §§ 17-80-402 and 17-80-403 and 17 CAR § 90-106 before the delivery of services via telemedicine.
2. (2) A client’s completing a nutrition history online and forwarding it to a licensed dietitian is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology.
3. (3) A licensed dietitian exhibits gross negligence if he or she provides and/or recommends any form of treatment via telemedicine without first establishing a proper licensed dietitian-client relationship.

(c) Minimum requirements for licensed dietitian-client relationship. For purposes of this section, a proper licensed dietitian–client relationship at a minimum requires that:

1. (1) The licensed dietitian:

   1. (A) Performs an in-person nutrition history of the client adequate to establish a diagnosis and develop a treatment plan;
   2. (B) Performs a face-to-face nutrition history using real-time audio and visual telemedicine technology that provides information at least equal to such information as would have been obtained by an in-person nutrition history; or
   3. (C) Knows the client and the client’s general nutrition issues through a previously established professional relationship; and
2. (2) Appropriate follow-up be provided or arranged when necessary.

(d) When a licensed dietitian-client relationship is deemed to exist. For the purposes of this section, a proper licensed dietitian–client relationship is deemed to exist in the following situations:

1. (1) When treatment is provided in consultation with, or upon referral by, another provider or treatment team who has:

   1. (A) An ongoing relationship with the client; and
   2. (B) Agreed to supervise the client’s treatment, including follow-up care; and
2. (2) On-call or cross-coverage situations arranged by the client’s treating provider or treatment team.

(e) Exceptions. Recognizing a licensed dietitian’s duty to adhere to the applicable standard of care and to comply with mandatory reporting laws, the following situations are excluded from the requirement of this section by Arkansas Code § 17-80-403(a)(2):

1. (1) Emergency situations where the life or health of the client is in danger or imminent danger; and
2. (2) Simply providing information of a generic nature not meant to be specific to an individual client.

(f) Professional relationship exceptions. Under Arkansas Code § 17-80-403(c), “professional relationship” does not include a relationship between a licensed dietitian and a client established only by the following:

1. (1) An internet questionnaire;
2. (2) An email message;
3. (3) Patient-generated medical history;
4. (4) Text messaging;
5. (5) A facsimile machine; or
6. (6) Any combination thereof.

(g) Requirements for services provided via telemedicine. The following requirements apply to all services provided by licensed dietitians using telemedicine:

1. (1) The practice of dietetics via telemedicine shall be held to the same standards of care as traditional in-person encounters;
2. (2) The licensed dietitian must obtain a detailed explanation of the client’s medical diagnosis from the client or the client’s treating provider or treatment team in order to individualize the nutrition interventions;
3. (3) If a decision is made to provide treatment (medical nutrition therapy), the licensed dietitian must agree to accept responsibility for the (nutrition) care of the client;
4. (4) If follow-up care is indicated, the licensed dietitian must agree to provide or arrange for such follow-up care;

5. (5) The licensed dietitian must keep a documented treatment record, including, but not limited to:

   1. (A) Nutrition history;
   2. (B) Interventions; and
   3. (C) Outcomes;

6. (6)

   1. (A) At the client’s request, the licensed dietitian must make available to the client an electronic or hardcopy version of the client’s treatment record documenting the encounter.
   2. (B) Additionally, unless the client declines to consent, the licensed dietitian must forward a copy of the record of the encounter to the client’s regular treating provider or treatment team if that provider or treatment team is not the same licensed dietitian delivering the service via telemedicine;
7. (7) Services must be delivered in a transparent manner, including providing access to information identifying the licensed dietitian’s licensure and other relevant certifications, as well as client financial responsibilities, in advance of the encounter;

8. (8)

   1. (A) If the client, at the recommendation of the licensed dietitian, needs to be seen in person, the licensed dietitian must:

(i) Arrange to see the client in person; or

1. (ii) Direct the client to their regular treating provider or treatment team or other appropriate provider if the client does not have a treating provider or treatment team.

   1. (B) Such recommendation shall be documented in the client’s treatment record; and
2. (9) Licensed dietitians who deliver services through telemedicine must establish protocols for referrals for emergency services.

(h) Scope of practice. Licensed dietitians may practice dietetics via telemedicine within the definitions found in 17 CAR § 90-104.

1. (i) Confidentiality.
2. (1) Licensed dietitians who use technology to facilitate supervision, consultation, or other confidential meetings shall use appropriate precautions to protect the confidentiality of those communications.

3. (2) Precautions to protect confidentiality depend on the type of technology being used, and may include:

   1. (A) Using passwords, firewalls, encryption, and antivirus software;
   2. (B) Using electronic service providers that rely on standards of security for data that are transmitted and stored; and
   3. (C) Ensuring a private setting when using their electronic devices.