1. (a) The APRN shall establish a proper APRN–patient relationship prior to providing any patient care.

2. (b) A proper APRN–patient relationship at a minimum requires that:

   1. (1) The APRN perform a history and an “in person” physical examination of the patient adequate to establish a diagnosis and identify underlying conditions and/or contraindications to the treatment recommended/provided; or
   2. (2) The APRN perform a face-to-face examination using real-time audio or visual telemedicine technology that provides information at least equal to such information as would have been obtained by an in-person examination; and
   3. (3) Appropriate follow-up be provided or arranged, when necessary, at medically necessary intervals.

3. (c) A proper APRN–patient relationship is also deemed to exist in the following situations:

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

      1. (A) An ongoing relationship with the patient; and
      2. (B) Agreed to supervise the patient’s treatment, including follow-up care and the use of any prescribed medications;
   2. (2) On-call or cross-coverage situations arranged by the patient’s healthcare provider; and
   3. (3) Has access to a patient’s personal health record maintained by a healthcare professional and uses any technology deemed appropriate by the healthcare professional, including the telephone, with a patient located in Arkansas to diagnose, treat, and, if clinically appropriate, prescribe a noncontrolled drug to the patient.

4. (d) Recognizing a provider’s duty to adhere to the applicable standard of care, the following situations are hereby excluded from the requirement of this section:

   1. (1) Emergency situations where the life or health of the patient is in danger or imminent danger;
   2. (2) Providing information of a generic nature not meant to be specific to an individual;
   3. (3) Providing prescriptions written or medications issued for use in expedited heterosexual partner therapy for the sexually transmitted diseases of gonorrhea and/or chlamydia; and
   4. (4) Administration of vaccines containing tetanus toxoid (e.g., DTaP, DTP, DT, Tdap, TD, or TT) or inactive influenza vaccines.

Codification Notes: “APRN” means advanced practice registered nurse. "DTaP" means diphtheria, tetanus, and pertussis. "DTP" means diphtheria, tetanus, pertussis. "DT" means diphtheria, tetanus. "Tdap" means tetanus, diphtheria, and pertussis. "TD" means tetanus, diphtheria. "TT" means tetanus toxoid. This section as promulgated prior to codification into the Code of Arkansas Rules provided as follows: "HISTORY: Adopted: January 1, 2018 Amended July 1, 2020"