1. (a)

   1. (1) An APRN–patient relationship shall be established in accordance with 17 CAR § 123-1201 before the delivery of services via telemedicine.
   2. (2) A patient completing a medical history online and forwarding it to an APRN is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology.

2. (b) The following requirements apply to all services provided by APRNs using telemedicine:

   1. (1) The practice of nursing via telemedicine shall be held to the same standards of care as traditional in-person encounters;

   2. (2) The APRN shall obtain a detailed explanation of the patient’s complaint from the:

      1. (A) Patient; or
      2. (B) Patient’s healthcare provider;
   3. (3) If a decision is made to provide treatment, the APRN shall agree to accept responsibility for the care of the patient;
   4. (4) If follow-up care is indicated, the APRN shall agree to provide or arrange for such follow-up care;

   5. (5) An APRN using telemedicine may not issue a prescription for any controlled substances defined as any scheduled medication under Schedules III – V and only hydrocodone combination products, which were reclassified from Schedule III to Schedule II as of October 6, 2014, unless:

      1. (A) The APRN has seen the patient for an in-person exam;
      2. (B) A relationship exists through consultation or referral; or
      3. (C) In on-call or cross-coverage situations;
   6. (6) The APRN shall keep a documented medical record, including medical history;

   7. (7)

      1. (A) At the patient’s request, the APRN shall make available to the patient an electronic or hardcopy version of the patient’s medical record documenting the encounter.
      2. (B) Additionally, unless the patient declines to consent, the APRN shall forward a copy of the record of the encounter to the patient’s regular treating healthcare provider if that healthcare provider is not the same one delivering the service via telemedicine;
   8. (8) Services shall be delivered in a transparent manner, including providing access to information identifying the APRN in advance of the encounter, with licensure and board certifications, as well as patient financial responsibilities;

   9. (9)

      1. (A) If the patient, at the recommendation of the APRN, needs to be seen in person for the current medical issue, the APRN shall arrange to see the patient in person or direct the patient to their regular treating healthcare provider.
      2. (B) Such recommendation shall be documented in the patient’s medical record;
   10. (10) APRNs who deliver services through telemedicine shall establish protocols for referrals for emergency services;
   11. (11) APRNs providing care via telemedicine to a patient located within the State of Arkansas shall be licensed to practice nursing in the State of Arkansas; and
   12. (12) Telemedicine may be utilized for group therapy for adults (over the age of eighteen (18)) who are participants in a program or plan authorized and funded under 42 U.S.C. § 1396a, if permitted by the Centers for Medicare and Medicaid Services.

Codification Notes: “APRN” means advanced practice registered nurse. This section as promulgated prior to codification into the Code of Arkansas Rules provided as follows: "HISTORY: Adopted: January 1, 2018 Amended: May 15, 2022"