191.1146.  Physician-patient relationship required, how established. — 1.  Physicians licensed under chapter 334 who use telemedicine shall ensure that a properly established physician-patient relationship exists with the person who receives the telemedicine services.  The physician-patient relationship may be established by:

  (1)  An in-person encounter through a medical evaluation and physical examination;

  (2)  Consultation with another physician, or that physician's delegate, who has an established relationship with the patient and an agreement with the physician to participate in the patient's care; or

  (3)  A telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

  2.  In order to establish a physician-patient relationship through telemedicine:

  (1)  The technology utilized shall be sufficient to establish an informed diagnosis as though the medical evaluation and, if required to meet the standard of care, the physical examination has been performed in person;

  (2)  Prior to providing treatment, including issuing prescriptions or physician certifications under Article XIV of the Missouri Constitution, a physician who uses telemedicine shall evaluate the patient, collect or review the patient's relevant medical history, and perform an examination sufficient for the diagnosis and treatment of the patient.  Any questionnaire completed by the patient, whether via the internet or telephone, shall be reviewed by the treating health care professional, as defined in section 376.1350, and shall include such information sufficient to provide the information as though the medical evaluation has been performed in person, otherwise such questionnaire does not constitute an acceptable medical evaluation and examination for the provision of treatment by telehealth; and

  (3)  Any provider that uses a questionnaire to establish a physician-patient relationship through telemedicine shall be employed or contracted with a business entity that is licensed to provide health care in this state.

  3.  A health care provider, utilizing a medical evaluation questionnaire completed by the patient by way of the internet or telephone, shall provide a written report to the patient's primary health care provider within fourteen days of evaluation, if provided by the patient, that contains:

  (1)  The identity of the patient;

  (2)  The date of the evaluation;

  (3)  The diagnosis and treatment provided, if any; and

  (4)  Any further instructions provided to the patient.