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AL · STATE RULES

Telehealth rules in Alabama

Alabama keeps its telehealth law in a short article of the medical practice act, and most of the friction there is arithmetic. A physician who treats the same unresolved condition remotely more than four times in a year owes the patient an in-person visit or a referral. A controlled substance needs synchronous contact plus an in-person encounter inside the previous twelve months. Set against that, a physician licensed elsewhere may work under ten days a year here without holding a state license.

Book a DemoAll states
First visit
Async allowed
Physician license
Compact member; 10-day rule
Controlled drugs
Live visit, yearly in person
Nurse practitioners
Reduced practice

Rules checked September 2026 · 28 sources cited

ONLY IN ALABAMA

What is different about Alabama

Each rule here is true of Alabama and of none of the states that border it. Beside each one: what the neighbours do instead.

  1. 01 · First visit

    Four remote visits, then a real one

    Ala. Code 34-24-703 puts a counter on remote care. Where the same physician or practice treats the same patient by telehealth more than four times in twelve months for the same medical condition and the condition has not resolved, the patient must be seen in person, or referred to a physician who can provide that care, within twelve months. Mental health services are carved out of the count entirely.

    Source: Ala. Code 34-24-703

    Across the border

    • Mississippi

      Board rule there loads the duty onto every encounter rather than onto a tally, since stored images may enhance a real-time interaction with the patient but never substitute for one.

      Source: 30 Miss. Code R. 2635-5.5

    • Tennessee

      Its telemedicine rule counts nothing, and a physician there owes a direct referral for inspection and actual physical examination only where the transmitted information will not support a judgment.

      Source: Tenn. Comp. R. & Regs. 0880-02-.16

    • Georgia

      The Composite Medical Board rule runs on the calendar instead, asking for diligent efforts toward one in-person examination a year for every patient treated by electronic means.

      Source: Ga. Comp. R. & Regs. 360-3-.07

    • Florida

      Remote treatment there may continue without any tally or interval, for as long as the telehealth evaluation remains sufficient to diagnose and treat the patient.

      Source: Fla. Stat. 456.47

  2. 02 · Licenses

    Under ten days a year, no license

    Ala. Code 34-24-702 sets a threshold rather than a credential. A physician holding a full license in another state may deliver telehealth to patients located here without a state license where the work is irregular or infrequent, which the statute fixes at fewer than ten days in a calendar year or fewer than ten patients in a calendar year. Cross the line either way and a full license is required.

    Source: Ala. Code 34-24-702

    Across the border

    • Mississippi

      Its board rule places the practice where the patient sits and reserves telemedicine to state licensees, opening only for laboratory, pathology and histopathology readings under a licensee's oversight.

      Source: 30 Miss. Code R. 2635-5.2

    • Tennessee

      Legacy telemedicine licensees there hold no prescriptive authority at all, so anyone writing a prescription works from a full and current medical license.

      Source: Tenn. Comp. R. & Regs. 0880-02-.16

    • Georgia

      A physician unrestricted elsewhere may apply for a telemedicine license from the Board, which is a credential to obtain rather than a volume below which none is needed.

      Source: O.C.G.A. 43-34-31.1

    • Florida

      The Department of Health runs a registration with no application fee, an ongoing credential carrying a registered agent, malpractice cover and a five-day reporting duty.

      Source: Fla. Stat. 456.47

  3. 03 · Prescribing

    A controlled drug leans on a prior visit

    Ala. Code 34-24-704 allows a controlled substance prescription out of a telehealth visit only where two things hold together: the visit itself runs on synchronous audio or audio-visual communication over HIPAA compliant equipment with the responsible prescriber, and that prescriber has had at least one in-person encounter with the patient in the preceding twelve months. A medical emergency is exempt, and a video visit attended in person by a clinician licensed by the medical or nursing board counts as the in-person encounter.

    Source: Ala. Code 34-24-704

    Across the border

    • Mississippi

      Its prescribing rule conditions every prescription on a good faith prior examination and medical indication, adding no separate look-back period for scheduled drugs.

      Source: 30 Miss. Code R. 2640-1.4

    • Tennessee

      The lever there is the monitoring database, searched at the start of a new episode of opioid or benzodiazepine treatment rather than paired with a past office visit.

      Source: Tenn. Code 53-10-310

    • Georgia

      Writing a controlled substance on an electronic consultation alone is unprofessional conduct there, with call coverage, documented emergencies and federal telemedicine definitions as the exceptions.

      Source: Ga. Comp. R. & Regs. 360-3-.02

    • Florida

      The line is drawn by schedule rather than by history, holding Schedule II off telehealth outside four named settings and leaving Schedule III to V untouched.

      Source: Fla. Stat. 456.47

  4. 04 · Prescribing

    Database checks keyed to the daily dose

    Board Rule 540-X-4-.09 measures the duty to search the monitoring database in morphine milligram equivalents. Below thirty a day the search is left to good clinical practice. Between thirty and ninety it happens at least twice a year, with a documented risk mitigation strategy. Above ninety it happens on the same day every prescription is written. Nursing home and hospice patients, active malignant pain and care inside an operation are excused.

    Source: Ala. Admin. Code r. 540-X-4-.09

    Across the border

    • Mississippi

      Its rule sorts prescribers by practice type, telling licensees outside pain management to search when a new patient first arrives and at least quarterly after that.

      Source: 30 Miss. Code R. 2640-1.3

    • Tennessee

      The statute counts episodes of treatment, asking for a search at the start, before each new prescription for ninety days, and then twice a year while the drug continues.

      Source: Tenn. Code 53-10-310

    • Georgia

      The trigger there is the drug class, reaching Schedule II narcotics and every benzodiazepine at the first prescription and at ninety-day intervals after.

      Source: O.C.G.A. 16-13-63

    • Florida

      Review is universal for controlled substances once a patient turns sixteen, excusing only nonopioid Schedule V drugs, hospice care and a system outage.

      Source: Fla. Stat. 893.055

PRACTICE RULES

How telehealth works in Alabama

The telehealth article, Ala. Code 34-24-700 and following, is compact. It settles who may treat a patient located here, what has to happen before the service begins, and when remote care must give way to a room.

  1. 01

    Identity, place and consent first

    Before the service begins the physician verifies that the patient is who they say they are, confirms the patient's physical location, discloses their own credentials, and obtains and documents consent to be treated by telehealth. The consent belongs in the record rather than in a marketing flow.

    Source: Ala. Board of Medical Examiners, telemedicine guidance

  2. 02

    Two ways in for a new patient

    The relationship forms when the patient initiates the contact themselves or when a provider who already treats them makes a referral. There is no statutory requirement that either route begin with a live examination.

    Source: Ala. Code 34-24-703

  3. 03

    An attended video visit counts

    Where a video visit reaches a patient at an originating site with in-person help from someone licensed by the Board of Medical Examiners or the Board of Nursing, the statute treats that as an in-person visit. It is the practical release valve for both the visit counter and the controlled-substance look-back.

    Source: Ala. Code 34-24-704

  4. 04

    Mental health is outside the count

    Services for mental health are excluded from the trigger that forces a patient into a room after repeated remote visits, so a behavioral health line can run continuously by telehealth while a dermatology or weight line cannot.

    Source: Center for Connected Health Policy: Alabama

  5. 05

    Who may own the practice

    There is no flat statutory bar on a company employing physicians, provided the contract leaves independent medical judgment with the clinician. Professional corporations and limited liability companies organized by physicians answer to Board Rule 540-X-9 as well as to the corporation statutes.

    Source: Ala. Admin. Code r. 540-X-9-.01

FIRST VISIT

Can a first visit happen without a live call in Alabama?

Yes

Yes for a first non-controlled prescription. Asynchronous communication sits inside the statutory definition of telemedicine, and the relationship opens on the patient's own request or on a referral, so nothing in the article forces live video before that first order.

The interesting question here is not whether a first visit can be asynchronous. It is what happens on the fifth one. The article is permissive at the start and prescriptive once a condition refuses to resolve.

  1. 01

    Asynchronous care is named in the law

    The definitions reach medical services delivered by a physician at a distant site to a patient at an originating site through asynchronous or synchronous communications, so store-and-forward review is inside the regulated category rather than outside it.

    Source: Ala. Code 34-24-701

  2. 02

    The counter starts at visit one

    The trigger is written per patient and per condition, not per brand or per clinician team. A product that treats one unresolved complaint over a year of remote check-ins has to know which visit is the fifth one before it happens.

    Source: Ala. Code 34-24-703

  3. 03

    A referral discharges the duty

    The statute accepts either outcome: the treating physician sees the patient in person, or refers them to a physician who can provide in-person care within a reasonable time, which cannot exceed twelve months. A referral is therefore a designable path rather than a failure state.

    Source: Ala. Board of Medical Examiners, telemedicine guidance

  4. 04

    Controlled drugs change the answer

    The permissive first-visit position applies to a non-controlled prescription. Once a scheduled drug is in view, the visit must be synchronous and a qualifying in-person encounter must already sit in the previous twelve months.

    Source: Ala. Code 34-24-704

PRESCRIBING

Prescriptions and controlled drugs in Alabama

A prescriber here carries a state certificate alongside the federal registration, works to a monitoring rule pegged to dose, and meets a separate chapter of board rules if the product treats weight.

  1. 01

    A state certificate on top of the federal one

    Prescribing, dispensing or distributing a controlled substance requires an annual state controlled substances certificate held alongside a current federal registration. It renews by the end of December each year, and the renewal certifies monitoring-database enrollment and continuing education in controlled-substance prescribing.

    Source: Ala. Board of Medical Examiners, controlled substances certificate

  2. 02

    Weight drugs have their own chapter

    Board Rule 540-X-17-.02 forbids ordering, prescribing or dispensing any Schedule II amphetamine or amphetamine-like anorectic drug for weight control, weight loss or the treatment of obesity. Non-narcotic Schedule II stimulants and sympathomimetic amine derivatives fall inside the same prohibition.

    Source: Ala. Admin. Code r. 540-X-17-.02

  3. 03

    Weight treatment returns to the room

    Where a controlled substance is continued for weight reduction, Rule 540-X-17-.05 caps the prescription at a thirty-five day supply and expects an in-person re-evaluation at least that often. A physician assistant or certified registered nurse practitioner may perform it, with the prescribing physician personally reviewing the resulting record before the drug continues.

    Source: Ala. Admin. Code r. 540-X-17-.05

  4. 04

    Paper remains lawful for Schedule II

    Board Rule 540-X-4-.06 accepts a Schedule II prescription either through an approved electronic prescribing platform or manually signed, which is unusual among states that have pushed scheduled drugs fully electronic. Pre-signed blanks and mechanically reproduced signatures are prohibited.

    Source: Ala. Board of Medical Examiners, prescribing guidance

  5. 05

    Federal conditions sit on top

    The federal telemedicine conditions for controlled substances run through December 31, 2026 and apply in addition to the state rules. The synchronous-contact and twelve-month conditions in the article are state law and do not lapse when the federal position changes.

    Source: Center for Connected Health Policy: Alabama

Federal rules apply on top of every state's. Prescribing controlled substances by telehealth without an in-person visit runs on DEA flexibilities currently extended through December 31, 2026, with a permanent rule still pending.

LICENSES

Who can treat patients in Alabama

Licensing splits between the Board of Medical Examiners and the Medical Licensure Commission, and the state issues through the physician compact. Nurse practitioners work under collaboration, with a separate certificate before they touch controlled substances.

  1. 01

    The threshold, then the license

    Below the statutory volume an out-of-state physician needs nothing from the state. At or above it, the ordinary full license applies, and there is no standing telehealth credential that would substitute for one.

    Source: Ala. Code 34-24-702

  2. 02

    Consulting has its own allowance

    A physician licensed elsewhere who provides telehealth in consultation with a state-licensed physician is treated separately, and board guidance holds that allowance to ten days in a calendar year as well.

    Source: Ala. Board of Medical Examiners, telemedicine guidance

  3. 03

    The compact route is open

    The state issues physician licenses through the medical compact and takes part in the nursing, physician assistant, counseling, psychology and several therapy compacts, so a multi-discipline care team has more than one expedited path in.

    Source: Center for Connected Health Policy: Alabama

  4. 04

    Nurse practitioners collaborate

    Certified registered nurse practitioners practice in collaboration with a state-licensed physician under written protocols, which is why the national practice-environment survey places this state in the reduced class rather than the full one.

    Source: AANP: full practice authority brief

  5. 05

    A second certificate for the team

    A nurse practitioner or physician assistant prescribing Schedules III to V holds a qualified state controlled substances certificate, and Schedule II requires a further limited purpose permit naming board-approved drugs in thirty-day supplies with two reissues.

    Source: Ala. Board of Medical Examiners, qualified certificate protocol

How Tessic Health's providers are licensed in Alabama

ADVERTISING

Marketing to patients in Alabama

There is no comprehensive state privacy act here, so marketing answers to the Medical Licensure Commission's conduct rules, the federal privacy floor, and a telephone solicitation act that reaches less far than brands often assume.

  1. 01

    False claims reach the license

    Commission Rule 545-X-4-.06(7) makes it unprofessional conduct to knowingly make a false, deceptive or misleading statement in any advertisement or commercial solicitation for professional services, including a statement about another physician or group.

    Source: Ala. Admin. Code r. 545-X-4-.06

  2. 02

    No promise of a permanent cure

    The same rule separately reaches a representation that a manifestly incurable condition can be permanently cured, or that any ailment yields to a secret method, procedure, treatment, medicine or device where that is not the fact.

    Source: Ala. Admin. Code r. 545-X-4-.06

  3. 03

    Unlimited remote care overstates it

    An offer built around indefinite virtual visits for one condition runs past the statute, because the fifth visit in a year for the same unresolved complaint has to be answered with a room or a referral. Mental health offers are the exception.

    Source: Ala. Code 34-24-703

  4. 04

    Weight offers meet the drug rules

    Copy that promises a fully remote course of a controlled weight-reduction drug conflicts with the thirty-five day in-person re-evaluation, and any Schedule II anorectic claim conflicts with the outright prohibition in the same chapter.

    Source: Ala. Admin. Code r. 540-X-17-.05

  5. 05

    Marketing texts sit outside the state act

    The state telephone solicitation act reaches voice calls, and a federal court sitting here held that it does not extend to text messages. Marketing texts therefore answer to the federal rules rather than to a state list.

    Source: TCPAWorld on Underwood v. IFA Holdings (N.D. Ala.)

TESSIC HEALTH IN ALABAMA

How Tessic Health's providers cover Alabama

Because the binding constraints here are a counter and a look-back, both are kept in the record rather than in a policy document. Each line below answers a rule established above.

  1. 01

    The chart counts the visits

    Remote encounters are tallied against the patient and the specific unresolved condition, and before a fifth one inside twelve months the patient is booked for an in-person visit or referred to a local physician who can provide it. Behavioral health care is not tallied.

  2. 02

    Scheduled drugs wait for two things

    No controlled substance is written for a patient here unless the encounter is running on synchronous audio or audio-visual contact and a qualifying in-person encounter already sits inside the previous twelve months.

  3. 03

    Both certificates before the first order

    A prescriber treating patients here holds the annual state controlled substances certificate alongside the federal registration, is enrolled in the monitoring database, and searches it on the cadence the daily morphine milligram equivalent sets.

  4. 04

    Weight products follow the chapter

    Schedule II anorectic drugs are not prescribed to patients here at all, and where a controlled weight-reduction drug is continued the supply is held to thirty-five days with an in-person re-evaluation at that interval and the prescribing physician reviewing the record.

  5. 05

    Where the medication comes from

    Orders for patients here are filled by pharmacies permitted to ship into the state, priced at 0% markup, and anything requiring refrigeration moves under cold chain from the pharmacy to the door.

COMMON QUESTIONS

Questions about telehealth in Alabama

  • For a non-controlled prescription, yes. Asynchronous communication is named inside the statutory definition of telemedicine, and the relationship opens on a patient request or a referral. The clinician's own standard of care still governs whether that is enough for the condition in front of them.

  • If the same condition has not resolved, the patient must be seen in person or referred to a physician who can provide that care, within twelve months. The trigger is per patient and per condition, and mental health services are excluded from it.

  • Only on a synchronous visit, and only where the prescriber has had an in-person encounter with that patient in the previous twelve months. A video visit attended in person by a clinician licensed by the medical or nursing board can satisfy the in-person leg.

  • Not below the statutory threshold. A physician with a full license in another state may treat patients located here on fewer than ten days in a calendar year, or for fewer than ten patients in a calendar year, without a state license. Above that, a full license is required.

  • It depends on the dose. Under thirty morphine milligram equivalents a day the search follows good clinical practice, from thirty to ninety it happens at least twice a year with a documented risk plan, and above ninety it happens the same day each prescription is written.

  • Not if it is a controlled substance. The board chapter caps a continued weight-reduction prescription at a thirty-five day supply and expects an in-person re-evaluation at least that often, and Schedule II anorectic drugs may not be prescribed for weight at all.

SOURCES

Rules checked September 2026 · 28 sources cited. A planning summary, not legal advice. Statutes, board rules and enforcement priorities change; a brand's own counsel should review its model and marketing before launch.

OTHER STATES

Rules in other states

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