• An MRO is authorized to accept an employee’s prescription for medication obtained over the Internet only if there is proof that a legitimate doctor-patient relationship had been established.
• The following four elements generally serve as an indication that a legitimate doctor-patient relationship has been established:
— A patient has a medical complaint;
— A medical history has been taken;
— A physical examination has been performed; and
— Some logical connection exists between the complaint, the medical history, the physical examination, and the drug prescribed.
• Standing alone, the completion of an online questionnaire reviewed later by a pharmacy-employed doctor fails to establish a proper doctor-patient relationship.
• The MRO should, at a minimum, consider the following items when verifying the test result:
— The name, physical location, and state(s) of licensure of the prescribing practitioner;

— Whether the employee was professionally evaluated for the current medical complaint by the prescribing practitioner, and the last time the employee was in direct contact with the prescribing practitioner;

— Whether the employee initiated the request to the pharmacy for a particular medication; and

— Whether a proper doctor-patient relationship existed.

• It is the employee’s responsibility to provide sufficient documentation to address MRO inquiries as to whether there was a legitimate doctor-patient relationship.