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The below case studies have been developed by National Boards to support safe telehealth care and will be updated when required to reflect new developments.
When prescribing medicinal cannabis, practitioners are expected to follow the medicinal cannabis prescribing guidance, their Code of conduct, and other guidance about standards of care and telehealth published by Ahpra and National Boards. It is vital the practitioner has sufficient clinical information, including about all current and relevant past medical conditions, to make an appropriate clinical judgement. It is also important that alternative approaches are considered.
The Codes of conduct provide guidance on conflicts of interest. Practitioners working for businesses must recognise and manage conflicts of interest.
The following is an example of good practice that follows these guidelines and supports high-quality patient care.
A patient accessed a single-treatment online medicinal cannabis telehealth platform. The patient disclosed a history of mental health issues and neurological symptoms, which are both currently under active management. The neurological symptoms are under ongoing investigation and being treated with medication. Despite treatment, the patient reported minimal improvement and expressed interest in trialling medicinal cannabis as an alternative therapy.
What the practitioner considered
The practitioner considered the following clinical information and decided:
Upon review, the practitioner decided that the patient’s history was too complex for a short, remote consultation. The practitioner declined to initiate medicinal cannabis treatment via the online platform and advised the patient that they needed to be seen in-person. The practitioner referred the patient for a in-person consultation and recommended a coordinated care plan involving all treating practitioners before any consideration of medicinal cannabis.
Members of the public are increasingly using telehealth platforms to obtain medication for various conditions. Management of weight loss is advertised as simple and effective, however, there are number of pitfalls. Boards are receiving an increasing number of complaints about practitioners managing a patient’s weight loss by online prescribing of weight loss medication.
When prescribing weight loss medication, practitioners are expected to follow their Code of conduct, and other guidance about standards of care and telehealth published by Ahpra and National Boards. As is the case for all consultations and prescribing, it is vital the practitioner understands that asynchronous prescribing is not supported by National Boards. Consultations with patients must be conducted in a way that ensures they have sufficient information to make an appropriate clinical judgement. It is also important that alternative approaches are considered.
A health practitioner works for an online telehealth platform that offers weight loss medication and facilitates patient interactions through text messaging, email, live chat and online questionnaires.
The practitioner receives a request from a new patient seeking weight loss medication and consults with them entirely via text message. The patient only provides minimal information such as their name, date of birth and contact details. Although the practitioner requests further information, the patient isn’t willing to provide their current weight and BMI, any presence of comorbidities (e.g. diabetes, cardiovascular disease) or medication history.
Despite this, the platform encourages prompt prescribing to maintain service efficiency and patient satisfaction.
Text and other forms of instant messages, email and website ‘bot’ interactions are all asynchronous and do not allow the practitioner to adequately assess the patient and consider relevant medical conditions.
This scenario highlights why asynchronous prescribing is not supported by National Boards. Prescribing weight loss medication via text, email or online messaging is inadequate because it:
The appropriate action in a case like this is for the practitioner to:
A registered nurse (RN) working in a multidisciplinary pain management clinic, has recently gained endorsement for scheduled medicines – designated registered nurse prescriber, under the NMBA’s new Registration Standard for Scheduled Medicines. This allows her to prescribe Schedule 2, 3, 4, and 8 medicines in partnership with an authorised health practitioner, under a clinical governance framework and active prescribing agreement.
A patient presents with chronic non-cancer pain and requests medicinal cannabis, citing anecdotal success stories. The RN, influenced by patient demand and the clinic’s growing interest in cannabis-based therapies, prescribes a Schedule 8 medicinal cannabis product during the initial consultation.
The patient returns to the clinic two weeks later reporting increased anxiety and paranoia. They are later admitted to an emergency department with symptoms of medicinal cannabis-induced psychosis.
This scenario raises several issues and concerns:
This case illustrates that medicinal cannabis must be treated with the same caution as other drugs of dependence. Prescribing based on patient and employer demand, without clinical justification or proper safeguards, can lead to significant patient harm and is not supported by Boards. The practitioner remains responsible for their prescribing decisions regardless of patient and employer expectations.
A busy suburban optometry clinic has introduced telehealth services involving a technician onsite with the patient. These services include virtual consultations for full eye exams, follow-up care, triage of eye symptoms and patient education.
A patient visits a busy optometry practice as his vision has been slowly deteriorating. All the optometrists are fully booked so the patient is offered a telehealth consultation with an offsite optometrist. The patient is fully informed about the limitations and benefits of telehealth, that the offsite optometrist is responsible for patient care, and the patient agrees.
The technician explains that he will be taking the preliminary tests and imaging, which will be reviewed, assessed and explained by the optometrist during the video consultation.
Once the telehealth connection has been established, the optometrist confirms the patient’s consent to the telehealth consultation, discusses the reasons for the visit and the patient’s symptoms. The optometrist uses remote instruments to refine the existing lens prescription to improve the patient’s vision. The optometrist then reviews the tests and images to check the patient’s eye health, finds that the images were adequate to make an assessment and the findings correlate with the patient’s concerns. The optometrist explains their findings to the patient1, including a recommendation to update the glasses with the new prescription and a recommendation to make an appointment for a routine review.
A patient visits a local optometry practice as they have been experiencing a sudden change in the vision in their left eye. All the optometrists at the practice are fully booked.
Due to the possible seriousness of the symptoms, the practice staff check with an optometrist who decides that the patient is not appropriate for a telehealth consultation. An emergency face-to-face consultation with an optometrist is arranged and after further examination, the patient is referred for an urgent review by an ophthalmologist.
Optometrists should ensure they:
Telehealth must be delivered with the same standards as face-to-face care in line with the shared Code of conduct. Telehealth is not a replacement for in-person care. Optometrists should assess whether virtual care is clinically appropriate for each patient. Obtaining informed consent is essential. You should ensure patients understand the nature and limitations of telehealth consultations. Optometrists remain fully responsible for the care you provide, regardless of the mode of delivery. Optometrists should ensure patients know how to access follow-up care and referrals when needed.
1 If the pre-testing or imaging reviewed by the optometrist raised concerns, a face to face follow-up would have been booked at an appropriate time.
Amira is a registered paramedic working in a virtual care centre, as part of a multidisciplinary team that includes doctors, nurses, allied health professionals, and Aboriginal and Torres Strait Islander Health Practitioners. The team provides remote care to patients in their homes, using videoconferencing, wearable monitoring devices, and digital health records.
Amira’s role involves triaging patients, conducting virtual assessments, and coordinating care with other team members. They also provide health education and follow-up support for patients with chronic conditions such as diabetes and heart failure.
Amira’s practice is guided by the Paramedicine Board of Australia’s Code of conduct, which outlines expectations for professional behaviour and ethical care. Key principles they apply includes:
Amira’s work demonstrates how paramedics can play a vital role in virtual care models, delivering safe, ethical, and culturally responsive care. Their adherence to the Code of conduct ensures public trust and high standards in a rapidly evolving healthcare environment.
Riley is a MICA paramedic working in regional Australia. He attends Sam, a 58-year-old patient experiencing shortness of breath and chest discomfort at home. Sam has a history of chronic obstructive pulmonary disease (COPD) and heart failure. Riley is the first paramedic on scene and initiates a physical assessment.
Riley conducts a thorough clinical assessment, including vital signs, ECG, and oxygen saturation and modifies Sam’s bronchodilator therapy. Recognising the complexity of Sam’s condition, Riley uses a videoconferencing platform to consult virtually with an emergency physician within a multidisciplinary team as part of a virtual clinical care centre.
During the virtual case conference, Riley communicates findings and shares real-time data from monitoring equipment. The team decides to initiate steroids and adjust Sam’s diuretic dosage. Riley explains the care plan to Sam in plain language, checks for understanding, and ensures informed consent before administering treatment. Given Sam’s history, they are transferred to the closest local hospital by ambulance for observation.
Riley documents all assessments, treatments, and virtual consultations in the patient’s digital health record. After the call out, Riley reflects on the case during a team debrief, identifying strengths in communication and areas for improvement in coordinating care across services.
Sam was diagnosed with an infection and with the commencement of antibiotics, their symptoms improve. The integration of in-person paramedic support with virtual clinical expertise ensures a safe, responsive approach and illustrates how paramedics can work across physical and virtual environments.
Jamie, a community paramedic working in a virtual care clinic, receives a call from Taylor, a 34-year-old patient experiencing mild abdominal discomfort and nausea. Taylor is at home and reports no fever, vomiting, or other red flags. They are unsure whether to seek emergency care.
Jamie conducts a virtual assessment via secure videoconferencing, asking targeted questions and guiding Taylor through a self-examination. Based on clinical guidelines, Jamie determines the symptoms are consistent with a non-urgent gastrointestinal upset, likely dietary in origin.
Jamie consults with the clinic’s on-call nurse practitioner to confirm the assessment and jointly decides that emergency care is not required. They coordinate a referral to Taylor’s regular GP for follow-up within 24–48 hours, ensuring continuity of care.
Jamie listens to Taylor’s concerns, explains the likely cause of symptoms, and provides clear advice on symptom monitoring, hydration, and dietary adjustments. Taylor is reassured and agrees with the plan. Jamie ensures informed consent is obtained before sharing referral information with the GP.
Jamie documents the virtual consultation, clinical reasoning, and referral details in Taylor’s digital health record. They also flag the case for follow-up to ensure Taylor’s symptoms resolve appropriately.
Taylor’s symptoms improve within 24 hours, and they attend a GP appointment as planned. Jamie’s virtual care approach avoids unnecessary emergency department use while ensuring safe, respectful, and coordinated care while effectively managing a low-acuity presentation in a virtual setting.
