Can You Prescribe While Outside the US? Complete Guide for 2026

Can you prescribe medications while sipping coffee in Paris or working remotely from Bali? The answer is complicated—and the rules for EHR access are different from e-prescribing rules.

This guide clarifies what's legal, what's technical, and how to stay compliant while working internationally.

Quick Answer

You can access your EHR from anywhere, but prescribing rules depend on multiple factors: (1) Your medical license state requirements, (2) Where the patient is located, (3) Whether you're prescribing controlled vs. non-controlled substances, and (4) Your e-prescribing platform's policies. Generally, you can prescribe non-controlled medications if you're licensed in the patient's state and your platform allows international access. Controlled substances require you to be physically in the US due to DEA regulations. Always verify with your state medical board and malpractice insurance before prescribing from abroad.

EHR Access vs. E-Prescribing: Key Differences

EHR Access (Usually Allowed)

What It Means:

• Logging into your EHR system
• Viewing patient records
• Writing clinical notes
• Reviewing lab results
• Communicating with patients

Legal Status: Generally allowed from anywhere

Technical Requirements:

• Secure internet connection
• VPN recommended
• HIPAA-compliant access
• Two-factor authentication

ClinikEHR: Accessible worldwide with secure login

E-Prescribing (Restricted)

What It Means:

• Electronically sending prescriptions
• Using EPCS for controlled substances
• Transmitting to pharmacies
• DEA-regulated activity

Legal Status: Depends on substance type and location

Requirements:

• Physical location matters
• DEA registration implications
• State board rules apply
• Platform restrictions

The Legal Framework

Federal Law (DEA Regulations)

Controlled Substances (Schedule II-V):

• Rule: Prescriber must be physically in the US
• Reason: DEA jurisdiction limited to US territory
• Penalty: Loss of DEA license, criminal charges
• No Exceptions: Even for established patients

Non-Controlled Substances:

• Rule: No specific federal prohibition
• But: State laws and licensing still apply
• Consideration: Malpractice insurance coverage

State Medical Board Rules

Varies by State:

• Some states explicitly prohibit prescribing from abroad
• Others have no specific rules
• Many require "appropriate" patient relationship
• Telemedicine rules may apply

States with Strict Rules:

• Texas: Must be in US for any prescribing
• California: Unclear, conservative interpretation recommended
• New York: Must be in US for controlled substances

States with Flexible Rules:

• Florida: No specific prohibition for non-controlled
• Colorado: Allows if licensed and appropriate care
• Washington: Telemedicine-friendly, but verify

Always Check: Your specific state medical board website

Where the Patient Is Located

Patient Location Matters:

• You must be licensed in the patient's state
• Patient must be physically in that state during consultation
• Prescriptions must be valid in patient's state
• Pharmacy must be in a state where you're licensed

Example:

You: Licensed in California, physically in France
Patient: Located in California
Prescription: Non-controlled medication

Legal? Technically yes, but check:
- California medical board rules
- Your malpractice insurance
- Your e-prescribing platform policies

Controlled vs. Non-Controlled Substances

Controlled Substances (Schedule II-V)

Examples:

• Schedule II: Adderall, Ritalin, oxycodone
• Schedule III: Testosterone, ketamine, buprenorphine
• Schedule IV: Xanax, Ativan, Ambien, Klonopin
• Schedule V: Lyrica, some cough syrups

Rules When Outside US:

• Cannot prescribe from outside US
• No exceptions even for established patients
• DEA requirement: Physical presence in US
• Penalty: DEA license revocation

Why It Matters:

• DEA has no jurisdiction outside US
• Considered violation of Controlled Substances Act
• Risk to your DEA registration
• Potential criminal liability

Workaround:

• Wait until you're back in US
• Have covering provider prescribe
• Patient sees another provider temporarily

Non-Controlled Substances

Examples:

• Antidepressants (SSRIs, SNRIs)
• Blood pressure medications
• Diabetes medications
• Antibiotics
• Most psychiatric medications

Rules When Outside US:

• Generally allowed if state-licensed
• Check state board rules
• Verify malpractice coverage
• Confirm platform allows it

Considerations:

• Standard of care still applies
• Must have appropriate patient relationship
• Documentation requirements unchanged
• Emergency access to patient if needed

Best Practice:

• Inform patients of your location
• Document reason for prescribing remotely
• Ensure ability to follow up
• Have backup coverage plan

E-Prescribing Platform Policies

Platform Restrictions

Many Platforms Block International Access:

• Surescripts (major e-prescribing network)
• DrFirst
• Some EHR built-in e-prescribing

Reasons for Blocking:

• Liability concerns
• DEA compliance
• Fraud prevention
• Technical limitations

What Happens:

• Login blocked from foreign IP
• E-prescribing disabled
• Error messages
• Account suspension risk

Platforms That Allow International Access

ClinikEHR:

• EHR access: Worldwide
• E-prescribing: Follows DEA/state rules
• Non-controlled: Allowed if legally compliant
• Controlled: Blocked when outside US

Other Options:

• Some platforms allow with VPN
• Others require pre-approval
• Many have no clear policy

Always Verify:

• Check your platform's terms of service
• Contact support before traveling
• Test access before relying on it
• Have backup plan

Practical Scenarios

Scenario 1: Short Vacation (1-2 Weeks)

Situation:

• You're in Europe for 2 weeks
• Established patient needs refill
• Non-controlled medication

Options:

Option A: Wait Until Return

• Safest approach
• No compliance risk
• Patient gets 2-week supply before you leave

Option B: Prescribe from Abroad

• Check state board rules
• Verify malpractice coverage
• Confirm platform allows it
• Document thoroughly

Option C: Covering Provider

• Arrange colleague coverage
• Patient sees covering provider
• Standard practice approach

Recommendation: Option A or C for peace of mind

Scenario 2: Extended Travel (1-3 Months)

Situation:

• Working remotely from Asia
• Seeing patients via telehealth
• Mix of controlled and non-controlled prescriptions

Approach:

For Non-Controlled:

• Verify state board approval
• Confirm malpractice coverage
• Use platform that allows international access
• Document your location in notes
• Inform patients

For Controlled:

• Arrange covering provider
• Schedule patients before/after travel
• Refer to other providers temporarily
• Cannot prescribe from abroad

Recommendation: Hybrid approach with covering provider

Scenario 3: Permanent Relocation Abroad

Situation:

• Living permanently outside US
• Want to continue US telehealth practice
• Prescribing needs ongoing

Challenges:

• Cannot prescribe controlled substances
• State board may have concerns
• Malpractice insurance issues
• Tax implications

Solutions:

Option A: Non-Prescribing Practice

• Therapy/counseling only
• No medication management
• Refer out for prescriptions

Option B: Partner with US-Based Prescriber

• You provide therapy
• Partner handles medications
• Collaborative care model

Option C: Periodic US Visits

• Return to US monthly/quarterly
• Prescribe during US visits
• Manage refills while abroad

Recommendation: Consult healthcare attorney for permanent situations

Scenario 4: Emergency Situation

Situation:

• You're abroad unexpectedly (family emergency)
• Patient has urgent need
• Controlled substance refill needed

Options:

For Controlled Substances:

• Cannot prescribe from abroad
• Direct patient to:
  • Emergency room
  • Urgent care
  • Your covering provider
  • Their primary care doctor

For Non-Controlled:

• May prescribe if platform allows
• Document emergency nature
• Follow up when back in US

Prevention:

• Always have covering provider arrangement
• Give patients emergency contact info
• Ensure adequate supplies before travel

Technical Considerations

Secure Access Requirements

HIPAA Compliance:

• Use secure, encrypted connection
• Avoid public WiFi without VPN
• Enable two-factor authentication
• Use private device, not shared computer

VPN Recommendations:

• NordVPN
• ExpressVPN
• Private Internet Access
• Your organization's VPN

Best Practices:

• Never access PHI on public WiFi without VPN
• Log out completely after each session
• Use strong, unique passwords
• Enable automatic logout

Platform Access Issues

Common Problems:

• IP address blocking
• Geo-restrictions
• Security alerts
• Account lockouts

Solutions:

• Contact support before traveling
• Whitelist your travel IP (if possible)
• Use VPN to US server
• Have phone support number handy

ClinikEHR Approach:

• Worldwide access allowed
• Secure encryption
• No geo-blocking for EHR access
• E-prescribing follows legal requirements

Time Zone Challenges

Considerations:

• Scheduling across time zones
• Prescription timing
• Pharmacy hours
• Emergency availability

Tips:

• Clearly communicate your availability
• Use scheduling software with time zone support
• Set expectations with patients
• Have backup coverage for off-hours

Malpractice Insurance Implications

Coverage Questions to Ask

Before Prescribing from Abroad:

1. Does my policy cover international practice?
2. Are there geographic restrictions?
3. Do I need to notify you of travel?
4. Is telehealth from abroad covered?
5. What about prescribing specifically?

Common Policy Restrictions:

• Coverage limited to US practice
• Notification required for extended travel
• Telehealth riders may have geographic limits
• Prescribing from abroad may void coverage

Getting Proper Coverage

Options:

• Add international rider to existing policy
• Purchase separate international coverage
• Verify telehealth coverage includes international
• Get written confirmation of coverage

Cost:

• International rider: $200-1,000/year
• Separate policy: $1,000-5,000/year

Recommendation: Get written confirmation before prescribing from abroad

State-by-State Guidance

States with Clear Prohibition

Texas:

• Must be physically in US to prescribe
• Applies to all substances
• Strict enforcement

Action: Do not prescribe from abroad if licensed in Texas

States with Flexible Rules

Florida:

• No specific prohibition for non-controlled
• Telemedicine-friendly
• Standard of care applies

Action: Verify with Florida Board of Medicine

States with Unclear Rules

California:

• No explicit prohibition
• Conservative interpretation recommended
• Telemedicine rules evolving

Action: Consult healthcare attorney or medical board

How to Check Your State

Steps:

1. Visit state medical board website
2. Search for "telemedicine" or "prescribing" rules
3. Look for geographic restrictions
4. Call board if unclear
5. Get written guidance if possible

Resources:

• Federation of State Medical Boards (FSMB)
• State medical board websites
• Healthcare attorneys
• Professional associations

Best Practices

Before You Travel

Checklist:

• [ ] Check state medical board rules
• [ ] Verify malpractice insurance coverage
• [ ] Confirm e-prescribing platform policies
• [ ] Arrange covering provider for controlled substances
• [ ] Notify patients of your travel
• [ ] Test EHR access from travel location (if possible)
• [ ] Set up VPN
• [ ] Have emergency contact plan

While Traveling

Guidelines:

• Document your location in clinical notes
• Use secure connections only
• Avoid prescribing controlled substances
• Be conservative with prescribing decisions
• Have low threshold for referring to local care
• Maintain regular communication with covering provider

Documentation

What to Document:

• Your physical location when prescribing
• Reason for prescribing remotely
• Patient's understanding and consent
• Emergency backup plan
• Covering provider information

Example Note:

"Provider note: This prescription was written while 
provider was located in [country] for [reason]. Patient 
was informed of provider's location. Standard of care 
maintained. Emergency coverage arranged with Dr. [Name]. 
Patient verbalized understanding and consent."

Frequently Asked Questions

Q: Can I access my EHR from another country? A: Yes, you can access your EHR from anywhere with internet. Use a secure connection (VPN recommended) and follow HIPAA security practices. ClinikEHR is accessible worldwide.

Q: Can I prescribe Adderall while on vacation in Mexico? A: No. Adderall is a Schedule II controlled substance. DEA regulations require you to be physically in the US to prescribe any controlled substance. Have a covering provider handle controlled substance prescriptions while you're abroad.

Q: What about antidepressants or blood pressure medications? A: Non-controlled medications may be prescribed from abroad if: (1) you're licensed in the patient's state, (2) your state board allows it, (3) your malpractice insurance covers it, and (4) your e-prescribing platform permits it. Verify all four before prescribing.

Q: Do I need to tell patients I'm prescribing from abroad? A: Yes, it's best practice to inform patients of your location and document their understanding. This maintains transparency and informed consent.

Q: What if there's an emergency and I'm out of the country? A: For controlled substances, direct patients to emergency care or your covering provider. For non-controlled substances, you may prescribe if your platform allows, but document the emergency nature and follow up when back in the US.

Q: Can I use a VPN to make it look like I'm in the US? A: Using a VPN for security is fine, but don't use it to circumvent legal restrictions. If you're physically outside the US, you cannot legally prescribe controlled substances regardless of your IP address.

Q: What about prescribing for family members while abroad? A: The same rules apply. Additionally, prescribing for family members has its own ethical considerations. Best practice is to have family members see another provider.

Q: How do I find a covering provider? A: Reach out to colleagues in your specialty, join local provider networks, or use locum tenens services. Establish the arrangement before you travel and provide patients with covering provider contact information.

The Bottom Line

EHR Access: Allowed from anywhere with secure connection

Prescribing from Abroad:

• Controlled substances: Not allowed (DEA requirement)
• Non-controlled substances: Allowed if state-licensed, board-approved, insured, and platform permits

Before Prescribing from Abroad:

1. Check state medical board rules
2. Verify malpractice coverage
3. Confirm platform policies
4. Arrange controlled substance coverage
5. Document thoroughly

Safest Approach:

• Arrange covering provider for all prescribing
• Focus on non-prescribing care while abroad
• Wait until return for prescribing needs

When in Doubt: Consult a healthcare attorney or your state medical board. The rules are complex and consequences of violations are severe.

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Last updated: January 2026. Laws and regulations change frequently. Always verify current requirements with your state medical board and legal counsel.