How to Work Internationally While Seeing US Telehealth Clients in 2026

The rise of telehealth has created unprecedented flexibility for healthcare providers. Many US-licensed clinicians now wonder: can I maintain my practice while traveling or living abroad? The short answer is yes, but with important considerations around licensure, technology, prescribing, and platform policies.

Quick Answer

Yes, you can legally practice telehealth from abroad if you're licensed in the state where your patient is located—your physical location doesn't affect licensure. However, check three critical areas: (1) malpractice insurance coverage internationally, (2) platform policies (Headway/Alma require US presence, private pay has no restrictions), and (3) prescribing rules (non-controlled meds okay, controlled substances require in-person visit). Use cloud-based EHR like ClinikEHR that works from any country, maintain reliable internet (5+ Mbps), and plan for time zones. Most clinicians work early mornings or late evenings to accommodate US hours. Tax obligations and work permits vary by country—consult professionals before traveling.

Why ClinikEHR is Perfect for International Clinicians

Before diving into the complexities, let's address the technology piece. ClinikEHR is specifically designed for clinicians who need reliable, cloud-based access from anywhere in the world:

Pros of Using ClinikEHR for International Practice:

• Cloud-based access from any country with internet connection
• No VPN required for basic EHR functions (unlike many competitors)
• HIPAA-compliant infrastructure regardless of your physical location
• Integrated telehealth platform that works internationally
• Automatic time zone conversion for scheduling across regions
• Mobile-optimized for working from various devices and locations
• Offline note-taking capability that syncs when connection returns
• Multi-currency billing support for international payment processing
• 24/7 support across all time zones
• Free plan available ($0/month for up to 20 clients) - perfect for testing international access

With technology sorted, let's explore the legal and practical considerations.

Understanding the Legal Framework

State Licensure: The Foundation

Your ability to practice telehealth internationally hinges on one critical principle: you must be licensed in the state where your patient is physically located during the session, not where you are.

Key Points:

• Patient location determines licensure requirements
• Your physical location is generally irrelevant for licensure
• You need active, unrestricted licenses in all states where you see patients
• Compact licenses (PSYPACT, NLC) simplify multi-state practice

Example Scenario:

• You're a psychologist in Bali
• Your patient is in California
• You need a California psychology license
• Your location in Bali doesn't affect licensure requirements

Platform-Specific Rules

Many telehealth platforms and insurance networks have policies about provider location that go beyond state licensure requirements.

Common Platform Restrictions:

Headway:

• Requires providers to be in the US during sessions
• May terminate contracts for international practice
• Uses IP address monitoring

Alma:

• Similar US-location requirements
• Less strict enforcement reported
• Check your specific contract

Grow Therapy:

• Requires US presence
• May allow short-term international travel
• Communicate with your rep

Insurance Panels:

• Most require US-based practice
• Some allow temporary international work
• Review each panel's policies

Private Pay Practice:

• No platform restrictions
• Only state licensure matters
• Maximum flexibility

EHR Access Considerations

Cloud-Based vs Server-Based Systems

Cloud-Based EHRs (Like ClinikEHR):

• Access from anywhere with internet
• No special setup required
• Automatic backups
• Real-time updates

Server-Based EHRs:

• May require VPN access
• Can have geographic restrictions
• Potential latency issues
• Complex IT setup

Internet Reliability

Essential Requirements:

• Minimum 5 Mbps upload/download for video
• Stable connection (not public WiFi for sessions)
• Backup internet option (mobile hotspot)
• Test connection before each session

ClinikEHR's Offline Features:

• Draft notes offline
• Auto-save locally
• Sync when connection returns
• Never lose documentation

Data Security Abroad

HIPAA Compliance Internationally:

• HIPAA applies regardless of your location
• Use encrypted connections
• Avoid public WiFi for PHI access
• Enable two-factor authentication
• Use VPN for added security (optional with ClinikEHR)

Best Practices:

• Secure your devices with passwords
• Use privacy screens in public spaces
• Lock your screen when stepping away
• Keep software updated
• Use secure video platforms

Prescribing Considerations

DEA and Controlled Substances

The Ryan Haight Act:

• Requires in-person visit before prescribing controlled substances
• Applies regardless of provider location
• COVID-era flexibilities have ended
• State-specific exceptions may apply

Controlled Substance Rules:

• Schedule II-V medications affected
• Cannot initiate controlled substances via telehealth alone
• Continuing existing prescriptions may be allowed
• Check state-specific regulations

E-Prescribing from Abroad

Technical Considerations:

• Most e-prescribe systems work internationally
• Requires DEA number and state license
• Some pharmacies flag international IP addresses
• May need to contact pharmacy directly

ClinikEHR's E-Prescribe Features:

• Works from any location
• Integrated with major pharmacy networks
• Supports non-controlled medications
• Clear documentation of prescribing location

Best Practices:

• Inform patients you're prescribing from abroad
• Document your location in notes
• Have backup prescribing plan
• Maintain US phone number for pharmacy callbacks

State-Specific Prescribing Rules

Varies by State:

• Some states restrict prescribing from outside US
• Others have no geographic restrictions
• Check your state medical board
• Review each state where you're licensed

Common Requirements:

• Active DEA registration
• Valid state license
• Established patient relationship
• Appropriate clinical documentation

Malpractice Insurance

Coverage While Abroad

Critical Questions for Your Insurer:

• Does coverage extend internationally?
• Are there geographic exclusions?
• Do rates change for international practice?
• What about claims arising from international work?

Common Scenarios:

Covered:

• Telehealth to US patients from abroad
• Short-term international travel
• Temporary relocation

May Not Be Covered:

• Treating patients in your current country
• Extended stays without notification
• Practicing without proper licensure

Action Steps:

• Contact your malpractice carrier before traveling
• Get written confirmation of coverage
• Update your policy if needed
• Consider supplemental coverage

Tax Implications

US Tax Obligations

For US Citizens:

• Must file US taxes regardless of location
• Foreign earned income exclusion may apply
• Self-employment tax still applies
• State tax obligations vary

Key Considerations:

• Where your business is registered
• Where patients are located
• Length of time abroad
• Tax treaties with host country

Consult a Tax Professional:

• International tax rules are complex
• State tax obligations vary
• Business structure matters
• Plan before leaving

Foreign Tax Obligations

Potential Requirements:

• Income tax in country of residence
• Business registration
• Work permits or visas
• Social security contributions

Digital Nomad Visas:

• Many countries now offer these
• Allow remote work for foreign companies
• Clarify tax obligations
• Simplify legal status

Practical Strategies for Success

Time Zone Management

Scheduling Challenges:

• 12+ hour time differences
• Early morning or late night sessions
• Maintaining work-life balance
• Communicating availability to patients

ClinikEHR Solutions:

• Automatic time zone conversion
• Display your availability in patient's time zone
• Block scheduling for sleep hours
• Calendar sync across devices

Best Practices:

• Set clear boundaries
• Block core sleep hours
• Use scheduling buffer
• Communicate time zone to patients

Communication with Patients

What to Disclose:

• You're practicing from abroad (optional but recommended)
• Your licensure status (required)
• Emergency contact procedures (required)
• Any potential limitations (required)

Sample Disclosure: "I'm currently traveling internationally while maintaining my practice. I'm fully licensed in [state] and available for our regular sessions. My internet connection is secure and HIPAA-compliant. If you have an emergency, please contact [emergency number] as usual."

Building Redundancy

Essential Backups:

• Secondary internet connection
• Backup device for sessions
• Alternative communication method
• Coverage for emergencies

Emergency Planning:

• Local colleague for urgent situations
• Crisis hotline numbers for patients
• Clear emergency protocols
• Backup session times

Platform-Specific Strategies

For Insurance-Based Practices

If Your Panels Require US Presence:

• Limit international travel
• Use US-based virtual office
• Maintain US phone number
• Consider transitioning to private pay

If Panels Allow International Work:

• Get written approval
• Document policies
• Maintain compliance
• Regular check-ins with reps

For Private Pay Practices

Maximum Flexibility:

• No platform restrictions
• Only licensure matters
• Set your own policies
• Full location independence

Building a Location-Independent Practice:

• Focus on private pay from the start
• Build email list
• Use direct scheduling
• Maintain professional website

Country-Specific Considerations

Internet Infrastructure

Best Countries for Telehealth:

• Portugal (excellent infrastructure)
• Spain (reliable connections)
• Mexico (good speeds, close time zones)
• Thailand (digital nomad friendly)
• Costa Rica (stable internet)

Challenging Locations:

• Rural areas anywhere
• Countries with internet censorship
• Regions with frequent outages
• Very remote locations

Legal Status

Work Permits:

• Some countries require work permits even for remote work
• Digital nomad visas simplify this
• Tourist visas may prohibit work
• Research before traveling

Professional Registration:

• Some countries require registration to practice any healthcare
• Even if only treating US patients
• Check local medical board rules
• Consult local attorney if needed

Technology Setup

Essential Equipment

Minimum Requirements:

• Reliable laptop with webcam
• Quality headphones with microphone
• Backup device (tablet or second laptop)
• Mobile hotspot
• Privacy screen

Recommended Additions:

• External webcam (better quality)
• Ring light for video sessions
• Noise-canceling headphones
• Portable monitor
• Laptop stand

Software Stack

Core Tools:

• ClinikEHR for practice management
• Secure video platform (ClinikEHR's integrated telehealth)
• VPN service (optional but recommended)
• Password manager
• Cloud backup service

ClinikEHR's Integrated Solution:

• All-in-one platform
• No need for multiple subscriptions
• Consistent interface
• Single login
• Unified billing

Financial Considerations

Banking and Payments

Maintaining US Banking:

• Keep US bank account active
• Use online banking
• Set up automatic payments
• Consider digital banks (Wise, Mercury)

Accepting Payments:

• Credit card processing works internationally
• ACH transfers continue
• Insurance reimbursements to US account
• Currency conversion considerations

ClinikEHR's Payment Features:

• Accept payments from anywhere
• Automatic payment processing
• Multiple payment methods
• Transparent fee structure

Cost Savings

Lower Cost of Living:

• Reduce overhead expenses
• Lower housing costs
• Decreased daily expenses
• Maintain US income

Potential Savings:

• $1,000-3,000/month in many countries
• No commute costs
• Flexible housing options
• Lower food and entertainment costs

Common Mistakes to Avoid

Legal Missteps

Don't:

• Practice without proper licensure
• Ignore platform policies
• Forget to update malpractice insurance
• Neglect tax obligations
• Treat patients in your current country without local license

Do:

• Research thoroughly before traveling
• Get everything in writing
• Maintain proper documentation
• Consult professionals (attorney, accountant)
• Stay current on regulations

Technology Failures

Don't:

• Rely on public WiFi
• Skip backup plans
• Use unsecured connections
• Forget to test equipment
• Ignore time zone differences

Do:

• Test everything before sessions
• Have backup internet
• Use secure connections
• Maintain equipment
• Plan for technical issues

Professional Boundaries

Don't:

• Overshare about your location
• Let travel interfere with care quality
• Ignore work-life balance
• Forget professional appearance
• Neglect self-care

Do:

• Maintain professional standards
• Set clear boundaries
• Prioritize patient care
• Take care of yourself
• Enjoy the experience

Building a Sustainable International Practice

Gradual Transition

Phase 1: Testing (1-3 months)

• Short international trips
• Maintain full schedule
• Test technology and logistics
• Identify challenges

Phase 2: Extended Travel (3-6 months)

• Longer stays in one location
• Adjust schedule for time zones
• Refine systems
• Build confidence

Phase 3: Full Location Independence (6+ months)

• Move freely between locations
• Optimized systems
• Sustainable schedule
• Thriving practice

Long-Term Considerations

Career Development:

• Continuing education access
• Professional networking
• Supervision requirements
• License renewals

Personal Life:

• Relationships and family
• Healthcare for yourself
• Long-term housing
• Community connections

Real-World Examples

Case Study 1: Sarah, LCSW in Portugal

Background:

• Licensed in California and New York
• Private pay practice
• Moved to Lisbon

Setup:

• ClinikEHR for practice management
• Sees clients 2-9 PM Lisbon time (5 AM-12 PM Pacific)
• Maintains US phone number
• Annual US visits for conferences

Results:

• Maintained full caseload
• Reduced living expenses by $2,000/month
• Improved work-life balance
• No patient complaints

Case Study 2: Dr. Mike, Psychiatrist in Mexico

Background:

• Licensed in Texas
• Mix of insurance and private pay
• Relocated to Mexico City

Challenges:

• Had to leave insurance panels
• Transitioned to private pay
• Rebuilt practice

Solutions:

• Used ClinikEHR's marketing tools
• Focused on telehealth-friendly states
• Built email list
• Offered flexible scheduling

Results:

• Fully private pay within 6 months
• Higher hourly rate
• Better lifestyle
• Sustainable practice

Case Study 3: Jennifer, PMHNP in Southeast Asia

Background:

• Licensed in multiple states via compact
• Prescribes non-controlled medications
• Travels continuously

Setup:

• ClinikEHR mobile app
• Flexible schedule
• 4-day work week
• Asynchronous communication

Results:

• Sees patients from 15 states
• Works 25 hours/week
• Travels to new country monthly
• Thriving practice

Why ClinikEHR is the Best Choice for International Clinicians

Designed for Location Independence

Technical Features:

• True cloud-based architecture
• Works on any device
• No geographic restrictions
• Automatic backups
• Real-time sync

Practical Benefits:

• Access from anywhere
• No IT setup required
• Reliable performance
• Mobile-friendly
• Offline capabilities

Comprehensive Practice Management

All-in-One Solution:

• Scheduling with time zone support
• Integrated telehealth
• E-prescribing (where allowed)
• Billing and payments
• Clinical documentation
• Patient portal
• Secure messaging

No Need for Multiple Tools:

• Single subscription
• One login
• Unified interface
• Consistent experience
• Lower total cost

Pricing That Makes Sense

Flexible Plans:

• Free Plan: $0/month (20 clients) - test international access risk-free
• Starter Plan: $29/month (50 clients, insurance billing)
• Professional Plan: $79/month (unlimited clients, AI notes, telehealth)
• Practice Plan: $149/month (multiple providers, advanced features)

No Hidden Fees:

• No per-claim charges
• No setup fees
• No long-term contracts
• Cancel anytime

Support When You Need It

24/7 Availability:

• Support across all time zones
• Quick response times
• Knowledgeable team
• Multiple contact methods

Resources:

• Comprehensive documentation
• Video tutorials
• Best practices guides
• Community forum

Frequently Asked Questions

Can I legally practice telehealth from another country? Yes, you can legally practice telehealth from another country as long as you're licensed in the state where your patient is located. Your physical location generally doesn't affect licensure requirements. However, check your malpractice insurance, platform policies, and tax obligations before practicing internationally.

Do I need to tell my patients I'm working from abroad? While not legally required in most cases, it's recommended to inform patients you're practicing from abroad. This builds trust and allows patients to make informed decisions. You must disclose your licensure status and ensure patients know how to reach you in emergencies.

Can I prescribe medications while outside the US? Yes, you can prescribe non-controlled medications from abroad if you're licensed in the patient's state and have an active DEA number. However, controlled substances (Schedule II-V) require an in-person visit under the Ryan Haight Act. Some states may have additional restrictions, so check your state medical board's policies.

Will my malpractice insurance cover me internationally? Coverage varies by insurer. Most malpractice policies cover telehealth to US patients from abroad, but you must notify your carrier before traveling. Get written confirmation of coverage and check for any geographic exclusions or additional requirements. Some insurers may charge higher premiums for international practice.

Can I work for Headway or Alma while living abroad? Most insurance-based platforms like Headway and Alma require providers to be physically in the US during sessions. They may use IP address monitoring and can terminate contracts for international practice. If you want location independence, consider building a private pay practice instead.

What internet speed do I need for telehealth sessions? You need a minimum of 5 Mbps upload and download speed for quality video sessions. More important than speed is stability - avoid public WiFi and have a backup internet option like a mobile hotspot. Test your connection before each session and choose accommodations with reliable internet.

How do I handle time zone differences with patients? Use an EHR like ClinikEHR that automatically converts time zones in scheduling. Set clear boundaries for your working hours and block core sleep times. Communicate your availability clearly to patients and consider offering flexible scheduling. Many international clinicians work early mornings or late evenings to accommodate US time zones.

Do I need a work permit to practice telehealth from another country? Requirements vary by country. Some countries require work permits even for remote work, while others offer digital nomad visas that simplify legal status. Tourist visas typically prohibit work. Research the specific country's requirements and consider consulting an immigration attorney. Digital nomad visas are now available in 50+ countries.

What are the tax implications of working internationally? US citizens must file US taxes regardless of location. You may owe taxes in your country of residence as well. The foreign earned income exclusion may apply, but self-employment tax typically still applies. State tax obligations vary. Consult an international tax professional before practicing abroad - tax rules are complex and mistakes can be costly.

Which EHR works best for international practice? ClinikEHR is specifically designed for international clinicians with cloud-based access from any country, automatic time zone conversion, offline capabilities, and no geographic restrictions. Unlike many EHRs that require VPNs or have location limitations, ClinikEHR works reliably from anywhere with internet. The free plan ($0/month) lets you test international access risk-free.

How do I maintain HIPAA compliance while abroad? HIPAA applies regardless of your location. Use encrypted connections, avoid public WiFi for accessing PHI, enable two-factor authentication, secure your devices with passwords, and use a HIPAA-compliant EHR like ClinikEHR. Consider using a VPN for added security, keep software updated, and use privacy screens in public spaces.

Can I build a sustainable practice while traveling continuously? Yes, many clinicians maintain thriving practices while traveling continuously. Keys to success include: reliable technology setup with backups, clear boundaries around working hours, private pay model for maximum flexibility, consistent schedule despite location changes, and using a mobile-friendly EHR like ClinikEHR. Start with short trips to test systems before committing to long-term travel.

Conclusion

Working internationally while maintaining a US telehealth practice is not only possible but increasingly common. The key is understanding the legal framework, choosing the right technology, and building sustainable systems.

Remember the essentials:

• Licensure follows patient location, not yours
• Platform policies may be more restrictive than laws
• Technology and internet reliability are critical
• Malpractice insurance and tax planning are essential
• Prescribing rules vary by state and medication type

With proper planning and the right tools like ClinikEHR, you can build a thriving, location-independent practice that gives you professional fulfillment and personal freedom.

Ready to Build Your International Practice?

Start with ClinikEHR's free plan and test international access risk-free. No credit card required, no setup fees, and full access to core features.

Get started today:

1. Sign up for free at clinikehr.com
2. Test access from your target location
3. Set up your practice management
4. Start seeing patients from anywhere

Questions about international practice? Our support team works across all time zones and can help you set up your location-independent practice. Contact us at [email protected] or visit our help center.

Join thousands of clinicians who've discovered the freedom of location-independent practice with ClinikEHR.