This May 2015 report from the American Telemedicine Association describes the physician practice standards and licensure requirements for telemedicine in each state. Physicians often encounter a patchwork of conflicting and disparate requirements for insurance claims and practice standards that prohibit them from practicing telemedicine. In fact, a few state medical boards (Alabama, Arkansas, Georgia, and Texas) have adopted practice standards with higher specifications for telemedicine than in-person care. Specifically, these boards have required that an initial examination be conducted in-person, that a physician-patient relationship be established in-person, and/or a follow-up exam be conducted in -person. Michigan, North Dakota, Pennsylvania, and South Dakota do not allow any licensure exemption for out-of-state physicians to provide consultations in their states.