Cristi Jacobs Wellness, LLC
Telehealth Provider Licensing & State Compliance Policy

Effective Date: 03/25/2026

Purpose

This policy outlines how Cristi Jacobs Wellness, LLC ensures that all patients are evaluated and treated only by healthcare providers licensed in the state where the patient is physically located at the time of the telehealth encounter, in accordance with applicable state and federal regulations.

Scope

This policy applies to all telehealth services provided by Cristi Jacobs Wellness, LLC, including but not limited to consultation, evaluation, diagnosis, and treatment.

Provider Licensure

Cristi Jacobs Wellness, LLC is operated by a board-certified Family Nurse Practitioner licensed in the following states:

  • Kansas

  • Missouri

The provider delivers care only within the scope permitted by each state’s Nurse Practice Act and applicable telehealth regulations.

Patient Location Verification

To ensure compliance with state licensure requirements:

  1. Initial Intake

    • Patients are required to provide their current residential address during onboarding.

    • Patients must attest to the state in which they are physically located at the time of care.

  2. Visit-Level Verification

    • At the start of each telehealth encounter, the provider confirms and documents the patient’s physical location (state).

    • Care is provided only if the patient is located in a state where the provider holds an active license.

  3. Technology Safeguards

    • Intake forms and/or telehealth platform workflows include required fields for patient location verification.

    • Encounters are not initiated without confirmation of location.

Restrictions on Care

  • Cristi Jacobs Wellness, LLC does not provide medical care to patients located outside of Kansas or Missouri at the time of the encounter.

  • If a patient is located in a non-licensed state:

    • The visit will be deferred or canceled

    • No diagnosis, treatment, or prescribing will occur

Prescribing Compliance

  • All prescribing is conducted in accordance with:

    • State-specific prescribing laws

    • Telehealth prescribing regulations

    • Applicable federal requirements

  • Prescriptions are issued only when:

    • A valid provider-patient relationship has been established

    • The patient is physically located in a state where the provider is licensed

Documentation

  • Patient location is documented in the medical record for each encounter.

  • Licensure compliance is maintained through:

    • Active license monitoring

    • Adherence to state-specific scope and supervision requirements

Ongoing Compliance

Cristi Jacobs Wellness, LLC regularly reviews telehealth regulations and updates internal policies to remain compliant with evolving state and federal requirements.

Authorized Provider:
Cristi Jacobs, FNP-C
Cristi Jacobs Wellness, LLC

Telehealth Acknowledgement and Understanding

I understand that my care may be delivered via telehealth using secure electronic communication technology.

I acknowledge:

• Telehealth may include video, audio, or electronic communication.

• There are potential risks to privacy despite reasonable safeguards.

• Technology failures may occur.

• I may withdraw consent to telehealth at any time.

• I may request in-person care when available.

• Telehealth is not appropriate for emergency situations.

I understand that the standard of care is the same as in-person medical care.