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Depression

Published: Jun 11, 2026

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Prescriber Scope of Practice for Depression in Michigan

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Written by Klarity Editorial Team

Published: Jun 11, 2026

Prescriber Scope of Practice for Depression in Michigan
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If you’re a psychiatrist or PMHNP treating depression, you’ve probably wondered: Can I legally prescribe antidepressants—or even controlled substances for co-occurring conditions—entirely via telehealth?

The short answer: Yes, in most cases. But the details matter—especially when it comes to DEA rules, state-specific prescribing laws, and your scope of practice depending on where you and your patient are located.

Whether you’re managing a patient’s first SSRI, adjusting treatment for treatment-resistant depression, or prescribing a benzodiazepine for co-occurring anxiety, understanding the regulatory landscape keeps you compliant, reduces liability, and—most importantly—lets you focus on patient care instead of paperwork.

Here’s what you need to know about telehealth prescribing for depression in 2025–2026, including the latest DEA extensions, state-by-state variations, and how your credentials (MD/DO vs. PMHNP) affect your practice authority.


Federal DEA Rules: Extended Flexibility Through 2026 (With Permanent Changes Coming)

The Current Landscape: COVID-Era Flexibilities Are Still in Effect

Good news: The DEA’s pandemic-era telehealth prescribing flexibilities have been extended through December 31, 2026. This is the fourth extension since the public health emergency ended in May 2023.

What this means for you:

  • You can initiate treatment for new patients via telehealth and prescribe controlled substances (Schedules II–V) without requiring an initial in-person visit.
  • This applies to psychiatric medications commonly used in depression care—including benzodiazepines for anxiety, stimulants for treatment-resistant depression or co-occurring ADHD, and even certain sleep medications.
  • Non-controlled antidepressants (SSRIs, SNRIs, bupropion, mirtazapine, etc.) were never restricted by DEA telehealth rules and can be prescribed via telemedicine under standard of care guidelines in any state.

The extension prevents what industry groups called a ‘telemedicine cliff’—a scenario where millions of patients on controlled substances prescribed via telehealth would suddenly lose access to their medications if providers were forced back to the pre-pandemic in-person requirement.

The Ryan Haight Act: Suspended, Not Gone

Under normal circumstances, the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 requires providers to conduct at least one in-person medical evaluation before prescribing any controlled substance via telemedicine.

However, that requirement has been continuously suspended since March 2020 through a series of temporary DEA rules. The latest extension runs through December 31, 2026.

What happens after 2026? The DEA is working on permanent regulations to replace the temporary extensions. In January 2025, the DEA proposed a new framework that would formalize telehealth prescribing without requiring the Ryan Haight in-person exam.

Proposed Permanent Rules: Special Telemedicine Registrations

The DEA’s January 2025 proposal introduces a two-tier special registration system:

1. Standard Telemedicine Registration (Schedule III–V):

  • Any DEA-registered provider could apply for this registration to prescribe Schedule III–V controlled substances via telehealth without an in-person visit.
  • Examples: ketamine (Schedule III), benzodiazepines like Xanax or Ativan (Schedule IV), sleep aids like Ambien (Schedule IV).

2. Advanced Telemedicine Prescribing Registration (Schedule II):

  • Available only to board-certified psychiatrists, hospice/palliative care physicians, pediatric specialists, and long-term care physicians.
  • Would allow prescribing Schedule II medications—like Adderall, Ritalin, or Vyvanse for ADHD/treatment-resistant depression—via telehealth without an in-person exam.

Key takeaway for psychiatrists: Under the proposed rules, you’d be explicitly authorized to manage the full spectrum of psychiatric medications via telehealth, including Schedule II stimulants. PMHNPs and other non-physician prescribers would need to rely on the standard registration (Schedule III–V) unless the final rule expands eligibility.

The DEA is currently accepting public comments on these proposals. If finalized as written, this would be a permanent solution replacing the temporary extensions—though providers would need to apply for the appropriate registration and comply with new reporting requirements.


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What About Non-Controlled Depression Medications?

Here’s the good news: DEA telehealth restrictions only apply to controlled substances.

First-line depression treatments—SSRIs (Prozac, Zoloft, Lexapro), SNRIs (Effexor, Cymbalta), bupropion (Wellbutrin), mirtazapine (Remeron), and most other antidepressants—are not controlled substances and can be prescribed via telehealth in any state as long as you meet that state’s standard of care for establishing a patient relationship.

No federal in-person exam requirement. No DEA restrictions. Just good clinical judgment.

Where DEA rules come into play is when you’re managing co-occurring conditions common in depression:

  • A patient with major depression and panic disorder who benefits from a short-term benzodiazepine (Schedule IV).
  • Treatment-resistant depression augmented with a stimulant like Vyvanse (Schedule II).
  • Insomnia in a depressed patient managed with Ambien or a similar sleep aid (Schedule IV).

For those scenarios, the current DEA extension allows you to prescribe those medications via telehealth. After 2026, you may need a special telemedicine registration—but the direction of federal policy is clear: telehealth prescribing for psychiatric care is here to stay.


Psychiatrist vs. PMHNP: Scope of Practice for Depression Treatment

Your credentials determine not just what you can prescribe, but how independently you can practice—especially via telehealth across state lines.

Psychiatrists (MD/DO): Full Independent Authority

Scope:

  • Diagnose and treat all mental health conditions, including depression, anxiety, ADHD, bipolar disorder, psychosis, etc.
  • Prescribe any medication—controlled or non-controlled, Schedule II–V or legend drugs—without restrictions beyond standard DEA and state licensing requirements.
  • Provide psychotherapy, ECT, TMS, or any other evidence-based treatment.

Telehealth implications:

  • No supervision or collaboration requirements in any state.
  • You can practice via telehealth in any state where you hold a valid medical license (or telehealth registration, in states like Florida that offer it).
  • Under the proposed DEA rules, psychiatrists would be the only non-physician specialists eligible for the Advanced Telemedicine Prescribing Registration (Schedule II authority without in-person exams).

Multi-state practice:

  • If you want to treat patients in multiple states, you’ll need to obtain a medical license in each state where your patients are located.
  • Some states participate in the Interstate Medical Licensure Compact (IMLC)—including Texas, Florida, Pennsylvania, and Illinois—which streamlines the licensing process for qualified physicians. California and New York are not IMLC members, so you’ll need to apply for a full license through their individual state boards.

Psychiatric Mental Health Nurse Practitioners (PMHNPs): It Depends on the State

Scope:

  • PMHNPs are trained to diagnose and treat mental health conditions, including depression, and to prescribe medications as part of a treatment plan.
  • However, state nurse practice acts determine the level of independence PMHNPs can exercise.

Full Practice Authority (FPA) States:

In these states, experienced PMHNPs can practice completely independently—no physician supervision or collaboration required:

  • California: After 3 years of practice (and meeting AB 890 requirements), PMHNPs can obtain ‘104 NP’ status and practice independently statewide as of January 2024.
  • New York: PMHNPs with ≥3,600 hours of clinical experience (roughly 2 years full-time) can practice without a written collaborative agreement as of 2022.
  • Illinois: PMHNPs can apply for Full Practice Authority after completing 4,000 hours of supervised practice plus additional continuing education. With FPA, they can prescribe all medications independently, including controlled substances.

Restricted Practice States:

In these states, PMHNPs must have a collaborative or supervisory agreement with a physician:

  • Texas: All APRNs must have a Prescriptive Authority Agreement with a Texas-licensed physician. The physician must be available for consultation and meet with the NP at least monthly to review complex cases.
  • Florida: Only primary care NPs (family medicine, internal medicine, pediatrics) can practice autonomously. Psychiatric NPs are excluded from independent practice and must work under a supervising physician with a signed protocol.
  • Pennsylvania: PMHNPs must have a collaborative agreement with a physician (often a psychiatrist) to prescribe medications. Full practice authority legislation has stalled in the state legislature as of 2025.

Prescribing controlled substances:

Even in collaborative states, PMHNPs can typically prescribe controlled substances—but you’ll need:

  • A DEA registration (which in some states requires physician authorization).
  • Compliance with your state’s nurse practice act and any specific limits on Schedule II prescribing (e.g., Texas restricts NP Schedule II prescribing to certain settings like hospitals).

Economic reality: If you’re a PMHNP in a restricted state, you’ll need to factor in the cost and logistics of maintaining a collaborative agreement—which may include monthly fees paid to the supervising physician, time spent in mandated meetings, and potential limitations on your autonomy. In full-practice states, you can operate independently, which means more control over your schedule, earnings, and practice model.


State-by-State Telehealth Prescribing Rules: What You Need to Know

Federal DEA rules set the floor, but states can impose additional requirements. Here’s what matters for depression prescribers in six key states.

California: Telehealth-Friendly, No State In-Person Requirement

Key Rules:

  • No California state law requires an in-person exam before prescribing via telehealth—you just need to meet the standard of care for establishing a patient relationship.
  • Telehealth parity laws require insurers (including Medi-Cal) to cover tele-mental health services equivalent to in-person.
  • PMHNPs with AB 890 ‘104 NP’ status (effective January 2024) can practice independently, including via telehealth.

Controlled substances:

  • California defers to federal DEA rules. Under the current extension, you can prescribe benzodiazepines, stimulants, or other controlled meds via telehealth for new patients.
  • You must check California’s Prescription Drug Monitoring Program (CURES) before prescribing controlled substances.

Licensing:

  • California is not in the Interstate Medical Licensure Compact. You need a full California medical license to treat patients located in California—no shortcuts.

Bottom line: California is one of the most permissive states for telehealth prescribing. If you’re licensed in CA, you can manage depression patients entirely remotely, including prescribing controlled substances for co-occurring conditions.


Texas: Open for Telehealth, But Watch the Chronic Pain Rules

Key Rules:

  • A valid physician-patient relationship can be established via live audio-visual telemedicine (video required; phone-only is generally insufficient for new patients).
  • Texas explicitly prohibits prescribing for chronic pain via telemedicine unless stringent conditions are met (e.g., prior in-person visit within 90 days). However, this rule targets opioid pain management, not psychiatric treatment.

Controlled substances:

  • You can prescribe benzodiazepines, stimulants, or sleep aids for psychiatric conditions via telehealth after a video evaluation.
  • If you’re managing a patient with co-occurring chronic pain on long-term opioids, you’ll need an in-person component or risk running afoul of Texas Medical Board rules.

NP collaboration:

  • All APRNs in Texas must have a Prescriptive Authority Agreement with a Texas-licensed physician. The physician must be available for consultation and meet with the NP at least monthly.
  • Texas does not allow independent NP practice, even for experienced PMHNPs.

Licensing:

  • Texas is an IMLC member, so out-of-state physicians can obtain a Texas license more easily if they qualify for the compact.

Bottom line: Texas is a large, underserved market for telepsychiatry (246 of 254 counties are mental health shortage areas). Psychiatrists can practice freely via telehealth; PMHNPs need a supervising physician on record.


Florida: Psychiatric Telehealth Carve-Out for Schedule II

Key Rules:

  • Florida allows out-of-state providers to register for telehealth practice without obtaining a full Florida license (Florida Statute §456.47). However, NPs must still meet Florida’s scope-of-practice rules.
  • Florida prohibits teleprescribing of Schedule II controlled substancesexcept for psychiatric disorders, inpatient care, hospice, or nursing home residents.

What this means for depression prescribers:

  • Psychiatrists can prescribe Schedule II stimulants (Adderall, Ritalin) via telehealth for ADHD or treatment-resistant depression because these fall under ‘psychiatric disorder’ treatment.
  • Schedule III–V drugs (benzodiazepines, sleep aids) can be prescribed via telehealth without restriction.

NP scope:

  • Florida’s 2020 autonomous practice law excludes psychiatric NPs. PMHNPs must practice under a supervising physician with a signed protocol—even if practicing via telehealth.

Licensing:

  • Florida is an IMLC member for physicians. Psychiatrists can obtain a Florida license through the compact or register for telehealth practice under §456.47.

Bottom line: Florida is a growth market for telepsychiatry, and the state explicitly allows Schedule II prescribing for psychiatric conditions via telehealth. PMHNPs need physician oversight.


New York: Progressive NP Laws, Strong Telehealth Parity

Key Rules:

  • Experienced PMHNPs (≥3,600 hours of practice) can work without a written collaborative agreement as of 2022. This is effectively full practice authority.
  • New York has robust telehealth parity laws and allowed audio-only telehealth for mental health services during COVID (many provisions extended through 2024+).

Controlled substances:

  • New York follows federal DEA rules. No additional state restrictions on teleprescribing controlled substances for psychiatric care.
  • Mandatory e-prescribing for all controlled substances.

Licensing:

  • New York is not in the IMLC. Out-of-state psychiatrists need a full New York medical license to treat patients in NY.

Bottom line: New York is one of the most progressive states for PMHNP independence. If you’re a PMHNP with 3,600+ hours of experience, you can run a fully independent telehealth practice in NY—no supervising psychiatrist required.


Pennsylvania: Collaborative Practice Required for NPs, Telehealth Permissive

Key Rules:

  • Pennsylvania has no comprehensive telehealth statute, but the Department of State confirms that providers can deliver care via telemedicine within their scope of practice as long as it meets the standard of care.
  • PMHNPs must have a collaborative agreement with a physician to practice and prescribe. Full practice authority legislation has not passed.

Controlled substances:

  • Pennsylvania defers to federal DEA rules. No state-specific ban on teleprescribing controlled substances.
  • Mandatory e-prescribing for controlled substances.

Licensing:

  • Pennsylvania joined the IMLC in 2021, so out-of-state psychiatrists can obtain a PA license through the compact.

Bottom line: Pennsylvania is a large, underserved state (especially in rural areas). Psychiatrists can practice telehealth freely; PMHNPs need a collaborative agreement with a PA-licensed physician.


Illinois: Full Practice Authority Available, Strong Telehealth Laws

Key Rules:

  • Illinois allows Full Practice Authority (FPA) for experienced APRNs after ≥4,000 hours of supervised practice plus continuing education. With FPA, PMHNPs can practice and prescribe independently.
  • Illinois’s 2021 Telehealth Expansion Act (Public Act 102-104) requires insurance parity and prohibits geographic restrictions on telehealth.

Controlled substances:

  • PMHNPs with FPA can prescribe Schedule II–V controlled substances independently, but must have a consultation process with a physician for managing chronic high-dose opioids (a safeguard, not a blanket restriction).
  • Psychiatrists face no additional state restrictions beyond federal DEA rules.

Licensing:

  • Illinois is an IMLC member for physicians.

Bottom line: Illinois is a favorable environment for telehealth psychiatric practice. Experienced PMHNPs can achieve full independence; psychiatrists have straightforward rules and access to a large patient base (especially in underserved areas outside Chicago).


The Business Case: Why Telehealth Prescribing for Depression Makes Sense

Patient Demand Is Massive

Depression is the most common mental health condition in the U.S.—affecting over 21 million adults annually. The pandemic accelerated demand for tele-mental health services, and that demand hasn’t slowed down.

Why patients prefer telehealth for depression:

  • Convenience (no commute, easier to fit into work schedules).
  • Access in underserved areas (246 of 254 Texas counties are mental health shortage areas; similar gaps exist in rural PA, upstate NY, and downstate IL).
  • Lower perceived stigma (seeing a provider from home vs. walking into a psychiatric clinic).

What this means for you: If you’re licensed in a high-demand state, you have access to a steady stream of patients who prefer—or require—telehealth care.


Klarity Health’s Model: Guaranteed Patient Flow, No Marketing Gamble

Here’s the reality of DIY patient acquisition for most providers:

The True Cost of Marketing:

Most psychiatrists and PMHNPs don’t have the expertise, budget, or patience to build a profitable practice through traditional marketing channels. Here’s what it actually costs:

  • SEO: Takes 6–12 months of consistent investment before generating meaningful patient flow. You need a professional website, ongoing content creation, backlink building, and technical optimization. Total monthly cost: $2,000–5,000+ for agency fees, and no guarantee of results.

  • Google Ads: Mental health keywords cost $15–40+ per click. Most clicks don’t convert to booked patients. A realistic cost per booked patient through PPC is $200–400+ when you factor in ad spend, testing, optimization, and no-show rates from cold leads.

  • Directory Listings (Psychology Today, Zocdoc): Monthly subscription fees ($30–100+) plus you’re competing with hundreds of other providers on the same page. Zocdoc charges per booking ($35–100+), and when you add up the subscription cost and per-lead fees, total monthly costs can easily exceed $500–1,000 for uncertain patient volume.

The bottom line: Acquiring a qualified psychiatric patient through DIY marketing realistically costs $200–500+ when you factor in ALL costs—agency/consultant fees, ad spend, staff time to handle and qualify leads, no-show rates, months of SEO investment before results, and failed campaigns.

Klarity Health’s value proposition:

Instead of gambling $3,000–5,000/month on marketing with uncertain ROI, Klarity uses a pay-per-appointment model:

  • You pay a standard listing fee per new patient lead (similar to Zocdoc’s model, but with better patient matching).
  • No upfront marketing spend or monthly subscription fees.
  • Pre-qualified patients already matched to your specialty and availability.
  • No wasted ad spend on clicks that don’t convert.
  • Built-in telehealth infrastructure—no separate platform costs for video, scheduling, billing, or EHR.
  • Both insurance and cash-pay patient flow, so you control your revenue mix.
  • You control your schedule—only pay when you see patients.

The economic comparison:

ChannelUpfront CostCost Per PatientTime to ResultsPatient QualityRisk
SEO$2,000–5,000/moUnknown (6–12 months before results)6–12 monthsVariable (depends on keyword targeting)High—no guarantee of ROI
Google Ads$1,500–3,000/mo$200–400+1–3 monthsVariable (high no-show rates)High—ongoing spend required
Psychology Today$30–100/mo subscriptionUnknown (depends on competition)Immediate listing, but slow resultsVariableMedium—low upfront cost, but limited control
Zocdoc$200–300/mo + $35–100/booking$50–150/booking (total)ImmediateModerate (patients may book multiple providers)Medium—predictable cost, but still a gamble
Klarity Health$0/moStandard listing fee per patientImmediatePre-qualified, matched to specialtyLow—only pay when you see patients

The smart economic choice: Instead of spending months and thousands of dollars hoping to attract patients, you pay only when a qualified patient books with you. That’s guaranteed ROI vs. gambling on marketing channels.


Compliance Checklist: What You Need to Practice Depression Telehealth Legally

State Medical/Nursing License: You must be licensed (or hold a valid telehealth registration) in each state where your patients are located at the time of the appointment.

DEA Registration: Required if you prescribe controlled substances. You need a DEA number in each state where you practice.

Malpractice Insurance: Ensure your policy covers telehealth practice and the states where you’re licensed.

HIPAA-Compliant Platform: Use a secure, encrypted video platform for telehealth visits. Document patient consent for telehealth services.

Prescription Drug Monitoring Program (PDMP): Check your state’s PDMP before prescribing controlled substances (required in most states).

E-Prescribing for Controlled Substances: Many states (PA, IL, NY, etc.) mandate electronic prescribing for controlled substances. Ensure your e-prescribing software is DEA-compliant.

Collaborative Agreement (if applicable): PMHNPs in Texas, Florida, and Pennsylvania must have a signed collaborative or supervisory agreement with a physician.

Documentation: Telehealth encounters must meet the same standard of care as in-person. Document mental status exams, risk assessments (suicidality, homicidality), treatment plans, and informed consent.

Emergency Protocols: Have a plan for handling psychiatric emergencies during a telehealth session (e.g., knowing how to activate local emergency services if a patient is acutely suicidal).


FAQ: Common Questions About Telehealth Prescribing for Depression

Q: Can I prescribe antidepressants to a new patient I’ve never met in person?

A: Yes. Non-controlled antidepressants (SSRIs, SNRIs, bupropion, mirtazapine, etc.) can be prescribed via telehealth in all 50 states as long as you conduct an appropriate evaluation (typically via live video). There is no federal or state law requiring an in-person visit for non-controlled medications.


Q: Can I prescribe benzodiazepines or stimulants via telehealth?

A: Yes, through December 31, 2026 under the DEA’s current temporary extension. After 2026, you may need to apply for a special telemedicine registration to continue prescribing controlled substances without an in-person exam. The DEA’s proposed permanent rules (announced January 2025) would allow psychiatrists to obtain an Advanced Telemedicine Prescribing Registration for Schedule II drugs and a standard registration for Schedule III–V.


Q: Do I need to see a patient in person before prescribing via telehealth in Texas or Florida?

A: No. Both Texas and Florida allow you to establish a physician-patient relationship via live video telemedicine and prescribe medications (including controlled substances for psychiatric conditions) without an initial in-person visit. However, Texas requires video (not just phone) for new patients, and Florida’s Schedule II exception explicitly allows psychiatric prescribing via telehealth.


Q: Can I practice telehealth across state lines?

A: Only if you’re licensed in the state where the patient is located at the time of the appointment. Some states (like Florida) offer out-of-state telehealth registrations. Others (like Texas, Pennsylvania, Illinois, and Florida) participate in the Interstate Medical Licensure Compact (IMLC) for physicians, which streamlines the multi-state licensing process.


Q: As a PMHNP, can I practice independently via telehealth?

A: It depends on the state. In full-practice states like California (AB 890 ‘104 NP’ status), New York (≥3,600 hours experience), and Illinois (Full Practice Authority after 4,000 hours), experienced PMHNPs can practice independently without physician oversight. In restricted states like Texas, Florida, and Pennsylvania, you’ll need a collaborative or supervisory agreement with a physician.


Q: What happens if the DEA temporary extension expires and no permanent rule is in place?

A: If the extension expires without a new rule, the Ryan Haight Act’s in-person requirement would be reinstated, meaning you’d need to see patients in person at least once before prescribing controlled substances via telemedicine. However, the DEA has repeatedly extended the flexibilities (four times since 2023) and is actively working on permanent regulations. Most industry observers expect either another extension or finalized permanent rules before the 2026 deadline.


The Bottom Line: Telehealth Prescribing for Depression Is Here to Stay

The regulatory environment for telehealth prescribing has never been more favorable—and the direction is clear: policymakers want to expand access to mental health care, not restrict it.

For psychiatrists:

  • You have full authority to diagnose and treat depression via telehealth in any state where you hold a license.
  • You can prescribe the full range of psychiatric medications—non-controlled antidepressants, benzodiazepines, stimulants, sleep aids—under current federal and state rules.
  • The proposed DEA special registration would give you permanent authority to prescribe Schedule II medications via telehealth without an in-person exam.

For PMHNPs:

  • Your scope of practice varies by state, but the trend is toward greater independence (California, New York, and Illinois have all expanded NP autonomy in recent years).
  • In full-practice states, you can run a fully independent telehealth practice. In restricted states, you’ll need a collaborative agreement—but you can still provide high-quality, accessible care to underserved populations.
  • You can prescribe non-controlled antidepressants in all 50 states and controlled substances in most states (subject to state scope-of-practice rules and current federal DEA extensions).

The opportunity:

Depression is one of the most common—and most undertreated—conditions in the U.S. Telehealth removes geographic barriers, reduces stigma, and increases access for patients who would otherwise go without care.

If you’re licensed, credentialed, and ready to see patients, platforms like Klarity Health remove the biggest barrier to growing a telehealth practice: patient acquisition. Instead of spending months and thousands of dollars on marketing with uncertain results, you get pre-qualified patients matched to your specialty and availability—and you only pay when you see them.

Ready to start seeing more patients without the marketing headache? Explore Klarity Health’s provider network and see how a pay-per-appointment model can scale your telehealth practice—while you focus on what you do best: treating depression and getting patients back to living their lives.


Sources

  1. HHS Press Release – ‘HHS & DEA Extend Telemedicine Flexibilities for Prescribing Controlled Medications Through 2026’ (January 2, 2026). www.hhs.gov

  2. DEA Press Release – ‘DEA Announces Three New Telemedicine Rules to Continue Open Access to Care’ (January 16, 2025). www.dea.gov

  3. Florida Statutes §456.47 – ‘Use of Telehealth to Provide Services’ (2019, updated through 2025). www.leg.state.fl.us

  4. Texas Administrative Code Title 22, §174.5 – ‘Telemedicine Issuance of Prescriptions’ (Last updated January 15, 2025). txrules.elaws.us

  5. California Board of Registered Nursing – ‘AB 890 Implementation: Nurse Practitioner Practice Without Standardized Procedures’ (Updated January 2023). www.rn.ca.gov

Source:

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All professional services are provided by independent private practices via the Klarity technology platform. Klarity Health, Inc. does not provide medical services.
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