Gentle Health serves patients across a growing multistate footprint, including Washington, DC. Across that footprint, we use two workflows for an initial prescribing decision: asynchronous review first or a scheduled video visit first.
The distinction matters, but it is easy to misunderstand. An async-first review is not an automatic approval process, and a video-first review is not inherently more serious or more individualized. Both are real clinical evaluations conducted by a clinician licensed in the patient’s location. Neither guarantees a prescription.
The difference is how the initial interaction begins. In an async-first jurisdiction, a patient submits a detailed health intake and medication request for clinician review. If the record contains enough information and the clinician determines that treatment is appropriate, the clinician may issue a prescription without requiring a live appointment first. The clinician can instead ask follow-up questions, request additional information, require a live visit, or decline to prescribe.
In a scheduled-video-first jurisdiction, the patient completes the intake and then attends a live video visit before an initial prescription can be issued. The clinician still makes an individual decision after reviewing the available information and speaking with the patient.
Gentle Health uses the most autonomy-preserving workflow that our current policy and applicable requirements permit. That means avoiding unnecessary appointments where a clinician can responsibly complete the evaluation without one, while using live video when our workflow requires it or when the reviewing clinician decides it is needed.
The current state-by-state workflow
The following matrix describes Gentle Health’s current operations. It is not a general statement about what every healthcare provider may do under each jurisdiction’s laws.
Async-first jurisdictions
Gentle Health currently begins with asynchronous clinical review in these 33 jurisdictions:
- Alabama
- Arizona
- Colorado
- Delaware
- Florida
- Hawaii
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Maine
- Maryland
- Michigan
- Minnesota
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Pennsylvania
- South Dakota
- Tennessee
- Utah
- Washington
- Washington, DC
- Wisconsin
- Wyoming
In these locations, the patient first submits the required intake and medication request. A clinician licensed in the patient’s location reviews that record and decides what should happen next.
Async-first does not mean that every patient completes the process asynchronously. A clinician may determine that the submitted information is incomplete, unclear, or better addressed through a conversation. The clinician may send follow-up questions, request more records or information, require a live visit, or decline the request. A prescription may be issued asynchronously only when the clinician has sufficient information and determines that treatment is appropriate.
Oklahoma and Pennsylvania are included in the async-first list under Gentle Health’s current operating policy. As in every jurisdiction, that describes our present workflow rather than a universal conclusion about what every provider may do under state law.
Scheduled-video-first jurisdictions
Gentle Health currently requires a scheduled video visit before an initial prescription decision in these five states:
- Arkansas
- Georgia
- Louisiana
- Mississippi
- West Virginia
The assignment is a per-state legal reading, not a convenience choice: some states’ telehealth statutes affirmatively name store-and-forward evaluation, while others are best read conservatively as expecting a live visit first - and where the law moves, the assignment moves with it.
Patients in these states complete the health intake and then meet with a clinician through live video. An initial prescription cannot be issued through Gentle Health’s workflow until that visit occurs and the clinician determines that prescribing is appropriate.
Several states are on this list for different operational reasons.
Gentle Health’s current Arkansas and West Virginia workflows require live interaction. Gentle Health uses a video visit to satisfy that requirement. For Arkansas in particular, it is important to be precise: Gentle Health complies through live video, but that does not mean the Arkansas requirement itself specifically mandates video as the only possible form of live interaction.
Louisiana is treated in our current internal documentation as requiring video.
What happens during async-first review
The async-first process begins with the patient, but it does not end there. Completing an online form is not the same as receiving a prescription.
First, the patient submits a detailed intake and requests a medication evaluation. The intake gives the reviewing clinician the information available for an initial assessment. Because prescriptions require a licensed clinician, the record is reviewed by a clinician licensed in the patient’s jurisdiction.
The clinician then chooses among several possible next steps:
- Prescribe asynchronously. If the information is sufficient and the clinician determines that treatment is appropriate, the clinician may issue a prescription without a live visit first.
- Ask follow-up questions. A clinician may need clarification about an answer or additional context before reaching a decision.
- Request more information. The existing record may not contain everything needed for an appropriate prescribing decision.
- Require a live visit. Even in an async-first state, the clinician may decide that a real-time conversation is necessary.
- Decline to prescribe. If the clinician does not determine that treatment is appropriate, no prescription is issued.
That final possibility is essential. A legitimate clinical process must preserve the clinician’s authority to say no. Patients are requesting an evaluation, not purchasing a guaranteed prescription.
Asynchronous review can reduce avoidable scheduling burdens. It allows a patient to provide information on their own time and gives the clinician an opportunity to review the record without making every person attend an appointment by default. But convenience does not remove clinical judgment. The clinician, not the workflow, makes the prescribing decision.
What happens during scheduled-video-first review
The scheduled-video-first process begins with the same core expectation: the patient provides a health intake for individual review. The additional requirement is that a live video visit takes place before an initial prescription may be issued through Gentle Health.
During the visit, the clinician can discuss the submitted information with the patient and address matters that require real-time interaction. After considering the intake and conversation, the clinician decides whether prescribing is appropriate.
The existence of a required appointment does not imply approval. A patient can complete the intake and attend the video visit without receiving a prescription. The purpose of the appointment is evaluation, not confirmation of a predetermined outcome.
Similarly, video-first should not be treated as the universal gold standard for every patient in every jurisdiction. Live communication can be useful or necessary, but requiring it in every case can also create practical barriers involving work schedules, caregiving, transportation to a private location, disability, connectivity, or limited appointment availability. When a responsible asynchronous review is available, avoiding an unnecessary live appointment can preserve patient time and autonomy.
Async-first is not automated prescribing
The word “asynchronous” describes timing. It means the patient and clinician do not necessarily communicate at the same moment. It does not mean software independently makes the prescribing decision, that every completed intake is approved, or that clinical review has been removed.
A patient can submit information at one time and a clinician can review it later. The clinician remains responsible for deciding whether the available record is sufficient and whether the requested treatment is appropriate. If either condition is not met, the process changes or stops.
This distinction is especially important in telehealth, where a smooth digital experience can make a process look simpler than the professional work behind it. Good product design should remove needless friction for patients. It should not erase the clinician’s independent judgment or disguise uncertainty as approval.
Gentle Health’s standard is straightforward: convenience must support clinical care, not replace it. We hold care and service to a high standard, communicate transparently about what the process involves, and do not promise that submitting an intake will produce a prescription.
Why the workflow differs by jurisdiction
There is no single operational path across Gentle Health’s entire footprint because multiple factors shape the current matrix. These include applicable requirements, clinician licensure, pharmacy availability, the clinical information collected by the service, and Gentle Health’s own operating policies.
That is why the lists above should be understood as a description of Gentle Health’s current workflow, not a 50-state legal guide. A state’s placement in the async-first group does not establish that every provider can use asynchronous prescribing in every circumstance. Placement in the video-first group does not necessarily mean state law explicitly commands a video appointment for every conceivable provider or care model.
The Arkansas example shows why careful wording matters. Our current matrix calls for live interaction, and Gentle Health uses video to comply. It would be inaccurate to turn that operational choice into the broader claim that Arkansas law specifically requires video.
North Dakota illustrates a different issue. A possible pathway may depend on objective clinical data, but a pathway that relies on information our workflow does not currently collect is not one we present to patients as available. The practical result is scheduled-first review.
Precise distinctions may make a state matrix less tidy, but they give patients a more honest picture of how the service actually works.
Why Gentle Health favors the least burdensome appropriate path
Healthcare often imposes administrative steps without clearly explaining what they add. An appointment should exist because it is required or because it contributes to the clinician’s evaluation, not simply because healthcare has traditionally demanded one.
Our approach is to use the most autonomy-preserving workflow that our current policy and applicable requirements allow. In an async-first jurisdiction, we do not require every patient to schedule a live appointment before a clinician has even reviewed the record. If the submitted information supports an appropriate decision, asynchronous prescribing may be available. If the clinician needs a conversation, the clinician can require one.
This approach gives clinical judgment room to operate in both directions. It avoids treating video as a box that must always be checked, and it avoids treating asynchronous review as an entitlement to medication. The patient receives a real evaluation, while the clinician retains control over what information and interaction are necessary.
In video-first states, we make the required path clear before an initial prescription is issued. Patients complete the intake and attend the visit knowing that the appointment is part of the evaluation rather than a sales formality.
Gentle Health protects patient privacy, follows the law, communicates transparently, and maintains high standards for care and service. In this context, transparency means telling patients which process applies, what the clinician may require, and why no workflow can honestly guarantee a prescription.
What patients should expect before starting
Patients considering Gentle Health should keep four practical points in mind.
Check the intake for the current path. State rules, internal reviews, licensure coverage, pharmacy availability, and Gentle Health policies can change. The intake presents the workflow currently available for the patient’s location.
Set aside time for a complete intake. In an async-first jurisdiction, the clinician’s ability to review the request depends on the information submitted. A clinician may still ask follow-up questions, seek additional information, or require video.
Do not treat async-first as a promise of no appointment. It means a live visit is not the default first step in Gentle Health’s current workflow. The reviewing clinician can require one when necessary.
Do not treat a scheduled visit as a guaranteed prescription. Completing a video appointment satisfies a process requirement. It does not predetermine the clinician’s decision.
Patients should also expect the workflow to be based on their current location. The relevant clinician is licensed in the patient’s jurisdiction, and the operational path is determined accordingly.
Questions about the process itself, before any intake, can also go to the real people behind our website chat.
A clear process without a predetermined answer
Gentle Health’s two initial-prescribing workflows are designed to balance access, patient autonomy, applicable requirements, and independent clinical judgment.
In 33 current jurisdictions, the process is async-first: a clinician reviews the submitted intake and may prescribe asynchronously if the information is sufficient and treatment is appropriate. The clinician can also ask questions, request more information, require a live visit, or decline.
In the scheduled-video-first states listed above, the process is scheduled-video-first: the patient completes the intake and attends a video visit before an initial prescription can be issued. The clinician then makes an individual decision.
Neither path is a shortcut around clinical review. Neither is a promise of medication. They are two ways of organizing a legitimate evaluation across a changing state-by-state operating environment.
Because that environment can change, the intake is the best source for the path currently available in a patient’s location. What remains constant is our standard: preserve patient autonomy where possible, explain the process honestly, and leave the prescribing decision with the licensed clinician responsible for making it.
Dr. James Simmons, MD