Telemedicine in Costa Rica: what a virtual clinic can and cannot do

There is an actual regulation, and it is readable

Costa Rica regulates remote consultation by name. Decreto 44363‑S, the Reglamento para el control y regulación de la teleconsulta sanitaria en Costa Rica, was signed on 18 January 2024, came into force three months after publication, and was amended by Decreto 44485‑S on 20 May 2024. It applies to public, private and mixed providers alike, and to professionals in independent practice (article 2).

Most countries improvised telemedicine during the pandemic and never wrote it down. Here it is written down, which means a patient can check a clinic against a document rather than against a feeling.

Who is allowed to do it

Article 4 lists the professions: pharmacy, medicine, dentistry, nursing, nutrition, psychology, therapies and social work. Each needs a licenciatura or higher, and each must be registered and authorised by their own professional colegio to practise in Costa Rica. Article 10 repeats the registration requirement as a condition of every consultation.

That last phrase is the one that matters for anyone being treated from abroad. A clinician licensed somewhere else, consulting into Costa Rica, is outside this regulation.

What a virtual consultation cannot do

Article 7 is an explicit list of exclusions:

• anything requiring a physical examination
• issuing a certificate of health status, a birth or death certificate, an aeronautical certificate, or a dictamen for a driving licence or a firearms permit

Article 5 adds the principle underneath those exclusions: teleconsultation is complementary, and does not for any reason replace the in‑person assessment a patient should receive from their treating professional. Whether a given consultation is suitable for video is to be discussed and agreed between you and the clinician, not decided for you.

The Colegio de Médicos y Cirujanos also publishes its own guidance on virtual practice, and on certificates it has taken a firmer line than some readings of the decree. Where a colegio's ethics rules are stricter, article 10 makes those binding too.

What it can do, including prescribing

Article 14 deals with prescribing by teleconsultation and permits it — for ordinary medicines, antibiotics, and controlled substances alike — subject to conditions. The prescription must carry the prescriber's name, profession, specialty and professional code, and your name, identification, age, date, weight and height. A digital prescription needs a valid digital signature certificate, and sending a photograph of a hand‑signed prescription is expressly prohibited.

Two extra conditions apply only to psychotropics and narcotics: your record must contain a previous in‑person consultation where that prescription was first indicated, and in the private sector it must go through the national Receta Digital system.

Article 15 allows follow‑up by teleconsultation explicitly, including reviewing laboratory results and adjusting treatment. For a condition managed by measurement rather than by examination, that is the whole model.

Consent, in more detail than you might expect

Consent must be given in writing or digitally before or at the start of the consultation, and may be withdrawn at any moment (articles 9 and 13). The clinician has to have explained how the consultation works, the privacy arrangements, what happens if the technology fails, how you will be contacted, and how your images and personal data will be handled. The consent document itself must carry your full name and identification, the date, your signature, your current diagnoses, and the risks of being seen this way.

For a patient under 12, or an adult legally unable to consent, a legal representative signs. Between 12 and 18, a separate asentimiento informado is required and goes in the record.

The quieter obligations

Article 8 sets principles that are easy to skip and tell you a lot about a clinic. The consultation must take place somewhere private. The clinician is custodian of every clinical document, printed or digital. And under no abandonment, they must agree with you — before starting — what happens if the connection fails or the consultation cannot continue.

Article 16 adds identity verification, secure platforms and encryption. Article 17 requires services to evaluate their own quality annually. Article 18 puts enforcement with the Ministry of Health, under the sanctions of the Ley General de Salud.

Five things you can check

1. Is the clinician registered with their Costa Rican colegio, and will they give you the number?
2. Did you sign a consent that named the risks and the diagnoses, or did you click past a terms page?
3. Were you told what happens if the call drops?
4. Does the consultation produce a record, and can you have a copy?
5. If a prescription follows, is it properly signed rather than photographed?

None of this tells you whether a remote consultation is the right way to deal with your particular problem. That is a clinical judgement, it is explicitly meant to be made jointly with you, and a clinician who says you need to be seen in person is following the regulation, not avoiding you.