Unlike the traditional relationship between a patient and the patient's health care professional, some online practitioners issue prescriptions in the absence of a physical examination or direct medical supervision. According to the American Medical Association, a health care professional who offers a prescription for a patient the practitioner has never seen before and based solely on an online questionnaire generally has not met the appropriate medical standard of care. As a result, patients may receive a drug that is inappropriate for them to use and may sacrifice the opportunity for a correct diagnosis or the identification of an underlying medical condition for which use of the prescription drug may be dangerous. It is a violation of the Federal Food, Drug, and Cosmetic Act to dispense prescription drugs without a valid prescription. FDA will work with the states to determine the validity of online prescriptions and to bring enforcement actions under state law, federal law, or both, as appropriate. In addition, several state boards of medicine have ruled that such practice is medical misconduct and have fined and suspended the licenses of health care practitioners who have prescribed drugs in this manner It is also illegal to possess a prescription medication without a legal prescription.