Services
Chronic care by telehealth in Puerto Rico: diabetes, blood pressure, thyroid and asthma
Our chronic care telehealth in Puerto Rico is ongoing follow-up by video for adults and children with diabetes, high blood pressure, high cholesterol, thyroid problems or asthma. The doctor reviews your home readings, labs and medications, adjusts your plan when appropriate and gives you any lab orders you need. A refill of a medicine you already take (non-controlled) is a follow-up visit.
Is it an emergency? Call 911.
Pay now, then choose your time right away. Full refund if you cancel 24 hours or more ahead.
See the cancellation policy
You can cancel for a full refund or change the time up to 24 hours before your visit. Within 24 hours you can't cancel and there's no refund. If you don't join in the first 10 minutes, there's no refund.
If you choose a time less than 24 hours away, it can't be cancelled or changed.
If the clinic can't see you, for example because of a technical problem on our side, we refund you in full.
Is this an emergency?
This is not an emergency service. Call 911 or go to the nearest emergency room if you have:
- Chest pain, pressure or squeezing, or shortness of breath.
- Sudden numbness or weakness in the face, an arm or a leg, especially on one side.
- Sudden trouble speaking, confusion, loss of balance or vision problems.
- A sudden, severe headache with no known cause.
- Very low blood sugar with fainting or a seizure.
- An asthma attack that doesn't improve with the rescue inhaler, trouble speaking from breathlessness, or bluish lips or nails.
Help lines
On this page(9)
What chronic care by telehealth in Puerto Rico is
A chronic condition stays under control with steady attention: readings, labs, up-to-date medicines and timely adjustments. You see Dr. Diana Nieves Castro, MD, a general practice physician licensed in Puerto Rico with several years of emergency-department experience, in English or Spanish.
We see adults and children of all ages. Diabetes is common on the island: according to the CDC, 14.4% of adults in Puerto Rico had diagnosed diabetes in 2021, the highest of any U.S. state or territory. A video visit saves you the trip, whether you live in San Juan or up in the mountains. And if what you need is virtual primary care for your everyday health, we see you for that too.
Before you leave home
Why a video visit
For anything that isn’t an emergency, compare what each option takes.
| Comparison | Video visit | Emergency room | CDT or doctor’s office |
|---|---|---|---|
| Getting there | From home: join from your phone, tablet or computer. | Drive and find parking. | Drive and find parking. |
| Waiting room | Skip the waiting room: join from wherever you are in Puerto Rico. | Yes, a waiting room. | Yes, a waiting room. |
| Hours and time | Every day, any time (Puerto Rico time). Video doctor visits 24/7 — book online and choose your time right away. | In Puerto Rico, a median of 4 h 52 min from arrival to departure for patients sent home (US: 2 h 42 min; Oct 2024–Sep 2025).1,2 | An in-person visit takes about 2 hours on average, including travel.3 |
| Price | $79 visit · $49 follow-up · $35 forms. You see it before you pay; no insurance needed. | Depends on your insurance and on what is done. | Depends on your insurance and on what is done. |
| Language | Spanish or English, with the same doctor. | Depends on the place. | Depends on the place. |
| Prescriptions | If appropriate, the doctor prescribes and we send your prescription to your pharmacy. | Yes, if needed. | Yes, if needed. |
| When to go in person | If the doctor needs to examine you in person or run a test, she tells you and guides you. | In an emergency: chest pain, trouble breathing, weakness on one side or bleeding that won’t stop. Call 911. | If you need stitches, an X-ray or a test on the spot. |
For problems that are not emergencies. In an emergency, call 911.
Table sources
- 1. CMS Care Compare, “Timely and Effective Care – State”, measure OP-18b: median time in the emergency department, arrival to departure, for patients sent home (opens in a new tab), data for Oct 2024–Sep 2025 (accessed 2026-10-02)
- 2. CMS Care Compare, “Timely and Effective Care – National”, measure OP-18b (US figure) (opens in a new tab), data for Oct 2024–Sep 2025 (accessed 2026-10-02)
- 3. Ray KN et al., “Opportunity costs of ambulatory medical care in the United States,” Am J Manag Care 2015;21(8):567-74 (US data, 2003–2010) (opens in a new tab) (accessed 2026-10-02)
We found no published source for what a patient pays at an ER or a CDT in Puerto Rico, so we give no figure.
Your doctor
Dr. Diana Nieves Castro, MD
General practice physician
Several years of emergency-department experience.
Founding Executive Director of The Health Initiative.
Conditions we follow
We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you:
- Diabetes, including type 2 diabetes, and prediabetes.
- High blood pressure (hypertension). More on high blood pressure.
- [High cholesterol](route:condition-high-cholesterol) and triglycerides.
- Thyroid conditions: hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid).
- [Asthma](route:condition-asthma), in adults and kids: symptom control, an action plan and inhaler refills.
- Weight management for adults with an evaluation and labs: the doctor reviews your weight, blood pressure and blood sugar, builds a plan with you and, if appropriate, prescribes and we send your prescription to your pharmacy. More on weight loss.
- Other conditions followed with labs: gout, fatty liver, enlarged prostate, anemia, low vitamin D and low vitamin B12.
What a follow-up visit looks like
Video doctor visits 24/7 — book online and choose your time right away. On the call, the doctor:
- Reviews your home blood pressure, blood sugar or peak-flow (asthma) readings.
- Goes over your medicines, how you take them and any side effects, whether pills, insulin or weekly injections such as Trulicity (dulaglutide).
- Reviews recent labs, or gives you a lab order if you need new ones.
- If appropriate, the doctor prescribes, adjusts doses or renews your medicines, and we send your prescription to your pharmacy.
- Talks through your targets, food and activity, and when to check in again. Food and activity are two of the six pillars of lifestyle medicine.
Three steps
Here's how it works:
Request a visit
on the booking page. Choose Doctor visit for an evaluation or a change in treatment, or Follow-up visit if you only need a refill of a medicine you already take (non-controlled).
Join by video.
We send you a secure video link. It works on your phone, tablet or computer.
Get your plan.
A prescription sent to your pharmacy, a lab order or the date of your next check-in, as the doctor considers appropriate.
Price
A doctor visit has a published price: to get started, to change treatment, or when something isn't going well. A follow-up visit has a published price: for a prescription refill of a medicine you already take (non-controlled), and, for existing patients, to review lab results from a previous visit.
If a follow-up visit turns out to need a full visit, the doctor explains why and, with your consent, you pay the difference. No membership. You pay by card when you request the visit. See pricing for details.
Video visit
Doctor visit
$79
For a new problem, urgent care (non-emergencies), primary care, children, birth control, STIs, skin and acne, and visitors. Includes a doctor's note if you need one.
- You’re charged when you request the visit.
- Full refund if the clinic can’t see you
Labs for diabetes, blood pressure, cholesterol and thyroid
Labs are part of good control. The CDC notes that most people with diabetes have an A1C test at least twice a year, and some more often. Cholesterol is checked with a lipid panel, and the thyroid with a TSH test.
The doctor tells you which tests you need and how often, and gives you an order for the lab of your choice. You pay the lab for the tests. Once your results are in, you go over them together in an online follow-up visit. In the meantime, our guide on how to read your lab results can help.
What to have ready
The more data you bring, the more useful the visit:
- Your blood pressure or glucose readings from the past few weeks, with dates and times.
- Your medicines, or a list with names and doses, including inhalers.
- Your most recent lab results, on paper or on your phone.
- Your blood pressure monitor or glucose meter nearby, in case the doctor asks for a reading.
- For a child: their current weight and your photo ID. Patients under 21 need a parent or legal guardian on camera for the whole visit.
When to go to the ER
For your safety, if you have any of the warning signs on this page, call 911 or go to the emergency room. When your condition needs a specialist, such as an endocrinologist or a cardiologist, the doctor tells you and helps you with the next step.
How we care for you
We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you.
We see adults and children of all ages. Patients under 21: a parent with patria potestad (parental authority) or a legal guardian is on camera for the whole visit and shows photo ID.
Real-time video visit. We send you a secure video link. It works on your phone, tablet or computer.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy.
You must be physically in Puerto Rico during the visit (visitors, tourists and cruise passengers are welcome).
In an emergency, call 911.
What the doctor treats
Some of the conditions, symptoms and guides the doctor handles in this service:
Frequently asked questions
Can I manage diabetes or high blood pressure by telehealth?
How much is a refill of my blood pressure or diabetes medicine?
Do you see children with asthma?
How often do I need labs if I have diabetes?
Is weight part of managing my diabetes or blood pressure?
Before you pay
Why do I pay before choosing a time?
Can I cancel or change the time?
Do you record the visit?
Need to see the doctor?
$79Doctor visit
- You’re charged when you request the visit.
- Full refund if the clinic can’t see you
Video doctor visits 24/7 — book online and choose your time right away.
Doctor visit: $79 — BookPay now, then choose your time right away. Full refund if you cancel 24 hours or more ahead.
See the cancellation policy
You can cancel for a full refund or change the time up to 24 hours before your visit. Within 24 hours you can't cancel and there's no refund. If you don't join in the first 10 minutes, there's no refund.
If you choose a time less than 24 hours away, it can't be cancelled or changed.
If the clinic can't see you, for example because of a technical problem on our side, we refund you in full.
About this page
Author: The Health Initiative
Medical care provided by Dr. Diana Nieves Castro, MD (PR license 24027)
Disclosure: Founding Executive Director of The Health Initiative
Published: 2026-09-30 · Updated: 2026-10-11
Sources (9)
- CDC Preventing Chronic Disease (2024): prevalence of diagnosed diabetes among adults (opens in a new tab) (accessed 2026-09-30)
- CDC: A1C test for diabetes and prediabetes (opens in a new tab) (accessed 2026-09-30)
- MedlinePlus (NIH): cholesterol levels (opens in a new tab) (accessed 2026-09-30)
- MedlinePlus (NIH): TSH test (opens in a new tab) (accessed 2026-09-30)
- NHLBI (NIH): asthma treatment and action plan (opens in a new tab) (accessed 2026-09-30)
- NHLBI (NIH): asthma attacks (opens in a new tab) (accessed 2026-09-30)
- CDC: signs and symptoms of stroke (opens in a new tab) (accessed 2026-09-30)
- CDC: heart attack symptoms (opens in a new tab) (accessed 2026-09-30)
- NIDDK (NIH): low blood glucose (hypoglycemia) (opens in a new tab) (accessed 2026-09-30)