A Comprehensive Stroke Center with a telestroke program is a hub for 14 partner hospitals. It has been providing expert stroke neurology consultation using telemedicine for 3 years. Accuracy of the physician assessment of a potential stroke patient using telemedicine is not widely reviewed. Utilizing real time audio/video encounters and the ability to visualize radiology images, it is expected that the physician would be able to make an accurate consult impression of acute ischemic stroke (AIS) and recommend safe treatment options. All patients that were consulted and subsequently transferred to the hub were analyzed for variances between consult impression for AIS and a final discharge diagnosis of AIS. In the first year of the telemedicine program, the stroke neurologists accurately diagnosed 79% of AIS patients transferred to the hub facility. In the second and third year, the accuracy decreased to 76% (p value > 0.05). The consult volume has greatly increased over the three years without impacting the level of care the stroke neurologists have be able to provide. In addition to an average of 77% accuracy in determining AIS, the use of tissue plasminogen activator (tPA) is dramatic when compared to the institutional treatment rate of 18%. The tPA treatment rate for patients consulted using telemedicine with an AIS impression transferred to the hub was compared to the true treatment rate based on discharge diagnosis (Table 1). Table 1 demonstrates a high rate of tPA administration using telemedicine. When the rates are adjusted to recognize the final diagnosis, the rate does not significantly change. Patients that were accepted from a partner hospital post-tPA infusion without a final stoke diagnosis did not experience any adverse sequela related to tPA administration. In conclusion, the Comprehensive Stroke Center Telestroke Program has demonstrated an average of 77% accuracy for evaluating the AIS patient and safe thrombolysis treatment recommendations.