I am afraid that the Hawaiian taxing authorities covered their bases on this pretty early.
Hawaii is still the only state that taxes medical services with some very narrow exceptions. Since telehealth was not exempted from the GET by Hawaiian law it is subject to it. Remote workers physically present in Hawaii and all residents of Hawaii are subject to the GET on services provided from Hawaii until specifically exempted.
So go ahead and send in the 4%.
Sorry, @OahuRN
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