In this paper a telemedicine system with some decision making capabilities has been developed to provide treatment assistance to renal impaired patients in rural areas of eastern India. The primary objective is to estimate the severity of the renal condition of the patients in rural areas, accordingly prioritize their referrals and exchange their relevant information on the basis of priority to seek medical advise from the nephrologists of the tertiary center via the communication network of the telemedicine framework. The concept has been implemented in a clinical trial of 50 patients. The clinical trial of the patients has been carried out for six months (June-Nov. 2007). Using the prioritization algorithm proposed here, 27 out of 50 patients’ information have been sent in the first month to the tertiary center for quick follow up. Out of the remaining 23 patients, only 5 patients were given follow up dates at the tertiary center and the remaining 18 patients were given medical advice through the telemedicine framework thus reducing the patient load of the tertiary center by almost 40%. The decision of the prioritization algorithm has been matched with that of the physicians. The results indicate that the proposed telemedicine system has the potential to work as an efficient tool to provide better treatment for renal impaired patients in rural areas by decreasing the work load of the nephrologist at the tertiary centers and also sparing the patients of the burden to travel long distances frequently.