Good-Faith Exam Requirements by State (incl. Telehealth)

A good-faith exam establishes a direct provider-patient relationship and documents that the prescriber has personally evaluated the patient's medical history, current medications, contraindications, and the specific anatomical area to be treated. At minimum, this includes:

• Direct assessment: The provider must personally examine the patient (or in telehealth-permitted states, visualize the treatment area via video).
• Medical history: Documentation of relevant conditions (autoimmune disease, bleeding disorders, pregnancy, neuromuscular disorders, prior adverse reactions).
• Informed consent: The patient must understand risks, benefits, alternatives, and realistic outcomes specific to their anatomy and goals.
• Treatment plan: Clear notation of what is being treated, why, and expected results.

The exam does not require a separate visit; it can occur on the same day as treatment. However, the exam must precede the injection or device application. Many states do not mandate a minimum time interval between exam and treatment, but documentation must show the exam occurred and informed the treatment decision. Telehealth exams are permitted in some states but prohibited or heavily restricted in others—this is where compliance fractures.

This is where scope-of-practice and supervision rules collide. In most states:

• Physicians (MD, DO) can perform exams and prescribe/treat independently.
• Nurse practitioners (NP) and physician assistants (PA) can perform exams in states where they have independent or collaborative prescriptive authority for aesthetics. Many states require physician supervision or a collaborative agreement; a few grant full independence.
• Registered nurses (RN) and licensed estheticians typically cannot legally perform the good-faith exam or prescribe. They may assist or perform injections/treatments under direct supervision after a physician or mid-level has completed the exam.
• Nurse injectors (RNs with injection training) occupy a gray zone: they can perform injections under supervision but usually cannot independently perform the exam that justifies treatment.

The critical distinction: the person who performs the exam must have prescriptive authority in your state for the substance or device being used. Delegating the exam to an unlicensed or insufficiently licensed staff member—even if they document findings—does not satisfy the good-faith requirement and exposes you to liability and board action.

Telehealth good-faith exams are increasingly permitted but remain state-specific and often product-specific:

• States permitting remote exams: Some states (e.g., California, New York, Florida) allow telehealth exams for injectables if the provider can visualize the treatment area via video and the patient is in the state. Real-time video is typically required; asynchronous photo submission alone is insufficient.
• States prohibiting or restricting telehealth: Other states require an in-person exam, particularly for controlled substances (e.g., anesthetics) or for initial consultations. A few states distinguish between established and new patients.
• Hybrid models: Some states permit telehealth exams for established patients or for follow-up consultations but require in-person exams for new patients or for certain procedures (e.g., laser/RF devices).
• No clear guidance: Many states have not explicitly addressed aesthetic telehealth, leaving practitioners to infer compliance from general telemedicine statutes or board guidance. This ambiguity is a compliance risk.

Check your state medical board's website and any recent guidance on telehealth; do not assume a national standard applies. If your state is silent, document your exam protocol thoroughly and consider consulting your state board or legal counsel before offering remote consultations.

The exam must be documented contemporaneously in the patient's medical record. Minimal documentation creates liability; thorough documentation is your defense. Required elements:

• Date and time of exam and who performed it.
• Chief complaint and patient goals.
• Relevant medical history: medications, allergies, prior cosmetic treatments, bleeding/clotting history, autoimmune conditions, pregnancy status.
• Physical exam findings: specific anatomical observations (e.g., "moderate nasolabial folds, good skin elasticity, no asymmetry").
• Assessment: diagnosis or clinical indication (e.g., "facial volume loss, glabellar rhytides").
• Plan: specific product, dose/units, injection sites, expected timeline for results.
• Informed consent: signature or electronic acknowledgment that risks and benefits were discussed.

If a complication arises or a board complaint is filed, your documentation is the evidence that a good-faith exam occurred. Sparse or generic notes (e.g., "patient consulted, approved for Botox") invite scrutiny and suggest the exam was cursory. Use a standardized template to ensure consistency and completeness.

Confusion often arises between who can perform the exam and who can perform the treatment. Clarify this in your protocols:

• The exam (assessment, diagnosis, informed consent, treatment plan) must be performed by a licensed provider with prescriptive authority in your state.
• The injection or device application can often be delegated to a supervised mid-level or nurse injector, provided the exam has already been completed by a qualified provider.

For example, a physician can perform the exam and create the treatment plan; a nurse injector can then administer the injectables under the physician's supervision. However, the nurse injector cannot independently perform the exam that justified the treatment. Some states require the supervising physician to be on-site during treatment; others permit off-site supervision if protocols and documentation are clear. Verify your state's supervision requirements—they vary widely and are a common source of board violations.

Because good-faith exam rules are state-regulated, you must verify your specific jurisdiction:

• Medical board website: Search for "good-faith exam," "telemedicine," or "injectables" guidance. Many boards have published FAQs or advisory opinions.
• State statutes: Look for language on prescriptive authority, supervision, and telehealth in your state's medical practice act and nursing/PA regulations.
• Professional societies: State chapters of the American Society of Plastic Surgeons (ASPS), American Academy of Dermatology (AAD), or American Society for Dermatologic Surgery (ASDS) often publish state-specific compliance summaries.
• Your malpractice carrier: Many insurers provide state-specific compliance checklists or will review your protocols.
• Legal counsel: If your state's guidance is ambiguous or if you operate across multiple states, consult a healthcare attorney familiar with aesthetic practice in your jurisdiction.

Do not rely on what competitors do or on informal advice from other practices. Board enforcement is increasing, and the cost of a violation—fines, license suspension, mandatory continuing education, or loss of malpractice coverage—far exceeds the cost of clarifying your state's requirements upfront.