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

A good-faith exam establishes that a qualified provider has evaluated the patient's medical history, current health status, and treatment goals before prescribing or administering a regulated product. The exam must be documented in the patient's chart and typically includes:

• Patient intake form (allergies, medications, prior treatments, contraindications)
• Visual and/or physical assessment of the treatment area
• Discussion of risks, benefits, and alternatives
• Confirmation of informed consent
• Provider signature and date

The depth and method of the exam—whether in-person, video, or hybrid—depends on state law and the treatment type. Injectables (neurotoxins, fillers) and laser/energy-based devices often have stricter requirements than topical products. Many states do not define "good-faith" in statute; instead, state medical boards and the FDA expect exams to meet the standard of care for the procedure and patient population.

Scope of practice varies by state and credential:

• Physicians (MDs, DOs): Always authorized; no restrictions in any state.
• Nurse Practitioners (NPs) and Physician Assistants (PAs): Permitted in most states, often under physician supervision or collaborative agreements; some states require NP/PA to work under a specific supervising physician.
• Registered Nurses (RNs): Limited authority; some states allow RNs to perform exams under physician delegation for specific treatments; others prohibit independent assessment.
• Licensed Aestheticians: Generally cannot perform medical exams or prescribe; may assist under provider supervision.
• Unlicensed personnel: Cannot legally perform or document a good-faith exam.

Telehealth providers must be licensed in the state where the patient is located (not where the provider is based). Verify your state's Medical Board website and your profession's licensing statute to confirm your authority.

No federal standard mandates in-person exams for aesthetic procedures; the FDA does not specify exam method. State rules differ sharply:

• In-person required: Some states (e.g., certain interpretations in CA, TX) expect in-person evaluation for injectables and lasers, especially first-time patients. Check your state medical board's guidance or advisory opinions.
• Telehealth permitted: Other states allow video-based exams if the provider can adequately assess the patient, document findings, and confirm informed consent. Telehealth is often acceptable for follow-up visits or established patients.
• Hybrid model: Many practices use in-person initial exams and telehealth for follow-ups or consultations.
• No explicit rule: Some states have no published guidance; in these cases, follow the standard of care (what a reasonable provider in your specialty would do) and document thoroughly.

Action: Contact your state's Medical Board or Board of Nursing (if NP/PA) and ask for written guidance on telehealth exams for aesthetic procedures. Request any advisory opinions or position statements.

Proper documentation is your legal shield if a patient claims injury or a regulator audits your practice:

• Chart entry must include: date, time, provider name/credential, exam findings (visual assessment, skin type, medical history review), treatment plan, informed consent signature, and any contraindications or risks discussed.
• Telehealth note: Document the platform used, patient's location, and confirmation of identity; note any limitations of remote assessment (e.g., "unable to palpate area in person").
• Informed consent: Use a written, signed form specific to the treatment (not a generic waiver). Include risks, benefits, alternatives, and cost.
• Retention: Keep records for the period required by your state (typically 5–7 years; check your state's medical records law).

Red flags that invite regulatory scrutiny: no chart entry, exam by unlicensed staff, no informed consent, or prescribing without any documented patient contact. A strong record demonstrates you met the standard of care and acted in good faith.

If you practice in one state but treat patients in another (e.g., via video):

• You must be licensed in the patient's state, not just your own.
• The patient's state law governs the exam requirement (not yours).
• Some states require a pre-existing provider–patient relationship before telehealth; others do not.
• Interstate medical compacts (e.g., the Interstate Medical Licensure Compact) may allow expedited licensure in multiple states; check if your profession participates.

Prescribing medications (e.g., topical anesthetics, antibiotics) across state lines via telehealth is heavily regulated by the DEA and state pharmacy boards. Verify your state's rules before offering remote consultations to out-of-state patients.

When in doubt, consult:

• Your state's Medical Board (or Board of Nursing for NPs/PAs): Website typically lists advisory opinions, rules, and contact info for informal guidance.
• State Attorney General's Office: May have consumer protection guidance on telehealth or unlicensed practice.
• Professional societies (e.g., American Society of Plastic Surgeons, American Academy of Dermatology, American Association of Nurse Practitioners): Often publish position statements on good-faith exams and telehealth.
• Your malpractice insurer: May provide model consent forms or state-specific guidance.
• FDA: For device-related questions (lasers, energy-based systems), check FDA.gov or contact the Center for Devices and Radiological Health.

Do not rely on vendor guidance alone; manufacturers may not account for your state's specific requirements.