SPA Healthcare

The good faith exam, and what your state actually requires

Most states do not use the phrase, which is why searching for it finds nothing. The requirement is real anyway: a prescriber has to examine the patient and decide the treatment is appropriate before anyone orders it, and the record has to show them doing it.

By , Co-Founder Published 13 min read
Two armchairs angled toward each other across a small round oak table in a quiet room, one upholstered in teal, with a folded cloth on the table and a fern on the windowsill.

What is a good faith exam?

A good faith exam is the clinical assessment that has to happen before a patient receives a medical aesthetic treatment. A licensed prescriber takes a history, examines the patient, decides whether the treatment is appropriate for that person, and records the reasoning. It is what creates the practitioner-patient relationship that authorises the order.

Everything else on this page follows from that one sentence. The exam is not paperwork attached to a treatment that was going to happen anyway. It is the step that decides whether the treatment happens at all, and the record of it is the evidence that a clinician actually made that decision.

Why you will not find “good faith exam” in your state’s statute

Search your state code for the phrase and you will usually find nothing. That is not because the requirement does not exist. It is because the phrase is industry shorthand rather than a legal term.

California is the clearest example. There is no statute called a good faith exam. What exists is Business and Professions Code section 2242(a), which makes it unprofessional conduct to prescribe, dispense or furnish dangerous drugs “without an appropriate prior examination and a medical indication”. The healthcare firm Bay Legal, which publishes a detailed breakdown of the California position, stresses that both elements are required: the examination and the indication. One without the other does not satisfy it.

Other states reach the same place through different language. The Texas Medical Liability Trust describes the Texas rules as requiring the physician or supervised advanced practice provider to establish a practitioner-patient relationship and complete an adequate medical record before the procedure. The law firm Quarles frames the general principle as the relationship that is “generally required before administering any prescription drug or utilizing a prescription device”.

This matters practically. If you ask your board about your “good faith exam obligations” you may get a blank response. Ask instead what your state requires before a prescriber may order a prescription drug or device for a patient, and you will find the rule that governs you.

Who can perform a good faith exam?

Someone with prescriptive authority. The American Med Spa Association states it plainly: “The good faith exam must be performed by a physician, physician assistant (PA) or advanced practice nurse (APN).” Registered nurses may assist, but AmSpa is explicit that “they cannot generate orders for treatment based on the exam.”

That distinction is the one most often got wrong in practice. An RN can be excellent, experienced and the person who actually administers the injection, and still not be the person who can decide the patient should have it. The exam and the injection are two different acts requiring two different authorities, and they do not have to be performed by the same person.

Delegation to a physician assistant or nurse practitioner is normal but conditional. AmSpa notes that “typically, the PA or APN must be delegated the ability to perform good faith exams by their supervising or collaborating physician.” Whether that delegation is needed at all depends on your state’s practice authority rules, which differ for NPs more than for any other licence.

Two further points worth knowing:

A standing order is not an exam. Standing orders and protocols describe what happens after a clinician has decided a patient is a candidate. They do not make that decision. Commentary from DJ Holt Law puts it directly: standing orders generally do not replace the evaluation.

Medical assistants cannot do it. Bay Legal’s reading of the California scheme is that section 2069 covers “technical supportive services, not assessment”, which places the exam outside what a medical assistant may perform.

Can a good faith exam be done by telehealth or telemedicine?

In some states yes, and California is more permissive here than its reputation suggests.

Bay Legal reports that section 2242(a) states an appropriate prior examination “does not require a synchronous interaction between the patient and the licensee”, and may be conducted through telehealth, including by questionnaire, provided the licensee complies with the appropriate standard of care. Section 2290.5(b) separately requires the provider to inform the patient and obtain consent for telehealth, and that consent must be documented.

Read that carefully, because it is doing two things at once. It permits asynchronous review, which is a meaningful allowance. And it hangs the whole permission on the standard of care, which is not a fixed rule but a clinical judgement that a board applies after the fact.

Other states are not California. Quarles is explicit that “states vary on whether the GFE can be performed via telehealth” and advises checking each state’s rules for permitted technology, consent requirements and whether a synchronous or asynchronous exam is required. Cohen Healthcare Law describes the broader trajectory: early regulators treated an online questionnaire alone as “grossly inadequate”, more states then accepted remote examination where the standard of care was met, and boards can reinterpret the standard of care back toward in-person visits.

So the honest answer is that asynchronous review is clearly permitted in some states, clearly insufficient in others, and in a third group the rule is written in terms of the standard of care rather than the technology, which means it is a question of clinical judgement rather than a question you can settle by reading a statute. Anyone telling you there is one national answer is selling something.

Good faith exam for aesthetics and injectables

Neurotoxins and dermal fillers are prescription products, so every treatment needs an order, and every order needs the exam that justifies it. That is the entire logic of the requirement in the aesthetics context and it does not have exceptions for experience, for repeat clients, or for a busy Saturday.

The failure mode is specific and worth naming. A clinic books a full day of injectables, the clinician performs exams in a block at the start, or signs off a list afterwards, and the record shows a set of identical assessments produced at the same minute. Boards read that as what it is. The exam has to be individual to the patient, and the record has to show individual reasoning.

Quarles notes that many med spa procedures are performed by nurses under standing protocols, which is lawful in itself, and is exactly the arrangement that collapses if the underlying exam was not properly done by someone with authority to order the treatment.

Good faith exam for IV hydration

The same rule reaches IV therapy, and operators are often surprised by it, because the vitamin infusion feels more like wellness than medicine.

It is not the vitamins that trigger the requirement. It is that establishing intravenous access is a medical procedure, and that the contents of the bag, including the saline, are prescription products. A patient still needs a prescriber to decide that IV administration is appropriate for them specifically, and some of the real contraindications, including cardiac and renal issues, are precisely the sort of thing a history is meant to surface.

We have written separately about the licensing and structural side of this at starting an IV hydration business, which covers who may own the business and who may write the order.

What a good faith exam has to document

An open notebook with blank pages and a fountain pen on a worn wooden table, beside a teal mug and a folded linen cloth.

Published compliance guidance converges on a consistent list. DJ Holt Law describes the record as needing to capture:

Quarles adds the point that the subsequent order for the prescription product should be documented in the patient’s record alongside the exam, and that follow-up visits should ask about changes in medical history.

The thread running through all of it is individualisation. The record has to show that a clinician considered this patient.

Is there a good faith exam template or PDF?

This is one of the most searched questions on the subject, and the honest answer is uncomfortable: the template is the part most likely to cause you a problem.

DJ Holt Law’s warning is direct. “Generic templates or checkbox-only forms may not withstand scrutiny.”

The reason is structural rather than fussy. The exam’s entire evidential value is that it shows a clinician reasoning about one person. A form that produces the same output for every patient demonstrates the opposite, and it does so in writing, in your own records, at the exact moment a board is looking for evidence that an individual assessment took place. A stack of identical forms is worse than a thin note that is visibly specific.

A template is still useful as a prompt, to make sure nothing in the list above gets missed. It stops being useful the moment it becomes the record itself. If you adopt one, it should be built around your own services, reviewed by your own counsel and your own medical director, and it should leave room for reasoning rather than only boxes.

We do not publish a downloadable template, and that is deliberate. A fill-in form for a clinical assessment, written by someone who is not your clinician and has not seen your service menu or your state’s rules, is not a document we think anyone should be handing out.

How often does a good faith exam need repeating?

There is often no stated interval. Bay Legal notes that no California statute or regulation sets a required frequency.

Where the rule is silent, published guidance converges on annually as a general practice, with a new exam triggered sooner by specific events. AmSpa describes a new exam being needed when the patient seeks treatments outside the initial plan, when their health substantially changes, or when enough time has elapsed, and gives at least annually as a rule of thumb. Quarles reaches the same annual default and gives the same reason: so the clinician can account for changes in condition or history.

Treat the trigger list as the operative part. The annual default is what catches the patient whose circumstances changed without telling you; the triggers are what catch the patient in front of you who is asking for something new.

Does the requirement vary by state?

Substantially, and in more ways than people expect. What varies includes who may perform the exam, whether telehealth is acceptable and in what form, whether a physician must be on site, how the examination requirement is worded, and what the board expects to see in the record.

Texas is a useful illustration of how much more than the exam itself can be in scope. The Texas Medical Liability Trust describes requirements including signed and dated written protocols reviewed annually, at least one person trained in basic life support on site, procedures performed while a physician, PA or APRN is on site or immediately available for emergency consultation, and the delegating physician’s name and licence number posted in public areas and treatment rooms. The exam is one piece of a larger structure.

We have deliberately not built a fifty-state table here. State rules on this move, the authoritative source is your own board rather than any summary, and a table that is wrong in your state is worse than no table. What we would suggest instead:

  1. Identify which board governs the question for you. Often more than one does, and they may not agree. Quarles makes the point that much of the published guidance comes from nursing boards and “do not address the authority of other advanced practice providers like physician assistants”, who answer to a different board.
  2. Ask the question in statutory language, not industry shorthand: what does this state require before a prescriber may order this drug or device for a patient.
  3. Ask separately about telehealth, because it is usually governed by its own rules rather than by the examination rule.
  4. Get the answer in writing, and have your own counsel read it against your actual service menu.

What happens if you skip it

A made-up treatment bed with folded towels in a quiet room, beside a teal cabinet and tall windows looking onto a garden.

The exposure is not one risk, it is several, and they land on different people.

Bay Legal’s summary of the California consequences is the most concrete published account we have found. It identifies unprofessional conduct for the prescribing licensee under section 2242; separate unprofessional conduct under section 2290.5(d) for failing to obtain and document telehealth consent; unprofessional conduct under section 2264 for a physician who allows an unlicensed person to practise medicine, which is the provision that reaches a medical director with no real involvement in the practice; and potential criminal exposure under section 2052 where the person assessing lacked authority, with fines up to $10,000 and possible jail time.

Two features of that list are worth drawing out. The licence risk sits with the clinician rather than the business, which means the person most exposed is often an employee rather than the owner. And the medical director provision reaches arrangements that exist only on paper, which is the common structure that owners most often assume is safe because it is widespread.

Alongside the regulatory exposure sits the insurance question. A malpractice claim arising from a treatment with no documented prior examination is a claim where the defence has to begin by explaining why the record does not show a clinician deciding the patient was a candidate.

Good faith exam companies: what outsourcing can and cannot do

There is a real market in third-party providers who supply the clinician who performs the exam. The model is legitimate in principle. A clinician does not have to be your employee to be the person who assesses your patient, and for a single-location business, retaining the right licence type in the right state is often harder than it sounds.

What outsourcing can do is supply clinical capacity. What it cannot do is move the obligation. The exam still has to be real, individual and documented, the clinician still has to be licensed in the patient’s state, and if the arrangement exists mainly to produce signatures then it reproduces exactly the paper-arrangement risk that the medical director provisions are aimed at.

Questions worth asking any provider, including us:

That last one is the tell. Payment per completed assessment regardless of whether treatment follows is a different arrangement from payment that arrives only when a treatment is sold.

Where we sit

Two cream armchairs with a teal cushion beside a round oak table in a bright room with large windows and a fiddle-leaf fig.

We run the prescription side of treatment programs for spa, salon, gym and clinic businesses, under your brand. The clinical decisions are made by Beluga Health, an independent physician-owned medical group whose clinicians are licensed in all fifty states. They are not your clinicians and do not become your clinicians; they are an independent group making independent decisions, and they are paid per completed consultation whether or not anything is prescribed.

What that covers is the prescription programs we run with you: medical weight loss, menopause and hormone health, anti-aging and longevity, and prescription skincare. Our fee is $50 per treatment per month. Medication and fulfilment are billed at cost and quoted directly, because pharmacy pricing varies by product, strength and pharmacy. You are the seller of record to your client, you set your own retail price, and you keep the difference.

What it does not cover, and we would rather say so plainly:

Availability varies by state. Compounded medications are not FDA approved, and are prescribed only where a clinician determines they are appropriate for an individual patient.

The short version

The good faith exam is the clinical decision that authorises a treatment, not the paperwork that accompanies one. It needs a prescriber, it needs to be individual to the patient, it needs to be documented with reasoning rather than ticks, and whether it can happen by telehealth depends on a state rule that genuinely differs and that is often written in terms of the standard of care rather than the technology.

The single most useful thing you can do with this page is stop searching for the phrase and start asking your own board the statutory question instead.

This article describes what published sources say about a regulatory requirement that varies by state and changes. It is not legal advice, and nothing in it should be relied on in place of your own counsel or your own licensing board.

Common questions

What is a good faith exam?

The clinical assessment that has to happen before a patient receives a medical aesthetic treatment. A licensed prescriber takes a history, examines the patient, decides whether the treatment is appropriate for that person specifically, and records the reasoning. It is what creates the practitioner-patient relationship that authorises the order. It is not paperwork attached to a treatment that was going to happen anyway; it is the step that decides whether the treatment happens at all.

Why can I not find good faith exam in my state's statute?

Because it is industry shorthand rather than a legal term. California, for example, has no statute of that name. What it has is Business and Professions Code section 2242(a), which makes it unprofessional conduct to prescribe, dispense or furnish dangerous drugs without an appropriate prior examination and a medical indication. Other states reach the same place through different wording. Ask your board what is required before a prescriber may order a prescription drug or device for a patient, rather than asking about good faith exams, and you will find the rule that governs you.

Who can perform a good faith exam?

Someone with prescriptive authority. The American Med Spa Association states that it must be performed by a physician, physician assistant or advanced practice nurse, and that registered nurses may assist but cannot generate orders for treatment based on the exam. That distinction is the one most often got wrong: an RN can be the person who administers the injection without being the person who can decide the patient should have it.

Can a nurse practitioner perform a good faith exam?

In many states yes, and whether delegation from a physician is required depends on that state's practice authority rules, which differ more for nurse practitioners than for any other licence. AmSpa notes that typically a PA or advanced practice nurse must be delegated the ability to perform good faith exams by their supervising or collaborating physician. Check your own board rather than assuming your state matches the one next door.

Can a good faith exam be done by telehealth?

It depends on the state, and this is the genuinely contested part. Bay Legal reports that California's section 2242(a) says an appropriate prior examination does not require a synchronous interaction and may be conducted through telehealth, including by questionnaire, provided the standard of care is met. Quarles is explicit that states vary on whether telehealth is acceptable and in what form. In some states the rule is written in terms of the standard of care rather than the technology, which makes it a clinical judgement rather than something you can settle by reading a statute.

Is there a good faith exam template or PDF I can download?

There are many, and the template is the part most likely to cause you a problem. DJ Holt Law warns that generic templates or checkbox-only forms may not withstand scrutiny. The exam's entire evidential value is that it shows a clinician reasoning about one person, and a form producing identical output for every patient demonstrates the opposite, in writing, in your own records. A template is useful as a prompt so nothing gets missed. It stops being useful the moment it becomes the record itself.

What does a good faith exam have to document?

Published guidance converges on past medical background, current medications, drug allergies and existing conditions; the patient's goals; an evaluation of contraindications and whether the treatment is appropriate; the clinician's reasoning for the chosen procedure; and informed consent covering risks and alternatives. Quarles adds that the subsequent order for the prescription product should be documented alongside the exam. The thread running through all of it is that the record has to show a clinician considered this patient.

How often does a good faith exam need to be repeated?

Often no interval is stated. Bay Legal notes no California statute or regulation sets one. Where the rule is silent, published guidance converges on at least annually, with a new exam triggered sooner when the patient seeks treatment outside the initial plan, when their health substantially changes, or when enough time has passed. Treat the triggers as the operative part and the annual default as the backstop.

Does a good faith exam apply to IV hydration?

Yes, and operators are often surprised by it. It is not the vitamins that trigger the requirement. Establishing intravenous access is a medical procedure, and the contents of the bag including the saline are prescription products, so a prescriber still has to decide IV administration is appropriate for that patient. Some of the real contraindications, including cardiac and renal issues, are exactly what a history is meant to surface.

Is a standing order the same as a good faith exam?

No. Standing orders and protocols describe what happens after a clinician has decided a patient is a candidate; they do not make that decision. Commentary from DJ Holt Law puts it directly: standing orders generally do not replace the evaluation. A protocol-driven service line is lawful in itself and collapses if the underlying exam was not properly performed by someone with authority to order the treatment.

What happens if a med spa skips the good faith exam?

The exposure lands on several people at once. Bay Legal's summary of the California consequences identifies unprofessional conduct for the prescribing licensee under section 2242; separate unprofessional conduct for failing to obtain and document telehealth consent; unprofessional conduct for a physician who allows an unlicensed person to practise medicine, which reaches a medical director with no real involvement in the practice; and potential criminal exposure where the person assessing lacked authority. The licence risk sits with the clinician rather than the business, so the person most exposed is often an employee rather than the owner.

Can I outsource good faith exams to a third party?

The model is legitimate in principle, since a clinician does not have to be your employee to assess your patient. What outsourcing can do is supply clinical capacity; what it cannot do is move the obligation. Worth asking any provider which licence type performs the exam and in which states, whether it is synchronous or asynchronous, who holds the record afterwards, what happens when the clinician declines to treat, and whether the clinician is paid per assessment or only when a treatment is sold. A provider whose clinicians never decline is not performing an assessment.

Does SPA Healthcare provide good faith exams for injectables?

No. We run the prescription side of treatment programs under your brand, with clinical decisions made by Beluga Health, an independent physician-owned group licensed in all fifty states. That covers the programs we run with you: medical weight loss, menopause and hormone health, anti-aging and longevity, and prescription skincare. If you are performing botox, fillers or laser treatments in your own room, those need their own exam from a clinician attached to that treatment, and we do not supply it. We are also not a medical director and do not satisfy a supervision or delegation requirement for procedures your staff perform.

This article is general information and is not legal advice. Requirements are set state by state and change. Confirm your own position with your state medical board and a healthcare attorney licensed in your state before you sign anything.

Or skip the search entirely.

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