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

A good-faith exam establishes that the provider has directly evaluated the patient, documented clinical findings, assessed contraindications and medical history, and formed a reasoned clinical judgment that treatment is appropriate. The exam typically requires:

• Direct patient contact (in-person or, in some states, synchronous telehealth with real-time visual assessment)
• Documentation of chief complaint, medical/surgical history, current medications, allergies, and prior aesthetic treatments
• Physical examination of the treatment area and relevant anatomy (e.g., facial asymmetry, skin quality, muscle mass, vascular patterns)
• Assessment of realistic expectations and informed consent (discussion of risks, benefits, alternatives)
• Notation of any contraindications (active infection, pregnancy, bleeding disorders, unrealistic expectations, signs of body dysmorphic disorder)

The exam need not be lengthy, but it must be documented contemporaneously or within a reasonable timeframe. State boards scrutinize whether the provider actually saw the patient or merely rubber-stamped a treatment ordered by a non-physician or delegated without oversight. Telehealth has complicated this: some states permit synchronous video exams; others require in-person evaluation before any injectable or device work.

Scope of practice varies by state and provider type:

• Physicians (MDs, DOs) can perform GFEs in all states and may delegate certain aspects (e.g., history-taking, photography) to staff, but the physician must personally examine the patient and make the clinical decision.
• Nurse Practitioners (NPs) and Physician Assistants (PAs) can perform GFEs in states where they have independent or collaborative prescriptive authority for injectables; in other states, they may conduct the exam under physician supervision but the physician must co-sign and retain ultimate authority.
• Registered Nurses (RNs) and Licensed Estheticians cannot independently perform a GFE for injectables or energy devices; they may assist but cannot be the sole evaluator.
• Dentists may perform GFEs for injectables in their scope (typically perioral and lower-face work) in states that permit it; scope is narrower than physicians'.

The supervising or delegating physician remains liable for the adequacy of the exam, even if a mid-level performed it. Documentation must clearly show who performed the exam, who supervised, and who made the treatment decision.

Telehealth GFE rules diverged sharply during and after the COVID-19 public health emergency. As of 2026, there is no uniform federal standard; state medical boards set policy:

• States permitting synchronous video GFEs (e.g., California, New York, Texas, Florida) allow real-time video exams if the provider can adequately visualize the treatment area, assess skin quality and anatomy, and document findings. Some require a follow-up in-person visit before injection; others do not.
• States requiring in-person GFEs (e.g., some conservative boards) mandate that the patient be physically present for any injectable or device treatment, even if initial consultation occurred via telehealth.
• Hybrid models allow telehealth consultation and photography review but require in-person exam and treatment on the same or a subsequent visit.

Check your state medical board's telehealth policy and any recent guidance on aesthetic procedures. Many boards have not yet issued explicit rules on telehealth injectables; absence of guidance does not mean it is permitted. Document the medium (in-person, video, hybrid) and the clinical rationale for the exam method chosen.

The medical record is your defense. A robust GFE note includes:

• Date, time, and method of exam (in-person, synchronous video, etc.)
• Chief complaint and patient goals
• Relevant medical history (prior surgeries, allergies, bleeding disorders, autoimmune conditions, pregnancy status, GLP-1 use)
• Current medications and supplements (anticoagulants, NSAIDs, herbal agents)
• Physical exam findings (facial anatomy, asymmetry, skin quality, muscle tone, vascular patterns, any contraindications)
• Assessment and plan (diagnosis, treatment rationale, alternatives discussed, risks and benefits reviewed)
• Patient signature or electronic consent (ideally specific to the procedure and provider)
• Provider signature and credentials

Templates and EMR systems should prompt for these elements. Avoid generic or pre-populated notes; boards view boilerplate language as evidence of inadequate individualized assessment. If a patient is declined treatment, document the clinical reason (e.g., "unrealistic expectations," "active herpes simplex," "recent filler in adjacent area").

In a typical medspa, a physician may not personally perform every exam or injection. Delegation is lawful if:

• The delegated provider is within scope (NP/PA with prescriptive authority, or RN under direct supervision for certain tasks).
• The supervising physician has established protocols and reviewed the patient's record before treatment.
• The physician remains available for consultation and is ultimately accountable for the clinical decision.
• Documentation clearly identifies who performed the exam, who supervised, and who authorized treatment.

State boards increasingly scrutinize whether the physician is genuinely supervising or merely signing off. "Supervision" does not mean the physician is in the room; it means the physician has reviewed the exam, assessed the patient's suitability, and is available if complications arise. Establish written protocols, conduct regular chart audits, and ensure mid-level providers understand the limits of their delegation. Failure to do so can result in board discipline against both the mid-level and the supervising physician.

State boards and prosecutors increasingly target practices that skip or falsify GFEs. Common violations include:

• No exam documented or exam performed by unlicensed staff (esthetician, medical assistant).
• Telehealth exam without adequate visual assessment or without state board authorization.
• Exam performed by a non-physician without physician review or co-signature.
• Boilerplate or pre-populated notes with no individualized findings.
• Treatment of patients with clear contraindications (active infection, unrealistic expectations, pregnancy).
• Unlicensed injection (e.g., esthetician or medical assistant injecting without RN or physician oversight).

Recent high-profile cases (e.g., unlicensed medspa operators in Arizona and Florida) have resulted in felony charges and lengthy sentences. Boards are also targeting practices that use telehealth to bypass in-person exam requirements. Maintain a conservative posture: when in doubt, require an in-person exam, document thoroughly, and ensure the supervising physician has genuinely reviewed the record.