Good Faith Exam for Med Spas by State (2026 Guide)

Search this site for the phrase good faith exam and it turns up in more than a hundred and sixty articles. It is the load-bearing step in almost every compliance answer we publish: who may inject depends on it, what a medical director owes depends on it, whether a standing order is lawful depends on it, and most med spa board discipline traces back to its absence.

This guide fills it. It is the narrative companion to our good faith exam requirements across all 51 jurisdictions — the cited dataset view, every state, every primary source. That page answers what does my state say. This one answers what is this thing, who may do it, what has to be in the chart, and what happens when it is skipped, with depth on the thirteen states where we hold dedicated scope guides.

What a Good Faith Exam Actually Is

Strip away the industry vocabulary and the requirement is simple. Botulinum toxin is a prescription drug. So is dermal filler in its regulatory treatment, so is a compounded GLP-1, so is the lidocaine in the tray. A prescription drug may only be given to a patient a prescriber has decided should have it. The good faith exam is the decision — the encounter in which a licensed prescriber evaluates this patient, forms a clinical impression, decides the treatment is appropriate, and orders it.

It is an evaluation, not a document

The most expensive misunderstanding in the field is that the good faith exam is a piece of paper. Operators buy a template, add it to the intake stack, have the patient sign it at the front desk, and believe the box is ticked. The template is the record of an evaluation; it is not the evaluation. A signed form describing an examination that did not happen is worse than no form, because it converts a compliance gap into a documentation falsity a board will read as intent.

It produces an order, and the order is the point

The exam has an output, and the output is what makes everyone else's day lawful. When a nurse injects, the legal authority is not the nurse's licence and not the medical director's signature on a protocol. It is the order — a prescriber's instruction that this patient receive this product at this dose. Without an exam there is no order, and without an order the injection is an unauthorised administration of a prescription drug however skilled the injector. Our guide to who can inject Botox across the United States works through the role-by-role verdicts downstream of this step.

It establishes a relationship the law recognises

Several states describe the requirement in relationship terms rather than examination terms — Texas requires a practitioner-patient relationship, Virginia a bona fide practitioner-patient relationship, Ohio a bona fide provider-patient relationship. The framing matters. A relationship implies continuity and responsibility: someone is now clinically accountable for this patient and answerable for the decision. A one-off signature does not create that. A real evaluation does.

What it is not

It is not informed consent, though the two usually happen in the same visit. Consent is the patient agreeing to a risk; the exam is the prescriber deciding the treatment is appropriate in the first place. It is not a medical history questionnaire, which is data collection rather than evaluation. It is not the medical director countersigning charts at the end of the week, because the exam has to precede the treatment. And it is not the injector's own assessment, unless the injector is themselves a prescriber with authority to order.

Why the Name Is Wrong Almost Everywhere

The phrase good faith examination comes from one state. California's Business and Professions Code section 2242 makes it unprofessional conduct to prescribe, dispense or furnish a dangerous drug without an appropriate prior examination and a medical indication, and California's enforcement culture around that provision gave the industry its vocabulary. The vocabulary then travelled to states that never adopted it.

Twelve of thirteen states do not use the term

This is not pedantry. Compliance vendors sell a "good faith exam requirement" in states whose codes contain no such phrase; operators go looking for the rule, fail to find it, and conclude the requirement is optional. Our New York guide is blunt about it: New York has no statute or regulation using the term for cosmetic injectables, and no board has published its elements. Michigan, Colorado, Ohio and Washington have none either, and Texas repealed the rule that once spelled the steps out.

Absence of the phrase is never absence of the duty

In every one of those states the obligation is real and reaches the same place by a different route. Ohio's hook is ORC 4731.22(B), which disciplines failure to maintain minimal standards for the selection or administration of drugs and departure from minimal standards of care. Michigan's is MCL 333.16221, making negligent delegation and negligent care grounds for discipline. New York's is Education Law section 6530, under which treating or prescribing without an appropriate evaluation is misconduct, alongside the State Board for Medicine's energy-device guidance requiring assessment before, during and after a procedure. None say good faith exam. All punish its absence.

Citing a rule that does not exist is its own risk

There is a practical reason to get the vocabulary right. A compliance manual that cites a non-existent statute is a document a board or a plaintiff's expert can discredit in a sentence, and once one citation is shown to be invented the rest of the file loses its authority. Where a state's duty is derived rather than named, the honest formulation is to say so and cite what it is actually derived from.

The Four Ways States Get to the Same Rule

Across the thirteen states here, the requirement arrives through four distinct legal mechanisms. Knowing which one applies in your state tells you where to look when someone challenges the practice, and what the defence looks like.

One: a named examination statute

California alone. Section 2242 makes prescribing without an appropriate prior examination and a medical indication unprofessional conduct, full stop, and the drug does not have to be controlled. This is the strongest and clearest form, and it is why California enforcement on this point is both the most active in the country and the easiest to predict.

Two: a prescribing-relationship rule

Texas, Virginia and Tennessee run through this channel. Texas requires the practitioner-patient relationship to be established before a delegated cosmetic act under 22 TAC section 169.26(c), the rule that took effect in January 2025 when the Texas Medical Board consolidated its nonsurgical cosmetic provisions into Chapter 169 and repealed the old section 193.17. Virginia's Code section 54.1-3303 permits a prescription only within a bona fide practitioner-patient relationship established by an appropriate examination. Tennessee's board rules require a history, a physical examination, a diagnosis and a therapeutic plan before any drug is prescribed, and make prescribing based solely on answers to a set of questions a prima facie violation.

Three: a board position or advisory opinion

Arizona, Georgia and Illinois. Arizona's requirement comes from the Board of Nursing advisory opinion on medical aesthetic procedures: an initial face-to-face examination by a qualified licensed practitioner must precede any medical aesthetic treatment, and a licensed-practitioner order is required to initiate the higher-risk procedure tiers. Georgia's comes from the Composite Medical Board's FAQ position, its cosmetic-laser rule requiring examination by a consulting physician, and its IV Hydration and Therapy Position Statement of 7 May 2026, which requires a completed history and physical by a physician, NP or PA and says standing orders are not a substitute for an individualised order. Illinois's comes from the IDFPR Statement on Prohibited Practices: for delegated medspa procedures the person receiving services must be a patient of the physician, and the physician must examine the patient and determine the appropriateness and the course of treatment.

Four: the general standard of care

Michigan, New York, Ohio, Colorado, Florida and Washington reach it here, though Colorado and Washington have rule text that comes close to naming it. Colorado's Medical Board Rule 800 requires delegated medical-aesthetic services to be provided in the context of an appropriate physician-patient relationship with a physician initial consultation. Washington's WAC 246-919-606 writes the exam out as clinical steps without the label: before authorising a nonsurgical cosmetic procedure the physician must take a history, perform an appropriate physical examination, make an appropriate diagnosis, recommend treatment and obtain informed consent. That is a good faith exam in everything but name, and it is more prescriptive than most states that use the phrase.

Good Faith Exam Requirements by State: The Comparison Table

Each row reflects what our own state guide and our cited regulations dataset say for that jurisdiction, and links to the full guide. The required column distinguishes a named statutory requirement from a board position and from a duty derived from prescribing or standard-of-care rules, because the distinction changes how you cite it and how much interpretive room a regulator has.

This table covers the thirteen states where we hold dedicated scope guides. It is not a fifty-state table. Do not read a row across to a neighbouring state that is not listed. For the other thirty-eight jurisdictions plus the District of Columbia, our good faith exam comparison across all 51 jurisdictions gives each one its own wording and primary sources.

How to read the required column

Every row says yes, and that uniformity is the most useful finding on this page. There is no covered state in which a med spa may lawfully treat a patient with a prescription drug on the strength of an intake form alone. What varies is the citation you would produce if asked — a statute in California, a rule in Texas, Virginia, Tennessee and Washington, a board position in Arizona, Georgia and Illinois, a derived standard elsewhere. A derived duty is not a weaker duty. It is a duty with a less convenient citation.

Where the table says unsettled

Two cells carry a genuine hedge rather than a verdict. Illinois is marked effectively in-person for injectables because no Illinois primary source we can find authorises a physician to conduct the good faith exam itself by telehealth for cosmetic injectables; the narrow telehealth-adjacent carve-outs in the IDFPR medspa memo concern on-site supervision and an APRN-performed exam for non-ablative laser, not remote physician examination for neurotoxins. Washington is marked unsettled because WAC 246-919-606 asks for a physical examination in terms, while the state's general telemedicine framework permits establishing care remotely, and the cosmetic rule does not resolve the tension. In both cases the conservative reading is the one we publish.

Why the re-exam column says no fixed interval everywhere

Operators want a number — six months, a year, every third visit — and no covered state supplies one. That absence is real and worth stating plainly rather than inventing a convention. What the rules actually require is that the order behind each treatment be a live clinical decision about the patient in front of you, which puts the trigger on events rather than on the calendar. The section below on re-examination sets out the events that matter.

Who May Perform a Good Faith Exam

The permitted examiner list is the narrowest part of the whole framework, and it is remarkably consistent across states that agree on very little else. Three roles appear; the fourth, the one most med spas would like to use, appears nowhere.

Physicians, everywhere and without qualification

An MD or DO licensed in the state where the patient is located may perform the exam, order the treatment and administer it. The only real constraint is competence: a physician with no training in facial anatomy who clears a patient for glabellar toxin is exposed under unprofessional-conduct provisions, not protected by the breadth of the licence. Location matters more than operators expect — the practice of medicine occurs where the patient is, so an out-of-state physician performing a remote exam needs a licence in the patient's state.

Nurse practitioners and APRNs, subject to their state's authority

This is where the variation lives, and it tracks practice authority closely. In Arizona and Washington, full practice authority means an NP or ARNP with prescriptive authority performs the exam, orders and injects with no physician anywhere in the structure; Illinois grants the same to a full-practice-authority APRN. California has three tiers after AB 890: an NP under standardised procedures, a 103 NP practising without them where a physician also practises, and a 104 NP — a designation the Board of Registered Nursing began accepting applications for on 1 January 2026 — practising independently in any setting. In Georgia, Ohio and Tennessee the APRN examines within a nurse protocol, a Standard Care Arrangement or a collaborative agreement, which must exist and must reflect the aesthetic services actually delivered.

Physician assistants, within the delegation instrument

PAs may perform the exam in every covered state, always within a practice agreement, supervision agreement or delegation instrument with a physician. California's SB 697 replaced the old delegation-of-services agreement with the practice agreement and removed the statewide supervision formula, which in practice gives California PAs the widest latitude of any delegated examiner: one document covers the exam, the order and the injection, and the supervising physician need not be present. Texas names the PA expressly in the closed list at section 169.26(c).

Registered nurses, in no covered state

This is the hardest line on the page and the one most often crossed. Not one of the thirteen states permits an RN to perform the good faith exam. California's guides put it plainly: the RN does not decide candidacy, does not select the product, and may not perform the examination that authorises the injection. Colorado reaches the same result and adds that an unlicensed delegatee cannot either. Texas's list is closed by its own terms. The myth operators state most often is that an RN can perform the exam if the protocol says so — and a protocol purporting to authorise it records a violation rather than creating authority.

Medical assistants, estheticians and unlicensed staff, never

They may collect intake data, take photographs, obtain vitals and prepare the room. They may not evaluate, and the fact that a physician later reviews their notes does not convert data collection into an examination. Where an esthetician's own licence sits relative to the medicine is a separate question our esthetician scope of practice by state comparison works through.

What the Exam Must Actually Contain

Few states enumerate the elements, so the reliable approach is to build to the most prescriptive rule you can find and apply it everywhere. Washington and Tennessee happen to supply that rule, and Texas's medical-record rule supplies the documentary version of it.

The five elements the prescriptive states name

Washington's WAC 246-919-606 requires the physician to take a history, perform an appropriate physical examination, make an appropriate diagnosis, recommend treatment and obtain informed consent before authorising a nonsurgical cosmetic procedure. Tennessee's board rule requires an appropriate history and physical, a diagnosis and a therapeutic plan before any drug is prescribed. Texas's Chapter 163 record rule requires relevant history, physical examination findings, an assessment, a clinical impression and a diagnosis. Three states, three instruments, one list.

History that is aesthetic-specific, not generic

A generic medical history form misses the items that actually change an aesthetic decision. Prior neuromodulator and filler treatments with products, dates and outcomes. Neuromuscular disorders. Pregnancy and breastfeeding status. Aminoglycoside use. Autoimmune conditions and immunosuppression. Anticoagulants and supplements affecting bleeding. Prior vascular events, occlusions or nodules. Known allergies including lidocaine and hyaluronidase. Recent dental work, vaccination or illness. Body dysmorphia screening and treatment expectations. A history capturing none of these has technically been taken and has clinically done nothing.

Examination proportionate to the treatment

Nobody expects a full physical for glabellar toxin. The standard of care asks for an examination adequate to the risk of the specific treatment: facial assessment, muscle activity, asymmetry, skin quality, prior filler location and character, injection-site inspection for infection or inflammation. For a GLP-1 programme the proportionate examination is a considerably longer list, which is why weight-management models fail this requirement more often than injectable ones.

Assessment, indication and plan

The chart must show a clinical impression and the indication for treatment — not simply that the patient asked for it. Patient request is a reason to consider treatment; it is not a medical indication. The plan names the product, the dose or units, the sites, and the follow-up. This is the part of the record that later distinguishes a considered decision from an order-taking transaction, and it is the part most commonly missing.

The candour to say no

A good faith exam that has never produced a declined treatment is a red flag on its face. If the same practitioner has cleared every patient for every requested service across two thousand charts, the exam is functioning as a formality and a reviewer will say so. Documented declines, deferrals and modified plans are the strongest evidence the process is real.

Documenting the Exam

Boards do not observe examinations. They read charts. Everything about compliance on this topic reduces to whether the record shows an evaluation happened, who performed it, and what it concluded — and a defensible chart entry looks the same in every state.

The eight things a reviewable entry contains

Patient identity and the date and time of the encounter. The examining practitioner's name, credential and licence number. The modality — in person, or the named telehealth platform and interaction type. The history taken. The examination findings. The assessment, clinical impression and indication. The order: product, dose or units, sites and parameters. The consent obtained and the follow-up plan. Where the injector differs from the examiner, record who administered and when.

Timestamps are the quiet evidence

The single most revealing thing in a med spa chart is the time gap between the exam entry and the treatment entry. A four-minute gap across every chart in a busy clinic tells a reviewer the exam is a click in the workflow rather than an encounter. Timestamps that vary, and that occasionally show a patient returning another day after a deferral, are the signature of a real process. This is also why backdating is catastrophic: electronic records keep audit trails, and an altered timestamp turns a documentation finding into a fraud finding.

Templates help, and templates are also the trap

A structured template raises the floor: it prompts the questions, keeps the elements consistent and makes review fast. It becomes a liability the moment its default values are the answers. Charts in which every patient has identical negative findings and identical plans are the classic pattern, and a reviewer pulling ten charts at random will find it in minutes. Build templates that require entry rather than accept defaults.

Run the ten-chart test on yourself

Pull ten charts at random from the last quarter. For each, ask whether a stranger could identify who performed the examination, what they found, why the treatment was indicated, who wrote the order, and when. If any of the ten fails, the gap is already in the record — and finding it yourself costs nothing compared with a regulator finding it.

The Order That Comes Out of the Exam

The exam and the order are separate things that the industry routinely merges, and separating them clarifies most of the confusion around delegation.

What makes an order patient-specific

A patient-specific order names the patient, the product, the dose or units, the sites and the date, and is attributable to an identified prescriber who evaluated that patient. Anything missing one of those elements is a protocol, not an order. Texas forecloses the substitution three ways: the relationship must be established prior to the delegated act without exception, the drugs eligible for standing delegation orders are a closed narrow list including neither botulinum toxin nor filler, and standing medical orders apply only after patients have been evaluated.

Who may write it, and who may not

The order comes from the examiner, or from a prescriber acting on the examiner's evaluation within the same practice. It does not come from the injector unless the injector is a prescriber, and it does not come from the medical director in the abstract — a director who has not evaluated the patient has not ordered anything for that patient, however many protocols they have signed.

The examiner and the injector can be different people

This is the ordinary and lawful arrangement in most med spas: a prescriber examines and orders, and a qualified injector administers. Nothing requires the examiner to hold the syringe. What it requires is that the clinical decision belong to someone authorised to make it, and that the record show the chain. Where that chain runs through a physician who is not on site, our guide to remote and telehealth medical director arrangements covers the oversight mechanics.

Standing Orders, Protocols and Why Neither Is an Exam

Standing orders are legitimate, useful and widely misunderstood. The misunderstanding is always the same: treating a document that describes a class of patients as though it authorised treatment of an individual one.

A protocol says what to do if; an order says do this

A protocol is a conditional instruction. It says that if a patient is a candidate, here is the treatment, the dose range, the technique and the complication pathway. It does not determine that this patient is one. When an injector treats a new patient under a document signed weeks earlier that names no patient and reflects no evaluation, the clinical decision was the injector's — and the protocol signature does not retroactively make it someone else's.

Where a standing order is legitimate

After the exam, not instead of it. Once a prescriber has evaluated the patient, established a plan and ordered a course of treatment, several states permit follow-up doses within that course under the standing order without a fresh prescriber visit each time. Arizona is explicit: standing orders cover repeat administration, not the initial assessment of a new patient. Georgia's board addressed the substitution question in its 2026 position statement, saying standing orders are not a substitute for an individualised order and a completed history and physical.

What a compliant protocol set looks like

Protocols do real work when they are procedure-specific, current, signed and dated by someone with authority, and matched to what the practice actually offers. Our guide to the protocols a med spa needs sets out the full document set. The point to carry from this page is narrower: however good the protocol library, it sits downstream of the exam and cannot stand in for it.

The delegation trap that follows

Delegation of the injection is not delegation of the evaluation. States that allow generous delegation of the administration step — Colorado's unlicensed-delegatee route being the widest among covered states — do not extend that generosity to the exam. The wider the delegation, the more the lawfulness of the treatment rests on the examination that preceded it.

Does the Exam Have to Be In Person?

Short answer: in most covered states, no — but the standard of care does not drop because the visit is remote, and two of our thirteen states leave the question genuinely open for injectables. This section is deliberately brief, because remote delivery has its own guides.

Where remote is clearly permitted

California permits it expressly in the same section that creates the requirement. Texas is more permissive than operators expect: a valid relationship may be established through synchronous audiovisual interaction with no prior in-person visit, and the statute bars holding telemedicine to a higher standard of care. Ohio, Michigan, Tennessee, Virginia, Georgia, Florida, Arizona, Colorado and New York all permit it in some form.

Where it is not settled

Illinois and Washington, for the reasons the table sets out. In both, the conservative operating assumption is that the physician's own examination for cosmetic injectables happens in person until a board says otherwise.

Same standard, different medium

The condition that defeats most remote models is not the technology but the standard: a thirty-second video call, or a questionnaire completed in the treatment chair with the injector already waiting, is not an appropriate examination in any state. For the full picture — platform requirements, cross-state licensure, prescribing rules, documentation of the remote encounter — see our dedicated guides to telehealth prescribing for med spas by state and to remote and telehealth medical director models, which own that ground.

When the Exam Has to Happen Again

No covered state publishes an interval, so the honest guidance is event-based. These are the events that should trigger a fresh evaluation, drawn from what the rules require rather than from a convention someone invented.

A new patient, without exception

Every state's requirement attaches at minimum to the first encounter. There is no version of the rule under which a walk-in is routed straight to an injector's chair. The Illinois memo, the Ohio and Tennessee director duties and the Arizona advisory all describe that failure in the same terms.

A new product, indication or treatment area

An evaluation that cleared a patient for glabellar toxin did not clear them for a mid-face filler, a GLP-1 programme or an ablative laser. Each is a different risk profile, a different contraindication set and a different clinical decision. Adding a service to an existing patient's plan is a new decision requiring a prescriber who is authorised to make it.

A material change in the patient

New medication, pregnancy, a new diagnosis, an adverse reaction to a prior treatment, a significant interval since the last visit, or a complication under management. Any of these can move a patient from candidate to non-candidate, and the practice only finds out by asking.

Within a course of treatment, follow the state

This is where standing orders do legitimate work. Repeat doses inside an ordered course, at the same product and indication, generally proceed under the existing order in states that permit it. What does not survive is the practice of treating a returning patient two years later, on a different product, under the order from the original visit.

A practical default

Because no state sets a number, most well-run practices adopt one voluntarily: a documented re-evaluation at least annually for continuing patients, plus the event triggers above. That is a standard-of-care choice rather than a legal requirement, and saying so in your own policy is more defensible than presenting it as a rule your state imposed.

What Happens When the Exam Is Skipped

The consequences arrive in four separate channels, and a single skipped exam can trigger all four. What makes this requirement unusual is that no patient needs to be harmed for any of them to fire.

The examiner-of-record and the injector both carry it

Board discipline attaches to individuals. A nurse who administered without a documented prior evaluation faces action for accepting a delegation outside its terms, while the prescriber whose name appears on the protocol faces action for negligent delegation and inadequate supervision. Neither can point at the other, and both answers to who decided this patient should be treated are bad.

Findings multiply by chart, not by incident

This is the mechanic operators most consistently underestimate. A chart review that finds inadequate examinations across five files produces five findings, each capable of carrying its own penalty. Because the failure is systemic when it occurs — practices do not skip the exam once, they skip it as a workflow — the exposure scales with volume.

Unlicensed practice exposure for whoever actually decided

Where the person who determined candidacy holds no authority to do so, the conduct is not merely a delegation defect. Practising medicine without a licence is criminal in many states and a felony in several, and deciding which patient gets which prescription drug is the clearest evidence of practising there is. Texas's limited safe harbour for delegates evaporates the moment the delegate knows the arrangement is improper.

The insurance and civil layer

Professional liability policies commonly exclude services not lawfully rendered. A missing exam can therefore be simultaneously the reason a claim exists and the reason it is not covered — the worst possible pairing. In civil litigation the absent evaluation is the plaintiff's opening argument on both negligence and informed consent, because the practice cannot show it ever decided the treatment was appropriate.

Why it surfaces at the worst commercial moment

Most practices do not discover the gap through an inspection. They discover it during diligence on a sale, when an acquirer's clinical reviewer pulls charts. At that point the finding is not a request to fix something; it is a holdback, a price reduction or a walk. Our med spa inspection guide covers what reviewers ask for and in what order.

The Six Failure Patterns We See Most

These are the recurring shapes, described the way they actually look inside a practice rather than the way a rule describes them.

One: the questionnaire that thinks it is an exam

Intake collects a full history, the patient signs, and nobody evaluates. Tennessee's rule names it precisely — prescribing based solely on answers to a set of questions is a prima facie violation — and both Ohio's and Tennessee's director duties say a questionnaire alone does not establish the relationship.

Two: the protocol standing in for the order

A signed protocol covering neurotoxin treats every patient as pre-authorised. It is the most common structural failure and the easiest to see in a chart, because no entry names a prescriber who evaluated that patient.

Three: the exam performed by the wrong person

An experienced RN injector assesses the patient, decides units and sites, and treats, with a physician's name in the file. The clinical decision was the nurse's. No covered state permits this, and seniority does not change the analysis.

Four: the four-minute telehealth call

A remote visit meeting the technology requirement and not the standard of care. Virginia's guide puts the test well: the standard does not drop because the visit is remote, and a call conducted with the injector waiting in the room is not an appropriate examination.

Five: the exam that never expires

A patient examined in 2023 for toxin is treated in 2026 for filler and a weight-loss injectable under the original evaluation. Different product, different risk, different decision, no new order.

Six: the medical director who reviews after the fact

Charts countersigned weekly, treatment delivered days earlier. Retrospective review is valuable oversight and it is not an exam, because the exam has to precede the treatment. A director who believes countersignature cures the gap has two findings instead of one.

Building the Exam Into Your Patient Flow

Every practice that fixes this fixes it the same way: by moving the exam from a compliance artefact into an operational step that the booking system will not let anyone skip.

Make it a scheduled appointment type

Give the evaluation its own slot with its own duration, assigned to a provider with authority to perform it. A new-patient booking that does not include one should not be bookable. This single change eliminates most of the failure patterns above, because it stops relying on staff remembering under pressure. It is also the change owners resist longest, because it visibly costs throughput.

Gate the treatment on the order, not on the chart note

Configure the record so a treatment cannot be started without an attached patient-specific order naming a prescriber. The discipline then holds even on the busiest days, precisely because it is no longer a matter of discipline.

Decide who examines, in writing, per service line

Name the roles permitted to examine for each service you offer, in your state, in a policy document, and check it against every provider's actual credential. A practice offering toxin, filler, GLP-1 and laser may have a different permitted examiner list for each — Georgia's laser rule and Illinois's non-ablative laser provisions are service-specific variation within a single state.

Audit ten charts a quarter, and write down what you find

Self-audit is the cheapest control available and the one most practices skip. Ten charts, the questions from the documentation section above, and a short written record of the result. The written record matters: a board that sees a practice finding and fixing its own gaps reads the file differently from one that sees nothing.

Get the underlying documents right once

Most of this is a document problem before it is a behaviour problem — intake forms that prompt the right history, an evaluation template that requires entry, an order form that cannot be completed without a prescriber, a delegation policy naming who may examine. Building that set from scratch is where practices lose months. To start from documents already built to these requirements, our med spa compliance SOP library covers the full operational document set across every service line.

What This Guide Does Not Cover

A comparison invites over-reading, so the edges are worth stating.

It is thirteen states, not fifty

The table covers Arizona, California, Colorado, Florida, Georgia, Illinois, Michigan, New York, Ohio, Tennessee, Texas, Virginia and Washington, because those are the states where we hold dedicated scope guides with the underlying rules worked through. No row should be read across to a state that is not listed. For the other thirty-eight jurisdictions, the cited comparison at good faith exam by state is the right starting point, and the wider med spa regulations by state reference sets the exam beside the nine other compliance dimensions.

It is the exam, not the delegation matrix

Who may perform the examination is a narrower question than who may perform each procedure, and this page answers only the first. For the role-by-role verdicts on injection authority — physician, PA, NP, RN, LPN, medical assistant, esthetician — our national who-can-inject guide owns that ground.

It is a snapshot of a moving area

Texas rewrote its rule in January 2025. California's AB 890 pathway opened a new NP category in January 2026. Georgia's board issued a position statement in May 2026 and clarified it in June. The direction of travel is toward more explicit requirements, and a compliance file built to the current line should be reviewed when the line moves.

This article is for informational purposes only and does not constitute legal advice. Pre-treatment evaluation requirements are set by each state's legislature, medical board and nursing board and change over time; in most states the duty is derived from prescribing, delegation or standard-of-care rules rather than from a statute that names a good faith examination, and two positions described here — remote examination for cosmetic injectables in Illinois and in Washington — are genuinely unsettled and are reported conservatively. Confirm current requirements with the relevant state agency and consult a healthcare attorney licensed in your state before designing or changing your evaluation and ordering process.

Frequently Asked Questions