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

A GFE establishes a bona fide provider-patient relationship and documents clinical judgment. At minimum, it should include: patient history (medical, surgical, medication, allergy, prior aesthetic procedures), physical examination of the treatment area and relevant anatomy, assessment of candidacy and contraindications (pregnancy, active infection, neuromuscular disorders, unrealistic expectations), informed consent documenting risks and alternatives, and documentation in the medical record. The exam must occur before the patient receives product—not after. Many states do not codify GFE requirements in statute, leaving interpretation to state medical boards, professional societies (American Academy of Dermatology, American Society of Plastic Surgeons), and case law. The standard of care typically mirrors what a reasonable, prudent provider in that specialty would document. Telehealth complicates this: a video visit may satisfy the relationship requirement but may not permit adequate palpation or assessment of skin texture, asymmetry, or neuromuscular function—gaps that vary in clinical significance by procedure.

Physicians (MDs, DOs) can always perform a GFE and prescribe injectables. Nurse practitioners and physician assistants can perform exams and prescribe in states where their scope permits independent or collaborative prescribing of injectables; this varies widely. Registered nurses (RNs) and licensed practical nurses (LPNs) typically cannot independently perform a GFE or prescribe but may administer injectables under physician supervision or delegation, depending on state law and the practice setting. Aestheticians and medical aestheticians have no prescriptive authority in any state and cannot legally perform a GFE for prescription products. Some states (e.g., California) explicitly require a physician to perform the initial exam; others allow NPs/PAs with appropriate training and delegation. Critical step: verify your state's nursing board rules, medical board rules, and any state-specific statutes governing injectable administration. The Corporate Practice of Medicine doctrine in some states (e.g., California, Texas) also restricts non-physician ownership and control, which can affect who legally performs the exam and how supervision is documented.

Telehealth GFE rules are fragmented and evolving. Some states explicitly permit telehealth exams for injectables if the provider can adequately assess the patient via video; others require an in-person initial exam before any telehealth follow-up. A few states remain silent, leaving the standard to professional judgment. Key variables: (1) Initial vs. follow-up: many states allow telehealth for follow-ups but require in-person initial exams; (2) prescribing authority: some states permit telehealth prescription of injectables by licensed providers; others do not; (3) state medical board guidance: boards in California, Texas, New York, and Florida have issued telehealth guidance, but specificity varies. Red flag: do not assume that a telehealth GFE valid in one state is valid in another. During the COVID-19 pandemic, many states relaxed telehealth rules; some have since tightened them. Action: contact your state medical board and nursing board directly—ask whether telehealth exams are permitted for injectable prescribing, whether an in-person initial exam is required, and whether there are specific documentation requirements (e.g., video recording, patient consent to telehealth).

Documentation is your defense. A thorough GFE note protects you in a malpractice claim or board investigation. At minimum, document: patient's stated goals and expectations, relevant medical and surgical history, current medications and allergies, prior aesthetic procedures and outcomes, physical exam findings (skin type, asymmetries, muscle tone, relevant anatomy), assessment of candidacy and any contraindications, informed consent (risks, benefits, alternatives, realistic outcomes), and the date and time of the exam. Electronic health records (EHRs) designed for aesthetics (e.g., Simplee, Weave, Medidata) often include templates that prompt for these elements. Telehealth-specific documentation should note the modality (video, phone), any limitations in assessment (e.g., "unable to palpate in person"), and explicit patient consent to proceed via telehealth. State board audits often focus on whether documentation supports the clinical decision to treat. Sparse notes (e.g., "patient wants Botox") invite scrutiny. Conversely, detailed notes demonstrating clinical reasoning—"patient has moderate glabellar lines, no contraindications, realistic expectations, consented to risks"—support your judgment. Malpractice insurers increasingly require documented GFEs; some policies exclude coverage if the exam is inadequate.

California requires a physician to perform the initial exam for injectable prescribing; NPs and PAs can administer under physician supervision but cannot independently prescribe. Telehealth exams are permitted if the provider can adequately assess the patient; the state medical board has not prohibited them but expects documentation of clinical reasoning. Texas permits NPs and PAs to prescribe injectables under collaborative agreements with physicians; telehealth exams are allowed if the provider documents adequate assessment. New York requires an in-person initial exam before any injectable treatment; telehealth follow-ups are permitted. Florida allows telehealth exams for injectables if the provider can adequately assess the patient and documents informed consent. Trend: state boards are increasingly scrutinizing telehealth exams, particularly for procedures requiring tactile assessment (e.g., filler placement, assessment of skin laxity). Some boards have issued guidance requiring in-person exams for initial treatment; others remain permissive. Action: do not rely on national guidance; contact your state medical board, nursing board, and state attorney general's office for current rules. Join your state's medical society or aesthetic society for updates on regulatory changes.

• Verify your state's GFE requirements by contacting your state medical board and nursing board; request written guidance on telehealth exams and scope-of-practice rules for your profession.
• Document every exam in the medical record with patient history, physical exam findings, assessment, informed consent, and the date and time.
• For telehealth exams, explicitly document the modality, any limitations in assessment, and patient consent to proceed via telehealth.
• Establish a written protocol for GFEs in your practice (in-person vs. telehealth, who performs exams, documentation requirements) and train all staff.
• Use an EHR with aesthetic-specific templates to ensure consistent, thorough documentation.
• Maintain malpractice insurance that covers your specific procedures and modalities; verify that your policy requires documented GFEs.
• Review your state's Corporate Practice of Medicine doctrine (if applicable) to ensure your practice structure complies with ownership and supervision rules.
• Consult legal counsel in your state if you operate across multiple states or use telehealth; rules vary, and a single misstep can trigger board complaints or malpractice claims.