Every state requires some version of a pre-treatment provider exam before a patient receives an injectable, laser treatment, or other prescription-based aesthetic service. The details, who can perform it, whether telehealth counts, and how often it must be renewed, come from state medical and nursing board rules that vary considerably. Treating one state’s good faith exam standard as universal is one of the most common compliance mistakes in med spa operations.
Key takeaways
- California ties its requirement to an “appropriate prior examination” standard under Business and Professions Code Section 2242, not the term good faith exam. (Jump to Section)
- Texas has detailed, recently reorganized rules governing how physicians delegate aesthetic treatments and what a telemedicine exam must include. (Jump to Section)
- Nursing boards in states including Arkansas, Kentucky, and Arizona have issued guidance clarifying exactly what a registered nurse can and cannot do during this exam. (Jump to Section)
How Individual States Frame the Requirement
Good faith exam rules differ by state in three specific ways: who can perform the exam, whether telehealth satisfies it, and how delegation works. California, Texas, and Florida each illustrate one of these differences clearly. The statute language and conditions attached to each state’s requirement are not interchangeable.
- California: Business and Professions Code Section 2242 requires an “appropriate prior examination” rather than a good faith exam, and it permits telehealth methods such as a self-screening tool or questionnaire as long as the provider meets the applicable standard of care.
- Texas: A physician, physician assistant, or advanced practice registered nurse must conduct the exam before a nonsurgical cosmetic procedure can be delegated, under rules reorganized in January 2025 from Medical Board Rule 193.17 into Texas Administrative Code Sections 169.25 through 169.29.
- Florida: The provider conducting a telehealth-based evaluation must also hold prescribing authority for the treatment involved, a stricter pairing than states that allow the exam and the prescription to come from two different providers.
The practical difference across these three states comes down to where a policy is most likely to fail an audit. California accepts remote evaluation methods that Texas and Florida do not, Texas ties the exam directly to a delegation record rather than the patient chart alone, and Florida requires the same provider to both examine and prescribe. Confirm the current state-specific rules before assuming a mechanic that works in one state will hold up in another.
Why Nursing Board Guidance Matters Here
Good faith exam requirements intersect directly with nurse practice acts in a way many practices overlook. Arkansas, Kentucky, and Arizona have each issued nursing board guidance addressing this intersection since 2025. Each state draws its own line between what a nurse can document and what a nurse can decide.
- Arkansas: The Arkansas State Board of Nursing clarified in writing in 2025 that “good faith exam” does not appear in the state’s Nurse Practice Act, and it flagged cases where exams were not being properly conducted or followed up on.
- Kentucky: Kentucky’s Board of Nursing allows a registered nurse to perform cosmetic and dermatological procedures only within a medically prescribed plan of care that a qualified provider has already established, and only after a good faith physical exam has been conducted ahead of each treatment.
- Arizona: Arizona’s nursing board issued guidance in January 2025 permitting telemedicine for the initial exam in some circumstances, while still requiring that a licensed provider, not the treating nurse, perform and sign off on it.
The distinction across all three states comes down to this: a nurse can carry out or document the procedure, but a nurse cannot establish the patient-nurse relationship or decide whether the patient is a candidate for treatment. That determination has to trace back to a physician, physician assistant, or nurse practitioner with prescribing authority. Med spa owners hiring RN-heavy teams should read how telehealth good faith exams work before assuming a nurse can close this gap internally.
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How to Confirm Your State’s Current Requirement
State rules change often enough that a policy written two or three years ago may already be outdated. Texas is a direct example, since the rule number practices cited for years no longer exists in that form. Confirming a state’s current requirement takes a specific sequence of checks.
- Check your state medical board’s website: Search specifically for advisory opinions or position statements on aesthetic procedures, cosmetic injectables, or delegated medical acts.
- Check your state nursing board’s website: Look for the same category of guidance, since several of the clarifications covered above, including Arkansas and Kentucky, came from nursing boards rather than medical boards.
- If neither board has issued dedicated med spa guidance: Fall back to the general practitioner-patient relationship and delegation rules in that state’s medical and nursing practice acts, since those underlying rules still apply.
- Set a review cadence: Revisit this at least once a year, since board guidance in this space has shifted multiple times in the past two years alone.
A check that stops at the medical board is incomplete, since nursing board guidance can be more specific than medical board rules for practices that rely on RN-performed procedures. Cross-referencing both boards is what separates an audit-ready policy from a rule inherited from a template.
How Medical Director Co. Keeps Placements Aligned With Current State Rules
Rule numbers get renumbered, and board guidance changes mid-year. A compliance policy that was accurate last year can be wrong today. Medical Director Co. places supervising physicians and medical directors who track state rule changes as part of ongoing oversight.
FAQ
Do all states use the term good faith exam?
Most states regulate the underlying requirement through practitioner-patient relationship or examination language instead of that exact phrase. California calls it an “appropriate prior examination” under its Business and Professions Code. The requirement works the same way in practice regardless of which label a state’s statute uses.
Which states have issued specific med spa guidance?
California, Texas, Florida, Arizona, Arkansas, and Kentucky have issued board guidance, statutes, or advisory opinions on aesthetic and cosmetic procedures. States without dedicated guidance apply their general delegation and practitioner-patient relationship rules instead.
Does my state allow telehealth for this exam?
Most states permit some form of telehealth for the exam, but the technology, documentation, and prescribing-authority requirements differ. California allows asynchronous tools such as questionnaires. Texas and Florida permit telehealth but attach specific delegation and prescribing-authority conditions.
What if my state hasn’t issued specific med spa guidance?
Check the general practitioner-patient relationship and delegation rules in your state’s medical and nursing practice acts. The underlying exam requirement still applies without aesthetics-specific language, since it comes from the state’s core prescribing and delegation law.
How often do state requirements change?
Annual review is the minimum. Texas reorganized its entire delegation framework in January 2025, and Arizona and Arkansas issued new nursing board guidance the same year. A policy accurate two years ago may not reflect current board expectations.
Confirming Your State’s Rule Before an Audit Does It for You
State good faith exam requirements share a common purpose, but not a common rulebook. California, Texas, Florida, Arkansas, and Kentucky each define who can perform the exam, whether telehealth qualifies, and how delegation works differently enough that a policy built for one state will not automatically satisfy another. Confirm your specific state’s current rule before your next audit reviews it for you.
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Bolton M. Harris, J.D., is a seasoned attorney with a formidable background in criminal law and a focus on healthcare law and compliance. As the in-house legal counsel at Medical Director Co., Harris brings a unique blend of prosecutorial experience and regulatory expertise to support healthcare professionals across Texas. Her career spans roles as a prosecutor in multiple counties and now as a trusted advisor on the legal intricacies of medical practice operations.
Education & Early Career
Bolton Harris completed her undergraduate studies at Southern Methodist University (SMU) in 2013. During her time at SMU, she was not only a dedicated student but also a competitive athlete on the university’s women’s swimming team. She went on to earn her Juris Doctor from Texas A&M University School of Law in 2016 and became a member of the Texas Bar that same year. Armed with a strong academic foundation and discipline honed as a student-athlete, Harris embarked on a career in criminal law immediately after law school.
Prosecutorial Experience in Texas
Bolton Harris began her legal career in public service as a criminal prosecutor. She served as an Assistant District Attorney in multiple jurisdictions, where she quickly rose through the ranks and handled a broad spectrum of cases. Some highlights of her prosecutorial career include:
- Assistant District Attorney, Dallas County, Texas: Prosecuted a high volume of criminal cases in one of the state’s busiest DA offices, gaining extensive trial experience in both misdemeanor and felony courts.
- Assistant District Attorney, Ellis County, Texas: Continued to hone her courtroom advocacy skills, known for meticulous case preparation and a tenacious pursuit of justice on behalf of the community.
- Assistant District Attorney, Navarro County, Texas: Broadened her legal expertise by handling diverse criminal matters in a smaller county, working closely with law enforcement and community leaders to uphold the law.
Through these roles, Harris built a reputation for being a tough but fair advocate. She brought numerous cases to trial and developed an in-depth understanding of the criminal justice system. This distinguished prosecutorial background laid a strong foundation for the next phase of her career in the private sector.
Healthcare Law & Compliance at Medical Director Co.
After her tenure as a prosecutor, Harris shifted her focus to healthcare law, applying her legal acumen to the medical field. She recognized that the same attention to detail and tenacity that served her in criminal law could benefit healthcare providers navigating complex regulations. Embracing this new direction, Harris became well-versed in the intricate laws governing medical practices – from licensing requirements to patient safety and privacy standards – and is passionate about helping practitioners stay compliant.
In her current role as the in-house attorney for Medical Director Co., Bolton Harris oversees all legal and compliance matters for the organization and its clients. Medical Director Co. is a nurse-owned firm that connects nurse practitioners (NPs), physician assistants (PAs), and registered nurses with qualified medical directors and collaborating physicians, offering fast placements and comprehensive compliance support for healthcare practices. Harris ensures that each of these partnerships and clinical ventures adheres to all applicable state and federal laws. She is responsible for drafting and reviewing collaborative practice agreements, advising on regulatory requirements, and providing ongoing legal counsel as clients establish and grow their clinics. Drawing on her prosecutorial eye for risk management, Harris proactively identifies potential legal issues and addresses them before they escalate, giving healthcare professionals peace of mind.
Bolton M. Harris’s multifaceted expertise – spanning high-stakes courtroom litigation to detailed healthcare compliance – makes her a formidable legal ally. Whether advocating in front of a jury or guiding a medical practice through regulatory hurdles, she remains committed to the highest standards of the legal profession. Her blend of courtroom-tested skill and healthcare law knowledge ensures that clients of Medical Director Co. receive elite-level counsel and steadfast protection in an ever-evolving legal landscape.
