The short answer
A good faith exam is the evaluation a licensed prescriber performs before ordering a medical treatment — reviewing history, examining the patient, screening contraindications, establishing a medical indication and issuing a patient-specific order. It derives from state prescribing law requiring an appropriate prior examination, and it cannot be performed by a registered nurse or unlicensed staff.
Where does the term come from?
Not from a federal statute. "Good faith exam" is industry shorthand for a requirement that appears in state law under different wording — an "appropriate prior examination," a "documented patient evaluation," or a "physician assessment" preceding delegation.
California states it most plainly: Business and Professions Code section 2242 makes prescribing without an appropriate prior examination and a medical indication unprofessional conduct, and the Medical Board of California has taken the position that this examination may not be delegated to a registered nurse. Texas Medical Board rule 22 TAC section 193.17 builds the same requirement into its framework for nonsurgical medical cosmetic procedures, pairing a prior assessment by a physician, PA or APRN with written protocols and documented orders. The Nevada State Board of Nursing's aesthetic practice decision approved in January 2025 ties an RN's aesthetic practice to a valid order following a provider evaluation. The Florida Boards of Medicine and Nursing reach the same place through supervision and protocol requirements.
What is it, clinically?
It is a real medical encounter, not a form. A defensible good faith exam contains, at minimum:
| Component | What it establishes |
|---|---|
| Chief complaint and goals | Why the patient is here and what outcome they expect |
| Relevant medical history | Comorbidities, prior procedures, prior adverse reactions |
| Medications and allergies | Anticoagulants, aminoglycosides, isotretinoin, immunosuppression |
| Focused physical assessment | Skin type, anatomy, asymmetry, muscle activity, contraindicating findings |
| Contraindication screening | Pregnancy, neuromuscular disease, active infection, keloid history |
| Clinical impression | The provider's assessment |
| Treatment plan | Specific products, areas, doses and intervals |
| Patient-specific order | The prescriber's order naming this patient and this treatment |
The order is the part that most often goes missing. An exam that concludes "patient is a candidate for cosmetic treatment" is not an order. The order must identify the product, the units or volume, and the anatomic areas, for this patient — a blanket standing order covering everyone who walks in for glabellar treatment satisfies no state's requirement.
Who can perform it?
A licensed prescriber acting within their scope: a physician, or a nurse practitioner or physician assistant within their state's authority and any collaboration or supervision requirement. Registered nurses, licensed practical nurses, medical assistants and estheticians cannot, because the exam requires diagnosis and ordering, which are prescriptive functions.
This is the distinction that generates most med spa discipline. An RN injector may be excellent and highly experienced and still be legally barred from clearing the patient. Their role begins after the prescriber has examined and ordered.
The exam also has a shelf life. It establishes an indication at a point in time, and a documented re-evaluation is expected when the treatment plan changes, a new product class is introduced, the patient's health or medications change, or an adverse event occurred at the prior visit. Many practices additionally set a fixed re-exam interval — commonly annual — for maintenance patients.
What this means for your paperwork
The exam note should read like a clinical note, not a checklist: history, findings, assessment, plan, signed and dated by the prescriber with their credential. Attach the patient-specific order, and make sure the treatment record shows that what was administered matches what was ordered. Product, lot, expiration, units and sites belong in the record every time.
If a non-prescriber collects intake information first, the note must show that the prescriber personally reviewed it and made the clinical decision. If the exam is remote, record the modality, the platform, whether it was live audio-video, the patient's and prescriber's locations, and the patient's telehealth consent.
Keep the whole set — exam note, order, consent, treatment record — for your state's medical record retention period. A file where the consent is immaculate and the exam note says only "GFE completed" with an initial is the file that fails an audit.
Related questions
This answer is educational and is not legal or medical advice. Requirements vary by state and change over time — verify with your own legal and clinical advisors before applying anything here in practice.