Good faith exam requirements come from several sources, including medical practice acts, nursing practice acts, delegation regulations, and guidance issued by state medical and nursing boards. Knowing where those requirements come from makes it easier to identify which rules apply to your providers, your treatments, and your day-to-day operations.
Key Takeaways
- Good faith exam requirements often come from multiple regulatory sources rather than a single state law. (Jump to Section)
- Medical boards and nursing boards regulate different parts of the same med spa workflow. (Jump to Section)
- Several states have issued advisory opinions that specifically address cosmetic and aesthetic procedures. (Jump to Section)
- Even without med spa-specific guidance, delegation rules, scope of practice, and prescriptive authority requirements still apply. (Jump to Section)
- Reviewing guidance directly from your state’s regulatory boards helps maintain compliant physician oversight. (Jump to Section)
How Medical and Nursing Boards Regulate Good Faith Exams
Good faith exam requirements rarely come from a single regulator. In many states, both the medical board and the nursing board oversee different parts of the same patient journey. While each board regulates different license holders, their rules work together to define how physician oversight, delegation, and patient care should be delivered in a med spa.
Unlike many healthcare settings where one provider manages most aspects of patient care, med spas often rely on physicians, nurse practitioners, physician assistants, registered nurses, and aestheticians to deliver different parts of the treatment process. Each licensed professional is accountable to the board that regulates their license. As a result, practices should understand how these regulations overlap rather than reviewing each board’s guidance in isolation.
What Medical Boards Regulate
State medical boards generally regulate physicians and, in many states, physician assistants. Their responsibilities often include physician licensure, delegation authority, supervision requirements, prescriptive authority, and standards of medical practice.
For med spas, medical board guidance often addresses:
- Who can perform a good faith exam: State rules determine whether the exam must be performed by a physician or whether a qualified nurse practitioner or physician assistant can conduct it under applicable state law.
- When physician involvement is required before treatment: Medical boards establish when a physician must evaluate the patient, review the treatment plan, or provide clinical oversight before medical aesthetic procedures begin.
- How medical procedures may be delegated: Delegation rules define which treatments physicians can assign to qualified healthcare professionals and the responsibilities that remain with the supervising provider.
- What level of supervision is expected for aesthetic services: State regulations specify whether physician supervision must be provided in person, remotely, or through another approved oversight model, depending on the procedure and applicable laws.
Because many aesthetic treatments are considered the practice of medicine, physician oversight requirements often originate with the state medical board, even when delegated procedures are performed by other licensed professionals.
What Nursing Boards Regulate
State nursing boards oversee registered nurses and nurse practitioners within their respective scopes of practice. Their guidance focuses on nursing standards, delegation responsibilities, independent or collaborative practice authority, and the clinical activities nurses may perform under state law.
For med spas, nursing board guidance often addresses:
- Whether nurse practitioners can perform good faith exams: State regulations determine whether nurse practitioners have the authority to evaluate patients independently or under a collaborative or supervisory relationship before treatment begins.
- The responsibilities of registered nurses administering aesthetic treatments: Nursing boards define the procedures registered nurses can perform, the education and competency required, and the circumstances under which those procedures may be delegated.
- Documentation and clinical decision-making expectations: Nursing guidance outlines the documentation nurses must maintain and clarifies when clinical decisions should be made independently versus referred to a physician or other qualified provider.
- Delegation and supervision requirements for nursing professionals: State rules establish how nursing professionals receive delegated authority, the level of physician oversight required, and the responsibilities that remain with both the supervising provider and the nurse.
Because many med spas rely on nurse practitioners and registered nurses to deliver patient care, nursing board guidance is just as important as medical board regulations when establishing compliant workflows.
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How Medical and Nursing Board Rules Work Together
A single patient visit often involves professionals regulated by different licensing boards. For example, a physician may establish physician oversight, a nurse practitioner may perform the good faith exam where permitted, and a registered nurse may administer treatment under delegated authority. Because each provider is accountable to a different regulatory board, med spas must understand how these requirements work together instead of treating them as separate compliance obligations.
In practice, this means a compliant workflow should address responsibilities across multiple regulators, including:
- Physician oversight: Medical board regulations establish the physician’s responsibilities for patient care, delegation, supervision, and clinical decision-making.
- Nursing scope of practice: Nursing board rules define the procedures registered nurses and nurse practitioners may perform and the conditions under which those services can be provided.
- Delegation and supervision: Both boards establish requirements that determine how medical procedures can be delegated and the level of provider oversight required throughout treatment.
- Documentation and accountability: Each licensed professional is responsible for maintaining documentation and practicing within the standards established by the board that regulates their license.
Reviewing guidance from both the medical board and the nursing board provides a more complete understanding of the requirements governing physician oversight, delegation, and patient care. It also helps med spa owners identify compliance gaps before they become regulatory issues.
States With Med Spa-Specific Good Faith Exam Guidance
Reading state law alone often does not answer every compliance question. Advisory opinions and declaratory statements issued by medical and nursing boards provide additional guidance on how regulators expect physicians, nurse practitioners, registered nurses, and other licensed professionals to perform medical aesthetic procedures. Several states have published guidance specific to med spas and cosmetic treatments.
Arizona
The Arizona State Board of Nursing has issued an advisory opinion addressing medical aesthetic procedures performed by registered nurses and nurse practitioners. The guidance outlines the education, competency, delegation, and clinical judgment expected when nurses participate in aesthetic treatments.
For med spas operating in Arizona, this advisory opinion provides practical direction on:
- The responsibilities of registered nurses performing delegated procedures
- The role of nurse practitioners in patient evaluation and treatment
- Required competency before performing medical aesthetic services
- The importance of practicing within the individual’s authorized scope of practice
While the advisory opinion does not replace Arizona law, it explains how the board interprets nursing responsibilities in aesthetic medicine and should be reviewed alongside applicable statutes and regulations.
Kentucky
The Kentucky Board of Nursing has published an advisory opinion on cosmetic and dermatological procedures performed by nursing professionals. Instead of creating new law, the opinion explains how existing nursing regulations apply to common aesthetic treatments.
The guidance addresses topics such as:
- Scope of practice for registered nurses and advanced practice registered nurses
- Provider competency and education requirements
- Delegated medical procedures
- Clinical accountability when providing cosmetic services
Practices employing nursing professionals should understand that compliance involves more than physician supervision alone. Nursing board expectations also influence how aesthetic services are delivered.
Louisiana
The Louisiana State Board of Nursing has issued a declaratory statement addressing cosmetic procedures performed by registered nurses. It explains the conditions under which nurses may participate in aesthetic treatments and reinforces the importance of physician orders, delegation, and clinical oversight.
The statement also emphasizes that:
- Cosmetic procedures remain medical procedures when they involve the practice of medicine
- Registered nurses must work within their authorized scope of practice
- Delegated treatments require appropriate physician involvement
- Clinical decisions remain the responsibility of the qualified provider directing patient care
For Louisiana med spas, this guidance provides additional clarity on how nursing regulations intersect with physician oversight requirements.
What These States Have in Common
Although Arizona, Kentucky, and Louisiana have issued different forms of regulatory guidance, their recommendations reinforce many of the same compliance principles. While the language varies by state, the expectations for provider involvement, delegation, and clinical oversight remain consistent.
Across these states, med spas are expected to:
- Ensure qualified provider involvement: Good faith exams and medical aesthetic procedures require active participation from a qualified provider, not administrative approval or retrospective sign-off.
- Follow delegation requirements: Delegating a procedure does not transfer the supervising provider’s responsibility for patient care or clinical decision-making.
- Maintain provider competency: Physicians, nurse practitioners, registered nurses, and other licensed professionals must perform only those procedures they are qualified and authorized to provide.
- Document clinical decisions: Good faith exams, treatment orders, delegation, and physician oversight should be supported by complete and accurate documentation.
- Define clinical roles clearly: Every member of the care team should understand their responsibilities and practice within the scope of their license and state regulations.
Practices in states without similar advisory opinions should not assume fewer requirements apply. Instead, they should review their state’s medical practice act, nursing practice act, delegation regulations, and any guidance issued by the appropriate licensing boards to confirm that their physician oversight model complies with current requirements.
How to Determine Good Faith Exam Requirements Without State-Specific Guidance
Many states have not issued advisory opinions specifically addressing med spas or good faith exams. That does not mean practices operate without regulatory requirements. In most cases, compliance is determined by applying existing healthcare laws that govern the practice of medicine and nursing.
These sources typically include:
- Medical Practice Acts: Define physician responsibilities, delegation authority, and standards for practicing medicine.
- Nursing Practice Acts: Establish the scope of practice for registered nurses and nurse practitioners, including when collaboration or physician oversight is required.
- Delegation regulations: Explain which medical procedures may be delegated, who may perform them, and the level of supervision expected.
- Prescriptive authority rules: Determine which providers can evaluate patients, issue treatment orders, and prescribe medications used during aesthetic procedures.
- Telehealth regulations: Specify whether good faith exams may be performed remotely and the conditions that must be met before treatment begins.
Because these requirements vary by state, med spa owners should review the current regulations published by both their state medical board and nursing board instead of relying on general online summaries. Establishing physician oversight around current regulatory guidance helps reduce compliance risks as laws and board interpretations continue to evolve.
How Medical Director Co. Tracks the Rules That Apply to Your Practice
Medical Director Co. helps med spas establish compliant physician oversight by matching practices with qualified medical directors who understand the regulatory requirements in the states where they practice. Every placement is designed to support physician oversight that aligns with current state requirements rather than relying on generic compliance approaches.
Our placement process includes:
- Matching your practice with a qualified physician: Work with a medical director licensed in your state and familiar with its regulatory requirements.
- Supporting physician oversight that reflects board guidance: Build provider relationships that align with current medical and nursing board expectations.
- Providing attorney-reviewed agreements: Receive documentation that supports compliant delegation and physician oversight.
- Helping practices maintain compliant provider relationships: Access ongoing support as regulations, board guidance, and practice needs evolve.
By combining qualified physician placement with attorney-reviewed documentation and ongoing compliance support, Medical Director Co. helps practices build physician oversight programs that reflect their state’s current regulatory requirements.
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Frequently Asked Questions
Is there one law that covers good faith exams for med spas?
In most states, good faith exam requirements come from several regulatory sources rather than a single statute. Medical practice acts, nursing practice acts, delegation regulations, and guidance issued by state medical and nursing boards work together to establish how good faith exams should be performed and documented.
Which regulator oversees my med spa’s compliance?
The answer depends on the licensed professionals involved in patient care. State medical boards generally regulate physicians and physician assistants, while nursing boards oversee registered nurses and nurse practitioners. A compliant med spa often operates under requirements issued by both regulators, making it important to understand how their guidance works together.
What if my state hasn’t issued med spa-specific guidance?
The absence of a med spa-specific advisory opinion does not eliminate compliance obligations. Practices should follow their state’s medical practice act, nursing practice act, delegation regulations, prescriptive authority rules, and telehealth requirements. These regulations establish the framework for physician oversight and good faith exam compliance even without aesthetic-specific guidance.
Do these laws change often?
State legislatures, medical boards, and nursing boards periodically update statutes, administrative rules, and advisory opinions. Practices should review current guidance at least annually and whenever new services are introduced or provider responsibilities change. Staying informed helps maintain compliant workflows and reduces the risk of relying on outdated interpretations.
Where can I find my state’s current guidance?
The most reliable source is your state’s official medical board and nursing board websites. Many boards publish advisory opinions, declaratory statements, position statements, and administrative rules. Reviewing these resources helps practices understand how existing laws apply to physician oversight, delegation, and good faith exams.
Build Your Compliance Program on Current Regulatory Guidance
Good faith exam requirements are rarely found in one law or one regulatory document. They are built from a combination of statutes, board regulations, delegation rules, and official guidance that together define how physician oversight should operate in your state. Because these requirements vary by state, physician oversight should be built around current statutes, board guidance, and delegation rules instead of assumptions or outdated interpretations.
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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.
