Before a med spa prescribes any medical treatments, an initial appointment with a licensed healthcare practitioner is legally required to establish a formal relationship. In the industry, we call this the “Good Faith Exam.” 


But how do you make sure your Good Faith exam is good enough? 


What do you do in the age of telemedicine? 


What kinds of healthcare professionals are allowed to complete these exams, and how often do they need to be completed? 


At Lengea, we receive hundreds of questions like these from clients across multiple states, so we compiled a handy list to help you clarify these issues.


Med spas are not like most other businesses because you are required to comply with unique legal requirements in order to operate. Of course, the rules vary by state, and new laws are constantly being written and rewritten, so we recommend undergoing regular compliance reviews with a legal counsel at least once every six months. 


Why do we need Good Faith Exams?

The primary purpose of the Good Faith Exam is twofold: to establish a relationship between the medical practitioner and the patient, as well as to ensure that that patient is a good candidate for the treatment they are seeking. 


Most importantly, the exam must occur prior to the client receiving any treatment. This is because many procedures performed in the med spa industry, though non-invasive, are considered to be medical and surgical procedures using FDA-approved drugs or devices.  In the eyes of the law, they are considered to be like any other prescription drug, which must be “ordered” by a  licensed physician, physician assistant, or nurse practitioner before being given to a client. 


What constitutes a Good Faith Exam?


While some states refer to it as a “physical exam” or “initial exam,” all states require that a patient be examined before treatment commences. Usually, the exam consists of two main objectives. First, the healthcare provider gathers the patient’s medical history: general lifestyle, allergies to medicine, as well as past and ongoing medical procedures or treatments. This is important information so that the medical professional can ensure that no future treatment will negatively impact any past or ongoing treatments or exacerbate any health conditions that the patient has. 


The second part of a Good Faith Exam consists of a physical examination of the patient. The medical professional examines the patient’s physical condition and overall health, looking for signs of medical issues.  Unlike a regular physical exam that a patient undergoes with a primary care physician annually, a medical professional at a med spa will also pay specific attention to the parts of the client’s body that will be receiving treatment to ensure that those areas are able to benefit from the intended treatment. 


After the initial Good Faith Exam on a new patient, in most states, these exams should be completed annually, when the patient undergoes a new type of procedure, or if a patient experiences  significant change in health condition. 


Who can complete a Good Faith Exam?


Generally, Good Faith Exams are required to be performed by a physician, physician assistant (PA), or advanced practice nurse/nurse practitioner (APN/NP). Typically, the supervising or collaborating physician must formally delegate the ability to perform Good Faith Exams to the PA or APN. This may be exempted in states where APNs/NPs have full practice authority and are not required to be supervised by a physician. Registered nurses (RNs) may aid the physician, PA, or APN in administering the Good Faith Exam, but they cannot generate orders for treatment based on the exam. 


May Good Faith Exams be conducted via telemedicine?


Initial exams in the med spa space are subject to the same laws that oversee the medical field. Wherever a federal insurance plan is not covering the interaction, the rules and regulations for remote medical care are generally governed by state laws. Although many advances have been made to allow more remote and digital aspects of medical care due to the recent pandemic, state telehealth laws still differ widely. It is important to check with a legal counsel on whether your state allows physical examinations to be performed via telemedicine, and if so, how they are to be performed. 


Many states have requirements for each type of technology used, whether the interaction may be asynchronous or synchronous, where the patient and medical professional may be located, and the type of security and confidentiality measures required to protect digital communication. All states require that any medical care performed through remote means is performed to the same standard of care that would be required if performed in person. This means that in any medical situation, if a video call, phone call, message, or email is not enough to respond to a patient’s needs—even if technically allowed by a  state’s general telehealth rules—it would not be allowed in that instance. 


Overall, almost all states have some allowances for creating a provider-patient relationship and treating patients using some form of telemedicine, but many do not allow prescriptions to be issued based solely on a remote exam.


What is a Good Good Faith Exam?


Good Faith Exams are not just a bureaucratic task to dispense with as quickly and easily as possible. When done properly, they are critical to forming a good relationship with the patient and ensuring that they are getting the best care possible.


A well-performed Good Faith Exam improves healthcare outcomes, avoids medical malpractice, and boosts your med spa’s reputation as a professional medical provider—that means great reviews. So, how can you be sure your med spa provides good Good Faith Exams? The most important thing is to make sure that your medical records are accurate and up-to-date. Ensure that you have a full medical history for every client and that it includes a full list of all past and current medications. Also, ensure that whoever is performing your Good Faith Exams is properly licensed to do so as required by your state. 


Remember: a verbal assessment alone is not sufficient to be compliant. At a minimum, the exam should measure a client’s age, height, weight, and vital signs– temperature, blood pressure, and heart rate–and evaluate a client’s body using observation, palpitation, percussion, and auscultation. A full head-to-toe examination is highly recommended. For the verbal part of the exam, conduct a full assessment to identify and address health problems and obtain a comprehensive review of relevant health, social, and medical history. Inquire about recent examinations, past health screenings, social determinants of health, and signs of early disease or risk factors for disease. If appropriate, make referrals to other medical specialists. 


It’s just a med spa check-up


While Good Faith Exams may seem inconvenient and costly to perform, they are legally required and common practice in every medical establishment.  On the bright side, these exams are not required prior to every treatment, just the ones considered to be medical procedures with required prescriptions.  Most importantly, a Good Faith Exam builds a strong relationship between your practitioners and patients, allowing your clinical team to get the conversation started about treatment plans. Once you establish trust early on, your clients will likely keep coming back to you for years.