Can a good faith exam be done by telehealth?

What determines whether telehealth is acceptable?

Three separate questions, answered by three different bodies of law.

Licensure. The prescriber must generally hold a licence in the state where the patient is physically located at the time of the encounter, not where the clinic sits. This is the requirement most multi-location and franchise med spas violate without realising it, by routing patients to whichever provider is available on a national roster.

Standard of care. Most state medical boards apply the same standard of care to telemedicine as to in-person practice. The modality may change; the adequacy of the evaluation may not. If a determination normally requires palpation, dynamic assessment of muscle activity, or inspection under proper lighting, the remote encounter has to deliver clinically equivalent information or it is not an adequate examination.

Modality rules. States differ on what counts. The prevailing standard where remote examination is permitted is a live, synchronous audio-video connection allowing real-time interaction. Several boards have moved explicitly against text-only chat and static form-based intake as a basis for prescribing. Some states accept a high-standard asynchronous review where the information gathered matches what an in-person visit would produce, but that is a narrower allowance than vendors typically suggest.

Does the Ryan Haight Act apply?

Only to controlled substances, and this distinction matters commercially. Botulinum toxin, dermal fillers, semaglutide and tirzepatide are not controlled substances, so the Ryan Haight Act's in-person examination requirement does not reach them; telehealth prescribing of those products is governed by ordinary state telemedicine law.

Controlled substances are a different track. DEA and HHS issued a fourth temporary extension of the COVID-era telemedicine flexibilities for prescribing controlled medications, running through 31 December 2026, which continues to allow DEA-registered clinicians to prescribe Schedule II–V medications by telemedicine without a prior in-person visit. That is a temporary extension pending a final rule, not a permanent regime — a med spa offering testosterone or other scheduled therapies should be tracking it and should not build a model that assumes it continues.

Who has to be present, and where?

The prescriber conducts the encounter. Non-prescriber staff may collect intake information beforehand, but the note must show that the prescriber personally reviewed it, personally interacted with the patient, and reached the clinical decision. A "telehealth GFE" in which a provider signs off on a batch of questionnaires at the end of the day is not an examination, and boards have treated it as prescribing without an examination.

The treating injector's supervision requirement is a separate question again. Even where a remote exam is acceptable, your state may require a supervising practitioner physically on site or reachable for emergency consultation during the procedure — Texas Medical Board rule 22 TAC section 193.17, for example, addresses on-site presence or emergency availability independently of how the assessment was performed.

What this means for your paperwork

The telehealth encounter record needs details an in-person note does not: the modality used, the platform, confirmation that the connection was live and two-way, the patient's physical location during the encounter, the prescriber's location, the prescriber's name and licence number with the state of licensure, verification of the patient's identity, and the patient's consent to telehealth.

That telehealth consent should be a distinct document covering the nature of remote evaluation, its limitations for aesthetic assessment, the possibility that an in-person evaluation may still be required, privacy and technology risks, what happens if the connection fails, and how to reach a provider for an emergency.

Keep a written policy naming which services your practice will and will not clear remotely, which states your prescribers are licensed in, and how patient location is verified at the start of each encounter. Review it whenever you add a state, because licensure — not technology — is what actually limits where you can operate.

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