There is no calendar. We opened the statutes, board rules and board statements of seventeen states looking for the rule that says a good faith exam is good for twelve months, and as of September 2026 we could not source it in any of them. The law ties the exam to the order. A new order needs a prescriber who has assessed the patient for that order.
The law ties the exam to the order
Read the operative words, state by state, and the trigger is always an act. It is never a date.
California makes it unprofessional conduct to prescribe, dispense or furnish a dangerous drug “without an appropriate prior examination and a medical indication” (Bus. & Prof. Code § 2242(a)). Texas requires that a physician, or a PA or APRN acting under delegation, establish the practitioner-patient relationship and complete the record “prior to performance of the delegated act” (22 TAC § 169.26(c), effective January 9, 2025). Washington lists what a physician must do “prior to authorizing a nonsurgical medical cosmetic procedure” (WAC 246-919-606(5)). Arizona bars prescribing unless the licensee “first conducts a physical or mental health status examination of that person or has previously established a doctor-patient relationship” (A.R.S. § 32-1401(27)(tt)).
None of these sentences contains an interval. Each one asks the same thing of you: on the day this drug or device was ordered for this patient, who had assessed the patient, and for what.
Two boards say an established patient does not automatically need a new exam
The rule cuts in both directions, and two boards have said so in writing.
Tennessee’s prescribing rule requires a history, a physical examination, a diagnosis and a plan before a prescription, and then carves out “established patients who, based on sound medical practices, the physician feels do not require a new physical examination before issuing new prescriptions” (Tenn. Comp. R. & Regs. 0880-02-.14). The North Carolina Medical Board’s position statement says the same thing in plainer words: “Established patients may not require a new history and physical examination for each new prescription, depending on reasonable medical practice.”
That is clinical judgment, and judgment only counts if it is on the record. A chart that shows a prescriber looked at the interval history and decided the prior exam still holds is defensible. A chart that shows nothing between the first visit and the fortieth treatment is the one a board reads as no exam at all. See what a good faith exam has to contain.
The triggers that appear in the text
Where the sources do name a trigger, it is an event.
| Trigger | Source | What it reaches |
|---|---|---|
| Each new intervention needs its own order from a practitioner who has assessed the patient | Nevada State Board of Nursing practice decision, approved January 17, 2025 | Nurses performing aesthetic procedures in Nevada |
| Written treatment instructions “for each procedure performed” | R.I. Gen. Laws § 23-105-2(e)(2), effective June 30, 2025 | Every Rhode Island medical spa |
| A complication: the supervising doctor must see and evaluate the patient before treatment continues | 18VAC85-20-91(E) | Laser hair removal in Virginia only |
| “At other times as medically indicated” | NCMB position statement on laser surgery | Laser hair and tattoo removal in North Carolina |
| Anything beyond the original prescription or one refill | Cal. Bus. & Prof. Code § 2242(b)(3) | A covering practitioner renewing without a new exam |
The Virginia rule is the clearest example of an event-driven re-exam in the country, and it is narrow. We cover it in the Virginia complication rule.
The calendar figures that exist, and what they cover
Three numbers circulate. Each is real, and each covers less than the people quoting it suggest.
- Georgia, annually. A Georgia practitioner treating by telemedicine “must make diligent efforts to have the patient seen and examined in person by a Georgia licensed physician, physician assistant or nurse practitioner at least annually” (Ga. Comp. R. & Regs. r. 360-3-.07(a)(8)). It applies to care delivered by electronic means, and it is a duty of diligent effort.
- Federal, 24 months. The Ryan Haight provisions let a covering practitioner prescribe a controlled substance if the practitioner they cover has evaluated the patient in person “within the previous 24 months” (21 U.S.C. § 829(e)). That is controlled substances only, which for most of our readers means testosterone. The telemedicine flexibilities that currently relax it run through December 31, 2026; see the DEA deadline.
- Nevada, six months. NRS 639.235(4) deems a bona fide relationship to exist where the prescriber examined the patient within the preceding six months. By its own words that subsection serves a provision about controlled substance prescriptions from out-of-state prescribers. The nursing board cites it by cross-reference. We do not read it as a general six-month rule for Nevada med spas, and you should not tell staff it is one without asking counsel.
“Initial” does not mean once
Connecticut requires “an initial in-person physical assessment” before the procedure (Conn. Gen. Stat. § 19a-903c(c)). Rhode Island requires the supervising physician, APRN or PA to “perform an initial assessment of the patient” (§ 23-105-2(c)(1)). Maryland requires the physician to “personally perform the initial assessment of each patient” (COMAR 10.32.09.05). All three are silent on what happens at visit ten.
Silence is where operators go wrong in both directions. It does not mean the first exam lasts forever, because the prescribing rules above still attach to every later order. It does not create an annual requirement either.
The triggers nobody documents
These are the events that, in our clinical judgment, should send a patient back to a prescriber. They follow from the rules above. They are our protocol recommendations, and no statute lists them.
- A new service line. A patient cleared for neurotoxin has not been assessed for a GLP-1, an IV infusion or filler.
- A new drug, a dose change outside the written order, or a new anatomical area.
- Anything new at check-in: a medication, a diagnosis, a pregnancy, a surgery, an allergy.
- An adverse event or an unexpected result from the last treatment.
- A long gap since the last visit. Pick a number, write it into the protocol, and call it what it is: your policy.
- A new prescriber taking over the panel, including when you replace a medical director.
That fifth item is where the annual exam belongs. An annual refresh is a sound internal policy. Describe it to staff as policy, so nobody in your clinic learns the wrong law from you.
What this means for you
Stop telling staff that a good faith exam “expires” after a year, and stop assuming it never does. Put the event triggers above into your written protocol, name the interval you chose as a policy, and make the check-in form ask the questions that fire them. Make sure each order in the chart points back to an assessment that covers that drug or device for that patient. If a nurse is deciding whether the old exam still applies, the structure is already wrong, because that decision belongs to a prescriber. Start with how good faith exams work, and where the prescriber is remote, the telehealth rules.
Related reading
Frequently asked questions
Does a good faith exam expire after one year?
No state source we could find, as of September 2026, sets a twelve-month life for a good faith exam. California, Texas, Washington and Arizona each tie the exam to the act of ordering or authorizing treatment. An annual re-exam is a reasonable clinic policy. It should be written down as your policy and not described to staff as a legal requirement.
Do I need a new good faith exam for a different treatment?
Yes, in practice. The exam supports a specific order, and a patient assessed for neurotoxin has not been assessed for filler, a GLP-1 or an IV infusion. Nevada’s nursing board requires an order for each individual intervention, and Rhode Island requires written treatment instructions for each procedure performed.
Is an annual good faith exam required in Texas?
The Texas rule, 22 TAC § 169.26(c), requires the practitioner-patient relationship and an adequate medical record before the delegated act is performed. It states no interval. The Texas Medical Board notices we read through September 2026 show no change to that chapter since it took effect on January 9, 2025.
Can a nurse decide that the old good faith exam still applies?
No. Whether a prior assessment still supports a new order is a prescribing judgment, and it belongs to the physician, NP or PA who is responsible for the order. The nurse’s role is to collect the interval history, flag anything new, and route the patient back to the prescriber when a trigger in your protocol fires.
This is general information, not legal advice. Rules vary by state and change. Confirm your own facts with counsel.