Washington — Good Faith Exam
Who can perform the good faith exam in Washington, whether an RN can, the telehealth nuance, and why the GFE gates every injectable treatment — from Washington board and statutory sources, reviewed by Faisal Darwiche, NP.
Last reviewed 2026-06-27 · Faisal Darwiche, NP. General guidance, not legal advice — confirm with your Washington board and counsel.
In Washington, before authorizing a nonsurgical cosmetic procedure the rule (WAC 246-919-606) is explicit: a physician must take a history, perform an appropriate physical exam, and make a diagnosis — that's the Good Faith Exam, and parallel rules cover DOs and PAs, while an ARNP can perform it under the nursing rules in this full-practice-authority state. An RN cannot perform that exam or order treatment; she injects under the order the prescriber writes. So your structure has a prescriber (physician, PA, or ARNP) who owns the exam-and-order step. Confirm your GFE workflow with a Washington healthcare attorney.
Sources: WAC 246-919-606(5) (physician must take a history, perform an exam, and make a diagnosis before authorizing the procedure) · WA Board of Nursing — ARNP guidance (ARNP diagnoses, orders, prescribes independently) · Verified 2026-06-26.
The GFE isn't paperwork — it's the legal hinge of the whole treatment. It establishes the patient relationship, the diagnosis, the plan, and the order that makes the injection a delegated medical act instead of unlicensed practice. In Washington, skipping or shortcutting it is the single most common compliance failure for a new med spa. Build the exam into your patient flow from day one — it protects the patient, the injector, and the owner.
Many states allow the GFE to be performed by compliant synchronous (live audiovisual) telehealth, which is why per-patient telehealth-GFE and medical-director services have become a standard way to source the exam and order before an RN injects. Whether Washingtonpermits a telehealth-only GFE with no prior in-person visit — and under what conditions — should be confirmed with the Washington board and your healthcare attorney before you build your protocol around it.
The free 17-question assessment returns a Washington-specific plan: how to source the GFE and orders for your credential, your medical-director path, and your exact next action. 7 minutes, no card. Built by Faisal Darwiche, NP.
In Washington the good faith exam must be done by a provider who can diagnose and order treatment — a physician, nurse practitioner, or physician assistant. The exam establishes the treatment plan and the order for the product before any injectable is administered.
No. An RN in Washington can gather history and assist, and can administer injectables under a valid order, but cannot perform the GFE or write the treatment order — that is the practice of medicine. The exam and order come from a physician, NP, or PA.
In many states a GFE can be done by compliant synchronous (audiovisual) telehealth, which is why per-patient telehealth-GFE services are common. The exact Washington rule and any in-person requirement should be confirmed with the Washington board and your healthcare attorney.
Treating without a valid GFE is one of the most common ways a Washington med spa draws enforcement — it means treating without an order, i.e. the unlicensed practice of medicine. Every patient needs a documented exam, plan, and order before their first treatment.