Good Faith Exam in Florida — what Rule 64B8-9.009 and § 458.331(1)(t) actually require.

Where the Good Faith Exam comes from, in Florida

The phrase "Good Faith Exam" does not appear as a single defined term in a single Florida statute. It is shorthand for what Florida law requires before a delegated medical procedure may be performed on a patient — the necessary practitioner-patient encounter, history-taking, examination, and authorization step. The legal substance comes from a stack of provisions:

• Chapter 458 (Medical Practice Act) — defines who may practice medicine and under what conditions delegation is lawful;
• § 458.347 / § 458.348 — the joint review and supervisory framework for ARNPs and PAs (see our § 458.348 explainer);
• Florida Administrative Code Rule 64B8-9.009 — the Board of Medicine standards for office-based supervision and protocols;
• § 893.03 — Florida's controlled substance schedule (relevant for clinics that handle actual DEA-scheduled drugs like testosterone or ketamine; not applicable to botulinum toxin or fillers, which are prescription-only legend drugs but not on any schedule);
• § 458.331(1)(t) — the standard-of-care provision under which Board of Medicine enforcement is anchored; the GFE is the encounter that satisfies it for a prescription injectable;
• § 456.47 — Florida's telehealth framework (replaced § 456.0625 in 2019); defines the synchronous audio + video encounter required for telehealth prescribing and how a practitioner-patient relationship is established remotely;
• AHCA Rule 59A-33 and the Health Care Clinic Act — the licensure layer that expects GFE documentation as part of the patient record (see our AHCA HCC explainer);
• The standard of care — Board of Medicine and case law develop what a reasonable practitioner would do, and that is what investigators measure your records against.

What a defensible GFE actually contains

A GFE is a clinical note written by the prescribing or supervising practitioner. It is dated. It identifies the patient and the practitioner with full credentials. And it documents — substantively, not by checkbox alone — the elements of a real medical encounter:

1. Patient identification. Full legal name, date of birth, contact information.
2. Chief concern and aesthetic goal. What the patient is asking for, in their own words, and the practitioner's understanding of the goal.
3. Past medical history. Conditions of relevance to the procedure — neuromuscular disorders for botulinum toxin, hypersensitivity history for fillers, bleeding diathesis for injectables, immunosuppression for any procedure breaking the skin barrier, pregnancy and lactation status.
4. Current medications and supplements. Particularly anticoagulants, immunomodulators, isotretinoin, and any product with relevant interactions.
5. Allergies and prior reactions. Including reactions to anesthetics, prior injectables, latex.
6. Targeted physical examination. The site or sites the procedure will address, with documentation of skin condition, asymmetries, prior procedure outcomes if relevant.
7. Risk-benefit discussion. A note that the practitioner discussed the procedure, its expected results, the alternatives, the foreseeable risks (including off-target effects, neuro- and vascular events, infection), and the patient's understanding and consent.
8. Authorization to proceed. The prescription or standing order under which the procedure will be performed, the dose or units, the site, and any restrictions. For an actual DEA-scheduled drug (testosterone for TRT, ketamine, anabolic steroids — not botulinum toxin or fillers), the authorization must additionally comport with controlled-substance prescribing rules under § 893.
9. Practitioner identification and signature. Full name, credentials, Florida license number, signature, date.

The phrase that does not appear in this list, but should: "in the practitioner's own words." A GFE that is identical across 200 charts is not credible. EMR templates are fine — and helpful — but each GFE should reflect the actual encounter with the actual patient. Reviewers can spot a copy-paste GFE in seconds.

Botulinum toxin: prescription-only, not a controlled substance

Industry coverage of Florida med spa law often claims that botulinum toxin is "a Schedule III controlled substance under § 893.03." It is not. Botulinum toxin (Botox, Dysport, Xeomin, Jeuveau) is an FDA-approved prescription-only biologic — a "legend drug" — but it is not on any DEA schedule (II–V) and is not listed in Florida § 893.03. The mythology runs deep enough that we mention it explicitly: confirm with your healthcare attorney before relying on any source that frames it as a controlled substance.

Why does the GFE requirement still apply, then? Because the source is different:

• Florida Administrative Code Rule 64B8-9.009 sets the Board of Medicine standard of care for the practice of medicine — including the elements of a defensible patient encounter before any prescription medical procedure (cosmetic or otherwise).
• Florida Statute § 456.47 governs telehealth prescribing and what counts as a qualifying practitioner-patient relationship for prescription drugs administered remotely (synchronous audio + video; replaced § 456.0625 in 2019).
• The standing order or written supervisory protocol under § 458.348 / § 458.347 is the instrument by which an MD authorizes an ARNP or PA to perform the procedure for an individual patient — but the per-patient GFE is what authorizes the procedure for that specific patient. Standing order alone is not enough.
• For clinics that do handle actual DEA-scheduled drugs — testosterone for TRT, ketamine, anabolic steroids — § 893 prescribing rules and § 893.07 recordkeeping apply in addition to the GFE workflow above. Those clinics need DEA registration evidence, a controlled-substance log, secure storage, and inventory reconciliation.

Telemedicine and the Florida GFE

Florida's telehealth framework — § 456.47 and the registration regime for out-of-state telehealth providers — generally permits a Florida-licensed practitioner to establish a practitioner-patient relationship and perform a Good Faith Exam by audio-video telehealth, subject to several conditions:

• The technology must support real-time, two-way audio and video — not telephone-only;
• The practitioner must be appropriately licensed in Florida (an out-of-state telehealth provider registered under § 456.47 is not authorized to perform GFEs for in-Florida med-spa patients in the same way a Florida-licensed practitioner is — see your healthcare attorney for case-specific guidance);
• The encounter must include the substantive elements of an in-person GFE: identification, history, targeted exam (visual exam by camera, with the patient cooperating), risk-benefit, and authorization;
• The encounter must be documented to the same standard as an in-person encounter;
• The practitioner must be available for follow-up, including emergency consultation, and the clinic must have a procedure for transfer of care;
• The supervisory protocol under § 458.348 should explicitly contemplate telehealth GFEs if they are used.

Telephone-only or text-only encounters do not satisfy the GFE standard for a prescription injectable. A 30-second video call where the practitioner reads from a template is unlikely to satisfy it either. The defensible practice is a documented audio-video encounter of meaningful duration, with a note that reflects the actual exchange.

Who can perform a Good Faith Exam in Florida

For prescription injectables and similar delegated procedures, the universe of qualified examiners is narrow:

• A Florida-licensed MD or DO (Chapter 458 / 459) with an active license and no practice restrictions; DEA registration is required only when prescribing actual DEA-scheduled drugs (testosterone, ketamine, etc.);
• An ARNP licensed under Chapter 464, operating under a written supervisory protocol that includes the delegated procedure (controlled-substance prescriptive authority additionally required when prescribing DEA-scheduled drugs);
• A PA licensed under § 458.347 operating under a written supervisory protocol that includes the delegated procedure.

A registered nurse is not authorized to perform a Good Faith Exam in this sense. An RN may administer the procedure under a supervising practitioner's order, but the GFE itself — the establishing exam and authorization — must come from a qualified prescriber.

An esthetician, LMA, or front-desk staffer is not qualified to perform a GFE under any configuration. An intake form completed by the patient and reviewed by a non-prescriber is not a GFE.

Repeat exams: what triggers a new GFE

A patient who received Botox six months ago is back for another appointment. Does she need a new Good Faith Exam? Florida statutes and Board of Medicine rules don't set a single re-exam interval, but the standard of care framework typically pushes a repeat exam in the following situations:

• New procedure type. The prior GFE was for botulinum toxin; today's appointment is for a dermal filler in a different region. A new GFE specific to the new procedure is the defensible path.
• Material change in medical history. New medications (especially anticoagulants, immunomodulators, isotretinoin), new diagnoses, pregnancy, lactation, recent surgery, recent infection, or any change the practitioner would want to know about before treating.
• Material change in product or technique. A new product, a new injection technique, or a new dosing strategy may warrant re-examination.
• Time-based interval the practice has set. Many Florida med spas use a 12-month re-exam window for stable patients, with shorter intervals for higher-risk patients (advanced age, multiple comorbidities, history of complications). The interval should be set in the supervisory protocol and applied uniformly.
• Adverse event or unexpected outcome. Any complication — bruising beyond expectation, infection, asymmetry the patient flags, allergic reaction — should trigger re-examination before further treatment.

The defensible practice records the re-exam interval in the protocol and tracks each patient's last-GFE date. ProofOps reads from your EMR and flags any patient on the schedule whose GFE is expired or doesn't cover today's procedure type, before the appointment runs.

How a GFE shows up in an inspection or complaint

GFEs are sampled in three contexts in Florida:

1. AHCA Health Care Clinic survey. The inspector pulls a sample of charts from the prior month or two and looks for a documented GFE. A missing or template-only GFE is a recurring Form 3020 deficiency.
2. DOH / Board of Medicine complaint investigation. A patient or third-party complaint triggers a § 456.073 inquiry. The first chart requested is the named patient's, and the first record looked at is the GFE. A 20-day response window applies.
3. Civil litigation. A patient injury becomes a tort claim; the chart and the GFE become exhibits. A GFE that documents the risk-benefit discussion and the authorization meaningfully limits liability exposure.

The GFE × supervisory protocol × prescription triangle

A defensible GFE doesn't sit alone. It is the patient-level instantiation of a supervisory protocol (§ 458.348) and a written prescription or standing order. All three records have to line up:

• The supervisory protocol authorizes the ARNP or PA to perform the delegated medical act;
• The standing order or prescription for the prescription injectable (botulinum toxin, fillers, GLP-1, etc.) authorizes the procedure category, with dosing, indications, and contraindications;
• The patient-specific GFE authorizes the procedure for this patient on this date;
• The procedure note documents what was actually done.

A clinic that has a clean supervisory protocol but a sloppy GFE record fails on the GFE. A clinic with strong GFEs but no supervisory protocol fails on the protocol. ProofOps stores all four records against each appointment and shows the chain.

SB 1728 and the GFE conversation

SB 1728 / HB 1429 — the Medical Spa Prescription Drug Oversight Act — would have introduced explicit statutory language around the GFE for med-spa procedures, including specific timing rules and adverse-event reporting. The bill died in subcommittee on March 13, 2026. The current GFE framework is therefore still derived from the existing § 458, § 893.03, § 456.47, and Board of Medicine rules — which are already strict. A revived bill in 2027 may codify what the standard of care already expects. See our SB 1728 explainer.

How ProofOps Medical handles GFE documentation

ProofOps reads from Aesthetic Record, Boulevard, Symplast, PatientNow, Nextech, and Mangomint to pull the GFE record for each scheduled procedure. We compare it to the rules your clinic has configured (procedure type covered, last-exam interval, telehealth-permitted-or-not, prescriber authority). If the GFE is missing, expired, the wrong procedure type, or signed by an unauthorized practitioner, the agent SMS-flags the medical director and the front desk before the appointment. The patient is not refused — but the chart is queued for owner review and the medical director is notified that a GFE is required before treatment proceeds.

Frequently asked questions

Does an intake form count as a GFE?

No. An intake form is patient-supplied data. A GFE is a practitioner-authored note documenting the practitioner's evaluation and authorization. The intake informs the GFE; it does not replace it.

Can a registered nurse perform a Good Faith Exam in Florida?

No. An RN is not a qualified examiner for the GFE. An ARNP, PA, or physician must perform the GFE. An RN may administer the procedure under proper authorization once the GFE is on file.

Can the medical director sign GFEs they didn't perform?

No. The GFE must be performed and signed by the practitioner who actually conducted the encounter. A "co-sign" by a medical director who never saw the patient does not cure a missing GFE.

What if the patient is a returning regular?

A returning patient still needs a current GFE. Most clinics use a re-exam interval (commonly 12 months) plus the trigger list above. A regular who comes in for the same procedure within the interval, with no medical changes, may proceed under the prior GFE — but the chart should reflect that the practitioner reviewed the prior GFE and confirmed continued appropriateness.

Is a video call really a defensible GFE?

Yes, if it's a real video call (audio + video, two-way, real-time), of meaningful duration, with a practitioner authorized to perform the GFE, documented to the same substantive standard as an in-person encounter, and supported by a supervisory protocol that contemplates telehealth GFEs. A 60-second template-driven video does not meet that standard.

What about IV therapy — does the GFE framework apply?

Yes. IV therapy is a delegated medical act in Florida, and the GFE framework applies before initiation. The specifics (vasopressor or anti-emetic protocols, vitamin or amino-acid IV menus, NAD+ infusions) all sit under the same § 458.348 / Board of Medicine framework.

What if my supervising physician changes mid-year?

The supervisory protocol must be re-executed with the new supervising physician. Standing orders must be re-authorized. GFEs already on file remain valid for the patient encounters they cover, but going forward, the new prescriber's authorization governs. Update AHCA designations within the statutory notice window.

How ProofOps Medical helps with GFE compliance

ProofOps' GFE Tracker reads from your EMR, applies the rules you've configured (procedure type, re-exam interval, telehealth permitted, prescriber authority), and surfaces any patient on the schedule whose GFE is missing, expired, or out of scope. The supervisory protocol and standing order sit alongside, so the medical director's approval chain is visible in one place. Each month, GFE samples appear in your inspection-ready PDF.

Get a free audit — see your specific FL gaps before you commit. Or watch the 6-minute demo.

This page is informational. It is not legal or medical advice and should not be relied upon as the basis for clinical decisions. For interpretation of GFE standards specific to your clinic, consult your Florida healthcare attorney and your medical director. Source: Florida Statutes Chapter 458, Chapter 459, Chapter 464, § 456.47, § 893.03; Florida Administrative Code Title 64B8; and Board of Medicine published guidance as of May 2026.