Who may perform the pre-treatment exam, state by state
The same question, answered for 9 states from each state’s own law. States disagree on this, which is the point — an answer that is right in one is wrong next door. Every entry below is a statute or board rule we verified, most recently Sep 8, 2026.
Intake · part of The Practice Perimeter
| State | What its rule says | Cited to |
|---|---|---|
| Alaska | Not delegable — assessment of the patient's medical condition and formulation of the plan of care sit on Alaska's non-delegable list, so a delegating physician, podiatrist, osteopath, or PA must do the exam. The cited rules don't settle whether an APRN may. | 12 AAC 40.920(f) (duties that may not be delegated) Sep 8, 2026 |
| California | Only a physician — or an NP or PA acting under standardized procedures — may perform the good-faith prior exam and issue the patient-specific order; it cannot be delegated to an RN, who may then carry out the injection or laser treatment. | Medical Board of California — Medical Spas guidance Jul 26, 2026 |
| Florida | The cited rules do not settle this — Florida names no one who must perform it. What they do establish: an APRN may evaluate, prescribe and initiate therapy only within an established protocol kept on site, under a physician supervising the course of treatment. | Fla. Stat. §464.012(3) and (4)(a) Sep 1, 2026 |
| Georgia | The consulting physician — or, by physician delegation under a PA job description or a Board-approved APRN protocol, a physician assistant or APRN who is a licensed cosmetic laser practitioner. No exam is required for laser hair removal or pulsed light. | Ga. Comp. R. & Regs. 360-35-.05(1)(b) Aug 17, 2026 |
| Illinois | A physician must examine the patient and set treatment before any laser procedure — except before a non-ablative one, where an APRN may examine if a delegation protocol is on file, a trained RN or LPN performs it, and a physician is reachable remotely. | 68 Ill. Adm. Code 1285.336(b), (b)(1) Sep 8, 2026 |
| New Mexico | It depends on the setting — in an aesthetic healthcare facility, an APRN or other licensed independent practitioner must do the exam, diagnosis and treatment plan and may never delegate them; for medical-assistant device work, the supervising physician does. | 16.12.14.10(B) NMAC (Patient care) Sep 4, 2026 |
| North Carolina | A physician, nurse practitioner, physician assistant or other prescriber must evaluate the client and issue the order — it may not be delegated to the nurse performing the treatment; a first laser hair or tattoo removal exam requires a physician, PA or NP. | NC Board of Nursing, Cosmetic/Aesthetic Dermatological Procedures Position Statement (rev. 9/2022) Aug 17, 2026 |
| Pennsylvania | The cited rules do not settle this — no rule names an exam performer; a physician may delegate a service only if it isn't complex or dangerous enough to need physician-level judgment, and must still judge undue risk for that patient. | 49 Pa. Code §18.402(b) Aug 17, 2026 |
| Texas | Only a physician, or a PA or APRN acting under the physician's delegation, may establish the practitioner-patient relationship before a delegated cosmetic act, and an adequate medical record must be maintained. | 22 TAC §169.26 Jul 26, 2026 |
Every state, in its own words
Alaska
ALASKA ANSWERS THIS AS A NON-DELEGATION RULE RATHER THAN AS AN EXAMINATION REQUIREMENT. “Duties that require the exercise of professional medical knowledge or judgment or complex medical skills may not be delegated.” The enumerated list opens with “the assessment of the patient’s medical condition, and referral and follow-up” and “formulation of the plan of medical care and evaluation of the patient’s response to the care provided”, so the pre-treatment evaluation stays with the delegating physician, podiatrist, osteopath, or physician assistant and cannot be handed to an unlicensed person.
12 AAC 40.920(f) (duties that may not be delegated) · verified Sep 8, 2026
The full Alaska answer, with the rest of the section → · Every Alaska rule on good-faith examination →California
Per the Medical Board, the required prior examination may NOT be delegated to a registered nurse — a physician (or an NP or PA under standardized procedures) must perform the good-faith exam and issue a patient-specific order before an RN performs the injection or laser treatment.
Medical Board of California — Medical Spas guidance · verified Jul 26, 2026
The full California answer, with the rest of the section → · Every California rule on good-faith examination →Florida
An advanced practice registered nurse must perform their authorized functions within the framework of an ESTABLISHED PROTOCOL, which has to be maintained ON SITE at every location where they practice — unless registered under §464.0123 — and a physician licensed under chapter 458, 459 or 466 must maintain supervision for directing the specific course of medical treatment. Within that framework the nurse may prescribe, dispense, administer or order any drug, and may manage selected medical problems and initiate, monitor or alter therapies.
Fla. Stat. §464.012(3) and (4)(a) · verified Sep 1, 2026
The full Florida answer, with the rest of the section → · Every Florida rule on good-faith examination →Georgia
Patients treated by an assistant laser practitioner must be examined before the service by a consulting physician, or by a physician assistant who is a licensed cosmetic laser practitioner, or by an advanced practice registered nurse who is a licensed cosmetic laser practitioner.
Ga. Comp. R. & Regs. 360-35-.05(1)(b) · verified Aug 17, 2026
The full Georgia answer, with the rest of the section → · Every Georgia rule on good-faith examination →Illinois
A physician must examine the patient and determine a course of treatment appropriate to the patient prior to any procedure utilizing a laser, although if the established course of treatment requires multiple procedures a subsequent examination is not required before each individual procedure; and an ablative or non-ablative procedure that can potentially disrupt the eye may only be performed by a physician licensed to practice medicine in all of its branches and may not be delegated.
68 Ill. Adm. Code 1285.336(b), (b)(1) · verified Sep 8, 2026
The full Illinois answer, with the rest of the section → · Every Illinois rule on good-faith examination →New Mexico
Prior to a licensee providing any aesthetic healthcare procedure, an APRN or other licensed independent practitioner must conduct an assessment in a face-to-face examination, determine a diagnosis and prescribe a treatment plan for the patient. The APRN or other licensed independent practitioner may never delegate the examination, diagnosis, or treatment plan.
16.12.14.10(B) NMAC (Patient care) · verified Sep 4, 2026
The full New Mexico answer, with the rest of the section → · Every New Mexico rule on good-faith examination →North Carolina
A licensed physician, nurse practitioner, physician assistant or other practitioner with prescriptive authority must complete the client evaluation and assessment for the appropriateness of the procedure and issue the prescription or order before a licensed nurse carries it out. That evaluation may not be delegated to the nurse who will perform the treatment.
NC Board of Nursing, Cosmetic/Aesthetic Dermatological Procedures Position Statement (rev. 9/2022) · verified Aug 17, 2026
The full North Carolina answer, with the rest of the section → · Every North Carolina rule on good-faith examination →Pennsylvania
A medical service may not be delegated where it is sufficiently complicated, difficult or dangerous that it requires knowledge and skill possessed by medical doctors but not commonly held by non-physicians, or where potential adverse reactions may not be readily apparent to someone without medical doctor training.
49 Pa. Code §18.402(b) · verified Aug 17, 2026 · read at Cornell Legal Information Institute
The full Pennsylvania answer, with the rest of the section → · Every Pennsylvania rule on good-faith examination →Texas
Before a delegated cosmetic act, a practitioner-patient relationship must be established by a physician, or by a PA or APRN acting under the physician’s delegation, and an adequate medical record must be maintained. The identity and title of the person who will perform the act must be disclosed to the patient.
22 TAC §169.26 · verified Jul 26, 2026 · read at Cornell Legal Information Institute
The full Texas answer, with the rest of the section → · Every Texas rule on good-faith examination →Which states this covers
9 of the 51 states for which we publish statute-cited rules. That is not every state, and nothing above should be read as describing one that is not listed — the answer genuinely differs, so a neighbouring state is not a guide. We monitor all 50 state legislatures plus the FDA and the Federal Register daily; the cited rule set is narrower than the monitoring and is growing on its own timetable.
What we track in every state →Just one state?
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