Hawaii medical director requirements for med spas

Physician supervision & delegation in Hawaii

HAWAII DEFINES THE PRACTICE OF MEDICINE BY ANY MEANS, METHOD, OR AGENT, AND THE SECTIONS CITED HERE PUT THE SUPERVISION LINE IN THE STATUTE RATHER THAN IN A RULE ABOUT MEDICAL ASSISTANTS. The practice of medicine includes the use of drugs, surgery, electricity, telehealth, and any means to diagnose, treat, prescribe for, or correct any human condition, and no person may practice or offer to practice medicine without a license from the Hawaii medical board. A physician assistant or emergency medical services licensee may render services under the direction and control of a licensed physician, that direction and control does not in every case require the physician’s personal presence, and the employing physician retains full professional and personal responsibility for any act that constitutes the practice of medicine. Anyone practicing medicine under a physician’s supervision must be licensed as a physician assistant, except a person trained to do only a very limited number of diagnostic or therapeutic procedures under a physician’s direction, who is not deemed a practitioner of medicine; the board sets the degree of supervision, and a physician who supervises below it commits professional misconduct. The Board’s rule makes the physician assistant the supervising physician’s agent. A registered nurse may delegate nursing tasks to unlicensed assistive personnel but never assessment, evaluation, or nursing judgment. On the cosmetology side, an esthetician is defined by the work of massaging, cleansing, stimulating, manipulating, exercising, or beautifying the skin with hands or nonmedically prescribed apparatus, cosmetic preparations, and hair removal by means other than electrolysis; the practice of cosmetology is beauty care of the skin, hair, scalp, and nails for cosmetic purposes; and the chapter does not restrict licensed professionals acting within their own scope. None of the sections cited here names microneedling, lasers, or a medical director.

• the practice of medicine by a physician or an osteopathic physician includes the use of drugs and medicines; surgery; manual medicine; water; electricity; hypnotism; telehealth; the interpretation of tests, including primary diagnosis of pathology specimens, medical imaging, or any physical; osteopathic medicine; any means, method, or agent, either tangible or intangible, to diagnose, treat, prescribe for, palliate, or correct disease, or prevent any human disease, condition, ailment, pain, injury, deformity, illness, infirmity, defect, physical or mental condition in the human subject.

  Haw. Rev. Stat. § 453-1 · verified Sep 8, 2026

• Except as otherwise provided by law, no person shall practice medicine or surgery in the State, either gratuitously or for pay, or offer to practice medicine or surgery in the State, or advertise or announce one's self, either publicly or privately, as prepared or qualified to practice medicine or surgery in the State, or append the letters "Dr.", "M.D.", or "D.O." to one's name with the intent to imply that the person is a practitioner of medicine or surgery, without having a valid unrevoked license or a limited and temporary license obtained from the Hawaii medical board.

  Haw. Rev. Stat. § 453-2(a) · verified Sep 8, 2026

• (5) Prohibit services rendered by any person licensed under part II of this chapter to provide emergency medical services, or any physician assistant, when the services are rendered under the direction and control of a physician or osteopathic physician licensed in this State except for final refraction resulting in a prescription for spectacles, contact lenses, or visual training as performed by an oculist or optometrist duly licensed by the State. The direction and control shall not be construed in every case to require the personal presence of the supervising and controlling physician or osteopathic physician. Any physician or osteopathic physician who employs or directs a person licensed under part II of this chapter to provide emergency medical services, or a physician assistant, shall retain full professional and personal responsibility for any act that constitutes the practice of medicine when performed by the licensed person or physician assistant;

  Haw. Rev. Stat. § 453-2(b)(5) · verified Sep 8, 2026

• The Hawaii medical board shall require each person practicing medicine under the supervision of a physician, osteopathic physician, or group of physicians, other than a person licensed under section 453-3, to be licensed as a physician assistant. A person who is trained to do only a very limited number of diagnostic or therapeutic procedures under the direction of a physician or osteopathic physician shall not be deemed a practitioner of medicine or osteopathy and therefore does not require licensure under this section.

  Haw. Rev. Stat. § 453-5.3(a) · verified Sep 8, 2026

• The board shall establish the degree of supervision required by the supervising physician, osteopathic physician, or group of physicians when a physician assistant performs a service within the practice of medicine. A physician or osteopathic physician who does not supervise a physician assistant's services at the degree required by the board shall be deemed to have engaged in professional misconduct.

  Haw. Rev. Stat. § 453-5.3(f) · verified Sep 8, 2026

• A registered nurse may delegate nursing care tasks, functions, and activities to unlicensed assistive personnel in a manner that is appropriate to the level of knowledge and skill of the unlicensed assistive personnel; provided that the delegation of tasks, functions, and activities complies with applicable federal and state laws; and provided further that the practice-pervasive functions of assessment, evaluation, and nursing judgment shall not be delegated. (b) The delegating nurse is responsible for individually assessing the patient and the situational circumstances and for ascertaining the competence of the delegatee before delegating any task, function, or activity. The delegating nurse shall supervise, monitor, evaluate, and follow-up on instructions to a delegatee after delegating any task, function, or activity. The delegatee shall assume liability for accepting the delegation and for the delegatee's own actions in carrying out the delegated task, function, or activity.

  Haw. Rev. Stat. § 457-7.5(a)-(b) · verified Sep 8, 2026

• A physician assistant shall be considered the agents of the physician assistant's supervising physician in the performance of all practice-related activities as established in writing by the employer. (b) Medical services rendered by the physician assistants may include, but are not limited to: (1) Obtaining patient histories and performing physical examinations; (2) Ordering, interpreting, or performing diagnostic and therapeutic procedures; (3) Formulating a diagnosis; (4) Developing and implementing a treatment plan; (5) Monitoring the effectiveness of therapeutic interventions; (6) Assisting at surgery; (7) Offering counseling and education to meet patient needs; and (8) Making appropriate referrals.

  Haw. Admin. R. § 16-85-49.1(a)-(b) · verified Sep 8, 2026

• "Esthetician" means a person licensed in the State who, with hands or nonmedically prescribed mechanical or electrical apparatus or devices or by use of cosmetic preparations, antiseptics, tonics, lotions, or creams, engages for compensation in any of the following practices: (1) Massaging, cleansing, stimulating, manipulating, exercising, beautifying, or doing similar work on the scalp, face, neck, hands, arms, bust, upper part of the body, legs, or feet; (2) Cleansing, exfoliating, wrapping, or doing similar work upon the entire body, without direct contact by the hands and utilizing gloves, loofah mitts, or brushes; or (3) Removing superfluous hair about the body of any person by means other than electrolysis.

  Haw. Rev. Stat. § 439A-2 ("Esthetician") · verified Sep 8, 2026

• "Practice of cosmetology", also known as beauty culture, means the art and science of beauty care of the skin, hair, scalp, and nails, and includes any one or a combination of the beauty operator license categories if they are performed on a person's head, face, neck, shoulders, arms, hands, bust, upper part of the body, legs, or feet for cosmetic purposes.

  Haw. Rev. Stat. § 439A-2 ("Practice of cosmetology") · verified Sep 8, 2026

• Nothing in this chapter shall be construed to prohibit or restrict the practice of a profession by individuals who are licensed, certified, or registered under the laws of the State who are performing services within their authorized scope of practice.

  Haw. Rev. Stat. § 439A-3(d) · verified Sep 8, 2026

• A physician assistant may perform those duties and responsibilities delegated by the physician assistant's supervising physician; the supervising physician accepts responsibility for the supervision of services rendered by physician assistants and shall direct and exercise supervision at all times; and supervision, which means overseeing the activities of and accepting responsibility for the medical services rendered by a physician assistant, is continuous: supervision shall be continuous but shall not be construed as necessarily requiring the physical presence of the supervising physician at the time and place the services are rendered.

  Haw. Admin. R. § 16-85-44.5 (Definitions — “Supervising physician”; “Supervision”) · verified Sep 8, 2026

Recent Hawaii changes

• HI HB2456: Relating To Drugs For Weight Loss.Jan 28, 2026