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Is an exam required before a patient can be treated in Virginia?

Intake · part of The Practice Perimeter

⚠️ VIRGINIA’S EXAMINATION DUTY IS IN THE PHARMACY CHAPTER, NOT THE BOARD OF MEDICINE REGULATIONS. § 54.1-3303 lets a prescription issue ONLY to a patient with whom the practitioner has a BONA FIDE PRACTITIONER-PATIENT RELATIONSHIP, and defines that by four elements — history, risk disclosure, AN APPROPRIATE EXAMINATION, and follow-up. Botulinum toxin and fillers are prescription drugs, so a Virginia med spa is inside it. The Board of Medicine regulations then add a separate duty about WHO may be handed the patient.

Drawn from 8 verified rules in this section · regulatory monitoring, not legal advice

The rest of what Virginia says on this

Every other rule we have verified under good-faith examination, each linked to its primary source.

  • No practitioner shall knowingly allow subordinates to jeopardize patient safety or to provide patient care OUTSIDE THE SUBORDINATE’S SCOPE OF PRACTICE or area of responsibility, and practitioners SHALL DELEGATE PATIENT CARE ONLY TO SUBORDINATES WHO ARE PROPERLY TRAINED AND SUPERVISED. In Virginia the pre-treatment question is framed as a delegation question rather than an examination one.

    18 Va. Admin. Code § 85-20-29(A)(1) · verified Sep 2, 2026

  • The same rule bars exploiting the practitioner-patient relationship for personal gain, and treats an egregious pattern of disruptive behavior in a health care setting as professional misconduct where it interferes with patient care or could reasonably be expected to affect its quality.

    18 Va. Admin. Code § 85-20-29(A)(2) and (3) · verified Sep 2, 2026

  • ⚠️ THE RULE, AND IT GATES THE PRESCRIPTION ITSELF. “A prescription shall be issued ONLY to persons or animals WITH WHOM THE PRACTITIONER HAS A BONA FIDE PRACTITIONER-PATIENT RELATIONSHIP.” This is chapter 33 (Pharmacy) rather than chapter 29 (Medicine), which is why it is missed — but it governs every prescription, and botulinum toxin and dermal fillers are prescription drugs.

    Va. Code § 54.1-3303(B) · verified Sep 2, 2026

  • AND THE RELATIONSHIP IS DEFINED BY FOUR ELEMENTS, ALL OF WHICH MUST BE PRESENT: “(i) OBTAINED OR CAUSED TO BE OBTAINED A MEDICAL OR DRUG HISTORY OF THE PATIENT; (ii) PROVIDED INFORMATION TO THE PATIENT ABOUT THE BENEFITS AND RISKS OF THE DRUG BEING PRESCRIBED; (iii) PERFORMED OR CAUSED TO BE PERFORMED AN APPROPRIATE EXAMINATION OF THE PATIENT, either physically or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically; and (iv) INITIATED ADDITIONAL INTERVENTIONS AND FOLLOW-UP CARE, IF NECESSARY, especially if a prescribed drug may have serious side effects.” Clause (iii) is Virginia’s good-faith examination; clause (ii) makes risk disclosure part of the same duty.

    Va. Code § 54.1-3303(B) · verified Sep 2, 2026

  • WHO MAY PERFORM IT IS LIMITED: “Except in cases involving a medical emergency, THE EXAMINATION REQUIRED PURSUANT TO CLAUSE (iii) SHALL BE PERFORMED BY THE PRACTITIONER PRESCRIBING THE CONTROLLED SUBSTANCE, A PRACTITIONER WHO PRACTICES IN THE SAME GROUP as the practitioner prescribing the controlled substance, OR A CONSULTING PRACTITIONER.” A med spa cannot outsource the examination to someone outside the prescriber’s own group or a consultant.

    Va. Code § 54.1-3303(B) · verified Sep 2, 2026

  • ⚠️ THE BOARD OF MEDICINE REGULATIONS THEMSELVES CONTAIN NO EXAMINATION RULE — 18 VAC 85-20 part II was surveyed via the chapter index and imposes no pre-treatment or “good faith” examination requirement for cosmetic procedures. ⚠️ READ THAT STRICTLY: it is a statement about the BOARD’S REGULATIONS. Virginia’s examination duty is statutory and sits in the Drug Control chapter at § 54.1-3303(B), cited above.

    18 Va. Admin. Code ch. 85-20, pt. II (surveyed via the chapter index) · verified Sep 2, 2026

  • A bona fide practitioner-patient relationship may be established via telemedicine when, among other conditions, the patient has provided a medical history available for review, the prescriber obtains an updated medical history and makes a diagnosis at the time of prescribing, the prescriber conforms to the standard of care expected of in-person care, including when the standard of care requires diagnostic testing and a physical examination, which may be carried out through peripheral devices appropriate to the patient's condition, and the establishment of the relationship via telemedicine is consistent with the standard of care and the standard of care does not require an in-person examination for the purpose of diagnosis.

    Va. Code § 54.1-3303(B)(d), (h) · verified Sep 8, 2026

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← All Virginia rules and changes · MedSpaRadar is regulatory monitoring and reference, not legal, medical, or compliance advice. Verify against the linked primary source and consult qualified counsel before acting — rules change and turn on your specific facts. Legislative data via LegiScan (CC BY 4.0).