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

Intake · part of The Practice Perimeter

Washington writes out SEVEN things a physician must do before authorizing a nonsurgical medical cosmetic procedure, rather than naming a “good-faith exam”. The same seven attach whether the procedure is an injection or an energy device.

Drawn from 7 verified rules in this section · regulatory monitoring, not legal advice

The rest of what Washington says on this

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

  • Before authorizing a nonsurgical medical cosmetic procedure a physician must take a history, perform an appropriate physical examination, make an appropriate diagnosis, recommend appropriate treatment, obtain the patient’s informed consent, provide instructions for emergency and follow-up care, and prepare an appropriate medical record. All seven, before the procedure is authorized.

    Wash. Admin. Code 246-919-606(5) · verified Sep 2, 2026

  • The same seven duties apply before treatment with an energy device, with one addition that is easy to miss: the informed consent must INCLUDE INFORMING THE PATIENT THAT A NONPHYSICIAN MAY OPERATE THE DEVICE. The patient is entitled to know who will be holding it before they consent.

    Wash. Admin. Code 246-919-605(6) · verified Sep 2, 2026

  • Consent is documented at the level of the individual delegate: each patient must sign a consent form before treatment listing foreseeable side effects and complications AND the identity and license of the delegate or delegates who will perform the procedure. Each delegate must also be readily identifiable by a name tag or similar means, so the patient understands the identity and license of whoever is treating them.

    Wash. Admin. Code 246-919-606(11)(f) and (g) · verified Sep 2, 2026

  • Regardless of who performs the procedure, THE PHYSICIAN IS ULTIMATELY RESPONSIBLE FOR THE SAFETY OF THE PATIENT and is responsible for ensuring each treatment is documented in the patient’s medical record. Delegation moves the hands, not the responsibility.

    Wash. Admin. Code 246-919-606(6) and (7); 246-919-605(7) and (8) · verified Sep 2, 2026

  • ⛔ WASHINGTON PUTS A TRAINING REQUIREMENT ON EVERYONE DOING TELEMEDICINE EXCEPT THE PHYSICIAN, WHICH IS THE OPPOSITE OF WHAT MOST OPERATORS ASSUME. Beginning January 1, 2021, “a health care professional who provides clinical services through telemedicine, other than a physician licensed under chapter 18.71 RCW or an osteopathic physician licensed under chapter 18.57 RCW, shall complete a telemedicine training.” The training “Must include information on current state and federal law, liability, informed consent” and other criteria set by the telemedicine collaborative, and “If a health care professional completes the training, the health care professional shall sign and retain an attestation.” In a med spa that reaches the nurse, the advanced practice nurse and the physician assistant, and leaves the supervising physician out.

    Wash. Rev. Code § 43.70.495(1)-(2) (Telemedicine training for health care professionals) · verified Sep 8, 2026

  • AND AN OUT-OF-STATE CLINICIAN MAY JOIN BY TELEMEDICINE ONLY AS A CONSULTANT, WITH A WASHINGTON LICENSEE STILL CARRYING THE PATIENT. Exempt from the licensure requirement is “The consultation through telemedicine or other means by a practitioner, licensed by another state or territory in which he or she resides, with a practitioner licensed in this state who has responsibility for the diagnosis and treatment of the patient within this state.” The exemption is written around a Washington-licensed practitioner who retains responsibility; it is not a route for treating a Washington patient remotely from elsewhere.

    Wash. Rev. Code § 18.71.030(6) (Exemptions — consultation through telemedicine) · verified Sep 8, 2026

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← All Washington 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).