Texas good faith exam requirements

Who can perform a good faith exam in Texas

Texas-licensed physicians (MD/DO), advanced practice registered nurses (APRNs) operating under a prescriptive authority agreement with a delegating physician (Tex. Occ. Code §§157.001-157.060), and physician assistants under physician delegation. APRNs cannot independently perform GFE for prescribing in Texas; the delegation agreement must be on file with the TMB.

Visit format rules in Texas

Synchronous visit required: Yes. Audio-only permitted: No. Prior in-person exam required: No. Synchronous audio-visual is required for telehealth GFE. Audio-only telehealth has limited application and is not sufficient for new-prescription GFE for compounded medications or controlled substances.

When a good faith exam is required in Texas

GFE is required before prescribing any new medication via telehealth, performing any aesthetic medical procedure, initiating compounded medication therapy (including GLP-1, peptides, hormone), administering IV therapy, and ordering controlled substances. The Texas Medical Board has cited inadequate GFE in multiple disciplinary actions against telehealth weight-loss and aesthetic programs.

What must be documented

Establishment of the practitioner-patient relationship via synchronous interaction Patient identification verification Medical history including current medications, allergies, and relevant prior conditions Chief complaint and clinical assessment supporting the prescription Documented medical decision-making with clinical rationale Treatment plan with dosing, frequency, and follow-up cadence Informed consent appropriate to the prescribed therapy Provider signature, credentials, and DEA registration if controlled substance

Enforcement context in Texas

The Texas Medical Board has been particularly active in disciplining telehealth GLP-1 and aesthetic prescribers in 2025-2026, citing async-only GFE, undocumented clinical decision-making, and unestablished practitioner-patient relationships. The TMB has issued multiple cease-and-desist orders and license suspensions against telehealth programs operating outside §174.5.

Statutes and rules cited

Tex. Admin. Code §174.5 — Texas Medical Board Telemedicine Rule: Establishes the practice standards for telemedicine in Texas, including the requirement for an established practitioner-patient relationship before prescribing, and what constitutes a sufficient GFE. Tex. Occ. Code §164.052 — Grounds for medical license suspension: Texas Medical Practice Act provisions defining grounds for license discipline, including prescribing without examination and inadequate documentation — frequently cited in TMB actions against non-compliant telehealth GFE. Tex. Occ. Code §§157.001-157.060 — Physician delegation to APRNs: Establishes the prescriptive authority agreement framework that APRNs must operate under to perform GFE and prescribe in Texas.

Frequently asked questions

Why has the Texas Medical Board been disciplining telehealth GFE providers?

The TMB has cited several issues in 2025-2026 disciplinary actions: asynchronous-only GFE workflows, no established practitioner-patient relationship before prescribing, template chart notes without individualized clinical decision-making, and inadequate follow-up evaluation. Programs running synchronous documented visits with full medical decision-making have not been targeted.

Can a Texas APRN independently perform a GFE without a physician?

No. Texas does not have full practice authority for APRNs. A prescriptive authority agreement (delegation agreement) with a delegating Texas physician is required, and the agreement must be filed with the Texas Medical Board. This applies to GFE for all prescription medications including compounded GLP-1 and aesthetic treatments.

Is audio-only telehealth GFE acceptable in Texas?

Audio-only telehealth is not sufficient for new-patient GFE establishing a practitioner-patient relationship for higher-risk prescribing (compounded medications, controlled substances, aesthetic procedures). Tex. Admin. Code §174.5 requires synchronous audio-visual interaction for the standard of care to be met.

What chart documentation does Texas expect from a compliant GFE?

Texas expects documented establishment of the practitioner-patient relationship via synchronous interaction, patient identification, comprehensive medical history, chief complaint and clinical assessment, medical decision-making with rationale, treatment plan, informed consent, and provider signature with credentials. Template-only notes are explicitly cited as inadequate in TMB enforcement.