A lot of telehealth and wellness clinic operators treat good faith exams as a step in the intake process, something to complete before a prescription goes out. That framing is not wrong, but it is incomplete. Good faith exams carry real clinical and legal weight, and the practices that treat them as a checkbox tend to find out why that matters at the worst possible time.
If your good faith exam process was built around convenience rather than compliance, that is worth taking seriously now rather than later.
What A Good Faith Exam Is Actually Doing
At its core, a good faith exam is a clinical evaluation. The prescribing provider, whether a physician, nurse practitioner, or physician assistant is establishing that a treatment or prescription is appropriate for a specific patient at a specific point in time. That evaluation needs to be real. It needs to be documented. And it needs to reflect actual clinical judgment, not a templated response generated to satisfy a workflow.
The Ryan Haight Online Pharmacy Consumer Protection Act set the original federal framework requiring an in-person medical evaluation before prescribing controlled substances via the internet, with specific exceptions. The DEA has since worked through proposed rules around telemedicine prescribing that carry direct implications for how good faith exams function in telehealth contexts. State boards add their own layer on top of that.
So the exam is not just a courtesy. It sits inside a regulatory framework that has enforcement teeth.
Synchronous Versus Asynchronous: The Difference Matters
Not all good faith exams work the same way. Synchronous exams happen in real time a live video or phone interaction where the provider and patient communicate directly. Asynchronous exams rely on information the patient submits in advance, which the provider reviews and acts on without a live exchange.
Both formats can meet the standard when done correctly. Both can fall short when done carelessly.
Synchronous exams fail when the provider rushes through them without actually reviewing the patient’s health history, contraindications, or current medications. Asynchronous exams fail when the intake form is too shallow to give the provider what they need to make a real clinical decision or when the provider’s review is cursory at best.
The format is less important than the substance. What did the provider actually evaluate? What did they document? Would that documentation hold up if a board or the DEA asked to see it?
Where Clinics Run Into Trouble
Here is a pattern that shows up more than it should. A clinic builds an intake process that technically includes a good faith exam step. A provider reviews the submission, approves the prescription, and the workflow moves forward. Everything looks fine on the surface.
Then a complaint gets filed. Maybe a patient had a contraindicated condition that the intake form did not screen for. Maybe the provider approved a GLP-1 prescription without adequate documentation of a weight-related diagnosis. Maybe the asynchronous review took less than two minutes for every patient in the queue.
None of that is visible until someone looks. And regulators, when they look, look carefully.
The DEA and state medical boards have both taken enforcement actions against telehealth operations where prescribing practices did not reflect genuine clinical evaluation. The good faith exam process is one of the first things they examine.
What The Exam Needs To Cover
Let’s break it down. A good faith exam that actually meets the standard typically addresses:
- The patient’s current health status and relevant medical history
- Any conditions that would contraindicate the treatment being requested
- Current medications and potential interactions
- Whether the requested treatment is appropriate for this patient’s situation
- The provider’s clinical reasoning is documented clearly.
That last point matters more than most operators realize. Documentation of reasoning not just a checkbox that says “exam completed”, is what demonstrates that a real evaluation happened. A provider who cannot articulate why they approved or declined a prescription, in writing, has not completed a defensible exam.
Building A Process That Holds Up
The practices that stay out of trouble on good faith exams tend to share a few things. They treat the exam as a clinical event, not an administrative step. They build their intake forms around what the prescribing provider actually needs to evaluate. They document clinical reasoning, not just outcomes. And they review their process periodically to make sure it still reflects current regulatory expectations, which do shift.
If you have not looked at your good faith exam process since you launched, that review is worth scheduling. Not because something is necessarily wrong, but because the standard does not stay still, and your process should not either.