California Med Spa owners are reviewing SB 351 alongside their existing Good Faith Exam (GFE) processes. The law raises questions about practice ownership, Management Services Organization (MSO) involvement, clinical decision-making, and the documentation needed before treatment.
SB 351 is not written as a new Good Faith Exam form requirement, and it does not use the term “Patient-Specific Order” or establish a universal Patient-Specific Order (PSO) template. Instead, it focuses on clinical independence and limits on control by private equity groups, hedge funds, and the entities they control.
In practical terms, clinical independence means licensed providers retain control over treatment decisions and other care-related judgments, while administrative support stays separate from clinical decision-making, patient-record content, clinical competency decisions, and patient-care coding or billing decisions. SB 351 became effective January 1, 2026.
For your practice, the practical response is a combined GFE and Patient-Specific Order review. A Good Faith Exam establishes whether a patient is an appropriate candidate for treatment. A Patient-Specific Order, a Med Spa operational practice tied to California’s standardized-procedure and delegation rules and not a term drawn from SB 351 itself, documents the treatment decision for that patient when required by the treatment, provider scope, delegation structure, standardized procedures, or applicable law.
Spakinect completes Patient-Specific Orders as part of every virtual Good Faith Exam, so California Med Spas can connect the patient evaluation, treatment decision, and documentation workflow in one process. Exact requirements still vary by treatment, provider scope, delegation structure, and applicable law.
Use the checklist below to review ownership, clinical control, GFE timing, Patient-Specific Order documentation, delegation, records, contracts, and workflow updates.
If you are reviewing your California GFE and Patient-Specific Order process in light of SB 351, our team can help you understand how California GFE, Patient-Specific Order, and clinical-independence workflows fit together.
SB 351 California: Quick Checklist
| Review area | What to check in 2026 |
| Ownership | Determine whether a private equity group, hedge fund, or controlled entity is involved |
| Clinical control | Confirm licensed providers control treatment decisions |
| Patient volume | Make sure business targets do not dictate clinical quotas or work hours |
| Records | Confirm the licensed practice controls patient-record content |
| Staffing | Confirm clinical competency decisions remain with the licensed practice |
| Coding and billing | Review who makes coding and billing decisions for patient care services |
| Equipment | Confirm clinical equipment decisions remain appropriately controlled |
| GFE | Evaluate whether the patient received an appropriate prior examination |
| Patient-Specific Order | Document the patient-specific treatment decision when required |
| Contracts | Review prohibited control terms and restricted noncompete or nondisparagement clauses |
| Documentation | Connect the exam, order, consent, treatment, and follow-up records |
| Updates | Reassess the workflow when services, providers, ownership, or laws change |
What SB 351 Actually Changes
SB 351 adds Division 1.7 to the California Health and Safety Code. It applies to a private equity group or hedge fund involved with a California physician or dental practice, including as an investor or asset owner. It also applies to entities controlled directly or indirectly by one of these groups.
SB 351 does not categorically ban MSO support. The compliance question is whether a private equity group, hedge fund, or entity it controls (referred to here as a restricted investor) has prohibited influence over clinical judgment or specified care-related decisions.
The statute prohibits a restricted investor from interfering with professional judgment. Examples include determining appropriate diagnostic tests, deciding whether referrals are needed, taking responsibility for overall patient care and treatment options, and determining how many patients a physician sees or how many hours the physician works.
SB 351 also restricts a restricted investor from exercising control over specified operational areas that can affect patient care. These include patient-record content, clinical hiring and firing based on competency, clinical competency rules, coding and billing procedures for patient care services, and medical equipment or supplies.
| SB 351 control area | What a restricted investor cannot do | Safer operating boundary |
| Treatment decisions | Choose or dictate patient treatment options | Licensed provider evaluates and approves treatment |
| Patient volume | Set clinical quotas or work hours | Operations support access without overriding judgment |
| Records | Own or determine clinical chart content | Licensed practice controls clinical records |
| Staffing | Hire or fire based on clinical competency | Licensed practice controls competency decisions |
| Billing | Make patient-care coding decisions | Administrative team supports provider-approved rules |
| Equipment | Approve clinical equipment or supplies | Provider retains clinical approval |
SB 351 also restricts certain noncompete and nondisparagement-style clauses in contracts between a physician or dental practice and a restricted investor, subject to the statute’s terms and exceptions. The bill addresses clauses that prevent providers from competing after termination or commenting on care quality, utilization, ethical issues, or revenue-increasing strategies.
Contracts or arrangements that enable prohibited interference or control are barred. The statute states that provisions violating its restrictions are void, unenforceable, and against public policy.
For your practice, the main takeaway is operational. A management agreement may say the licensed provider controls treatment decisions, but clinical independence also has to show up in the day-to-day workflow. What matters is whether that’s still true in how the practice actually handles exams, orders, records, staffing, equipment, and billing.
GFE vs. Patient-Specific Order: What to Check
A Good Faith Exam and a Patient-Specific Order support different parts of the clinical process.
California’s GFE rule comes from existing medical practice law, not SB 351. Business and Professions Code section 2242 links prescribing, dispensing, or furnishing dangerous drugs to an appropriate prior examination and medical indication. The statute specifies that this exam does not require a synchronous interaction and can be satisfied through telehealth, including a self-screening tool or questionnaire, provided the licensee meets the applicable standard of care.
The Medical Board of California’s Medical Spas materials describe cosmetic medical services such as injections and laser treatments as procedures requiring appropriate medical oversight, delegation, and prior examination.
Under current California nursing and medical board guidance, a physician, nurse practitioner, or physician assistant must perform this evaluation before treatment; a registered nurse may administer treatment under a standardized procedure but does not independently perform or sign off on the exam itself.
A Good Faith Exam is the patient evaluation. It helps the licensed provider assess the patient’s medical history, condition, risks, treatment goals, and suitability for the planned service.
A Patient-Specific Order is commonly used in Med Spa operations to describe a documented, individualized authorization for a particular treatment or service. SB 351 does not create or reference a Patient-Specific Order requirement. The exact order requirements depend on the treatment, provider scope, delegation structure, standardized procedures, and applicable law.
Under California’s nursing statute, a nurse can only carry out a treatment regimen that an authorized provider has ordered, either directly or through a standardized procedure the practice has already set up with input from qualified clinical staff. In a Med Spa workflow, a Patient-Specific Order can help document that the treatment decision was patient-specific and connected to an authorized provider’s order.
| Document | Primary purpose | Key question |
| Good Faith Exam | Evaluate the patient | Is this patient an appropriate candidate? |
| Patient-Specific Order | Authorize or document the planned treatment | What treatment is approved for this patient? |
| Standardized procedure | Define delegation and supervision rules | Who may perform the service and under what conditions? |
| Informed consent | Explain risks, benefits, and alternatives | Does the patient understand the proposed care? |
| Medical record | Preserve the clinical history and decision | Can the practice show what happened and why? |
The documents work together, but they are not interchangeable. A completed intake form does not automatically replace a provider’s clinical assessment. A GFE does not necessarily contain every detail needed for a patient-specific treatment order. A standing protocol does not remove the need for licensed clinical judgment. A complete workflow includes all five.[/nectar_responsive_text]
The 2026 GFE and Patient-Specific Order Checklist
Use this checklist to review whether your workflow supports patient-specific care and the clinical independence standards reinforced by SB 351.
| Checklist item | GFE review | Patient-Specific
Order review |
Clinical-control review |
| Licensed-provider authority | Confirm the evaluator is authorized for the service | Confirm the ordering licensed provider has authority for the treatment | Clinical authority stays with the licensed practice |
| Patient identity | Match the exam to the correct patient record | Match the order to the same patient | No business shortcut replaces patient review |
| Medical history | Review conditions, medications, allergies, and prior treatments | Include relevant facts that support the order | Provider controls what information matters |
| Treatment requested | Identify the patient’s requested service | Name the specific treatment or service | MSO cannot dictate the treatment choice |
| Clinical assessment | Document whether the patient is an appropriate candidate | Connect the order to the assessment | Provider makes the final care decision |
| Contraindications | Screen for risks and reasons to delay or decline care | Record limits, precautions, or follow-up needs | No quota should pressure approval |
| Treatment details | Confirm the exam supports the planned service | Identify treatment type, area, dosage, device, or settings when relevant | Provider controls clinical specifications |
| Modality | Confirm telehealth or in-person care meets the standard of care | Ensure the order follows the completed evaluation | Speed cannot be the only reason for the modality |
| Timing | Complete the exam before the applicable treatment | Issue or document the order before treatment when required | Workflow timing cannot be controlled by revenue goals |
| Documentation | Store the exam and provider assessment in the chart | Store the Patient-Specific Order with the related clinical record | MSO cannot control chart content |
| Patient changes | Update the review when health history changes | Reassess whether the existing order remains appropriate | Provider can pause or change treatment |
| Follow-up | Document instructions and next steps | Record monitoring or follow-up needs | Clinical follow-up remains provider-led |
A practical Patient-Specific Order should be specific enough to show what the provider approved for that patient. Depending on the service, that may include the treatment type, treatment area, product or device, dosage or settings, relevant precautions, and follow-up instructions.
Not every Med Spa service follows the same GFE and Patient-Specific Order path. Injectable treatments, prescription products, energy-based devices, IV services, and other medical procedures may involve different providers, delegation, supervision, and documentation rules.
For that reason, avoid using one generic order for every service. Build the workflow around the actual treatment, the provider’s authority, the patient’s condition, and the applicable standard of care.
MSO and Clinical-Control Checklist
SB 351’s clinical-independence requirements should be tested against the way your MSO operates day to day.
| MSO activity | What to review | Clinical independence standard |
| Treatment menus | Who decides which treatments the practice offers? | Provider input must remain meaningful |
| Patient quotas | Are providers required to meet daily or hourly targets? | Business goals cannot dictate clinical volume |
| Treatment approvals | Can an administrator approve or deny care? | Licensed provider controls treatment decisions |
| Provider staffing | Who hires or terminates staff based on competency? | Licensed practice controls clinical competency |
| Medical records | Who owns, edits, or controls chart content? | Clinical records remain under licensed control |
| Equipment | Who selects lasers, injectables, or medical supplies? | Provider retains clinical approval |
| Coding and billing | Who sets patient-care coding rules? | Administrative support cannot alter clinical judgment |
| Quality review | Who evaluates clinical performance? | Clinical review remains provider-led |
| Escalation | Can a provider pause or decline treatment? | No business-side override should apply |
SB 351 does not prevent an MSO from providing administrative support. It does require the practice to examine whether administrative support has crossed into clinical control.
Review both the management services agreement and the actual workflow. A contract may state that the physician retains control, while internal policies or performance metrics give an MSO practical authority over treatment, staffing, records, or patient volume.
Documentation Checklist
The strongest GFE and Patient-Specific Order workflow is one that allows the practice to connect each clinical decision to a clear record.
| Record element | What the chart should show |
| Patient history | Relevant conditions, medications, allergies, and prior treatments |
| Exam or assessment | The provider’s evaluation of the patient’s condition and candidacy |
| Treatment decision | Why the planned treatment is appropriate or why it was declined |
| Patient-Specific Order | The treatment, product, device, dosage, area, or other relevant details |
| Consent | Risks, benefits, alternatives, and patient questions |
| Licensed-provider identity | Name, credentials, license information, and role in the encounter |
| Delegation record | Applicable supervision, standardized procedure, or delegation details |
| Treatment record | What was performed, by whom, when, and under which order |
| Follow-up | Instructions, precautions, monitoring, and next steps |
| Changes | Updates when the patient’s history, treatment, or risk profile changes |
The Medical Board has emphasized the importance of appropriate supervision, qualified personnel, and clear responsibility for Med Spa procedures. Medical Board materials caution against arrangements where supervision exists only on paper or where business arrangements interfere with appropriate medical oversight.
Documentation should do more than prove that a form was completed. It should show the licensed provider’s reasoning, the treatment authorized, the person who performed the service, and the practice’s follow-up plan.
When to Review Your Workflow
A GFE and Patient-Specific Order workflow should be reviewed whenever the clinical or business structure changes.
Consider reviewing your workflow when:
- Your Med Spa adds a new injectable, device, prescription product, or medical service.
- A new physician, nurse practitioner, physician assistant, or registered nurse joins the practice.
- The practice changes its delegation or standardized procedures.
- The MSO changes ownership, control, staffing, or performance metrics.
- The practice changes its electronic medical record or documentation system.
- A patient reports a significant health, medication, or treatment change.
- A patient requests a service outside the original treatment plan.
- A provider changes the way telehealth or in-person evaluations are performed.
- The practice enters into a new management, vendor, or equipment agreement.
- Legal or Medical Board guidance changes.
The American Med Spa Association describes the GFE as occurring before a patient’s first treatment, with a new exam appropriate when the patient seeks a new treatment, experiences a substantial health change, or has gone a significant amount of time since the prior exam. AmSpa cites an annual exam as a general rule of thumb, not a universal statutory interval.
Quarles also notes that GFE rules vary by state, including who may perform the exam, when it must occur, whether telehealth is allowed, and what the exam must document.
The Workflow Behind Clinical Independence
SB 351 itself doesn’t impose new GFE paperwork or a standardized Patient-Specific Order requirement for California Med Spas. It does, however, ask Med Spa owners to confirm that clinical decisions still sit with a licensed provider.
A workflow that connects patient evaluation, treatment-specific authorization, licensed-provider identity, scope, delegation, and documentation into one traceable process is the clearest way to answer that question.
Spakinect completes Patient-Specific Orders as part of every Good Faith Exam, helping California Med Spas connect the patient evaluation, treatment decision, and documentation workflow in one process.
See how Spakinect’s California Good Faith Exam service supports a provider-led GFE and Patient-Specific Order workflow for your Med Spa, fill out the form at spakinect.com/contact.
This article is for general educational purposes and is not legal advice. California Med Spas should consult qualified healthcare counsel about their ownership, management, provider, delegation, GFE, and Patient-Specific Order arrangements.
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References
- California Legislative Information, “SB-351 Health facilities,” chaptered text, Health and Safety Code §§ 1190–1192. https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202520260SB351
- Stinson LLP, “New California Health Care Transaction Rules Are Here: SB 351 and AB 1415 Are Now Effective,” January 7, 2026. https://www.stinson.com/newsroom-publications-new-california-health-care-transaction-rules-are-here-sb-351-and-ab-1415-are-now-effective
- California Legislative Information, Business and Professions Code § 2242. https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=2242.&lawCode=BPC
- Medical Board of California, “Medical Spas: What You Need to Know.” https://www.mbc.ca.gov/Resources/Medical-Resources/Medical-Spas.aspx
- Medical Board of California, “Frequently Asked Questions: Complaint: Internet Prescribing.” https://www.mbc.ca.gov/FAQs/?cat=Consumer&topic=Complaint:%20Internet%20Prescribing
- American Med Spa Association, “What Is Required of a Medical Spa’s Good Faith Exams?” by Sam Pondrom, JD (ByrdAdatto). Published May 21, 2019; last updated March 31, 2026. https://www.americanmedspa.org/news/what-is-required-of-a-medical-spas-good-faith-exams/
- Quarles, “Med Spa Compliance Series: Area of Focus: Good Faith Examination,” September 2, 2025. https://www.quarles.com/newsroom/publications/med-spa-compliance-series-area-of-focus-good-faith-examination
- Spakinect, “California Good Faith Exam (GFE) Requirements.” https://www.spakinect.com/california-good-faith-exam-gfe-ca
- California Board of Registered Nursing, “Standardized Procedure Guidelines” (NPR-I-19), reproducing Title 16 CCR §§ 1470–1474, rev. 01/2011 (current version as published). https://www.rn.ca.gov/pdfs/regulations/npr-i-19.pdf
- California Legislative Information, Business and Professions Code §§ 2725 and 2725.1. https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=2725.&lawCode=BPC
- David Holt Law, “What Counts as the Practice of Medicine in California Med Spas?” https://djholtlaw.com/what-counts-as-the-practice-of-medicine-in-california-med-spas/
- LegiScan, “CA SB351 | 2025–2026 | Regular Session,” status and legislative history. https://legiscan.com/CA/bill/SB351/2025
- David Holt Law, “The Good Faith Exam Requirement in California: What Clinics Must Do Before Treatment” (2026), confirming that only a physician, PA, or NP may conduct the GFE and that an RN may not clear patients for treatment. https://djholtlaw.com/the-good-faith-exam-requirement-in-california-what-clinics-must-do-before-treatment/
