Good faith exam paperwork is the first thing a state medical board or malpractice attorney asks for when a tirzepatide patient has a bad outcome — and most medspas can't produce it in the format regulators actually want.
This guide walks through the exact documentation a good faith exam needs for tirzepatide (and Zepbound) patients in 2026, step by step, so your chart holds up under review instead of falling apart the first time someone asks for it.
- A compliant good faith exam documentation tirzepatide file needs baseline vitals, med reconciliation, and a documented risk discussion before the first dose.
- Verbal-only good faith exams are the top audit failure in 2026 — if it isn’t written down, a board treats it as never having happened.
- Re-exams are required at dose escalation intervals, not just at intake, for GLP-1 and GIP prescribing under most state good faith exam rules.
- US Medical Directors reviews tirzepatide charts against state-specific good faith exam standards before a board ever asks.
Why this matters
Tirzepatide prescribing volume at medspas and weight loss clinics has exploded since 2023, and state boards have caught up fast. Several states that were lax on GLP-1 supervision in 2022 now require a documented, in-person or synchronous-telehealth good faith exam before the first prescription and at defined re-exam intervals after that.
The problem isn't that clinics skip the exam — it's that they do the exam and never write down enough to prove it happened the way the rule requires. A collaborating physician or medical director can sign off on a good faith exam, but if the chart doesn't show what was checked, when, and by whom, that signature doesn't protect anyone. For clinics running high tirzepatide volume, this is the same documentation gap covered in good faith exams for semaglutide clinics — the two drug classes get audited the same way.
What you'll need
- A standardized intake form covering weight history, prior GLP-1/GIP use, thyroid history, pancreatitis history, and pregnancy status
- A vitals station — blood pressure, pulse, weight, height, and BMI calculation, all recorded at the visit
- A medication reconciliation list, including supplements and any compounded peptides the patient is already using
- A documented risk discussion covering GI side effects, thyroid C-cell tumor warnings, and gallbladder risk
- A signature block for the supervising or collaborating physician, plus the exam date and re-exam due date
- Roughly 20-30 minutes per new patient exam; re-exams typically run 10-15 minutes
The steps
1. Confirm state-specific good faith exam rules before you see the patient
Good faith exam requirements vary by state — some require in-person exams for the first tirzepatide visit, others allow synchronous telehealth with a licensed provider. Check the rule for your state before scheduling, not after the patient is already in the chair.
Mistake to avoid: assuming your neighboring state's rule applies to you. A clinic operating across state lines needs a separate compliance check for each license jurisdiction.
2. Take a full weight and metabolic history
Document prior weight loss attempts, prior GLP-1 or GIP medication use (including brand and dose if known), and any bariatric surgery history. This history is what a reviewer checks first when deciding whether tirzepatide was an appropriate starting point.
Record it in the patient's own words where possible, then translate it into clinical shorthand — both versions strengthen the chart. A one-line note like "patient reports no prior GLP-1 use" is not enough; note the source (patient self-report) and the date it was collected.
3. Record objective vitals and BMI at the visit
Blood pressure, pulse, weight, and calculated BMI need to be recorded the same day as the good faith exam, not pulled from a prior visit. A stale vitals entry is one of the fastest ways a chart gets flagged during a chart review.
Expected outcome: a vitals block with a timestamp matching the exam date, not a generic "vitals within normal limits" note with no numbers attached.
4. Screen for contraindications and document the negative findings
Personal or family history of medullary thyroid carcinoma, Multiple Endocrine Neoplasia syndrome type 2, and pancreatitis are the standard tirzepatide contraindication screens. Document a specific "no" for each one — a blank field reads as "not asked," not "not present."
Common mistake: writing "no contraindications" as a single catch-all line. Boards want each contraindication addressed individually, with the patient's answer attached.
5. Document the risk discussion and informed consent
The good faith exam needs a written record that GI side effects, injection site reactions, and thyroid tumor warnings were discussed and understood before the first dose. A checkbox alone doesn't satisfy most state standards — pair it with a short narrative note confirming the patient asked questions or had none.
This is also where you note who conducted the exam. If a nurse practitioner or physician assistant performed the exam under supervision, the supervising physician's name and license number belong in the same entry, not a separate document filed elsewhere. Clinics prescribing at volume often centralize this under a dedicated medical director for tirzepatide and Zepbound clinics so every provider follows the same documentation template.
6. Set and document the re-exam schedule
Most states require a follow-up good faith exam at dose escalation, not just at intake. Write the re-exam due date directly into the chart at the close of the initial visit — don't leave it to a separate scheduling system that isn't part of the medical record.
Expected outcome: a chart that shows a clear compliance trail from intake through each dose increase, with a re-exam entry matching each escalation step.
7. Have the supervising physician co-sign within a defined window
A good faith exam isn't complete until the collaborating or supervising physician has reviewed and signed the chart entry. Set an internal standard — 24 to 48 hours is common — and track it, because an unsigned exam sitting for weeks is exactly what a chart review flags first.
Get Tirzepatide Charts Board-Ready
Medical director oversight built for GLP-1 and tirzepatide prescribing volume.
Troubleshooting
- Vitals were taken by a medical assistant but not co-signed by the exam provider. Add a co-signature line to your intake template so the exam provider confirms the numbers before the visit closes.
- Contraindication screening exists but has no date attached. Timestamp every screening field, not just the overall visit — a reviewer needs to see the screening happened at the same encounter as the exam.
- Re-exam due dates are tracked in a scheduling app, not the chart. Duplicate the due date inside the clinical note itself; scheduling software isn't part of the legal medical record.
- Risk discussion notes are copy-pasted across every patient with no individual detail. Vary the note enough to show the discussion actually happened for that patient — identical boilerplate across 40 charts is a red flag in any chart review.
- The supervising physician's signature is missing a license number or date. Require both fields as mandatory in your EMR template so an incomplete signature can't be saved.
- Telehealth good faith exams don't note the platform or synchronous nature of the visit. Document that the exam was live video, not asynchronous messaging, if your state requires synchronous contact.
Tools and resources
- Standardized intake and good faith exam templates covering weight history, contraindications, and consent
- A documented chart review workflow — see how to document chart reviews for medical director compliance for the format boards expect
- A collaborating or supervising physician with defined turnaround time for chart co-signature
- A re-exam tracking system tied directly to the clinical chart, not a standalone calendar
What to do next
Once your good faith exam template is locked, the next compliance gap to close is ongoing chart review — the process that catches documentation drift before a board does. Weight loss clinics running tirzepatide at scale typically pair good faith exam documentation with a recurring review cycle built for GLP-1 volume.
FAQ
What is a good faith exam for tirzepatide patients?
A good faith exam is the clinical evaluation a licensed provider performs before prescribing tirzepatide, covering vitals, medical history, and contraindication screening. In 2026, most states require it before the first dose and again at defined re-exam intervals.
Does a good faith exam have to be in person?
It depends on the state. Some states allow synchronous telehealth for tirzepatide good faith exams, while others require an in-person visit for the initial exam, so check your state’s specific rule before scheduling.
How often is a re-exam required for tirzepatide patients?
Most states require a follow-up good faith exam at dose escalation intervals, not just at intake. Write the re-exam due date directly into the chart so it isn’t tracked only in a separate scheduling tool.
Can a nurse practitioner perform a tirzepatide good faith exam?
Yes, in most states a nurse practitioner or physician assistant can conduct the exam under a supervising or collaborating physician’s oversight. The supervising physician’s name and license number need to appear in the same chart entry, not a separate file.
What happens if a good faith exam isn’t documented properly?
An undocumented or incomplete good faith exam is treated by most state boards as if the exam never happened, regardless of whether it was actually performed. This exposes both the prescribing provider and the supervising physician to corrective action.
Is a checkbox enough for informed consent on tirzepatide risks?
No, a checkbox alone rarely satisfies state good faith exam standards. Pair it with a short narrative note confirming the specific risks discussed and that the patient had an opportunity to ask questions.
How is a tirzepatide good faith exam different from a semaglutide one?
The documentation structure is nearly identical — vitals, history, contraindications, consent, and re-exam schedule — but tirzepatide’s dual GIP/GLP-1 mechanism means some states specify additional monitoring notes at dose escalation.
Who co-signs a tirzepatide good faith exam chart?
The supervising or collaborating physician reviews and co-signs the exam entry, typically within 24 to 48 hours of the visit. An unsigned exam sitting open for weeks is one of the first things a chart review flags.
One last thing
The single most common reason a tirzepatide good faith exam fails a board review isn't a missing exam — it's a missing re-exam. Clinics document the intake visit well and then let dose escalation happen with no matching chart entry, which is exactly the gap state boards started targeting hardest through 2026.
Related guides
- Chart review services for tirzepatide weight loss clinics
- How to stay compliant with good faith exam requirements
- Good faith exams for medspas
