Key Provisions in a Med Spa Standing Orders Agreement

Med spas in Texas often rely on standing orders to authorize individuals to administer treatments such as Botox, dermal fillers, IV therapy, and laser procedures. These standing orders must be properly structured to comply with Texas law and ensure patient safety, clinical consistency, and legal protection for the supervising physician and staff. Below are some of the key provisions that should be included in a standing orders agreement for a Texas med spa.

1. Identification of Supervising Physician and Delegated Providers

Clearly identify:

• the supervising physician, including their license number and scope of practice,

• the delegated individuals authorized to carry out procedures under the standing orders, and

• The location(s) where the orders apply.

This ensures compliance with the Texas Medical Board (TMB) rules on delegation and supervision.

2. Scope of Authorized Procedures

The agreement must list each procedure covered by the standing orders, for example:

• neurotoxin injections (e.g., Botox, Dysport),

• dermal fillers,

• laser hair removal and other energy-based treatments,

• microneedling, and

• IV hydration and vitamin therapy, along with

• any other aesthetic procedures permitted under Texas law.

The list should be specific and regularly updated to reflect current offerings and regulatory changes. Under the new law, Tex. Admin. Code §169.26 the Orders must be more detailed than was required under Tex. Admin. Code §193.17.

3. Patient Eligibility Criteria

Define inclusion and exclusion criteria for patients who can be treated under the standing orders.

For example:

• adults 18+,

• no history of contraindications (e.g., neuromuscular disorders for Botox),

• not pregnant or breastfeeding, and

• no recent cosmetic surgeries in the treatment area.

This provision helps ensure clinical appropriateness and limits liability.

4. Protocols for Assessment and Consent

Standing orders should require:

• a good faith exam (GFE) by a qualified provider before any treatment,

• use of a standardized consent form explaining risks, benefits, and alternatives, and

• documentation of medical history, allergies, and current medications.

This section is critical to both medical necessity and legal compliance.

5. Step-by-Step Clinical Protocols

Each treatment should have a corresponding clinical protocol, including:

• required supplies and equipment,

• medication dosages and brands,

• injection techniques and anatomical guidelines, and

• post-treatment instructions and emergency procedures

Protocols ensure consistency and safety across staff and shift changes. Under the new law it is wise to attach these as an exhibit to each procedure, thereby providing the necessary specificity.

6. Supervision and Review Requirements

Texas law requires appropriate physician supervision, which may include:

• regular chart reviews,

• periodic in-person evaluations, and

• availability for consultation via phone or telemedicine

The standing orders should outline how often this supervision occurs and how it is documented.

7. Expiration, Review, and Revocation

The agreement should include:

• an expiration date (typically annual),

• a process for review and updates, and

• the ability for the supervising physician to revoke standing orders at any time.

Keeping the orders current is essential for regulatory compliance and clinical relevance.

8. Training and Competency Verification

Before staff can operate under standing orders, they must:

• complete training on each procedure,

• demonstrate clinical competency, and

• undergo periodic evaluations

This protects the medical director from liability and ensures that patients receive care from qualified professionals.

9. Documentation and Recordkeeping

Establish requirements for:

• charting patient assessments, treatments, and outcomes,

• logging medications used, and

• storing signed consent forms and treatment records.

This section ensures compliance with state recordkeeping laws and supports audits or investigations if needed.

Final Thoughts on Key Provisions in a Med Spa Standing Orders Agreement

A well-drafted standing orders agreement is not just a formality it is a legal and clinical mandatory safeguard that ensures proper delegation, protects the supervising physician, and supports consistent, safe care in the med spa environment. It is imperative to have a comprehensive standing orders agreement for operating a med spa. To that end, Texas med spas should consult a healthcare attorney to ensure their standing orders are compliant with the Texas Medical Board, Nursing Board, and other applicable regulations.

Feel free to reach out if you need more specific information or further clarification.

Weitz Morgan is a leading law firm in Texas in providing comprehensive advice and guidance to med spas. With a deep understanding of the unique challenges and complexities faced by this rapidly growing industry, our team of experienced attorneys is dedicated to helping med spas navigate the legal landscape successfully.

We recognize that med spas operate at the intersection of healthcare and beauty, which necessitates a multifaceted approach to representation. Our firm offers a range of services, including a flat-fee med spa formation package and an outside general counsel subscription, tailored to meet the specific needs of med spas, ensuring compliance, mitigating risks, protecting licenses, and fostering a legally sound business environment.