A directive is one order that covers many clients when set conditions are met. A client-specific order is written for one client, after the prescriber has assessed them. From March 1, 2027, CNO's updated standards say Ontario nurses providing aesthetic services use client-specific orders instead of directives.
Source: the College of Nurses of Ontario, Aesthetic Services: practice standards changes coming into effect on March 1, 2027. CNO Council approved the changes on September 24, 2026. The updated standards are not published yet, and CNO says it will update its Aesthetic Services guideline to match. This is general information, not legal or regulatory advice: confirm your own obligations with CNO.
Directive and client-specific order, side by side
| Directive | Client-specific order | |
|---|---|---|
| Covers | A number of clients, when specific conditions are met | One client |
| Based on | Conditions written in advance | The authorized provider's assessment of that client |
| Aesthetic services in Ontario from March 1, 2027 | Not used for services involving prescription drugs or controlled acts | Required |
The definitions are CNO's, from its Aesthetic Services practice guideline.
What a good client-specific order contains
CNO's example of an order for a neuromodulator treatment plan names the medication, the dose, the frequency and the treatment areas, for a set period, based on the client's assessment and goals. It has to be clear, complete and appropriate for that client. If it is not, the nurse follows up with the prescriber before treating.
Who assesses, and how
The authorized provider, a Nurse Practitioner or a physician, assesses the client before the first order and sets a plan of care with follow-up. CNO says that assessment can be in person or virtual, as appropriate. The nurse still does their own assessment at each visit.
How long an order lasts
As long as the order specifies. While it is in date and nothing has changed, the nurse can treat under it. A change in the client's health, medications, side effects or goals means consulting the prescriber. At the end of the period, the prescriber reassesses and writes a new order.
What this means for choosing a Medical Director
The question to ask is no longer whether a director will sign a directive. It is how they will assess your clients, how fast, and how reachable they are when something changes. Read what to have in place by March 1, 2027, and the red flags to walk away from.
Find a director who writes client-specific orders.
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Questions about orders and directives
What is the difference between a medical directive and a client-specific order?
A directive is an order that can be implemented for a number of clients when specific conditions are met. A client-specific order is written for one client, based on the authorized provider's assessment of that client.
Is a patient-specific order the same as a client-specific order?
Yes. CNO uses the word client; patient-specific order and direct order are common names for the same thing.
Can a directive still be used for Botox in Ontario after March 1, 2027?
Not by nurses providing aesthetic services involving prescription drugs or controlled acts, according to CNO's summary of the updated standards.
How long does a client-specific order last?
As long as the order specifies. The prescriber reassesses the client and writes a new order when it ends, or sooner if something changes.
General information about the College of Nurses of Ontario changes to the Scope of Practice and Medication standards that take effect on March 1, 2027, based on CNO's published summary and FAQs as read in October 2026. The updated standards had not been published when this was written. Not legal, regulatory or compliance advice. Plus One MD is not affiliated with or endorsed by CNO. Confirm your own obligations with CNO and your liability protection provider.