11.1 Client Consultation and Documentation

11.1 Client Consultation and Documentation

NIC Theory Domain 4, Pre-service process, is about 5% of the scored written exam. That is a small slice of the blueprint and a large slice of how you keep a Washington manicurist license out of a complaint file. Domain 4 is not "be friendly." It is consultation, documentation, nail and skin analysis, contraindications, service and product selection, workstation setup, and client and practitioner sanitation. This section is the conversation and the card. Section 11.2 is the look-and-decide step. Section 11.3 is the table you set before the first file stroke.

If you skip intake because the book is full, you are guessing which monomer, glove, solvent, and metal the next pair of hands can tolerate. Guessing is not a Washington sanitation skill and it is not an NIC pre-service skill.

Consultation is a safety interview

A client consultation is a structured interview that happens before water, primer, or polish. It has two jobs: (1) collect facts that change the service, and (2) get informed agreement on what you will actually do. A smile and "the usual?" is not a consultation. A Tacoma regular who has been in the chair for two years still needs a short update: last fill date, new products at home, new medicines, new redness, new lifting.

Speak in ordinary language. You are licensed as a manicurist under RCW 18.16, not as a physician. You may ask "Have you had a reaction to acrylic liquid, gel, dip, or nail glue?" You may not announce "You have a methacrylate allergy" as a diagnosis. You may ask whether the client has diabetes or reduced feeling in the feet. You may not diagnose neuropathy. Chapter 9 taught refuse-and-refer pictures. This chapter is how those pictures get onto a card before you soak.

Look while you talk. Intake that happens after the feet are already in a circulating spa is too late. Macerated skin hides rash. Wet folds hide pus. Ask, look, then decide.

Service history

Service history is what has already been done to these nails and this skin.

Ask:

• What service is requested today (manicure, pedicure, gel polish, acrylic, hard gel, dip, wrap, removal, repair)?
• What has been done before, in this shop or elsewhere?
• Any prior lifting, odor, green discoloration, swelling, or rash after a nail service?
• Any recent injury, surgery, or open crack on the hands or feet?

A walk-in who says "just a fill" is not a complete history. Fill of what? Acrylic liquid-and-powder, soak-off gel, dip powder, and a silk wrap are different chemistries and different removal plans. A client who had a mall acrylic set three months ago and never returned may have a moisture trap, not a two-week maintenance fill.

Last enhancement fill

Last enhancement fill is its own line, not a footnote. Record the date, the system (acrylic, soft gel, hard gel, hybrid, dip, wrap, tip), and whether the client has been picking, oiling the free edge, or soaking in acetone at home.

Why the date matters: product grows out. A two-week acrylic fill on a sound plate is ordinary maintenance. A ten-week "fill" on a lifting set is often removal, not more powder. Late fills collect moisture, odor, and debris under the free edge. If you add product over that space, you trap whatever is living there. Section 11.2 will refuse unsound nails; the consultation is how you learn the fill is late before you open the monomer.

Ask who applied the last set if it was not you. A Kirkland suite that inherits a dip set from an unknown kit still owns the next decision. "I did not put this on" is not a license to cover green lift with a new color.

Home care

Home care tells you whether the service will survive the week and whether the skin can tolerate more solvent.

Ask about cuticle oil, lotion, gloves for dishes, picking, using nails as tools, home acetone, and whether the client files the free edge between visits. A client who soaks off gel in a coffee mug every Sunday is describing repeated solvent exposure. A client who never oils and peels polish is describing mechanical damage. Those facts change aftercare talk and they change whether you recommend a new enhancement or a rest period on natural nails.

Do not scold. Record. A Yakima client who admits she pries product off with her teeth has just told you the sidewalls may be torn. Look before you nip.

Allergies you must actually name

"Any allergies?" is too vague. People remember peanuts. They forget monomer, latex, acetone, and nickel unless you name those four.

• Monomer here means acrylic liquid and related methacrylate chemistry (gels, some primers, some glues). Prior redness, itching, vesicles, or swelling after a set is a stop-and-choose-another-system moment, or a refuse-and-refer moment if the skin is still inflamed. Uncured product on living skin is a classic sensitization route from Chapter 10. Asking now is cheaper than a Monday complaint.
• Latex lives in some gloves, finger cots, and elastic supplies. A latex-allergic client needs nitrile or another non-latex barrier, not "I will just be careful." Your own glove choice is part of the consultation when you will wear gloves for disinfectant, a blood-exposure event, or a chemical service.
• Acetone is a common remover and soak solvent. Prior burning, intense irritation, or breathing trouble around acetone changes removal method, ventilation, and whether you even offer a soak-off. Sensitivity is not a diagnosis of disease; it is a product-selection fact.
• Nickel is a common contact allergen in metal. Cuticle pushers, nippers, clippers, and some jewelry can contain nickel. A client who cannot wear costume rings without a finger rash may also react to a metal implement on wet skin. Offer an alternative implement if you have one; do not grind through a known metal allergy because "tools are tools."

If the client reports a past reaction, write the product class and the body site ("red itchy eponychium after acrylic liquid last winter"). Do not write a medical label you are not licensed to assign. Do not open that monomer "just this once" because the wedding is Saturday.

Salon scenario — Bellevue first set. A first-time acrylic client has a latex balloon allergy and a nickel watch-band rash. You switch to nitrile gloves, you ask about monomer and acetone by name, and you keep the metal pusher off inflamed skin. That is Domain 4. Starting the liquid before those four questions is how a preventable dermatitis becomes a shop problem.

Medications that affect healing

You are not taking a hospital history. You are screening for healing and bleeding risk that changes nipping, aggressive pedicure, and whether an open crack is even more important than usual.

Ask whether the client takes medicines that thin the blood, slow skin repair, or thin the skin, as they understand those effects — anticoagulants, systemic steroids, some acne retinoids, chemotherapy, and similar drugs the client already knows they take. You do not name the prescription. You do not tell them to stop a medicine. You do use the answer: skip living-tissue nipping, skip hot aggressive soaks, refuse if the skin is already open, and document that you modified or declined because of reported delayed healing or easy bleeding.

A medicine list is not a diagnosis of the disease being treated. "Client reports a blood-thinning medicine; no cuticle nip; skin intact; polish manicure" is professional. "Client has atrial fibrillation" is a medical statement you should not be writing.

Diabetes and neuropathy questions are screening, not diagnosis

Diabetes and reduced sensation in the feet (neuropathy in exam language) belong on a pedicure intake. They also belong on a manicure intake when the hands are involved. The point is safety, not a lecture.

Ask:

• Do you have diabetes, or reduced feeling, burning, or numbness in the feet or hands?
• Do cuts or cracks take a long time to heal?
• Any open areas, ulcers, or recent infection that a physician is already following?

What you do with yes:

• Look even more carefully for open sores, inflamed skin, and rash — already a WAC 308-20-110(1)(e) refuse if visible.
• Do not use water so hot the client cannot feel a burn.
• Do not nip living tissue. Do not use a razor-edged callus tool (already banned under WAC 308-20-110(16) for everyone).
• Do not treat numbness as permission to work deeper because "they will not feel it." Reduced sensation is a reason to be less aggressive, not more.
• Refer when you see open cracks, drainage, color change of concern, or a foot that does not belong in a salon basin.

What you do not do: diagnose diabetes, diagnose neuropathy, tell the client their sugar is high, or sell a salon treatment as medical care. A Spokane client who says "I have diabetes" has given you a screening fact. You still decide from the skin in front of you. Intact skin and a gentle cosmetic pedicure may be possible. An open heel crack is a refuse, diabetes or not. The word diabetes did not create a special Washington form and it did not create a medical license.

What belongs on the record

Washington does not publish, in the WAC 308-20 materials this guide uses, a statute that requires one official numbered manicurist consultation form. Do not invent that form on the exam. Do not tell a DOL inspector that notes were optional because "the state never printed a blank."

Professional documentation is still the standard. After a complaint, an adverse reaction, a blood-exposure event, or an inspection that follows a written complaint, the question is what you did. A card that exists in the shop is how you show it.

Write, in plain language:

• Date, licensee, service requested, service actually performed (or refused).
• What was seen: plate shape, lift, moisture, color, skin of hands or feet, open areas. Describe. Do not diagnose.
• What was refused: the service declined and the visible reason ("open crack on left great-toe medial fold; pedicure refused; referred to physician").
• Products used: system and brand or type actually applied (acrylic liquid/powder, gel, dip, primer, acetone, latex vs nitrile gloves). Include this even when the visit is a simple polish change.
• Aftercare you previewed (oil, gloves, fill timing, pick warning).

Do not write a disease name as if you laboratory-confirmed it. Do not alter a card after a complaint to make the story prettier. Do not hide a refusal because the client was angry. The refusal is often the fact that protects the next client in the same basin.

Keep the card where the shop can retrieve it. Do not discuss a client's medicine list at the reception desk in front of the waiting bench. Consultation is professional, not public entertainment.

Floor pictures

Tacoma late fill. A client wants a "quick fill" at week nine. Intake shows last product was acrylic, she has been prying corners, and she reports no monomer allergy. You still have not decided the service — that is 11.2 — but the card already says last fill nine weeks ago, picking at lateral edges, monomer allergy denied. That record is why you will not be able to claim later that you thought it was a two-week maintenance visit.

Olympia diabetes screen. A new pedicure client mentions diabetes and "tingling toes." You do not diagnose neuropathy. You ask about open areas and healing. You look at the feet before the basin. If the skin is intact you plan a gentle cosmetic pedicure and skip hot water and living-tissue work. If you see an open crack, you refuse, write the crack, and refer. The word diabetes did not become a treatment plan.

Kent complaint file. A client says a gel service caused a rash. DOL or the shop owner will ask what you used, whether you asked about monomer and acetone, and whether inflamed skin was already present. A card that lists "gel polish, brand X, monomer/latex/acetone/nickel denied, skin intact at start, aftercare given" is a professional record. A blank appointment slot that only says "gel $55" is not.

Domain 4 is 5% of the written exam because every later service assumes this interview happened. If the card is empty, the analysis in 11.2 has nothing to stand on, and the setup in 11.3 is just a pretty table over an unknown pair of hands.