North Dakota Administrative Code
Title 50 - North Dakota Board of Medicine
Article 50-02 - Physician Licensure
Chapter 50-02-15 - Telemedicine
Section 50-02-15-03 - Standard of care and professional ethics

1. Scope of practice. Professional ethical standards require all practitioners to practice only in areas in which they have demonstrated competence, based on their training, ability, and experience. In assessing a licensee's compliance with this ethical requirement, consideration must be given to board certifications and specialty groups' telemedicine standards.

2. Patient-licensee relationship. A licensee practicing telemedicine shall establish a valid relationship with the patient prior to the diagnosis or treatment of a patient. A licensee practicing telemedicine shall verify the identity of the patient seeking care, and disclose, and ensure the patient has the ability to verify, the identity and licensure status of any licensee providing medical services to the patient.

3. Evaluations and examinations required to establish a patient-licensee relationship. Prior to initially diagnosing or treating a patient for a specific illness or condition, an examination or evaluation must be performed. An examination or evaluation may be performed entirely through telemedicine, if the examination or evaluation is equivalent to an in-person examination. A video examination that utilizes appropriate diagnostic testing and use of peripherals that would be deemed necessary in a like in-person examination or evaluation meet this standard, as does an examination conducted with an appropriately licensed intervening health care provider, practicing within the scope of their profession, providing necessary physical findings to the licensee. An examination or evaluation that consists only of a static online questionnaire or an audio conversation may not be considered to meet the standard of care.

Once a licensee conducts an acceptable examination or evaluation, whether in-person or by telemedicine, and establishes a patient-licensee relationship, subsequent followup care may be provided as deemed appropriate by the licensee, or by a provider designated by the licensee to act temporarily in the licensee's absence.

It is recognized that in certain types of telemedicine utilizing asynchronous store-and-forward technology or electronic monitoring, such as teleradiology or intensive care unit monitoring, it is not medically necessary for an independent examination of the patient to be performed.

4. Medical records. Licensees practicing telemedicine are subject to all North Dakota laws governing the adequacy of medical records and the provision of medical records to the patient and other medical providers treating the patient.

5. Licensees must have the ability to make appropriate referrals of patients not amenable to diagnosis or complete treatment through a telemedicine encounter, including those patients in need of emergent care, or complementary in-person care.