North Dakota Code § 43-17-44

Standard of care and professional ethics
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A licensee is held to the same standard of care and same ethical standards, whether 
practicing traditional in -person medicine or telemedicine. The following apply in the context of 
telemedicine:
1. Professional ethical standards require a practitioner to practice only in areas in which 
the practitioner has demonstrated competence, based on the practitioner's training, 
ability, and experience. In assessing a licensee's compliance with this ethical 
requirement, the board shall give consideration to board certifications and specialty 
groups' telemedicine standards.
2. A licensee practicing telemedicine shall establish a bona fide relationship with the 
patient before the diagnosis or treatment of a patient. A licensee practicing 
telemedicine shall verify the identity of the patient seeking care and shall 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. Before 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. An examination utilizing secure videoconferencing or store -and-forward 
technology for appropriate diagnostic testing and use of peripherals that would be 
deemed necessary in a like in -person examination or evaluation meets this 
standard, as does an examination conducted with an appropriately licensed 
intervening health care provider, practicing within the scope of the provider's 
profession, providing necessary physical findings to the licensee. An examination 
or evaluation consisting only of a static online questionnaire or an audio 
conversation does not meet the standard of care.
b. 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. 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. A licensee practicing telemedicine is 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. A licensee must have the ability to make appropriate referrals of patients not amenable 
to diagnosis or complete treatment through a telemedicine encounter, including a 
patient in need of emergent care or complementary in-person care.

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