§ 43-17-44 — Standard of care and professional ethics

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.