N.D. Admin. Code Title 50 — North Dakota Board of Medicine

Article 50-01 General Administration

Chapter 50-01-01 Organization of Board

N.D. Admin. Code 50-01-01-01 Organization of North Dakota board of medicine

1.History and function. The 1890 legislative assembly passed a medical practice act, codified as North Dakota Century Code chapter 43-17. This chapter requires the governor to appoint a state board of medicine. It is the responsibility of the board to protect the health, safety, and welfare of the public by licensing qualified and competent individuals.

2.Executive director. The executive director of the board is appointed by the board and is responsible for administration of the board's activities.

3.Inquiries. Inquiries regarding the board may be addressed to the executive director:

Executive Director North Dakota Board of Medicine 4204 Boulder Ridge Road, Suite 260 Bismarck, 58503-6392

December 1, 1993; August 1, 2003; January 1, 2009; October 1, 2022; April 1, 2024.

History

• History: Amended effective December 1, 1980; September 1, 1983; July 1, 1988; November 1, 1993;
• General Authority: NDCC 43-17-07.1
• Law Implemented: NDCC 43-17-06, 43-17-07.1

Chapter 50-01-02 Rulemaking [Repealed]

N.D. Admin. Code 50-01-02 Rulemaking [Repealed]

CHAPTER 50-01-02

RULEMAKING [Repealed effective October 1, 2022.]

Chapter 50-01-03 Record Retention

N.D. Admin. Code 50-01-03-01 Record retention

1.A licensee shall retain all medical records unless otherwise appropriately transferred to another licensee or entity, for at least seven years from the last date of service for each patient, except as otherwise required by law.

2.Beginning January 1, 2024, a licensee shall appoint another North Dakota licensee or other representative or entity, to ensure that all requirements of this section are met in the event of the licensee's death or incapacitation. Upon request by the board, the licensee shall show proof of appointment of a representative.

3.Upon a licensee's death or retirement, the sale of a medical practice, or a licensee's departure from the licensee's medical practice:

a.The licensee or the licensee's representative shall ensure all medical records are transferred to another licensee or entity that is held to the same standards of confidentiality and agrees to act as custodian of the records.

b.The licensee or the licensee's representative shall notify all active patients that the patient's records will be transferred to another licensee or entity that will retain custody of the patient's records and that, at the patient's written request, the records will be sent to the patient, licensee, or entity of the patient's choice.

c.The licensee or the licensee's representative shall notify the board of the location and contact information of the custodian of the records which may be provided to a patient requesting such information.

History

• History: Effective April 1, 2024.
• General Authority: NDCC 43-17-07.1(10)
• Law Implemented: NDCC 43-17-27.2

Article 50-01.1 Definitions

Chapter 50-01.1-01 Grounds for Discipline - Definitions

N.D. Admin. Code 50-01.1-01 Grounds for Discipline - Definitions

ARTICLE 50-01.1

DEFINITIONS

Chapter 50-01.1-01Grounds for Discipline - Definitions

CHAPTER 50-01.1-01

GROUNDS FOR DISCIPLINE - DEFINITIONS

Section 50-01.1-01-01Grounds for Discipline - Definitions 50-01.1-01-01. Grounds for discipline - Definitions.

The following definitions apply to grounds for discipline for licenses under the jurisdiction of the board.

1."Chaperone" means a third individual who is present during a medical examination, with the patient's consent.

2."Conduct" includes:

a.Behaviors, gestures, or expressions, whether verbal or physical; or

b.The creation, receipt, exchange, saving, or sending of images or communications, whether verbal or written, via a telecommunications device.

3."Former patient" means one of the following:

a.An individual for whom the licensee has not rendered health care services since the licensee-patient relationship was terminated; or

b.An individual who has otherwise been admitted, discharged, or referred to another licensee for care subsequent to receipt of health care services by a licensee in an emergency setting or on an episodic basis, and such action has been recorded in the individual's medical record or chart.

4."Health care services" means examination, consultation, health care, treatment, or other services provided by a licensee under the legal authority conferred by a license, certificate, or registration issued by the board.

5."Intimate examination" means an examination of the pelvic area, genitals, rectum, breast, or prostate.

6."Key third party" means an individual closely involved in the patient's decisionmaking regarding health care services, including the patient's spouse or partner, parent, child, sibling, or guardian. An individual's status as a key third party ceases upon the termination of the licensee-patient relationship or upon termination of the individual's relationship with the patient.

7."Licensee" means any professional licensed under the jurisdiction of the board of medicine.

8."Patient" means an individual for whom the licensee has provided health care services, whether provided by mutual consent or implied consent, or provided without consent pursuant to a court order. Once a licensee-patient relationship is established, an individual remains a patient until the relationship is terminated. The determination of whether an individual is a patient is made on a case-by-case basis with consideration given to a number of factors, including the nature, extent, and context of the professional relationship between the licensee and the individual. The fact that an individual is not actively receiving treatment or professional services is not the sole determining factor. The term includes:

a.An individual who is receiving or has received health care services from the licensee without termination of the licensee-patient relationship; or

b.A key third party, as that term is defined in this section.

9."Sexual abuse, misconduct, or exploitation" means conduct that exploits the licensee-patient relationship in a sexual way, whether verbal or physical, and may include the expression of thoughts, feelings, or gestures that are sexual or that reasonably may be construed by a patient or key third party as sexual. Sexual abuse, misconduct, or exploitation include:

a."Sexual impropriety" means conduct by the licensee that is seductive, sexually suggestive, disrespectful of patient privacy, or sexually demeaning to a patient, including the following:

(1)Neglecting to employ disrobing or draping practices respecting the patient's privacy;

(2)Subjecting a patient to an intimate examination in the presence of a third party, other than a chaperone, without the patient's consent or if consent has been withdrawn;

(3)Making comments that are not clinically relevant about or to the patient, including making sexual comments about a patient's body or underclothing; making sexualized or sexually demeaning comments to a patient, criticizing the patient's sexual orientation, or making comments about potential sexual performance;

(4)Soliciting a date or romantic relationship with a patient;

(5)Participation by the licensee in conversation regarding the sexual problems, sexual preferences, or sexual fantasies of the licensee;

(6)Requesting details of the patient's sexual history, sexual problems, sexual preferences, or sexual fantasies if not clinically indicated for the type of health care services; and (7)Failing to offer the patient the opportunity to have a third individual or chaperone in the examining room during an intimate examination or failing to provide a third individual or chaperone in the examining room during an intimate examination upon the request of the patient.

b."Sexual contact" includes the following:

(1)Touching a breast, genital, or any body part that has sexual connotation for the licensee or patient, for any purpose other than appropriate health care services, or if the patient has refused or has withdrawn consent; and (2)Examining or touching of the patient's genitals without the use of gloves.

c."Sexual interaction" means conduct between a licensee and patient, whether or not initiated by, consented to, or participated in by a patient, that is sexual or may be reasonably interpreted as sexual, including:

(1)Sexual intercourse or genital to genital contact;

(2)Oral to genital contact;

(3)Oral to anal contact or genital to anal contact;

(4)Kissing in a romantic or sexual manner;

(5)Encouraging the patient to masturbate in the presence of the licensee or masturbation by the licensee while the patient is present;

(6)Offering to provide health care services, including drugs, in exchange for sexual favors;

(7)Performing an intimate examination without clinical justification; or (8)Conduct that is sexually demeaning to a patient or which demonstrates a lack of respect for the patient's privacy.

d.Conduct described in paragraph 1 of subdivision a, paragraph 2 of subdivision a, paragraph 7 of subdivision a, and paragraph 1 of subdivision b of this rule does not constitute sexual abuse, misconduct, or exploitation if the following criteria are met:

(1)The conduct occurred during the rendering of health care services in an emergency setting;

(2)The health care services rendered were clinically necessary;

(3)The patient was unconscious or otherwise unable to consent to health care services; and (4)The patient's clinical condition required immediate action and the licensee's violation of paragraph 1 of subdivision a, paragraph 2 of subdivision a, paragraph 7 of subdivision a, or paragraph 1 of subdivision b of this rule was due to circumstances not within the licensee's control.

e.This section does not prohibit conduct required for medically recognized diagnostic or treatment purposes if the conduct meets the standard of care appropriate to the diagnostic or treatment situation.

f.It is not a defense that the patient, former patient, or key third party initiated or consented to the conduct, or that the conduct occurred outside the professional setting.

10."Unethical conduct" means conduct contrary to the following codes of ethics for each licensed profession:

a.For medical doctors, the 2016 code of medical ethics adopted by the American medical association;

b.For osteopathic doctors, the 2016 code of ethics adopted by the American osteopathic association;

c.For physician assistants, the 2018 guidelines for ethical conduct for the physician associates profession adopted by the American academy of physician associates;

d.For genetic counselors, the 2017 code of ethics adopted by the national society of genetic counselors; and

e.For naturopaths, the 2015 code of ethics adopted by the American association of naturopathic physicians.

History: Effective January 1, 2025.

General Authority: NDCC 43-17-07.1(10), 43-58-03.1, 43-60-06

Law Implemented: NDCC 43-17-02.1(1), 43-17-02.5, 43-17-31(1), 43-58-11(2)(o), 43-60-07(1)(o)

Article 50-02 Physician Licensure

Chapter 50-02-01 Provisional Temporary License

N.D. Admin. Code 50-02-01-01 License for interval between board meetings

An officer of the board and the board's executive director or deputy executive director may issue a locum tenens license or a provisional temporary license to an applicant who is seeking a permanent North Dakota medical license if in their judgment the applicant meets all of the requirements for licensure. A provisional temporary license is valid from the date of issue until the time of the next regularly scheduled meeting of the board. The board's executive director or deputy executive director may issue a locum tenens license or a provisional temporary license if the application is routine, complete, and meets all other requirements for licensure.

April 1, 2024; January 1, 2026.

History

• History: Amended effective December 1, 2000; August 1, 2003; January 1, 2009; October 1, 2022;
• General Authority: NDCC 43-17-07.1(10)
• Law Implemented: NDCC 43-17-18(5), 43-51.1-03

N.D. Admin. Code 50-02-01-02 License for locum tenens

A license for "locum tenens" may be issued for a specific practice location or health care facility and for a period not to exceed three months.

History

• History: Amended effective October 1, 2022; April 1, 2024.
• General Authority: NDCC 43-17-07.1(10)
• Law Implemented: NDCC 43-17-07.1(8)

Chapter 50-02-02 Special License

N.D. Admin. Code 50-02-02-01 Exceptions to technical requirements on licensure

A license issued under this section is, for all purposes, the same as a regular medical license issued by the board.

1.The board shall issue a license to an applicant who holds a current valid letter of qualification issued through the interstate medical licensing compact. The issuance of a license does not preclude the board's ability to require additional information from the applicant. Failure of the applicant to complete the addendum questions within thirty days will be assessed a fee of five hundred dollars and may be subject to disciplinary action.

2.The board may issue a medical license to an applicant who does not meet all technical eligibility requirements if the board determines the applicant is uniquely qualified through training or experience or will make a unique or special contribution to the practice of medicine not readily available to the citizens of the state. In applying this rule, the board shall make written findings supporting the issuance of a special license. In addition to the potential benefit to the state, the board shall include in its analysis consideration of the following:

a.Board certification;

b.Nature and length of medical practice;

c.Nature and length of postgraduate training or research;

d.Licenses issued by other states;

e.The existence of disciplinary actions by other medical boards or adverse actions by medical facilities;

f.History of malpractice judgments or settlements;

g.Licensing examinations, such as the United States medical licensing examination (USMLE) or special purpose examination (SPEX); and

h.Such other considerations that bear upon an applicant's eligibility.

History

• History: Amended effective February 1, 1985; January 1, 2018; January 1, 2020; April 1, 2024.
• General Authority: NDCC 43-17-07.1(10)
• Law Implemented: NDCC 43-17-18(4), 43-17-46

N.D. Admin. Code 50-02-02-02 Special license requirements for foreign medical school graduates

Repealed effective February 1, 1985.

Chapter 50-02-02.1 Administrative License

N.D. Admin. Code 50-02-02.1 Administrative License

CHAPTER 50-02-02.1

ADMINISTRATIVE LICENSE

Section 50-02-02.1-01Administrative License 50-02-02.1-01. Administrative license.

The board may issue a license that is limited to administrative medicine, which is defined as administration or management using the medical knowledge, skill, and judgment of a licensed physician that may affect the health of any member of the public.

An administrative medical license does not permit the licensee to practice clinical medicine which, for purposes of this rule, includes the provision of any patient diagnosis or treatment, the prescribing of any drug, or the delegation of medical authority to, or the supervision of, any health professional. The board shall require an applicant for an administrative medical license to sign an acknowledgment of these limitations prior to the issuance of an administrative medical license.

An applicant for an administrative medical license must meet all the eligibility requirements for a regular medical license, except that the applicant will not be required to demonstrate the maintenance of an active clinical practice prior to applying for an administrative medical license.

The holder of an administrative medical license is subject to the same rules and regulations as those holding a regular medical license, including the regulations governing license renewal, fees, continuing medical education, and discipline.

History: Effective January 1, 2018; amended effective April 1, 2024.

General Authority: NDCC 43-17-07.1(10)

Law Implemented: NDCC 43-17-07.1(8)

Chapter 50-02-03 Examinations

N.D. Admin. Code 50-02-03-01 Medical licensure examination

Those applicants for licensure who have obtained a passing score on the FLEX (federation licensing examination), the NBME (national board of medical examiners) examination, the USMLE (United States medical licensing examination), the LMCC (licentiate of the medical council of Canada) examination, the NBOME (national board of osteopathic medical examiners) examination, or the COMLEX (comprehensive osteopathic medical licensing examination) shall be deemed to have met the medical licensure examination requirement specified in subdivision a of subsection 1 of North Dakota Century Code section 43-17-18.

History

• History: Amended effective May 1, 2002; April 1, 2024.
• General Authority: NDCC 43-17-07.1(1)
• Law Implemented: NDCC 43-17-18

N.D. Admin. Code 50-02-03-02 Effect of passage of parts of national board

Repealed effective December 1, 1988.

Chapter 50-02-04 National Board of Examiners for Osteopathic Physicians and Surgeons, Inc. [Repealed]

N.D. Admin. Code 50-02-04 National Board of Examiners for Osteopathic Physicians and Surgeons, Inc. [Repealed]

CHAPTER 50-02-04

NATIONAL BOARD OF EXAMINERS FOR OSTEOPATHIC PHYSICIANS AND SURGEONS,

INC. [Repealed effective May 1, 2002]

Chapter 50-02-05 Graduates of Foreign Medical Schools

N.D. Admin. Code 50-02-05-01 Standard certificate from educational commission required

All applicants for licensure who are graduates of foreign medical schools, except the medical schools of the United Kingdom, Australia, and New Zealand, are required to present a valid certification status from the educational commission for foreign medical graduates. This requirement does not apply to applicants who were first licensed to practice medicine in the United States prior to the availability of the educational commission for foreign medical graduates examination. This requirement does not apply to applicants for licensure who graduated from an accredited medical school of Canada prior to June 30, 2025.

History

• History: Amended effective April 1, 1996; October 1, 2022; April 1, 2024; January 1, 2026.
• General Authority: NDCC 43-17-18
• Law Implemented: NDCC 43-17-18

N.D. Admin. Code 50-02-05-02 Requirements for licensure by reciprocity or endorsement

N.D. Admin. Code 50-02-05-03 American specialty board certificate requirements

N.D. Admin. Code 50-02-05-04 Canadian medical school graduate licensure by endorsement

N.D. Admin. Code 50-02-05-05 Licentiates of medical council of Canada accepted by endorsement

Repealed effective May 1, 2002.

N.D. Admin. Code 50-02-05-06 FLEX examination requirements

Repealed effective November 1, 1995.

N.D. Admin. Code 50-02-05-07 Passing requirements for FLEX examination

N.D. Admin. Code 50-02-05-08 Fees for examination

Repealed effective December 1, 1988.

N.D. Admin. Code 50-02-05-09 Exception to statutory qualifications for license - When available

Repealed effective December 1, 2000.

Chapter 50-02-06 American Students in Foreign Medical Schools [Repealed]

N.D. Admin. Code 50-02-06 American Students in Foreign Medical Schools [Repealed]

CHAPTER 50-02-06

AMERICAN STUDENTS IN FOREIGN MEDICAL SCHOOLS [Repealed effective October 1, 2022.]

Chapter 50-02-07 License Fees [Repealed]

N.D. Admin. Code 50-02-07 License Fees [Repealed]

CHAPTER 50-02-07

LICENSE FEES [Repealed effective January 1, 2010]

Chapter 50-02-07.1 Physician License Fees

N.D. Admin. Code 50-02-07.1 Physician License Fees

CHAPTER 50-02-07.1

PHYSICIAN LICENSE FEES

Section 50-02-07.1-01License Fees 50-02-07.1-02Unlicensed Practice Fees 50-02-07.1-02.1Arrearage 50-02-07.1-03Administrative Sanctions 50-02-07.1-01. License fees.

The fee for licensure in North Dakota, whether it be by qualification, compact, locum tenens, or special license, is two hundred dollars per year. The fee to convert from a locum tenens license to permanent licensure status is two hundred dollars.

History: Effective January 1, 2010; amended effective October 1, 2011; October 1, 2022.

General Authority: NDCC 43-17-27.1

Law Implemented: NDCC 43-17-25 50-02-07.1-02. Unlicensed practice fees.

A physician seeking to renew a license who has failed to complete the registration process within three years from the expiration date must be assessed a fee equal to five hundred dollars, in addition to such other penalties as are authorized by law, if that physician is found to have been practicing medicine in this state after the physician's license expired.

History: Effective January 1, 2010; amended effective October 1, 2022; April 1, 2024.

General Authority: NDCC 43-17-25, 43-17-26.1

Law Implemented: NDCC 43-17-26.1 50-02-07.1-02.1. Arrearage.

A physician whose license has expired may renew the expired license upon payment of two hundred dollars per year, up to three years, for each year past the renewal deadline.

History: Effective October 1, 2022.

General Authority: NDCC 43-17-25

Law Implemented: NDCC 43-17-26.1 50-02-07.1-03. Administrative sanction.

An administrative sanction must be imposed in the amount of five hundred dollars for any applicant or licensed physician who provides false or deceptive information with regard to any material fact concerning eligibility for initial licensure or renewal after verifying or certifying that the information provided is true. This includes all material information provided in an initial license application, an annual registration renewal, or a report of compliance with mandatory continuing education requirements.

The imposition of an administrative sanction under this section is not a disciplinary action of the board; however, it does not preclude the board from also imposing disciplinary action, or other penalties provided by law, for the same conduct in appropriate cases.

An applicant or licensed physician may challenge the imposition of an administrative sanction under this section in a hearing under North Dakota Century Code chapter 28-32 before an administrative law judge.

History: Effective January 1, 2010; amended effective April 1, 2024.

General Authority: NDCC 43-17-07.1(3)

Law Implemented: NDCC 43-17-25

Chapter 50-02-08 Credentials Committee [Repealed]

N.D. Admin. Code 50-02-08 Credentials Committee [Repealed]

CHAPTER 50-02-08

CREDENTIALS COMMITTEE [Repealed effective July 1, 1988]

Chapter 50-02-09 Informal Disciplinary Action [Repealed]

N.D. Admin. Code 50-02-09 Informal Disciplinary Action [Repealed]

CHAPTER 50-02-09

INFORMAL DISCIPLINARY ACTION [Repealed effective December 1, 1988]

Chapter 50-02-10 Patient Records [Repealed]

N.D. Admin. Code 50-02-10 Patient Records [Repealed]

CHAPTER 50-02-10

PATIENT RECORDS [Repealed effective October 1, 2022.]

Chapter 50-02-11 Examinations

N.D. Admin. Code 50-02-11-01 Eligibility for examination

To be eligible for steps 1 and 2 of USMLE (United States medical licensing examination), the applicant must be in one of the following categories:

1.A medical student officially enrolled in, or a graduate of, a United States or Canadian medical school accredited by the liaison committee on medical education (LCME).

2.A medical student officially enrolled in, or a graduate of, a United States osteopathic medical school accredited by the American osteopathic association (AOA).

3.A medical student officially enrolled in, or a graduate of, a foreign medical school and eligible for examination by the educational commission for foreign medical graduates (ECFMG) for its certificate.

To be eligible for USMLE step 3, the applicant must (a) have obtained the MD degree or the DO degree; and (b) have completed successfully both parts I and II of the national board examination or steps 1 and 2 of the USMLE or part I and step 2 or step 1 and part II or FLEX component 1.

December 1, 2000; July 26, 2001; March 1, 2003; October 1, 2022.

History

• History: Effective November 1, 1993; amended effective November 1, 1995; December 1, 1996;

N.D. Admin. Code 50-02-11-02 Successful completion of examination - Time limitation

Repealed effective April 1, 2020.

N.D. Admin. Code 50-02-11-03 Limitation on attempts at examination passage

Repealed effective August 1, 2003. 50-02-11-03.1. Limitation on attempts at examination passage.

1.An applicant is permitted a maximum of three attempts to pass each step or part or component of a licensing examination. This rule does not apply to an individual who required more than three attempts to pass USMLE step 1 or USMLE step 2 if that individual was enrolled in a postgraduate training program in North Dakota prior to July 10, 2005, and if:

a.The individual is still enrolled in the program when the application for licensure is submitted to the board's office; or

b.The individual has completed the program successfully.

Parts, steps, and components may not be combined so as to enlarge the number of attempts permitted under this rule.

2.Upon review of an individual applicant, the board may allow an exception to this rule if it finds that it is in the best interest of the state and the applicant:

a.Is validly licensed as a physician in another state;

b.Has practiced a minimum of five years;

c.Has no disciplinary actions imposed by any other state medical licensing board within the last ten years immediately preceding the date of application; and

d.Is certified by a specialty board recognized by the American board of medical specialties or by the royal college of physicians and surgeons of Canada.

3.Upon review of an individual applicant, the board may allow an exception to this rule if it finds it is in the best interest of the state and the applicant shows a documented disability as determined by the board.

April 1, 2024.

History

• History: Effective June 1, 2005; amended effective October 1, 2011; April 1, 2020; October 1, 2022;

N.D. Admin. Code 50-02-11-04 Examination combinations acceptable

Any applicant who has successfully completed part I (NBME) or step 1 (USMLE) plus part II or step 2 plus part III or step 3; or FLEX component 1 plus step 3; or part I or step 1, plus part II or step 2, plus FLEX component 2 shall be deemed to have successfully completed a medical licensure examination as required by subsection 4 of North Dakota Century Code section 43-17-18, if such combination of testing was completed before January 1, 2000. The acceptable combinations include:

1.USMLE step 1 + USMLE step 2 + USMLE step 3;

2.NBME part I + NBME part II + NBME part III;

3.FLEX component 1 + FLEX component 2;

4.USMLE step 1 + NBME part II + NBME part III;

5.USMLE step 1 + USMLE step 2 + NBME part III;

6.USMLE step 1 + NBME part II + USMLE step 3;

7.NBME part I + USMLE step 2 + USMLE step 3;

8.NBME part I + USMLE step 2 + NBME part III;

9.NBME part I + NBME part II + USMLE step 3;

10.FLEX component 1 + USMLE step 3;

11.FLEX component 2 + USMLE step 1 + NBME part II;

12.FLEX component 2 + USMLE step 1 + USMLE step 2;

13.FLEX component 2 + NBME part I + USMLE step 2; or

14.FLEX component 2 + NBME part I + NBME part II.

History

• History: Effective November 1, 1993; amended effective November 1, 1995; October 1, 2022.

Chapter 50-02-12 Notice of Denial or Limitation of Licensure

N.D. Admin. Code 50-02-12-01 Notice of denial or limitation of licensure

In the event the board makes an initial determination that an applicant does not meet the requirements for licensure, or that an applicant should be granted a limited or conditioned license, the board shall promptly give the applicant notice, personally or by certified mail, that it has made an informal decision to deny the application or to place conditions or limitations on the applicant's license.

The board shall also advise the applicant as follows:

1.The applicant has the right to have the merits of the application considered at a formal hearing in accordance with the provisions of the North Dakota Administrative Agencies Practices Act, North Dakota Century Code chapter 28-32.

2.To secure a formal hearing on the merits of the application, the applicant must contact the board to request the hearing within thirty days of being given notice of the board's informal decision.

In the event an applicant does not request a formal hearing within thirty days of the date on which the applicant is given notice that the board has made an informal decision to deny the application or to place conditions or limitations on the applicant's license, then the board's informal decision will become the final order of the board.

History

• History: Effective April 1, 1999; amended effective October 1, 2022.
• General Authority: NDCC 43-17-18
• Law Implemented: NDCC 43-17-18

Chapter 50-02-13 Resident Licensure

N.D. Admin. Code 50-02-13-01 Definitions

As used in this chapter:

1."Approved postgraduate training program" means a postgraduate training program approved by the accreditation council for graduate medical education.

2."Board" means the North Dakota board of medicine.

3."Resident" means a person who is enrolled in an approved postgraduate training program.

History

• History: Effective May 1, 2000; amended effective April 1, 2024.

N.D. Admin. Code 50-02-13-02 License requirement

A person may not participate in an approved postgraduate training program in this state unless that person has first been granted a license by the board.

The provisions of section 50-02-13-02 notwithstanding, a resident who is enrolled in an approved postgraduate training program in another state may complete a rotation in this state without obtaining a North Dakota license if:

1.The out-of-state postgraduate training program is accredited by the accreditation council for graduate medical education;

2.Participation in the North Dakota rotation is an official component of the participant's postgraduate training program;

3.The North Dakota rotation will be completed within ninety days or less; and

4.The participant holds a valid unencumbered license to participate in postgraduate training programs in the state in which the participant's postgraduate training program is located. If that state does not require residents to hold a license, then the individual must obtain a North Dakota license before beginning the rotation in this state.

The director of the postgraduate training program shall provide written notice to the board with the names of individuals and the state of licensure who are practicing under this exception within twenty days.

History

• History: Effective May 1, 2000; amended effective October 1, 2022; April 1, 2024. 50-02-13-02.1. License requirement - Exception.
• History: Effective November 1, 2002; amended effective October 1, 2022; April 1, 2024.

N.D. Admin. Code 50-02-13-03 Qualifications

The board may issue an approved postgraduate training license to an applicant who meets each of the following requirements:

1.The applicant is enrolled in an approved postgraduate training program within the state of North Dakota;

2.The applicant meets all qualifications for permanent licensure except those requirements pertaining to postgraduate training and the examination requirement specified in North Dakota Century Code section 43-17-18; and

3.The applicant has paid the prescribed fee.

History

• History: Effective May 1, 2000; amended effective October 1, 2022; April 1, 2024.

N.D. Admin. Code 50-02-13-04 Applications

Applications for a postgraduate training license or the annual renewal of an approved postgraduate training license must be submitted to the office of the board upon such forms as are supplied by the board or otherwise approved by the board. The board may require any applicant to appear for an interview regarding the applicant's qualifications for licensure. The board shall establish a policy setting forth the criteria used in determining which applicants will be required to appear for such interviews.

History

• History: Effective May 1, 2000; amended effective October 1, 2022; April 1, 2024.

N.D. Admin. Code 50-02-13-05 Scope of practice

A postgraduate training license only authorizes the person receiving that license to practice within the context of an approved postgraduate training program and does not authorize that person to engage in the private practice of medicine or otherwise practice medicine outside the scope of the postgraduate training program.

History

• History: Effective May 1, 2000; amended effective April 1, 2024.

N.D. Admin. Code 50-02-13-06 Discipline

Individuals who have been granted an approved postgraduate training license are subject to the board's disciplinary authority as specified in North Dakota Century Code chapters 43-17 and 43-17.1 and a postgraduate training license may be revoked if:

1.The individual to whom that license was issued ceases to be enrolled in a postgraduate training program in this state; or

2.The individual to whom that license was issued engages in the practice of medicine outside the scope of a postgraduate training program.

Upon verification under section 50-02-13-08 that a resident has been terminated or resigned from the postgraduate training program, the license automatically expires. The expiration of a resident's license does not preclude the board from taking disciplinary action as provided in this section.

History

• History: Effective May 1, 2000; amended effective October 1, 2022; April 1, 2024.

N.D. Admin. Code 50-02-13-07 Period of licensure

A postgraduate training license may, in the discretion of the board, be issued for a period of one or more years. However, in no event shall the license be issued for a period of time exceeding the date on which the applicant is reasonably expected to complete the approved postgraduate training program for which the license is being issued.

In the event a license is issued for a period of time exceeding one year, the board may nevertheless require the licensee to periodically supply information to the board regarding the licensee's credentials and ability to practice in a competent and safe manner. Failure to provide that information to the board will constitute a violation of subdivision bb of subsection 1 of North Dakota Century Code section 43-17-31.

The board may issue a temporary postgraduate training license to allow the applicant to participate in an approved postgraduate training between the time the application is submitted to the board's office and the time of the next meeting of the board. A temporary postgraduate training license may not be issued if the application file contains significant derogatory information.

History

• History: Effective May 1, 2000; amended effective April 1, 2006; October 1, 2022; April 1, 2024.

N.D. Admin. Code 50-02-13-08 Reporting requirements

A person holding a postgraduate training license is subject to the mandatory reporting requirements specified in North Dakota Century Code section 43-17.1-05.1. In addition to the requirements imposed under North Dakota Century Code section 43-17.1-05.1, a postgraduate training licensee and the director of each postgraduate training program must report within ten days the following circumstances to the board's investigative panels:

1.The termination or resignation of a resident for any reason, including poor academic performance.

2.The imposition of sanctions against a resident for reasons other than poor academic performance.

History

• History: Effective May 1, 2000; amended effective October 1, 2022; April 1, 2024.

N.D. Admin. Code 50-02-13-09 Fees

The fee for a postgraduate training license is one hundred dollars for the duration of the postgraduate training program. That fee shall be paid in full at the time the license is issued.

History

• History: Effective May 1, 2000; amended effective April 1, 2006; July 1, 2013; April 1, 2024.

Chapter 50-02-14 Renewal of Licenses

N.D. Admin. Code 50-02-14-01 Renewal of licenses

Provided that all renewal requirements are deemed by the board to be met, a physician who applies for renewal of the physician's medical license within thirty-one days of the expiration date of that license shall be granted a license with an effective date of the first day following expiration of the physician's license. Nothing in this rule shall be construed to affect the board's ability to impose statutory fines or other disciplinary action against physicians for failing to renew a medical license prior to its expiration date or for practicing medicine with an expired license.

History

• History: Effective January 1, 2010.
• General Authority: NDCC 43-17-07.1
• Law Implemented: NDCC 43-17-24

Chapter 50-02-15 Telemedicine

N.D. Admin. Code 50-02-15-01 Definitions

As used in this chapter:

1."Telemedicine" means the practice of medicine using electronic communication, information technologies, or other means between a licensee in one location and a patient in another location, with or without an intervening health care provider. It includes direct interactive patient encounters as well as asynchronous store-and-forward technologies and remote monitoring.

2."Licensee" means a physician or physician assistant licensed to practice in North Dakota. A physician assistant practicing telemedicine from another state is subject to the rules regarding physician collaboration, except that collaboration must be by a North Dakota licensed physician who is practicing telemedicine in North Dakota and need not be by a North Dakota licensed physician who is physically located in North Dakota.

History

• History: Effective January 1, 2018; amended effective October 1, 2022.
• General Authority: NDCC 43-17-01(6)
• Law Implemented: NDCC 43-17-01, 43-17-44

N.D. Admin. Code 50-02-15-02 Prescribing

A licensee who has performed a telemedicine examination or evaluation meeting the requirements of this chapter may prescribe medications according to the licensee's professional discretion and judgment. Opioids may only be prescribed through telemedicine if done so as a federal food and drug administration-approved medication-assisted treatment for opioid use disorder. Opioids may not be prescribed through a telemedicine encounter for any other purpose.

Licensees who prescribe controlled substances, as defined by North Dakota law, in circumstances allowed under this rule, must comply with all state and federal laws regarding the prescribing of controlled substances, and must participate in the North Dakota prescription drug monitoring program.

History

• History: Effective January 1, 2018.
• General Authority: NDCC 43-17-45
• Law Implemented: NDCC 19-02.1-15.1, 19-03.1-22.4, 19-03.5-09, 43-17-45

N.D. Admin. Code 50-02-15-03 Exceptions

A physician who holds an active, unrestricted license in good standing to practice medicine or osteopathy in any state or territory of the United States, the District of Columbia, or a province of Canada, may practice medicine or osteopathy in this state via telehealth without first obtaining a license from the North Dakota board of medicine if one of the following applies:

1.A physician who has established a patient-provider relationship in another state with a patient who is a resident of North Dakota may provide continued care to the patient via telehealth without obtaining a North Dakota physician license subject to the following:

a.The provider-patient relationship must have been established in a state in which the physician is licensed;

b.Subsequent care may be provided to the patient via telehealth while the patient is in North Dakota if the care is logical and expected continuation of care previously provided in the state where the physician is licensed. If the patient is presenting with new medical conditions, or conditions for which the standard of care dictates an in-person encounter is needed, the patient shall return to the state in which the physician is licensed for care or must be referred to a North Dakota licensed health care provider; and

c.The telehealth care provided to a patient located in North Dakota may continue for up to one year after establishment of the provider-patient relationship in another state, after which an encounter must take place in a jurisdiction where the physician is licensed before the telehealth may resume for another one year.

2.Temporary care may be provided if a physician has an established patient-provider relationship with an individual who is in North Dakota temporarily for business, work, education, vacation, or other reasons and the individual requires health care services from that primary provider.

3.A physician may provide health care services in preparation for a scheduled in-person care visit.

4.A physician licensed in another state may consult using telemedicine or other means with a North Dakota licensed physician who has been and remains responsible for the diagnosis and treatment of the patient within the state and requests the consultation.

5.A physician may provide gratuitous service in the case of an emergency.

By engaging in virtual care with a patient located in North Dakota, a provider exempted from North Dakota licensure under this section consents to the applicable North Dakota laws, rules, and regulations governing the provider's profession, including sections 43-17-44 and 43-17-45 of the North Dakota Century Code, this title, North Dakota community standards of care, and the jurisdiction of the board, including the board's disciplinary process.

History

• History: Effective January 1, 2025.
• General Authority: NDCC 43-17-07.1(10)
• Law Implemented: NDCC 43-17-02.3(5)

Article 50-03 Physician Assistants

Chapter 50-03-01 Physician Assistants

N.D. Admin. Code 50-03-01-01 Description and authority of physician assistant. 50-03-01-01.1. Description and scope of practice of the physician assistant

The physician assistant is a medical professional qualified by academic and clinical training to provide patient services, including the diagnosing of illnesses, developing and managing treatment plans, prescribing medications, and often serving as a patient's principal health care provider in collaboration with physicians and other health care providers.

1.A physician assistant may:

a.Provide a legal medical service for which a physician assistant is prepared by education, training, and experience and is competent to perform, including:

(1)Obtaining and performing a comprehensive health history and physical examination;

(2)Evaluating, diagnosing, managing, and providing medical treatment;

(3)Ordering and evaluating a diagnostic study and therapeutic procedure;

(4)Performing a diagnostic study or therapeutic procedure not involving the use of medical imaging as defined in North Dakota Century Code section 43-62-01 or radiation therapy as defined in North Dakota Century Code section 43-62-01;

(5)Performing limited sonography on a focused imaging target to assess specific and limited information about a patient's medical condition or to provide real-time visual guidance for another procedure;

(6)Educating a patient on health promotion and disease prevention;

(7)Providing consultation upon request; and (8)Writing a medical order;

b.Obtain informed consent;

c.Supervise, delegate, and assign therapeutic and diagnostic measures not involving the use of medical imaging as defined in North Dakota Century Code section 43-62-01 or radiation therapy as defined in North Dakota Century Code section 43-62-01 to licensed or unlicensed personnel;

d.Certify the health or disability of a patient as required by any local, state, or federal program;

e.Authenticate any document with the signature, certification, stamp, verification, affidavit, or endorsement of the physician assistant if the document may be authenticated by the signature, certification, stamp, verification, affidavit, or endorsement of a physician; and

f.Pronounce death.

2.A physician assistant:

a.May prescribe, dispense, administer, and procure drugs and medical devices;

b.May plan and initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including durable medical equipment, nutrition, blood and blood products, and diagnostic support services, including home health care, hospice, and physical and occupational therapy;

c.May prescribe and dispense schedule II through V substances as designated by the federal drug enforcement administration and all legend drugs;

d.May not dispense a drug, unless pharmacy services are not reasonably available, dispensing is in the best interest of the patient, or an emergency exists;

e.May request, receive, and sign for a professional sample, and may distribute a professional sample to a patient; and

f.If prescribing or dispensing a controlled substance, shall register with the federal drug enforcement administration and shall comply with appropriate state and federal laws.

N.D. Admin. Code 50-03-01-02 Licensure requirements

An applicant for licensure shall file a written application, on a form provided by the board, showing to the board's satisfaction the applicant satisfies the requirements for licensure, including:

1.Satisfactory proof of graduation from a physician assistant program for physician assistants accredited by the accreditation review commission on education for the physician assistant or other entity as approved by the board;

2.Successful passage of the certifying examination of the national commission on certification of physician assistants or other certifying examinations approved by the North Dakota board of medicine. The physician assistant must maintain certification with the national commission on certification of physician assistants or other certifying entity approved by the board during the entire period of licensure;

3.Payment of the fee as required by section 50-03-01-13;

4.Submission to a statewide and nationwide criminal history record check pursuant to subsection 4 of North Dakota Century Code section 43-17-07.1; and

5.A history free of any finding by the board, any other state medical licensure board, or any court of competent jurisdiction, of the commission of any act that would constitute grounds for disciplinary action.

History

• History: Amended effective July 1, 1988; November 1, 1993; January 1, 2020; October 1, 2022; April 1, 2024; January 1, 2025.

N.D. Admin. Code 50-03-01-03 Supervision contract requirements. 50-03-01-03.1. Collaboration with physicians and other health care providers

A physician assistant shall collaborate with, consult with, or refer to the appropriate member of the health care team as indicated by the condition of the patient, the education, experience, and competence of the physician assistant, and the standard of care. The degree of collaboration must be determined at the practice which may include decisions made by the employer, group, hospital service, and the credentialing and privileging systems of a licensed facility. A physician assistant is responsible for the care provided by that physician assistant and a written agreement is not required. 50-03-01-03.2. Practice requirements.

1.A physician assistant shall practice at a:

a.Health care facility licensed by the department of health and human services;

b.Facility with a credentialing and privileging system; or

c.Physician-owned facility or practice.

2.If a physician assistant is not practicing at a facility under subsection 1 or at a correctional, state, or federal facility, the physician assistant may apply to the board for approval to practice independently with the following criteria:

a.The practice is at a physical location in a rural, medically underserved area in North Dakota as determined by the board;

b.Collaboration with a North Dakota-licensed physician who will perform chart reviews at periodic intervals as required by the board; and

c.If a physician assistant has less than four thousand hours of practice experience and seeks to practice at a facility or practice that is not a licensed health care facility, a facility with a credentialing and privileging system, or a physician-owned facility or practice, the physician assistant must execute a written collaborative agreement with a North Dakotalicensed physician that describes how collaboration with that physician will occur and provide it to the board upon request.

3.A physician assistant shall comply with any privileging and credentialing systems at the facility at which the physician assistant practices.

History

• History: Effective January 1, 2020; amended effective October 1, 2022.

N.D. Admin. Code 50-03-01-04 Supervising physician's responsibility

N.D. Admin. Code 50-03-01-05 Designation of substitute supervising physician

N.D. Admin. Code 50-03-01-06 Assistant's functions limited

N.D. Admin. Code 50-03-01-07 Drug therapy

Repealed effective January 1, 2010. 50-03-01-07.1. Medication dispensation.

N.D. Admin. Code 50-03-01-08 Assignment of tasks by supervising physician

Repealed effective July 1, 1988.

N.D. Admin. Code 50-03-01-09 Number of assistants under physician's supervision limited

Repealed effective January 1, 2010. 50-03-01-09.1. Physician assistant for more than one physician. 50-03-01-09.2. Physician assistants under physician's supervision.

N.D. Admin. Code 50-03-01-10 Assistant's services limited

Repealed effective July 1, 1988. 50-03-01-10.1. Disciplinary action.

The board is authorized to take disciplinary action against a licensed physician assistant in accordance with North Dakota Century Code chapter 43-17.1 by any one or more of the following means, as it may find appropriate:

1.Revocation of license.

2.Suspension of license.

3.Probation.

4.Imposition of stipulations, limitations, or conditions relating to the duties of a physician assistant.

5.Letter of censure.

6.Require the licensee to provide free public or charitable service for a defined period.

7.Impose fines, not to exceed five thousand dollars for any single disciplinary action. Any fines collected by the North Dakota board of medicine must be deposited in the state general fund.

In any order or decision issued by the board in resolution of a disciplinary proceeding in which disciplinary action is imposed against a physician assistant, the board may direct any physician assistant to pay the board a sum not to exceed the reasonable and actual costs, including reasonable attorney's fees, incurred by the board and its investigative panels of the board in the investigation and prosecution of the case. If applicable, the physician assistant's license may be suspended until the costs are paid to the board. A physician assistant may challenge the reasonableness of any cost item in a hearing under North Dakota Century Code chapter 28-32 before an administrative law judge. The administrative law judge may approve, deny, or modify any cost item, and the determination of the judge is final. The hearing must occur before the physician assistant's license may be suspended for nonpayment.

History

• History: Effective August 1, 2002; amended effective October 17, 2002; October 1, 2022; April 1, 2024. 50-03-01-10.2. Disciplinary proceedings.
• History: Effective January 1, 2020; amended effective October 1, 2022; April 1, 2024.

N.D. Admin. Code 50-03-01-11 Grounds for disciplinary action

The board may deny an application for licensure or may take disciplinary action against a physician assistant upon any of the following grounds:

1.Failing to demonstrate the qualifications for licensure under this act or the regulations of the board.

2.Soliciting or receiving any form of compensation from any person other than the physician assistant's employer or third-party payer for services performed as a physician assistant.

3.The use of any false, fraudulent, or forged statement or document or the use of any fraudulent, deceitful, dishonest, or immoral practice in connection with any of the licensing requirements.

4.The making of false or misleading statements about the physician assistant's skill or the efficacy of any medicine, treatment, or remedy.

5.The conviction of any misdemeanor, determined by the board to have a direct bearing upon a person's ability to serve the public as a physician assistant, or any felony. A license may not be withheld contrary to the provisions of North Dakota Century Code chapter 12.1-33.

6.Use of alcohol or drugs to such a degree as to interfere with the licensee's ability to safely practice medicine.

7.Physical or mental disability materially affecting the ability to perform the duties of a physician assistant in a competent manner.

8.Aiding or abetting the practice of medicine by a person not licensed by the board or by an incompetent or impaired person.

9.Gross negligence in the performance of the person's duties as a physician assistant.

10.Manifest incapacity or incompetence to perform as a physician assistant.

11.The willful or negligent violation of the confidentiality between physician assistant and patient, except as required by law.

12.The performance of any dishonorable, unethical, or unprofessional conduct.

13.Obtaining any fee by fraud, deceit, or misrepresentation.

14.The violation of any provision of a physician assistant practice act or the rules and regulations of the board, or any action, stipulation, condition, or agreement imposed by the board or its investigative panels.

15.Representing himself or herself to be a physician.

16.The advertising of the person's services as a physician assistant in an untrue or deceptive manner.

17.Sexual abuse, misconduct, or exploitation related to the licensee's performance of the licensee's duties as a physician assistant.

18.The prescription, sale, administration, distribution, or gift of any drug legally classified as a controlled substance or as an addictive or dangerous drug for other than medically accepted therapeutic purposes.

19.The failure to comply with the reporting requirements of North Dakota Century Code section 43-17.1-05.1.

20.A continued pattern of inappropriate care as a physician assistant.

21.The use of any false, fraudulent, or deceptive statement in any document connected with the performance of the person's duties as a physician assistant.

22.The prescribing, selling, administering, distributing, or giving to oneself or to one's spouse or child any drug legally classified as a controlled substance or recognized as an addictive or dangerous drug.

23.The violation of any state or federal statute or regulation relating to controlled substances.

24.The imposition by another state or jurisdiction of disciplinary action against a license or other authorization to perform duties as a physician assistant based upon acts or conduct by the physician assistant that would constitute grounds for disciplinary action as set forth in this

section. A certified copy of the record of the action taken by the other state or jurisdiction is conclusive evidence of that action.

25.The lack of appropriate documentation in medical records for diagnosis, testing, and treatment of patients.

26.The failure to furnish the board or the investigative panel, their investigators or representatives, information legally requested by the board or the investigative panel.

27.Noncompliance with the physician health program established under North Dakota Century Code chapter 43-17.3.

History

• History: Amended effective July 1, 1988; November 1, 1993; April 1, 1996; October 1, 1999; August 1, 2002; January 1, 2020; April 1, 2024.

N.D. Admin. Code 50-03-01-12 Physician's delegation to qualified person not restricted

Repealed effective April 1, 1999.

N.D. Admin. Code 50-03-01-13 Fees

The fee for initial licensure of a physician assistant is fifty dollars per year. The renewal fee is fifty dollars per year. The fee for license verification is thirty dollars.

History

• History: Effective July 1, 1988; amended effective November 1, 1993; December 1, 1996; October 1, 1999; January 1, 2020; October 1, 2022; April 1, 2024.

N.D. Admin. Code 50-03-01-14 License renewal requirements

The physician assistant's license renewal application must be accompanied with evidence of current certification by the national commission on certification of physician assistants or other certifying entity approved by the board.

History

• History: Effective August 1, 1989; amended effective November 1, 1993; October 1, 1999; July 1, 2013; January 1, 2020; October 1, 2022; April 1, 2024.

N.D. Admin. Code 50-03-01-15 Forms of licensure

The North Dakota board of medicine may recognize the following forms of licensure for a physician assistant and may issue licenses accordingly:

1.Permanent licensure - which will continue in effect so long as the physician assistant meets all requirements of the board.

2.Locum tenens permit - which may be issued for a specific health care facility and for a period not to exceed three months.

History

• History: Effective July 1, 1994; amended effective October 1, 1999; October 1, 2022; April 1, 2024.

N.D. Admin. Code 50-03-01-16 Renewal of licenses

Provided that all renewal requirements are deemed by the board to be met, a physician assistant who applies for renewal of a physician assistant license within thirty-one days of the expiration date of that license shall be granted a license with an effective date of the first day following expiration of the physician assistant's license. Nothing in this rule shall be construed to affect the board's ability to impose statutory fines or other disciplinary action against a physician assistant for failing to renew a license prior to its expiration date or for practicing with an expired license. A physician assistant whose license lapsed more than three years before the physician assistant petitioned the board for reinstatement shall submit a new application for licensure.

History

• History: Effective October 1, 2011; amended effective October 1, 2022; April 1, 2024.

N.D. Admin. Code 50-03-01-17 Late fees

A physician assistant seeking to renew the license who has failed to complete the annual registration process within three years from the expiration date must be assessed a fee of two hundred and fifty dollars, in addition to such other penalties as are authorized by law, if that physician assistant is found to have been practicing in this state after the physician assistant's license expired. A physician assistant may renew the expired license upon payment of fifty dollars per year, up to three years, for each year past the renewal deadline.

History

• History: Effective October 1, 2011; amended effective October 1, 2022; April 1, 2024.

N.D. Admin. Code 50-03-01-18 Physician assistant - Use of certain words or initials prohibited

A person that is not a physician assistant may not represent oneself as a physician assistant or act as a physician assistant or use any combination or abbreviation of the term or title "physician assistant" or "PA" to indicate or imply the person is a physician assistant. However, an individual who is not licensed as a physician assistant under this chapter but who meets the qualifications for licensure as a physician assistant under this chapter may use the title "physician assistant'' or "PA" but may not act or practice as a physician assistant unless licensed under this chapter.

History

• General Authority: NDCC 43-17-02.2
• Law Implemented: NDCC 43-17-02.2

N.D. Admin. Code 50-03-01-19 Physician assistant - Reporting requirements

A physician assistant is subject to the mandatory reporting requirements specified in North Dakota Century Code section 43-17.1-05.1. In addition to the requirements imposed under North Dakota Century Code section 43-17.1-05.1, the physician assistant must report to the board within ten days if the individual no longer holds a valid certification from the national commission on certification of physician assistants. Upon verification that the physician assistant no longer holds the certification, the license automatically expires. The expiration of the physician assistant license under this section does not preclude the board from taking disciplinary action.

History

• History: Effective October 1, 2022; amended effective April 1, 2024.

N.D. Admin. Code 50-03-01-20 License for interval between board meetings

An officer of the board and the board's executive director or deputy executive director may issue a locum tenens license or a provisional temporary license to an applicant who is seeking a permanent North Dakota physician assistant license if in their judgment the applicant meets all of the requirements for licensure. The board's executive director or deputy executive director may issue a locum tenens license or a provisional temporary license if the application is routine, complete, and meets all other requirements for licensure. A provisional temporary license is valid from the date of issue until the time of the next regularly scheduled meeting of the board.

History

• History: Effective January 1, 2026.
• General Authority: NDCC 43-17-07.1(10)
• Law Implemented: NDCC 43-17-02.1(1), 43-51.1-03

Chapter 50-03-02 Technicians [Repealed]

N.D. Admin. Code 50-03-02 Technicians [Repealed]

CHAPTER 50-03-02

TECHNICIANS [Repealed effective October 1, 2022.]

Chapter 50-03-03 Emergency Medical Technicians [Repealed]

N.D. Admin. Code 50-03-03 Emergency Medical Technicians [Repealed]

CHAPTER 50-03-03

EMERGENCY MEDICAL TECHNICIANS [Repealed effective October 1, 2022.]

Chapter 50-03-04 Fluoroscopy Technologists [Repealed]

N.D. Admin. Code 50-03-04 Fluoroscopy Technologists [Repealed]

CHAPTER 50-03-04

FLUOROSCOPY TECHNOLOGISTS [Repealed effective January 1, 2020]

Article 50-04 Continuing Medical Education

Chapter 50-04-01 Continuing Medical Education Standards

N.D. Admin. Code 50-04-01-01 Requirements

Except as is otherwise specified in this chapter, every physician licensed to practice medicine in North Dakota shall complete no less than forty hours of board-approved continuing medical education (CME) every two years. One hour of credit will be allowed for each clock-hour of participation in approved continuing medical education activities.

History

• History: Effective November 1, 1998; amended effective April 1, 2024.

N.D. Admin. Code 50-04-01-02 Exceptions

The following physicians are not required to meet the requirements of this chapter.

1.Physicians who are enrolled in full-time graduate medical education programs (residencies and fellowships) which are accredited by the accreditation council on graduate medical education or the American osteopathic association.

2.Physicians who hold a locum tenens permit or a special license and physicians who have not renewed their licenses for the first time since being granted a regular permanent license by the board.

3.Physicians who have retired from the active practice of medicine. This exception is available only to retired physicians who have completely and totally withdrawn from the practice of medicine. Any physician seeking to be excused from completing CME requirements under this subsection must submit an affidavit to the North Dakota board of medicine (on the board's form) certifying that the physician will render no medical services during the term of the next CME reporting period.

4.The board may grant an extension of time or other waiver to a licensee who, because of prolonged illness or other extenuating circumstances, has been unable to meet the CME requirements.

5.Physicians who hold a current certification, maintenance of certification, or recertification by a member of the American board of medical specialties, the American osteopathic association, or the royal college of physician and surgeons of Canada at the time of the CME audit.

History

• History: Effective November 1, 1998; amended effective April 1, 2024.

N.D. Admin. Code 50-04-01-03 Credits accepted

The board accepts the following as meeting its requirements for board approval:

1.American medical association (AMA) physician's recognition award category 1 credit certified by continuing education providers who are accredited by:

a.The accreditation council for continuing medical education (ACCME); or

b.Organizations recognized by the ACCME as accrediters of CME for physicians.

2.American osteopathic association (AOA) category 1 credit certified by continuing education providers who are accredited by the AOA.

3.American academy of family physicians prescribed credit and American academy of family physicians elective credit which has been approved for category 1 credit by that organization.

4.Courses approved for section 1 credit as defined by the royal college of physicians and surgeons of Canada.

5.Other courses approved by the North Dakota board of medicine as being equivalent to AMA or AOA category 1 credit.

Except in the case of any requests submitted pursuant to subsection 5, it is the responsibility of the licensee to verify an appropriate credit designation with the source of the program, not with the board.

All licensees are encouraged to verify an appropriate credit designation before taking any particular course.

History

• History: Effective November 1, 1998; amended effective August 1, 2002.

N.D. Admin. Code 50-04-01-04 Compliance

1.All physicians will periodically be required to answer questions on the board's license renewal forms to establish compliance, or eligibility for an exception, pursuant to this chapter.

Physicians are not required to provide additional documentation of compliance with continuing education requirements unless specifically requested to do so by the board.

Any physician who is required to report CME credits after having been licensed to practice medicine in North Dakota for more than one year but less than two full years will be required to demonstrate completion of twenty hours of board-approved CME credits during that physician's initial CME reporting period.

False statements regarding satisfaction of continuing education requirements on the renewal form or on any documents connected with the practice of medicine may subject the licensee to disciplinary action by the board.

2.The board will audit randomly selected physicians to monitor compliance with the continuing medical education requirements. Any physician so audited will be required to furnish documentation of compliance including the name of the accredited CME provider, name of the program, hours of continuing medical education completed, dates of attendance, evidence of credit designation (i.e., category 1 designation, prescribed credit designation, etc.), and verification of attendance. Any physician who fails to provide verification of compliance with the CME requirements will be subject to a fee of five hundred dollars and possible revocation of licensure.

3.In order to facilitate the board's audits, every physician is required to maintain a record of all CME activities in which the physician has participated. Every physician must maintain those records for a period of at least one year following the time when those CME activities were reported to the board.

History

• History: Effective November 1, 1998; amended effective July 1, 2013; October 1, 2022; April 1, 2024.

Article 50-05 Prescriptive Practices

Chapter 50-05-01 Expedited Partner Therapy [Repealed]

N.D. Admin. Code 50-05-01 Expedited Partner Therapy [Repealed]

ARTICLE 50-05

PRESCRIPTIVE PRACTICES

Chapter 50-05-01Expedited Partner Therapy [Repealed] 50-05-02Prescription Drug Monitoring Program Rule

CHAPTER 50-05-01

EXPEDITED PARTNER THERAPY [Repealed effective October 1, 2022.]

Chapter 50-05-02 Prescription Drug Monitoring Program Rule

N.D. Admin. Code 50-05-02-01 Prescription drug monitoring program rule

1.Every practitioner who prescribes a controlled substance in North Dakota shall register with the prescription drug monitoring program. 2.a.When a practitioner determines that reported drugs will be prescribed to a patient for a period to exceed twelve weeks, the practitioner shall request a prescription drug monitoring program report for that patient and, at a minimum, at least semiannually thereafter.

b.This requirement does not apply to reported drugs prescribed to patients in a controlled setting in which the drugs are locked and administered to the patient, for example, admitted hospital or hospice patients, long-term care patients or group home residents.

3.In addition to those reports requested under subsection 2, practitioners shall request a prescription drug monitoring program report when it is documented in the prescribing practitioner's medical record for that patient that the patient exhibits signs associated with diversion or abuse, including:

a.Selling prescription drugs;

b.Forging or altering a prescription;

c.Stealing or borrowing reported drugs;

d.Taking more than the prescribed dosage of any reported drug;

e.Having a drug screen that indicates the presence of additional or illicit drugs;

f.Being arrested, convicted, or diverted by the criminal justice system for a drug-related offense;

g.Receiving reported drugs from providers not reported to the treating practitioner;

h.Having a law enforcement or health professional express concern about the patient's use of drugs.

i.Violating any prescribing agreement with the physician;

j.Frequently requests early refills of a reported drug for any reason;

k.Appears impaired or excessively sedated to the physician in any patient encounter; and

l.Has a history of drug abuse dependency.

4.A practitioner shall document the receipt and assessment of prescription drug monitoring program reports made under this rule.

History

• History: Effective January 1, 2018; amended effective October 1, 2022.
• General Authority: NDCC 19-03.5-09(2)
• Law Implemented: NDCC 19-03.5-09(2)

Article 50-06 Naturopathic Licensure

Chapter 50-06-01 Admission to Practice Naturopathic Medicine

N.D. Admin. Code 50-06-01-01 Definitions

Unless specifically stated otherwise, all definitions found in North Dakota Century Code chapter 43-58 are applicable to this title. In this title, unless the context or subject matter otherwise requires:

1."Administration" means the intradermal, intramuscular, intravenous, oral, rectal, subcutaneous, sublingual, topical, auricular, nasal, ocular, or vaginal routes of administration in accordance with naturopathic medical training.

2."Council" means the council on naturopathic medical education or its successor. The successor must be an accrediting agency recognized by the United States department of education.

3."In accordance with naturopathic medical training" means the practice of naturopathic medicine by means that are consistent with the education of an approved naturopathic medical college, are generally recognized as safe and effective, and generally considered to be within the accepted practice standards for the naturopathic profession.

4."Manipulation of the spine" means therapeutic osseous manipulation techniques to realign the cervical, thoracic, and lumbar vertebrae and sacrum.

5."National board" means the North American board of naturopathic examiners or its successor.

6."National board examinations" means the naturopathic physicians licensing examinations (NPLEX) or its successor.

7."Nondrug prescription device" includes diabetic supplies, intrauterine devices, cold lasers, orthotics, and transcutaneous electrical stimulation units.

8."Nonprescription topical drug" means a topical analgesic, antibacterial, antifungal, antiseptic, antipruritic, or hormone that is not a prescription drug.

9."Prescription drug" means a legend drug as defined by section 503(b) of the Act of Congress entitled the Federal Food, Drug and Cosmetic Act [21 U.S.C. 353 et seq.] and under its definitions its label is required to state "Rx only".

N.D. Admin. Code 50-06-01-02 Approval of schools

The board shall approve a naturopathic medical school if it meets the definition pursuant to North Dakota Century Code section 43-58-01 and is accredited by the council.

N.D. Admin. Code 50-06-01-03 Applications for licensure

Application must be made on the official form issued by the board.

1.Applicants seeking licensure pursuant to North Dakota Century Code section 43-58-05 must be considered when all of the following have been received:

a.A signed and dated completed official application form.

b.An official transcript of the national board examinations sent directly to the board from the national board verifying satisfactory passage of both part one and part two.

c.An official complete transcript sent directly to the board from the approved naturopathic medical school from which the applicant graduated verifying date of graduation and completion of clinical training.

d.The license fee.

2.Applicants seeking a license or limited license pursuant to North Dakota Century Code section 43-58-06 shall submit the following documents for consideration:

a.A signed and dated completed official application form.

b.An official school transcript verifying graduation from a school of naturopathy.

c.Documentation of supervised clinical training and practical postgraduate clinical experience, including dates, clinic contact information, and supervisor contact information for verification purposes.

d.Documentation of North Dakota residency throughout calendar year 2011.

e.Documentation of the practice of naturopathy in North Dakota in 2011.

f.The initial licensing fee.

History

• Law Implemented: NDCC 43-58-04, 43-58-05, 43-58-06

N.D. Admin. Code 50-06-01-04 Licensure by reciprocity

An application for license by reciprocity shall be considered by the board if the following conditions are met:

1.The candidate has graduated from and holds a degree from an approved naturopathic medical school.

2.The candidate holds a current valid license in good standing to practice as a naturopath in another state or jurisdiction. Official written verification of licensure status must be received by the board from the other state or jurisdiction.

3.The examination requirements of the other state or jurisdiction are substantially similar as in North Dakota.

4.The candidate has filed with the board an official application for licensure by reciprocity, a copy of the diploma from an approved naturopathic medical school, a copy of the current valid license, and the required initial licensure fee.

History

• Law Implemented: NDCC 43-58-07

N.D. Admin. Code 50-06-01-05 Photograph

An unmounted passport photograph of the applicant must be provided with the application. The photograph must have been taken within one year of the date of application.

N.D. Admin. Code 50-06-01-06 Examination requirements

1.Those applicants for licensure who have obtained a passing score on the naturopathic physicians licensing examinations (NPLEX) part one and part two or its successor must be deemed to have met the examination requirement specified in North Dakota Century Code

section 43-58-05.

2.The examination requirements for licensure must be successfully completed within four years from graduation. The board may grant an exception to this requirement for applicants who have concurrently pursued another graduate degree, and the applicant presents a verifiable, rational, and compelling explanation for not meeting the four-year time limit.

3.An applicant is permitted a maximum of three attempts to pass each part or component of the national board examination. Upon review of an individual applicant, the board may allow an exception to this rule if it if finds it is in the best interest of the state and the applicant shows a documented disability as determined by the board, or the applicant:

a.Is validly licensed as a naturopath in another state;

b.Has practiced a minimum of five years; and

c.Has no disciplinary actions imposed by any other state licensing board.

N.D. Admin. Code 50-06-01-07 License issued

When the board determines any candidate has successfully completed all requirements by law and

rule for licensure, the board shall issue to such candidate a license to practice naturopathy.

An officer of the board and the board's executive director or deputy executive director may issue a provisional temporary license to an applicant who is seeking a permanent North Dakota naturopathic license if in their judgment the applicant meets all the requirements for a license. The board's executive director or deputy executive director may issue a provisional temporary license if the application is routine, complete, and meets all other requirements for licensure. A provisional temporary license is valid from the date of issue until the time of the next regularly scheduled meeting of the board.

History

• History: Effective April 1, 2024; amended effective January 1, 2026.
• Law Implemented: NDCC 43-51.1-03, 43-58-05, 43-58-07

N.D. Admin. Code 50-06-01-08 Change of location - License displayed

Each licensed naturopath shall maintain a permanent electronic mail or mailing address with the board to which all communications from the board to the licensee will be sent. A licensee who changes an address shall notify the board in writing of the new contact information within thirty days. A current certificate or duplicate certificate issued by the board must be displayed at all times in each office location of the naturopath.

N.D. Admin. Code 50-06-01-09 License renewal

1.Every naturopath who has been licensed by the board shall renew the license by remitting a renewal fee on or before December thirty-first of each odd-numbered year and completing the renewal application provided by the board. For applicants who receive an initial license after July first in an odd-numbered year, the license will be deemed to be automatically renewed on December thirty-first for an additional two years without payment of an additional renewal fee.

2.The applicant for renewal shall certify on the renewal application that the continuing education requirements have been or will be met by December thirty-first. The applicant must keep records of completed continuing education. The board shall conduct random compliance audits of licensees. Failure to complete continuing education is considered unprofessional conduct.

3.A license renewal application received on or after January first of an even-numbered year is an expired renewal and requires the renewal fee plus a late fee set by the board. Proof of appropriate continuing education hours must be presented. A license that has not been renewed within two years of expiration is a lapsed license requiring submission of a new application for licensure.

N.D. Admin. Code 50-06-01-10 Expired licenses

Once a license has expired, the individual who held the license may not practice naturopathic medicine or use a title reserved under state law for individuals who are licensed by the board until the license is renewed or a new license is issued. An individual whose license has expired but who continues to practice naturopathic medicine or use a restricted title violates state law and this chapter.

Such a violation may be considered grounds for denying an application by the former licensee for renewal of the lapsed license or for a new license.

History

• Law Implemented: NDCC 43-58-11, 43-58-03, 43-58-03.1

N.D. Admin. Code 50-06-01-11 Fees

The board charges the following nonrefundable fees:

1.Initial license. The fee for application and an initial license is four hundred dollars. The licensing period is biennial, ending on December thirty-first every odd-numbered year.

2.Renewal. Licenses renew on December thirty-first every odd-numbered year. The renewal fee is four hundred dollars.

3.Late filing. A naturopath seeking to renew a license who has failed to complete the renewal process within two years from the expiration date must be a assessed a late fee of five hundred dollars in addition to the renewal fee and such other penalties as are authorized by law, if that naturopath is found to have been practicing in this state after the naturopath's license expired. A naturopath with an expired license who has not practiced without a license may renew their license within two years of the expiration date upon payment of the four hundred dollars renewal fee.

History

• Law Implemented: NDCC 43-58-03.1, 43-58-05

N.D. Admin. Code 50-06-01-12 Administrative sanction

An administrative sanction must be imposed in the amount of five hundred dollars for any applicant or licensed naturopath who provides false or deceptive information with regard to any material fact concerning eligibility for initial licensure or renewal after verifying or certifying that the information provided is true. This includes all material information provided in an initial license application, renewal, or report of compliance with mandatory continuing education requirements.

The imposition of the administrative sanction under this section is not disciplinary action of the board; however, it does not preclude the board from also imposing disciplinary action, or other penalties provided by law, for the same conduct in appropriate cases.

An applicant or licensed naturopath may challenge the imposition of an administrative sanction under this section under North Dakota Century Code chapter 28-32.

History

• Law Implemented: NDCC 43-58-03.1, 43-58-05

Chapter 50-06-02 Authority of Naturopaths

N.D. Admin. Code 50-06-02-01 Rights and privileges

Unless otherwise limited by statute, naturopaths are entitled to all rights and privileges of physicians in this state recognized under North Dakota Century Code section 43-58-09.

History

• Law Implemented: NDCC 43-58-08, 43-58-09, 43-58-10

N.D. Admin. Code 50-06-02-02 Signing death certificates

In case of the death of any patient, the naturopath shall fill out and sign such certificate of death as is required by statute.

History

• Law Implemented: NDCC 43-58-09

N.D. Admin. Code 50-06-02-03 Advertising

Naturopaths may advertise their practice in any legitimate manner set forth in the code of ethics adopted by the board, except as limited or prohibited by statute.

History

• Law Implemented: NDCC 43-58-03.1

N.D. Admin. Code 50-06-02-04 Authority to administer, prescribe, and dispense

The practice of naturopath medicine includes the administration, prescription, dispensing, ordering, or performing of:

1.Food, vitamins, minerals, nutritional supplements, digestive enzymes, botanical medicine, and homeopathic remedies.

2.Health care counseling, nutritional counseling and dietary therapy, hydrotherapy, and naturopathic physical applications and therapeutic devices. Naturopathic physical application does not include manipulation of the spine. Naturopathic physical application does include osseous manipulation of the extremities, ribs, and pelvis.

3.Nondrug prescription devices.

4.Nonprescription topical drugs.

History

• Law Implemented: NDCC 43-58-08

N.D. Admin. Code 50-06-02-05 Intradermal, intramuscular, intravenous, and subcutaneous administration

1.A naturopath may not perform any intra-articular injection or intraspinal injection.

2.A naturopath may prepare and administer for immediate use vitamins, minerals, amino acids, and homeopathic remedies in accordance with naturopathic medical training through intradermal, intramuscular, or subcutaneous injection, or, if the naturopath holds the required endorsement, through intravenous therapy. Any injectable therapies must be prepared in accordance with USP 797 standards for immediate use. Substances administered by injection or intravenous therapy must be manufactured and supplied by a manufacturer or outsourcing facility required to register with the United States food and drug administration or compounded pursuant to a prescription by a pharmacy licensed by the board of pharmacy.

3.A naturopath may use intravenous therapy only after the naturopath has obtained an endorsement from the board to perform intravenous therapy by submitting a completed application with an attestation of training to the board. The training must be at least sixteen hours of instruction. At least eight hours of instruction must be from a graduate-level course through an approved naturopathic medical school. Instruction must include:

a.Indications;

b.Contraindications;

c.Formularies;

d.Emergency protocols;

e.Osmolarity calculation;

f.Aseptic technique; and

g.Proper documentation.

4.A naturopath shall retain documentation of intravenous training for at least five years from attestation date.

5.Intravenous chelation therapy is limited to use for heavy metal toxicity.

6.A naturopath who uses injection or intravenous therapy shall have a plan to manage adverse events, including sensitivity, allergy, overdose, or other unintended reactions.

History

• Law Implemented: NDCC 43-58-08

N.D. Admin. Code 50-06-02-06 Endorsement for prescriptive authority

A licensed naturopath may not prescribe medications pursuant to the formulary adopted under

section 50-06-02-08 unless the licensed naturopath first obtains an endorsement under this section and approval by the board.

1.Limited endorsement. To be eligible to prescribe, a licensed naturopath shall first obtain a limited endorsement by submitting an application to the board and entering into a written collaborative agreement with a supervising physician who meets the requirements of section 50-06-02-07.

2.Endorsement to practice independently. After completing the requirements of subsection 1, the naturopath may submit an application to prescribe independently by showing successful passage of the naturopathic physicians licensing examination (NPLEX) with the test results sent directly to the board by the North American board of naturopathic examiners (NABNE).

The supervising physician shall provide proof and verification attesting to the naturopath's safe prescribing practices sent directly to the board.

3.Waiver of limited endorsement. The requirements of subsections 1 and 2 may be waived if the naturopath shows substantial experience in prescribing medications under the laws and rules of another jurisdiction that has standards and qualifications for a licensed naturopath to prescribe medications at least equal to those required under North Dakota Century Code

chapter 43-58. The naturopath shall apply for the waiver by submitting an application with the board, providing a copy of the written collaborative agreement previously entered with a supervising physician from the other jurisdiction, and providing a copy of the laws and rules of the other jurisdiction showing equal requirements. The application will be reviewed by the board at its next available regular meeting.

History

• Law Implemented: NDCC 43-58-08.1

N.D. Admin. Code 50-06-02-07 Supervising physician for license endorsement for prescriptions

The supervising physician for a naturopath's limited endorsement for prescriptive authority shall possess an active, unencumbered physician license issued under North Dakota Century Code chapter 43-17 and must have been prescribing and administering prescription drugs without limitation for at least five years immediately preceding the application. The supervising physician shall provide objective and independent review of the naturopath's first one hundred prescriptions issued by the naturopath or twelve months of prescribing, whichever occurs first. The supervising physician shall evaluate the naturopath's ability to safely prescribe and administer prescription drugs within the naturopath's scope of practice, education, training, and the naturopath's compliance with federal and state laws and regulations. The naturopath shall keep a duplicate of all prescriptions written to be reviewed at least monthly with the supervising physician.

The naturopath and supervising physician shall have a formal written agreement. The agreement must address the requirements of this rule. A copy of the fully executed agreement must be filed with the board along with the application for limited endorsement pursuant to North Dakota Century Code

section 43-58-08.1.

History

• Law Implemented: NDCC 43-58-08.1

N.D. Admin. Code 50-06-02-08 Formulary

1.A naturopath may only prescribe drugs pursuant to this formulary after obtaining an endorsement for prescriptive authority under section 50-06-02-06.

2.A naturopath may not recommend altering or discontinuing a drug that is not within the naturopath's scope of practice and prescriptive authority that may be prescribed under this formulary. The naturopath instead shall refer the patient to their primary provider or prescribing provider.

3.The formulary for naturopaths with an endorsement for prescriptive authority consists of noncontrolled legend drugs and testosterone deemed appropriate for the primary health care of patients within the scope of practice and training of each naturopath. Prescribing pursuant to the formulary must be in accordance with the standard of care provided by the naturopath's training, experience, and the degree of expertise.

4.The use of all drugs must be supported by FDA label, compendia, expert opinion, or clinical practice guidelines. Compendia supported use is defined as recommended with evidence favoring efficacy in the American Hospital Formulary Service Drug Information, United States Pharmacopeia-Drug Information, or the DRUGDEX information system.

5.The following formulary references the United States Pharmacopeia (USP) drug classification system.

6.Unless otherwise indicated in the formulary, drugs specified in the formulary that are allowed to be prescribed include all forms of the drug including time release forms and other generic forms.

7.A naturopath who obtains an endorsement for prescriptive authority under section 50-06-02-06 may prescribe the following drugs or classes of drugs, and may only prescribe for use within the corresponding category and indication:

Category/Indication Drugs or Classes of Drugs that May be Prescribed with Prescriptive Endorsement Application and Other Limitations AnalgesicsAll drugs within the NSAID class may be AnestheticsAll drugs within the local anesthetics class may be prescribed.

Antiaddiction/Substance abuse treatment agents Naltrexone Nicotine AntibacterialsNeomycin Gentamicin (topical only)

Tobramycin (topical only)

Amoxicillin Amoxicillin/Clavulanate potassium Penicillin G Doxycycline Clarithromycin Clindamycin (topical only)

Nitrofurantoin Metronidazole Acetic acid Polymyxin B sulfate Rifaximin May not administer any drugs in this category via intravenous administration.

AntiemeticsOndansetron Diphenhydramine hydrochloride Hydroxyzine hydrochloride Meclizine hydrochloride Metoclopramide hydrochloride Scopolamine AntifungalsTerbinafine (topical only)

Miconazole nitrate (topical only)

Ketoconazole (topical only)

Terconazole (topical only)

Fluconazole Nystatin Antigout agentsProbenecid Allopurinol Colchicine Antimigraine agentsPropranolol hydrochloride AntineoplasticsAnastrozole Alitretinoin Tretinoin Topical only All drugs may only be prescribed for noncancer purposes and uses.

Antiobesity agentsOrlistat AntiparasiticsAlbendazole Ivermectin Mebendazole Topical only Antispasticity agentsBaclofen Tizanidine hydrochloride AntiviralsAcyclovir Valacyclovir Oseltamivir AnxiolyticsBuspirone Hydroxyzine Blood glucoses regulators All drugs within the antidiabetic agents and glycemic agents class may be prescribed.

All drugs within the biguanide and DPP 4 inhibitors group may be prescribed.

Blood products and modifiers AspirinNot allowed to do blood transfusions.

Heparin sodium (for nontherapeutic blood thinning only)

Cardiovascular agentsAll drugs within the following classes may be •Alpha-adrenergic agonists; •Alpha-adrenergic blocking agents; •Angiotensin II receptor antagonists; •Angiotensin-converting enzyme (ACE) inhibitors; •Calcium channel blocking agents - Dihydropyridines and nondihydropyridines; •Loop diuretics; •Potassium-sparing diuretics; •Thiazide diuretics; •Dyslipidemics - Fibric acid derivatives, HMG CoA reductase inhibitors, and PCSK9 inhibitors.

Beta adrenergics medications are limited to 100 mg.

Nondihydropyridines medications are limited to 120 mg.

Central nervous system agents Clonidine hydrochloride ContraceptivesAll drugs within the oral contraceptives combinations and oral progestins classes may be prescribed.

Citric acid/Lactic acid/Potassium bitartate Ethinyl estradiol/Etonogestrel Ethyinyl estradiol/Norelgestromin Levonorgestrel May not prescribe any drug within this category that would require a procedure such as implantable contraceptives.

Dental and oral agentsDoxycycline hyclate Minocycline hyclate Prilocaine hydrochloride Triamcinolone acetonide Dermatological agentsAll drugs within this category may be Topical only except can allow triamcinolone injection.

Electrolytes - Minerals - Metals - Vitamins All drugs within this category may be Gastrointestinal agentsAll drugs within the following classes may be •Anticonstipation agents; •Antidiarrheal agents; •Antispasmodics, gastrointestinal; •Histamine receptor antagonists; •Protectants; •Proton pump inhibitors.

Metoclopramide hydrochloride Rifaximin Ursodiol Cholic acid Betaine Betaine hydrochloride Cromolyn sodium Amoxicillin/Clarithromycin/Omeprazole Genitourinary agentsAll drugs within this category may be modifying (adrenal)

Hydrocortisone (dose limit: 30 mg daily)

Prednisone (dose limit: 5 mg daily)

Methylprednisolone acetate (burst dose pack dose limit of 1 pack per 60 days)

Triamcinolone acetonide modifying (sex hormones, modifies)

Testosterone All drugs within the androgens and progestins classes may be prescribed.

All drugs within the estrogens class may only be prescribed as topical and vaginal HRT.

Exception for oral estrogens prescribed for purposes of contraception.

Estradiol/Levonorgestrel Estradiol/Norethindrone acetate Estradiol/Norgestimate Estradiol/Progesterone Testosterone dosage limits:

Injectable - maximum 400mg/28 days dosage Topical - maximum 100mg/day dosage modifying (thyroid)

All drugs within this category may be Immunological agentsAll drugs within the vaccines class may be All drugs within the other immunological agents - Allergen specific immunotherapy group may be prescribed.

Inflammatory bowel disease agents Hydrocortisone Prednisone Metabolic bone disease agents Alendronate Ibandronate Cholecalciferol Calcitriol Doxercalciferol Paricalcitol Ophthalmic agentsAll drugs within antiallergy agents class may be prescribed.

All drugs within the anti-infectives class may be prescribed (topical only).

Diclofenac sodium Ketorolac tromethamine Nepafenac Bacitracin zinc/Hydrocortisone acetate/Neomycin sulfate/Polymyxin B sulfate Bacitracin zinc/Hydrocortisone acetate/Polymyxin B sulfate Hydrocortisone acetate/Neomycin sulfate/Polymyxin B sulfate Ciprofloxacin (topical only)

Otic agentsAll drugs within this category may be Topical use only Respiratory tract/ Pulmonary agents All drugs within the following classes may be •Antihistamines; •Anti-inflammatories - Inhaled corticosteroids; •Antileukotrienes; •Anticholinergic bronchodilators; •Sympathomimetic bronchodilators; •Combination bronchodilators; •Cold-cough; and •Mast cell stabilizers.

Acetylcysteine Sexual disorder agentsAll drugs within the sexual disorder agents (male) class may be prescribed.

Skeletal muscle relaxantsCyclobenzaprine hydrochloride

History

• History: Effective April 1, 2024; amended effective January 1, 2026.
• Law Implemented: NDCC 43-58-08(3)(c)

Chapter 50-06-03 Continuing Naturopathic Education

N.D. Admin. Code 50-06-03-01 Requirements

All active licensees shall complete:

1.A minimum of forty hours of approved continuing naturopathic education (CNE) credits biennially. Only hours earned at board-approved continuing naturopathic education programs are acceptable. One hour of credit is earned for every fifty minutes of approved continuing education.

2.Five of the forty hours of approved continuing naturopathic education credits must be topics on pharmacology.

3.An extension of time or other waiver to complete the hours required in this section must be granted upon written application if the licensee failed to meet the requirements due to illness, military service, medical or religious missionary activity, or other extenuating circumstance.

History

• Law Implemented: NDCC 43-58-03.1, 43-58-08.1

N.D. Admin. Code 50-06-03-02 Exceptions

The following naturopaths are not required to meet the requirements of this chapter:

1.A naturopath who is enrolled in a full-time graduate naturopathic medical education program (residency or fellowship).

2.A naturopath who holds a provisional temporary license or a naturopath who has not renewed the naturopath's licenses for the first time since being granted a regular permanent license by the board.

3.A naturopath who has retired from the active practice of medicine. This exception is available only to a retired naturopath who has completely and totally withdrawn from the practice of naturopathic medicine. Any naturopath seeking to be excused from completing continuing naturopathic education requirements under this subsection shall submit an affidavit to the board, on the board's form, certifying that the naturopath may not render naturopathic medical services during the term of the next continuing naturopathic education reporting period.

N.D. Admin. Code 50-06-03-03 Board approval

1.To receive board approval, a continuing naturopathic education (CNE) program must be one of the following:

a.A program sponsored by the board;

b.A program sponsored by an approved naturopathic medical school;

c.A health-related seminar sponsored by a college or university accredited by an organization recognized by the United States department of education;

d.A health-related seminar qualifying for continuing education credits through the state board of medical examiners, the state board of chiropractic examiners, or the state board of nursing; or

e.An educational program arranged by the North Dakota association of naturopathic doctors or the American association of naturopathic physicians or one of its affiliates and approved by the board.

2.To have a program approved, the sponsor shall submit to the board the following information in addition to any other information requested by the board:

a.A detailed course outline or syllabus, including such items as the method of instruction and the testing materials.

b.The qualifications and subjects taught by each instructor appearing in the program.

c.The procedure to be used for recording attendance of attendees seeking to apply for continuing naturopathic education credit.

3.The board shall be the sole determinant of whether the courses are approved for continuing naturopathic education credit. The board shall make that determination based on the information submitted to it. In making its decision, the board shall determine whether the course submitted for credit meets the basic goals of continuing naturopathic education. Those basic goals include the growth of knowledge, the cultivation of skills and greater understanding, the continual striving for excellence in naturopathic care, and the improvement of health and welfare of the public.

4.Except for continuing naturopathic education credits for a program sponsored by the board, it is the responsibility of the licensee to verify the appropriate credit designation with the source of the program, not with the board. All licensees are encouraged to verify eligibility for continuing naturopathic credit and the appropriate credit designation before taking any particular course.

N.D. Admin. Code 50-06-03-04 Board audit

Each biennium the board shall audit randomly selected naturopaths to monitor compliance with the continuing education requirements. Any naturopath so audited shall be required to furnish documentation of compliance, including the name of the accredited continuing naturopathic education provider, name of the program, hours of continuing education completed, dates of attendance, and verification of attendance. Any naturopath who fails to provide verification of compliance with the continuing naturopathic education requirements is subject to revocation of licensure. To facilitate the board's audits, every naturopath is required to maintain a record of all continuing naturopathic education activities in which the naturopath has participated. Every naturopath shall maintain those records for a period of at least two years following the time when those continuing naturopathic education activities were reported to the board.

Article 50-07 Genetic Counselors

Chapter 50-07-01 Genetic Counselors

N.D. Admin. Code 50-07-01-01 Definitions

Unless specifically stated otherwise, all definitions found in North Dakota Century Code chapter 43-60 are applicable to this article including:

1."ABGC" means the American board of genetic counseling.

2."ABMG" means the American board of medical genetics.

3."Board" means the North Dakota board of medicine.

History

• Law Implemented: NDCC 43-60-01, 43-60-06

N.D. Admin. Code 50-07-01-02 License issued

If the board determines that a candidate has successfully completed all requirements by law and

rule for licensure, the board shall issue a license to the candidate. An officer of the board and the board's executive director or deputy executive director may issue a provisional temporary license to an applicant who is seeking a permanent North Dakota genetic counselor license if in the officer and director's judgment the applicant meets all the requirements for a license. The board's executive director or deputy executive director may issue a provisional temporary license if the application is routine, complete, and meets all other requirements for licensure. A provisional temporary license is valid from the date of issue until the time of the next regularly scheduled meeting of the board.

History

• History: Effective January 1, 2025; amended effective January 1, 2026.
• Law Implemented: NDCC 43-51.1-03, 43-60-06

N.D. Admin. Code 50-07-01-03 Location of practice - License displayed

A licensed genetic counselor shall maintain a permanent electronic mail or mailing address with the board to which all communications from the board to the licensee shall be sent. A licensee who changes an address shall notify the board in writing of the new contact information within thirty days. A current certificate or duplicate certificate issued by the board at all times must be displayed in each office location of the genetic counselor.

N.D. Admin. Code 50-07-01-04 Fees

The fee for initial licensure of a genetic counselor is fifty dollars per year. The renewal fee is fifty dollars per year.

History

• Law Implemented: NDCC 43-60-03, 43-60-05, 43-60-06

N.D. Admin. Code 50-07-01-05 Reporting requirements

A genetic counselor is subject to the mandatory reporting requirements specified in North Dakota Century Code section 43-17.1-05.1. The genetic counselor shall report to the board within ten days if the individual no longer holds a valid certification from the ABGC. Upon verification that the genetic counselor no longer holds the certification, the license automatically expires. The expiration of the genetic counselor license under this section does not preclude the board from taking disciplinary action.

N.D. Admin. Code 50-07-01-06 Disciplinary action

The board may take disciplinary action against a licensed genetic counselor under North Dakota Century Code chapter 43-17.1 on the grounds set forth by North Dakota Century Code 43-60-07, by any one or more of the following means, as the board may find appropriate:

1.Revocation of license.

2.Suspension of license.

3.Probation.

4.Imposition of stipulations, limitations, or conditions relating to the duties of a genetic counselor.

5.Letter of censure.

6.Impose fines, not to exceed one thousand dollars for any single disciplinary action. The board shall deposit any fines collected by the board in the state general fund.

History

• Law Implemented: NDCC 43-60-06, 43-60-07

N.D. Admin. Code 50-07-01-07 Disciplinary proceedings

In an order or decision issued by the board to resolve a disciplinary proceeding in which disciplinary action is imposed against a genetic counselor, the board may direct any genetic counselor to pay the board a sum not to exceed the reasonable and actual costs, including reasonable attorney's fees, incurred by the board and investigative panels of the board in the investigation and prosecution of the case. If applicable, the board may suspend the genetic counselor's license until the costs are paid to the board. A genetic counselor may challenge the reasonableness of a cost item in a hearing under North Dakota Century Code chapter 28-32 before an administrative law judge. The administrative law judge may approve, deny, or modify a cost item, and the determination of the judge is final.

N.D. Admin. Code 50-07-01-08 Notice of denial or limitation of licensure

If the board determines that an applicant does not meet the requirements for licensure, the board promptly shall notify the applicant, personally or by certified mail, that the board has made an informal decision to deny the application or to place conditions or limitations on the applicant's license. The board shall also advise the applicant as follows:

1.The applicant has the right to have the merits of the application considered at a formal hearing in accordance with the provisions of the Administrative Agencies Practices Act (North Dakota Century Code chapter 28-32.)

2.To secure a formal hearing on the merits of the application, the applicant shall contact the board to request the hearing within thirty days of being notified of the board's informal decision.

If an applicant does not request a formal hearing within thirty days of the date on which the applicant was notified that the board has made an informal decision to deny the application or to place conditions or limitations on the applicant's license, the board's informal decision is the final order of the board.

N.D. Admin. Code 50-07-01-09 Limitation on attempts at examination passage

An applicant is permitted a maximum of three attempts to pass the certification examination. Upon review of an individual applicant, the board may allow an exception to this rule if it finds that it is in the best interest of the state and the applicant shows a documented disability as determined by the board, or the applicant:

1.Is validly licensed as a genetic counselor in another state;

2.Has practiced as a genetic counselor a minimum of five years; and

3.Has no disciplinary actions imposed by a licensing board or entity of any other jurisdiction within the last ten years immediately preceding the date of application.

History

• History: Effective January 1, 2026.
• Law Implemented: NDCC 43-60-03