Anyone running a multi-state telehealth or med spa brand has been told the rule: you need a licence where the patient is, not where the clinician is. It is usually presented as an interpretation. In North Dakota it is a statute.
N.D.C.C. § 43-17-02.3: “The practice of medicine is deemed to occur in the state the patient is located.” A practitioner providing medical care to a patient located in North Dakota is subject to the licensing and disciplinary laws of the state and shall possess an active North Dakota license for their profession.
Why a statute is different from a policy
A board policy can be argued about. A statutory deeming provision decides the jurisdictional question before the argument starts — and it brings the disciplinary laws with it. A practitioner in another state who treats a North Dakota patient is inside North Dakota’s disciplinary system, not merely at risk of an unlicensed-practice complaint.
The exceptions are narrow, and none of them is a business model
The section permits a physician holding a permanent, unrestricted licence elsewhere to practise in North Dakota without a North Dakota licence in a short list of circumstances:
- as a member of an organ harvest team;
- on board an air ambulance, as part of its treatment team;
- to provide one-time consultation on a diagnosis for a patient to a physician licensed in the state, or teaching assistance for not more than seven days;
- to provide consultation or teaching assistance previously approved by the board for charitable organizations; or
- under rules adopted by the board.
Note what is absent: there is no exception for an established relationship, a follow-up visit, or a patient who happens to be travelling. If you are building an asynchronous or telehealth service, the licence is the entry ticket.
What this means operationally
- Licence your physicians in every state where patients are located, North Dakota included.
- Route patients by their location at the time of the encounter, not by their billing address.
- Do not treat a one-time consultation exception as cover for a consultation service.
- Expect North Dakota disciplinary exposure for a North Dakota patient, whatever your home state.
Compare
Connecticut and Arkansas constrain telehealth through the examination requirement instead. North Dakota constrains it through licensure. Both are real; they fail in different ways, and a compliance plan built for one does not cover the other.
Related reading
Frequently asked questions
Where is the practice of medicine deemed to occur in North Dakota?
In the state the patient is located, under N.D.C.C. § 43-17-02.3.
Does an out-of-state physician need a North Dakota licence?
Yes, to provide medical care to a patient located in North Dakota, subject to a narrow list of statutory exceptions.
What are the exceptions?
Organ harvest teams, air ambulance treatment teams, one-time diagnostic consultation to a North Dakota-licensed physician or teaching assistance of not more than seven days, board-approved charitable consultation, and anything the board provides by rule.
Does an established patient relationship help?
The statute lists no such exception.
General information about North Dakota licensing requirements, not legal advice. Confirm your obligations with the North Dakota Board of Medicine and counsel licensed in North Dakota.