Title 50 of the
NORTH DAKOTA ADMINISTRATIVE CODE
GENERAL ADMINISRATION
CHAPTER 50-01-01 ORGANIZATION OF BOARD
50-01-01-01. Organization of board of medical examiners.
CHAPTER 50-01-02 RULE MAKING
50-01-02-01. Public participation.
50-01-02-02. Substantive rules.
A R T I C L E 50-02 PHYSICIAN LICENSURE
CHAPTER 50-02-01 PROVISIONAL TEMPORARY LICENSE
50-02-01-01. License for interval between board meetings.
50-02-01-02. License for locum tenens.
CHAPTER 50-02-02 SPECIAL LICENSE
50-02-02-01. Special license requirements.
50-02-02-02. Special license requirements for foreign medical school graduates.
CHAPTER 50-02-03 EXAMINATIONS
50-02-03-01. Medical licensure examination.
50-02-03-02. Effect of passage of parts of national board.
CHAPTER 50-02-04 NATIONAL BOARD OF EXAMINERS FOR OSTEOPATHIC PHYSICIANS AND SURGEONS, INC. REPEALED MAY 1, 2002
CHAPTER 50-02-05 GRADUATES OF FOREIGN MEDICAL SCHOOLS
50-02-05-01. Standard certificate from educational commission required.
50-02-05-02. Requirements for licensure by reciprocity or endorsement.
50-02-05-03. American specialty board certificate requirements.
50-02-05-04. Canadian medical school graduate licensure by endorsement.
50-02-05-05. Licentiates of medical council of Canada accepted by endorsement.
50-02-05-06. FLEX examination requirements.
50-02-05-07. Passing requirements for FLEX examination.
50-02-05-08. Fees for examination.
50-02-05-09. Exception to statutory qualifications for license - When available.
CHAPTER 50-02-06 AMERICAN STUDENTS IN FOREIGN MEDICAL SCHOOLS
50-02-06-01. Fifth pathway program.
50-02-06-02. Supervised clinical training.
50-02-06-03. Requirements for supervised clinical training.
50-02-06-04. Effect of supervised clinical training.
50-02-06-05. Consideration for licensure.
CHAPTER 50-02-07 LICENSE FEES
50-02-07-01. License fees.
50-02-07-02. Provisional temporary license fee.
50-02-07-03. Special license fee.
50-02-07-04. Locum tenens fee.
50-02-07-05. Annual registration fee.
50-02-07-06. Annual registration - Good standing required.
CHAPTER 50-02-08 CREDENTIALS COMMITTEE
50-02-08-01. Membership and authority.
CHAPTER 50-02-09 INFORMAL DISCIPLINARY ACTION
50-02-09-01. Informal disciplinary action.
50-02-09-02. Reconsideration of censure or probation.
CHAPTER 50-02-10 PATIENT RECORDS RELATING TO PSYCHIATRIC CARE
50-02-10-01. Patient records relating to psychiatric care.
CHAPTER 50-02-11EXAMINATION
50-02-11-01. Eligibility for examination.
50-02-11-02. Successful completion of examination - Time Limitation.
50-02-11-03. Limitation on attempts at examination passage.
50-02-11-03.1. Limitation on attempts at examination passage
50-02-11-04. Examination combinations acceptable.
CHAPTER 50-02-12 NOTICE OF DENIAL OR LIMITATION OF LICENSURE
50-02-12-01. Notice of denial or limitation of licensure.
CHAPTER 50-02-13 RESIDENT LICENSURE
50-02-13-01. Definitions.
50-02-13-02. License requirement.
50-02-13-02.1 License requirement - Exception.
50-02-13-03. Qualifications.
50-02-13-04. Applications.
50-02-13-05. Scope of practice.
50-02-13-06. Discipline.
50-02-13-07. Period of licensure.
50-02-13-08. Reporting requirements.
50-02-13-09. Fees.
A R T I C L E 50-03 PHYSICIAN ASSISTANTS AND TECHNICIANS
CHAPTER 50-03-01 PHYSICIAN ASSISTANTS
50-03-01-01. Description and authority of physician assistant.
50-03-01-02. Examination requirements.
50-03-01-03. Supervision contract requirements.
50-03-01-04. Supervising physician's responsibility.
50-03-01-05. Designation of substitute supervising physician.
50-03-01-06. Assistant's functions limited.
50-03-01-07. Drug therapy.
50-03-01-08. Assignment of tasks by supervising physician.
50-03-01-09. Number of assistants under physician's supervision limited.
50-03-01-09.1. Physician assistant for more than one physician.
50-03-01-10. Assistant's services limited.
50-03-01-10.1 Disciplinary Action
50-03-01-11. Grounds for Disciplinary Action
50-03-01-12. Physician's delegation to qualified person not restricted.
50-03-01-13. Fees.
50-03-01-14. License renewal requirements.
50-03-01-15. Forms of licensure.
CHAPTER 50-03-02 TECHNICIANS
50-03-02-01. Use of technicians authorized - Restrictions.
50-03-02-02. Technicians not considered to be practicing optometry or medicine.
CHAPTER 50-03-03 EMERGENCY MEDICAL TECHNICIANS
50-03-03-01. Scope of services regulated.
50-03-03-02. Certification required.
50-03-03-03. Certification requirement exemption.
50-03-03-04. Certification of emergency medical technicians.
50-03-03-05. Supervision.
50-03-03-06. Agreement termination.
CHAPTER 50-03-04 FLUOROSCOPY TECHNOLOGISTS
50-03-04-01. Definitions.
50-03-04-02. Permit required.
50-03-04-03. Initial requirements for permit.
50-03-04-04. Annual permit renewal.
50-03-04-05. Fees.
50-03-04-06. Scope of practice.
50-03-04-07. Supervising physician.
50-03-04-08. Supervision contract requirements.
50-03-04-09. Primary supervising physician's responsibility.
50-03-04-10. Onsite supervising physician required.
50-03-04-11. Requirements to serve as an onsite supervising physician.
50-03-04-12. Designation of substitute primary supervising physician.
50-03-04-13. Number of technologists under physician's supervision limited.
50-03-04-14. Disciplinary action.
50-03-04-15. Grounds for disciplinary action.
50-03-04-16. Communications.
A R T I C L E 50-04 CONTINUING MEDICAL EDUCATION
CHAPTER 50-04-01 CONTINUING MEDICAL EDUCATION STANDARDS
50-04-01-01. Requirements.
50-04-01-02. Exceptions.
50-04-01-03. Credits accepted.
50-04-01-04. Compliance.
GENERAL ADMINISRATION top..
CHAPTER 50-01-01 ORGANIZATION OF BOARD top..
50-01-01-01. Organization of board of medical examiners. top..
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 medical examiners. The board, generally speaking, stands between the medical school graduate and the public. It is the responsibility of the board to protect the public against poorly trained physicians.
2.Executive secretary and treasurer. The executive secretary and treasurer 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 secretary and treasurer:
Executive Secretary and Treasurer
State Board of Medical Examiners
418 East Broadway, Suite 12
Bismarck, ND 58501
CHAPTER 50-01-02 RULE MAKING top..
50-01-02-01. Public participation. top..
Any person, at any time, may submit data, views, or arguments in writing relating to any rule adopted by the board.
50-01-02-02. Substantive rules. top..
Any person desiring to be heard orally regarding a substantive rule of the board may request opportunity for oral hearing or may formally petition for reconsideration pursuant to North Dakota Century Code section 28-32-04.
A R T I C L E 50-02 PHYSICIAN LICENSURE top..
CHAPTER 50-02-01 PROVISIONAL TEMPORARY LICENSE top..
50-02-01-01. License for interval between board meetings. top..
An officer of the board and the board's executive secretary or deputy executive secretary may issue 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.
50-02-01-02. License for locum tenens. top..
A provisional temporary license for "locum tenens" may be issued for a period not to exceed three months.
CHAPTER 50-02-02 SPECIAL LICENSE top..
50-02-02-01. Special license requirements. top..
In the best interests of this state, the board may grant a special license to special applicants. The special applicant must appear before the board for such examination into the applicant's qualifications as may be required by the board. A special license is reviewable annually by the board. The special license may be converted to a regular license upon meeting all statutory and board requirements.
50-02-02-02. Special license requirements for foreign medical school graduates. top..
Repealed.
CHAPTER 50-02-03 EXAMINATIONS top..
50-02-03-01. Medical licensure examination. top..
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.
50-02-03-02. Effect of passage of parts of national board. top..
Repealed.
CHAPTER 50-02-04 NATIONAL BOARD OF EXAMINERS FOR OSTEOPATHIC PHYSICIANS AND SURGEONS, INC. REPEALED MAY 1, 2002 top..
CHAPTER 50-02-05 GRADUATES OF FOREIGN MEDICAL SCHOOLS top..
50-02-05-01. Standard certificate from educational commission required. top..
All applicants for licensure who are graduates of foreign medical schools, except the medical schools of Canada, the United Kingdom, Australia, New Zealand, are required to present the standard certificate from the educational commission for foreign medical graduates with an examination grade of seventy-five or better as a prerequisite for admission to the North Dakota medical board examinations.
50-02-05-02. Requirements for licensure by reciprocity or endorsement. top..
Graduates of medical schools not located within the United States or Canada who have a license from another state will not be licensed in North Dakota by either reciprocity or endorsement unless licensure was secured by passing the federation licensing examination, or the United States medical licensing examination (USMLE), and the candidate has fulfilled other North Dakota licensure requirements. However, those applicants seeking licensure by either reciprocity or endorsement who passed a written examination in another state before the advent of the federation licensing examination may be considered on an individual basis. Those candidates may also be required to pass the special purpose examination (SPEX) administered by the federation of state medical boards of the United States.
50-02-05-03. American specialty board certificate requirements. top..
A graduate from a foreign medical school who has an American specialty board certificate must also present an educational commission for foreign medical graduates standard certificate with a grade of seventy-five or better for admission to the North Dakota medical board examinations. For such a specialist, under special circumstances, the educational commission for foreign medical graduates standard certificate requirement may be waived by unanimous approval of the board.
50-02-05-04. Canadian medical school graduate licensure by endorsement. top..
A graduate of a Canadian medical school may be licensed by endorsement if the board deems it to be in the best interest of this state. However, such graduate must first present to the board satisfactory evidence establishing that the graduate has legally been licensed in another state or Canada in which the requirements for such license with respect to qualifications are equivalent to the requirements of this state.
50-02-05-05. Licentiates of medical council of Canada accepted by endorsement. top..
Repealed.
50-02-05-06. FLEX examination requirements. top..
Repealed.
50-02-05-07. Passing requirements for FLEX examination. top..
The minimum passing score for each component of the federation licensing examination is seventy-five percent as scored by the federation of state medical boards.
50-02-05-08. Fees for examination. top..
Repealed.
50-02-05-09. Exception to statutory qualifications for license - When available. top..
Repealed.
CHAPTER 50-02-06 AMERICAN STUDENTS IN FOREIGN MEDICAL SCHOOLS top..
50-02-06-01. Fifth pathway program. top..
A pathway for entrance to approved programs of graduate medical education is available for students who have fulfilled all of the following conditions:
1. Completion, in an accredited American college or university, of undergraduate premedical work of the quality acceptable for matriculation in an accredited United States medical school.
2.Study of medicine at a medical school located outside the United States, Puerto Rico, and Canada, which is listed in the world directory of medical schools, published by the world health organization.
3.Completion of all of the formal requirements of the foreign medical school except internship or social service, or both. Those who have completed all of these requirements including internship or social service, or both, are eligible.
50-02-06-02. Supervised clinical training. top..
Students who have completed the academic curriculum in residence in a foreign medical school and who have fulfilled the conditions of section 50-02-06-01 may be offered the opportunity to substitute for an internship required by a foreign medical school, an academic year of supervised clinical training (such as a clinical clerkship or junior internship) prior to entrance into the first year of approved graduate medical education. The supervised clinical training must be under the direction of a medical school approved by the liaison committee on medical education.
50-02-06-03. Requirements for supervised clinical training. top..
Before beginning the supervised clinical training, said students must have their academic records reviewed and approved by the medical schools supervising their clinical training and must attain a score satisfactory to the sponsoring medical school on a screening examination or procedure acceptable to the council on medical education, such as part I of the national board examinations, or the educational commission for foreign medical graduates examination, or the federation licensing examination. The council on medical education will consider the acceptability of any other screening examination or procedure proposed by a sponsoring medical school.
50-02-06-04. Effect of supervised clinical training. top..
Students who are judged by the sponsoring medical schools to have completed successfully the supervised clinical training are eligible to enter the first year of approved graduate training programs without completing social service obligations required by the foreign country or obtaining educational commission for foreign medical graduates certification.
50-02-06-05. Consideration for licensure. top..
Repealed.
CHAPTER 50-02-07 LICENSE FEES top..
50-02-07-01. License fees. top..
The fee for licensure in North Dakota whether it be by qualification, reciprocity, or endorsement, or special license is two hundred dollars. The fee for a locum tenens license is two hundred dollars, and the annual registration fee for all licensed physicians is one hundred fifty dollars.
50-02-07-02. Provisional temporary license fee. top..
Repealed.
50-02-07-03. Special license fee. top..
Repealed.
50-02-07-04. Locum tenens fee. top..
Repealed.
50-02-07-05. Annual registration fee. top..
Repealed.
50-02-07-06. Annual registration - Good standing required. top..
Repealed.
CHAPTER 50-02-08 CREDENTIALS COMMITTEE top..
50-02-08-01. Membership and authority. top..
Repealed.
CHAPTER 50-02-09 INFORMAL DISCIPLINARY ACTION top..
50-02-09-01. Informal disciplinary action. top..
Repealed.
50-02-09-02. Reconsideration of censure or probation. top..
Repealed.
CHAPTER 50-02-10 PATIENT RECORDS RELATING TO PSYCHIATRIC CARE top..
50-02-10-01. Patient records relating to psychiatric care. top..
Psychiatric records may be transferred or released to the patient or the patient's representative upon request of the patient whenever the treating physician believes that such action is not contrary to the patient's best interests. In other instances, psychiatric records shall be transferred to another physician or released to a representative of the patient when requested on behalf of the patient by another physician.
CHAPTER 50-02-11EXAMINATION top..
50-02-11-01. Eligibility for examination. top..
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 M.D. degree or the D.O. degree; (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; (c) if a graduate of a foreign medical school, be certified by the ECFMG or have successfully completed a fifth pathway program; and (d) have completed, or be within six months of having completed, at least one postgraduate training year in a program of graduate medical education accredited by the accreditation council for graduate medical education or the American osteopathic association or the royal college of physicians and surgeons of Canada or the college of family physicians of Canada or be enrolled in an approved postgraduate training program within the state of North Dakota.
50-02-11-02. Successful completion of examination - Time Limitation. top..
The examination requirements for licensure must be successfully completed within a seven-year period. The board may grant an exception to this requirement for applicants who have concurrently pursued both MD and PhD degrees provided that the applicant's PhD studies have been in a field of the biological sciences, and provided that the applicant presents a verifiable and rational explanation for not meeting the seven-year time limit.
50-02-11-03. Limitation on attempts at examination passage. top..
Repealed effective August 1, 2003.
50-02-11-03.1. Limitation on attempts at examination passage top..
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:
1. The individual is still enrolled in the program when the application for licensure is submitted to the board's office; or
2. 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.
50-02-11-04. Examination combinations acceptable. top..
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.
CHAPTER 50-02-12 NOTICE OF DENIAL OR LIMITATION OF LICENSURE top..
50-02-12-01. Notice of denial or limitation of licensure. top..
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 sixty days of being given notice of the board's informal decision.In the event an applicant does not request a formal hearing within sixty 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.
CHAPTER 50-02-13 RESIDENT LICENSURE top..
50-02-13-01. Definitions. top..
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 state board of medical examiners.
3. "Resident" means a person who is enrolled in an approved postgraduate training program.
50-02-13-02. License requirement. top..
A person may not participate in a postgraduate training program in this state unless that person has first been granted a license by the board.
50-02-13-02.1 License requirement - Exception. top..
The provisions of section 50-02-13-02 notwithstanding, a resident who is enrolled in a postgraduate training program in another state ay 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.
50-02-13-03. Qualifications. top..
The board may issue a 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.
50-02-13-04. Applications. top..
Applications for a postgraduate training license or the annual renewal of a 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.
50-02-13-05. Scope of practice. top..
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.
50-02-13-06. Discipline. top..
Individuals who have been granted a 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.
50-02-13-07. Period of licensure. top..
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 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 physical and mental health. Failure to provide that information to the board will constitute a violation of subsection 28 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 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.
50-02-13-08. Reporting requirements. top..
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, the director of each postgraduate training program must promptly report the following circumstances to the board's investigative panels:
1. The termination of resignation of a resident for any reason, including poor academic performance.
2. The imposition of sanctions against a resident for other than poor academic performance.
50-02-13-09. Fees. top..
The fee for a postgraduate training license is twenty-five dollars for each year for which the license is valid. That fee shall be paid in full at the time the license is issued.
A R T I C L E 50-03 PHYSICIAN ASSISTANTS AND TECHNICIANS top..
CHAPTER 50-03-01 PHYSICIAN ASSISTANTS top..
50-03-01-01. Description and authority of physician assistant. top..
The physician assistant is a skilled person, qualified by academic and clinical training to provide patient services under the supervision and responsibility of a licensed doctor of medicine or osteopathy who is responsible for the performance of that assistant. The assistant may be involved with the patients of the physician in any medical setting for which the physician is responsible.
50-03-01-02. Examination requirements. top..
No physician assistant may be employed in the state until the assistant has passed the certifying examination of the national commission on certification of physician assistants or other certifying examinations approved by the North Dakota state board of medical examiners.
50-03-01-03. Supervision contract requirements. top..
Upon undertaking the supervision of a physician assistant as contemplated by this chapter, the physician shall file with the board a copy of the contract establishing that relationship. That contract must be approved by the board of medical examiners.
The contract must be confirmed annually by completing and filing with the board such forms as are requested and provided by the board. The board must be notified within seventy-two hours of any contract termination or modification.
Every physician who supervises a physician assistant under this chapter must practice medicine in North Dakota. No physician may act as a supervising physician for any physician assistant who is a member of the physician's immediate family unless specific authorization for such supervision has been approved by the board of medical examiners. For purposes of this section, "immediate family" means a spouse, parent, child, or sibling of the supervising physician.
50-03-01-04. Supervising physician's responsibility. top..
For the purpose of this section, "supervision" means overseeing the activities of, and accepting the responsibility for, the medical services rendered by a physician assistant. Supervision shall be continuous but shall not be construed as necessarily requiring the physical presence of the supervising physician at the time and place that the services are rendered. It is the responsibility of the supervising physician to direct and review the work, records, and practice of the physician assistant on a continuous basis to ensure that appropriate and safe treatment is rendered. The supervising physician must be available continuously for contact personally or by telephone or other electronic means. It is the obligation of each team of physicians and physician assistants to ensure that the physician assistant's scope of practice is identified; that delegation of medical tasks is appropriate to the physician assistant's level of competence; that the relationship of, and access to, the supervising physician is defined; and that a process for evaluation of the physician assistant's performance is established.
50-03-01-05. Designation of substitute supervising physician. top..
Under no circumstances shall the supervising physician designate the physician assistant to take over the physician's duties or cover the physician's practice. During any absence or temporary disability of a supervising physician, it is mandatory that the supervising physician designate a substitute physician to assume all duties and responsibilities of the supervising physician. The physician assistant, during this period, will be responsible to the substitute physician. The designation of a substitute supervising physician must be in writing; signed by the supervising physician, the substitute supervising physician, and the physician assistant; and contain the following information:
1. The name of the substitute supervising physician.
2.The period during which the substitute supervising physician will assume the duties and responsibilities of the supervising physician.
3.Any substantive change in the physician assistant's duties or responsibilities.The appointment of a substitute supervising physician does not become effective unless it is first approved by the board of medical examiners.
50-03-01-06. Assistant's functions limited. top..
Physician assistants may perform only those duties and responsibilities that are delegated by their supervising physicians. No supervising physician may delegate to a physician assistant any duty or responsibility for which the physician assistant has not been adequately trained. Physician assistants are the agents of their supervising physicians in the performance of all practice-related activities. A physician assistant may provide patient care only in those areas of medical practice where the supervising physician provides patient care.
50-03-01-07. Drug therapy. top..
A physician assistant may dispense prepackaged medications prepared by a registered pharmacist acting on a physician's written order and labeled to show the name of the physician assistant and physician. The dispensation authorized shall be limited to controlled drugs of schedules four and five and non-scheduled drugs. The dispensation by the physician assistant must be authorized by, and within, the pre-established guidelines of the supervising physician.
50-03-01-08. Assignment of tasks by supervising physician. top..
Repealed.
50-03-01-09. Number of assistants under physician's supervision limited. top..
No physician may act as primary supervising physician for more than two physician assistants currently qualified under section 50-03-01-02, unless compelling reasons are presented to and approved by the board.
50-03-01-09.1. Physician assistant for more than one physician. top..
A physician assistant may provide services for more than one physician in the following circumstances if each of the physicians for whom the physician assistant provides services has filed a proper contract under section 50-03-01-03:
1. In a group practice setting where one physician is designated as the primary supervising physician, the primary supervising physician will remain primarily responsible for the acts of the physician assistant even when the physician assistant is acting under the immediate supervision of another physician in the group; or
2.If two or more physicians who are not associated in practice require assistance on a part-time basis, each may contract with the physician assistant as a supervising physician provided that a physician assistant has one primary supervising physician who is affiliated with each of the unassociated practice arrangements.
50-03-01-10. Assistant's services limited. top..
Repealed.
50-03-01-10.1 Disciplinary Action top..
The board is authorized to take disciplinary action against a licensed physician assistant 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 state board of medical examiners must be deposited in the state general fund.
50-03-01-11. Grounds for Disciplinary Action top..
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 assistant's registered employer 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.The habitual or excessive use of intoxicants or drugs.
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. Repeated or willful violation of the contract of employment on file with the board.
15. 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.
16. Representing himself or herself to be a physician.
17. The advertising of the person's services as a physician assistant in an untrue or deceptive manner.
18. Sexual abuse, misconduct, or exploitation related to the licensee's performance of the licensee's duties as a physician assistant.
19. 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.
20. The failure to comply with the reporting requirements of North Dakota Century Code section 43-17.1-05.1.
21. A continued pattern of inappropriate care as a physician assistant.
22. 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.
23. 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.
24. The violation of any state or federal statute or regulation relating to controlled substances.
25. 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 location.
26. The lack of appropriate documentation in medical records for diagnosis, testing, and treatment of patients.
27. The failure to furnish the board or the investigative panel, their investigators or representatives, information legally requested by the board or the investigative panel.
50-03-01-12. Physician's delegation to qualified person not restricted. top..
Repealed.
50-03-01-13. Fees. top..
The fee for initial licensure of a physician assistant is fifty dollars. The annual renewal fee is fifty dollars. The fee for approval of employment contract changes is twenty-five dollars.
50-03-01-14. License renewal requirements. top..
Every second year after the initial licensure of a physician assistant, the assistant's license renewal application must be accompanied with evidence of the successful completion of one hundred hours of continued education for physician assistants. Every sixth year, the applicant must demonstrate that the applicant has successfully passed reexamination by the national commission on certification of physician assistants or other certifying reexamination approved by the board.
50-03-01-15. Forms of licensure. top..
The board of medical examiners may recognize the following forms of licensure for the 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 period not to exceed three months.
CHAPTER 50-03-02 TECHNICIANS top..
50-03-02-01. Use of technicians authorized - Restrictions. top..
Any technician may aid or assist a physician licensed under North Dakota Century Code chapter 43-17, and act under such physician's direction in making size measurements, and in duplicating, adapting, fitting, or readjusting spectacles or frames, or inserting or changing lenses therein, whether in contact with the eye or not; but such technician shall not advise concerning the capability of an individual to wear glasses or lenses, nor shall the technician determine by measurements the optical strength of glass or lens an individual might need for optical correction.
50-03-02-02. Technicians not considered to be practicing optometry or medicine. top..
Technicians acting under the provisions of this chapter shall not be considered as practicing optometry within the definitions of North Dakota Century Code section 43-13-01, nor considered as practicing medicine within the definitions of North Dakota Century Code section 43-17-01.
CHAPTER 50-03-03 EMERGENCY MEDICAL TECHNICIANS top..
50-03-03-01. Scope of services regulated. top..
This chapter applies to all persons except physicians licensed under North Dakota Century Code chapter 43-17, providing, or offering to provide, emergency medical service except control of bleeding, immobilization of fractures, nonelectrical heart stimulation, basic airway management, basic treatment of shock, and other services of the same level of basic life support.
50-03-03-02. Certification required. top..
No person except as provided by section 50-03-03-03 may hold oneself out to provide, nor be employed in this state to provide, emergency medical services within the scope of this chapter unless certified as provided in this chapter and acting under the direction of a licensed physician.
50-03-03-03. Certification requirement exemption. top..
Any person possessing emergency medical services skills over and above those defined by the North Dakota state department of health as basic life support skills may perform those skills only if under the direction of a physician who has assumed responsibility for the services of that person through a written statement on file with the office of the board of medical examiners. That person must have met the training requirements of the North Dakota state department of health for such skills.
50-03-03-04. Certification of emergency medical technicians. top..
The certification of emergency medical technicians as required by this chapter means certification by the division of emergency health services of the North Dakota state department of health as EMT-I or EMT-P. It does not include certification for basic services.
50-03-03-05. Supervision. top..
Every emergency medical technician certified to perform emergency medical services must be under the direction and responsibility of at least one physician licensed to practice medicine in this state. This responsibility must be by the written express agreement of the physician or physicians, a copy of which is on file in the office of the state board of medical examiners.
50-03-03-06. Agreement termination. top..
When any physician terminates an agreement to supervise and be responsible for a certified emergency medical technician or any other person as stated in this chapter, the termination is not effective until written notification thereof has been received by the board of medical examiners at its office in Bismarck, North Dakota.
CHAPTER 50-03-04 FLUOROSCOPY TECHNOLOGISTS top..
50-03-04-01. Definitions. top..
As used in this chapter:
1. "Approved school for radiologic technologists" means a school that provides a course of instruction in radiologic technology which:
a.Has been found by the board of medical examiners to be adequate to meet the purposes of this chapter, or;
b.Has been approved by an accrediting body recognized by the board of medical examiners for this purpose.
2."Board" means the North Dakota state board of medical examiners.
3."Fluoroscopy" means a radiological examination utilizing fluorescence for the observation of the transient image.
4."Fluoroscopy technologist" means a radiology technologist who has been granted a radiologic technologist fluoroscopy permit by the board.
5."Immediately available supervision" means being physically available for consultation and supervision.
6."Onsite supervising physician" means a North Dakota-licensed physician who provides supervision of the fluoroscopy technologist's activities outside the presence of the primary supervising physician.
7."Primary supervising physician" means a North Dakota-licensed physician who:
a.Is certified by the American board of radiology, the American osteopathic board of radiology, or the royal college of physicians and surgeons of Canada;
b.Is approved by the board for this purpose, and;
c.Is contractually bound to provide primary supervision of fluoroscopy technologists as specified in this chapter.
8."Radiologic technologist" means any person in good standing with the American registry of radiologic technologists making application of x-rays to human beings for diagnostic purposes.
9."Supervision" means responsibility for, and control of, quality, radiation safety, and technical aspects of all x-ray examinations and procedures.
50-03-04-02. Permit required. top..
A radiologic technologist fluoroscopy permit issued by the board shall be required of any radiologic technologist who independently and directly controls a fluoroscopy procedure.
50-03-04-03. Initial requirements for permit. top..
To obtain a radiologic technologist fluoroscopy permit, an applicant must meet the following requirements:
1. Graduation from a radiologic technologist school approved by the board.
2.No less than five years experience as a radiologic technologist.
3.A history free of any finding by the board of any act that would constitute grounds for disciplinary action under this chapter.
4.Successful completion of the following educational requirements:
a.Classroom instruction must include at least the following:
Subject------------------------------Hours of Instruction
1.Fluoroscopy regulations and radiation safety 10
2.Fluoroscopy equipment 5
3.X-ray image intensifiers 4
4.Television, including closed circuit equipment 4
5.Image recording and image recording equipment 6
6.Special fluoroscopy equipment 5
7.Mobile image intensified units 2
8.Anatomy and physiology of the eye 2
9.Three-dimensional and radiologic anatomy 2
10. Radiation dosimetry 2
11. Quality assurance and quality control 2
b.At least fifteen hours of laboratory in which each student shall conduct experiments on phantoms to illustrate at least the following:
1.Methods of reducing dose to patients during fluoroscopy procedures;
2.Methods of reducing exposure to self and personnel;
3.Image recording during the exposure of a phantom, and;
4.Quality control of fluoroscopy equipment.
5.Completion of no less than seventy-five gastrointestinal fluoroscopy procedures under the direct supervision of the primary supervising physician.
6.Successful completion of board-approved examinations in:
a.Fluoroscopy radiation protection and safety, and;
b.Use of fluoroscopy and ancillary equipment.
7.Current certification and registration with the American registry of radiologic technology.
8.Physical, mental, and professional capability to provide medical services in a safe and appropriate manner.
9.Payment of the initial licensure fee fixed by the board.
50-03-04-04. Annual permit renewal. top..
Each fluoroscopy technologist who practices in North Dakota must annually submit a fluoroscopy permit renewal application. That application must be submitted on forms supplied by the board and must be accompanied by:
1. Evidence of the applicant's continued good standing with the American registry of radiologic technology;
2.The annual permit renewal fee;
3.Evidence of a contractual agreement with a primary supervising physician who meets the board's requirements, and;
4.Evidence that the applicant has completed at least three hours of continuing education which has been approved by the American registry of radiologic technology and pertains specifically to fluoroscopy.
50-03-04-05. Fees. top..
The fee for initial registration of a fluoroscopy technologist is fifty dollars. The annual renewal fee and the fee for approval of employment contract changes is fifty dollars.
50-03-04-06. Scope of practice. top..
The provisions of this chapter notwithstanding, a fluoroscopy technologist may only perform the following fluoroscopic procedures in North Dakota:
1. Gastrointestinal fluoroscopy of the esophagus;
2.Stomach, and;
3.Small and large intestine.
50-03-04-07. Supervising physician. top..
A radiologic technologist may not provide fluoroscopy services except under the supervision of a primary supervising physician.
50-03-04-08. Supervision contract requirements. top..
Upon undertaking the supervision of a fluoroscopy technologist as contemplated by this chapter, the primary supervising physician shall file with the board a copy of the contract establishing the supervisory relationship. That contract must be approved by the board. Upon effecting any significant change in this contract, or in the supervisory relationship, the primary supervising physician must immediately notify the board and the administrator of every facility where the fluoroscopy technologist is known to be providing services.
50-03-04-09. Primary supervising physician's responsibility. top..
It is the responsibility of the primary supervising physician to direct and review the work, records, and practice of the fluoroscopy technologist on a daily, continuous basis to ensure that appropriate and safe treatment is rendered. The primary supervising physician must be available continuously for contact personally or by telephone or radio, and the supervision must include at least two hours per week of onsite, personal supervision. A fluoroscopy technologist must be present at all times when fluoroscopic studies performed by the radiologic technologist are being interpreted by a supervising radiologist. All studies performed by a fluoroscopy technologist must be reviewed by a supervising radiologist. The primary supervising physician will remain primarily responsible for the acts of the fluoroscopy technologist even when the fluoroscopy technologist is acting under the immediate supervision of an onsite supervising physician.It is the responsibility of the primary supervising physician to evaluate and monitor fluoroscopy patient exposure to ionizing radiation to ensure that the cumulative absorbed dose is limited to the minimum amount necessary to achieve the clinical tasks. This includes requiring the use of equipment that aids in minimizing absorbed doses, the recording of "beam on" time in patient records for every fluoroscopy procedure, and the establishment of standard operating procedures and protocols for each specific type of procedures performed. Those protocols must address all aspects of each procedure and must be available for review by the board at all times.It is the responsibility of the primary supervising physician to ensure that the fluoroscopy technologist does not perform any fluoroscopy procedure in any facility that has not developed a comprehensive fluoroscopic quality control program. That quality control program must be approved by the board before the fluoroscopy technologist performs fluoroscopy procedures at that facility.
50-03-04-10. Onsite supervising physician required. top..
In circumstances in which a fluoroscopy technologist performs fluoroscopy procedures outside the presence of the fluoroscopy technologist's primary supervising physician, the fluoroscopy technologist must be supervised by an on-site supervising physician who is immediately available to the fluoroscopy technologist for consultation and supervision at all times when the fluoroscopy technologist is performing fluoroscopy procedures.
50-03-04-11. Requirements to serve as an onsite supervising physician. top..
A physician, except those who meet the postgraduate training requirements required of a primary supervising physician, may not serve as an onsite supervising physician unless:
1. The primary supervising physician has first certified to the board that the physician has demonstrated a satisfactory understanding of radiation safety standards, and;
2.The physician has certified to the board that:
a.The physician has read and understands all written materials recommended by the primary supervising physician.
b.The physician will be immediately available in the medical facility to provide advice regarding the appropriateness of specific exams and to serve in a general advisory capacity to the fluoroscopy technologist.
c.The physician will be available for telephone consultation with the primary supervising physician.
d.The physician will immediately report any variance or aberration in the fluoroscopy technologist's performance to the primary supervising physician.
e.The physician will ensure that the fluoroscopy technologist does not perform exams on any patients who are pregnant or have had endoscopic biopsies within the past forty-eight hours.
f.The physician will ensure proper use of lead-shielding devices by the fluoroscopy technologists.
50-03-04-12. Designation of substitute primary supervising physician. top..
1. A supervising physician may not designate the fluoroscopy technologist to take over the physician's duties or cover the physician's practice. During any absence or temporary disability of a primary supervising physician, the primary supervising physician must designate a substitute primary supervising physician to assume all duties and responsibilities of the primary supervising physician. During this period, the fluoroscopy technologist will be responsible to the substitute primary supervising physician. The designation of a substitute primary supervising physician must be in writing and be signed by the primary supervising physician, the substitute primary supervising physician, and the radiologic technologist and must contain the following information:
a.The name of the substitute primary supervising physician.
b.The period during which the substitute primary supervising physician will assume the duties and responsibilities of the primary supervising physician.
c.Any substantive change in the radiologic technologist's duties and responsibilities.
d.Documentation satisfactory to the board indicating that the substitute primary supervising physician possesses the qualifications required of a primary supervising physician.
2.The appointment of a substitute primary supervising physician does not become effective unless it is first approved by the board. A primary supervising physician may designate as many as three substitute primary supervising physicians. However, the notification filed with the board must clearly specify which individual will be responsible as primary supervising physician at any given time.
50-03-04-13. Number of technologists under physician's supervision limited. top..
A physician may not act as primary supervising physician for more than two fluoroscopy technologists currently qualified under this chapter, unless compelling reasons are presented to and approved by the board.
50-03-04-14. Disciplinary action. top..
The board is authorized to take disciplinary action against a fluoroscopy technologist who has been granted a fluoroscopy permit by any one or more of the following means, as it may find appropriate:
1. Revocation of permit.
2.Suspension of permit.
3.Probation.
4.Imposition of stipulations, limitations, or conditions relating to the practice of fluoroscopy.
5.Reprimand.
6.Letter of concern.
50-03-04-15. Grounds for disciplinary action. top..
Disciplinary action may be imposed against a fluoroscopy technologist upon any of the following grounds:
1. 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 requirements for obtaining a fluoroscopy permit.
2.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 practitioner of medicine or any felony.
3.Habitual use of alcohol or drugs.
4.Physical or mental disability materially affecting the ability to perform the duties of a technologist in a competent manner.
5.The performance of any dishonorable, unethical, or unprofessional conduct likely to deceive, defraud, or harm the public.
6.Obtaining any fee by fraud, deceit, or misrepresentation.
7.Aiding or abetting the practice of medicine by an unlicensed, incompetent, or impaired person.
8.The violation of any provision of a medical practice act or the rules of the board or any action, stipulation, condition, or agreement imposed by the board.
9.The representation to a patient that a manifestly incurable condition, sickness, disease, or injury can be cured.
10. The willful or negligent violation of the confidentiality between a medical provider and patient, except as required by law.
11. Gross negligence in the technologist's practice.
12. Sexual abuse, misconduct, or exploitation related to the technologist's practice.
13. A continued pattern of inappropriate care as a technologist.
14. The use of any false, fraudulent, or deceptive statement in any document connected with the practice of medicine.
15. The violation of any state or federal statute or regulation relating to controlled substances.
16. The failure to furnish the board or the board's investigative panels or their investigators or representatives, information legally requested by the board or the board's investigative panels.
17. The failure to maintain current certification and registration with the American registry of radiologic technology.
18. Performing any fluoroscopic procedure outside the presence of a properly trained supervising physician.
50-03-04-16. Communications. top..
All communications and reports concerning rules in this chapter and applications filed under them should be addressed to or be delivered in person to:North Dakota State Board of Medical Examiners418 E. Broadway Ave., Suite 12Bismarck, ND 58501Phone: 701-328-6500
A R T I C L E 50-04 CONTINUING MEDICAL EDUCATION top..
CHAPTER 50-04-01 CONTINUING MEDICAL EDUCATION STANDARDS top..
50-04-01-01. Requirements. top..
Except as is otherwise specified in this chapter, every physician licensed to practice medicine in North Dakota shall complete no less than sixty (60) hours of board-approved continuing medical education (CME) every three years. One hour of credit will be allowed for each clock-hour of participation in approved continuing medical education activities.
50-04-01-02. Exceptions. top..
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 those 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 those 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 board of medical examiners (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.
50-04-01-03. Credits accepted. top..
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 state board of medical examiners 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.
50-04-01-04. Compliance. top..
1. All physicians will periodically be required to answer questions on the board's annual license renewal forms to establish compliance, or eligibility for an exception, pursuant to this chapter. Physicians whose surnames begin with letters A through H shall report their CME credits to the board in the year 2001 and every third year thereafter. Physicians whose surnames begin with letters I through O shall report their CME credits to the board in the year 2002 and every third year thereafter. Physicians whose surnames begin with letters P through Z shall report their CME credits to the board in the year 2003 and every third year thereafter. 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.
Any physician who is required to report CME credits after having been licensed to practice medicine in North Dakota for more than two years but less than three full years will be required to demonstrate completion of forty hours of board-approved CME 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. Each year 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 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.
![[Back Home]](images/back.gif){kind=small}
© 1997 by The North Dakota State Board of Medical Examiners
All Rights Reserved.
Last modified on 12/22/2008 .