Starting a virtual clinic in North Dakota: 2026 telehealth requirements

Yes, for any new patient relationship. The Board of Medicine rules, as CCHP summarizes them, deem the practice of medicine to occur where the patient is located and require an active North Dakota license except as the rules provide. N.D. Cent. Code 43-17-01 defines telemedicine to include electronic communication, asynchronous store-and-forward technologies and remote monitoring, so an asynchronous questionnaire-based program is the practice of medicine in North Dakota when the patient is there.

North Dakota participates in the Interstate Medical Licensure Compact. A physician whose state of principal license is another compact state can obtain a full North Dakota license through the IMLC's expedited process. There is no telehealth-specific license, so the compact and the standard application are the two routes.

The limited exemption in N.D. Admin. Code 50-02-15-03 is about continuity of care, not market entry. A physician licensed in another state, the District of Columbia or a Canadian province who established a patient relationship with a North Dakota resident in the physician's licensing state may continue that care by telehealth while the patient is in North Dakota, but only as a logical and expected continuation of the prior care. New conditions, or conditions where the standard of care requires an in-person visit, require the patient to return to the licensing state or be referred to a North Dakota-licensed provider. The exemption lasts up to one year from when the relationship was established; after that, an in-person encounter in the licensing jurisdiction is required before another year of telehealth. The rule also covers established patients temporarily in the state, preparation for a scheduled in-person visit, requested consultation with a North Dakota-licensed physician, and gratuitous emergency care. Exempt physicians consent to North Dakota law, including N.D. Cent. Code 43-17-44 and 43-17-45, and to the Board's jurisdiction.

None of this allows a brand to onboard a new North Dakota patient without a North Dakota-licensed provider. The exemption can matter when an existing patient of a brand physician relocates to North Dakota, but it caps out at one year and excludes new conditions. Route North Dakota patients only to North Dakota-licensed clinicians.

North Dakota is a strong corporate practice of medicine state. The MedPath Compliance guide classifies it as a CPOM state grounded in statute, and the Permit Health guide states that North Dakota unequivocally enforces the doctrine with no nonprofit exceptions, citing N.D. Cent. Code 43-17-31. The same guide describes a fee rule within the doctrine that prohibits paying or receiving fees, commissions or rebates for services not rendered or for referrals, except where an arrangement complies with state regulations, and reports that the state medical board had the second highest per-capita rate of serious enforcement actions among state boards during 2019 through 2021.

The absence of a nonprofit exception is distinctive. In several states a nonprofit hospital or clinic may employ physicians even where a for-profit corporation may not; the Permit Health guide reports that North Dakota draws no such line. For a telehealth brand this does not change the structure, but it signals how little room there is for creative ownership arrangements.

A non-clinician brand therefore uses a management services organization owned by the brand and a North Dakota professional entity owned by a North Dakota-licensed physician. The MSO provides the platform, intake, marketing, scheduling, billing support and non-clinical staff; the professional entity engages the clinicians and renders and bills for care. Because the Permit Health guide ties a fee and referral prohibition to the doctrine, the management fee should be fixed or tied to measurable non-clinical services at fair market value, and nothing in the arrangement should look like payment for patient referrals.

MyOrbitHealth already operates through an MSO and friendly professional corporation structure built for strict states; counsel admitted in North Dakota should confirm the entity form, the management fee and the referral provisions before launch.

AANP classifies North Dakota as a full practice state, and the compliance dataset records the same as of May 2026. Under AANP's definition, that means North Dakota NPs evaluate patients, diagnose, order and interpret tests, and initiate and manage treatment including prescriptions under the exclusive licensure authority of the Board of Nursing, without a career-long collaborative agreement.

For a telehealth brand, full practice authority means North Dakota-licensed NPs can independently staff asynchronous reviews, video visits and renewals, which offsets some of the cost of the state's strict CPOM structure. Two state rules still apply to NPs as they do to physicians: the bona fide relationship requirement in N.D. Cent. Code 43-17-44, which treats a static online questionnaire or an audio-only conversation as insufficient for an initial evaluation, and the telemedicine opioid prohibition in N.D. Admin. Code 50-02-15-02. A North Dakota physician should still be on the roster for escalations and for ownership of the professional entity. The sources reviewed for this page do not state transition-to-practice conditions; confirm with the North Dakota Board of Nursing.