Is an exam required before a patient can be treated in North Dakota?

Short answer
Yes — an examination or evaluation must be performed before a licensee first diagnoses or treats a patient for a specific condition, and a bona fide patient relationship must exist first; the same standard applies whether in person or by telemedicine.

North Dakota wrote its pre-treatment rule inside a telemedicine section, and the scope of each part matters. Section 43-17-44 opens by holding a licensee to the same standard of care and the same ethical standards whether the practice is traditional in-person medicine or telemedicine. The requirements that follow are stated in the context of telemedicine: a bona fide relationship with the patient before any diagnosis or treatment, and — before initially diagnosing or treating a patient for a specific illness or condition — an examination or evaluation must be performed. a licensee practicing telemedicine must also verify the patient’s identity and let the patient verify that licensee’s own identity and licensure status. Prescribing follows the examination: 43-17-45 permits it where the telemedicine examination met the chapter’s requirements.