Protocol · PA · North Dakota
Practice Protocol for Physician Assistants in North Dakota
North Dakota does not define a named protocol for Physician Assistants. Here is what the state does require and what a written protocol usually covers.
A PA practicing outside a qualifying facility may seek independent-practice approval only if the site is in a board-designated rural/medically underserved area AND a ND-licensed physician performs periodic chart reviews (N.D. Admin. Code § 50-03-01-03.2(2)). Otherwise, no agreement is required at all once the 4,000-hour/qualifying-facility conditions are met (§ 43-17-02.1(3)).
Independent practice requires: ≥4,000 hours of board-approved practice (below this, a written collaborative agreement with a physician is required — N.D. Cent. Code § 43-17-02.1(6)); practicing at a licensed health care facility, a facility with a credentialing/privileging system, a physician-owned facility/practice, or a board-approved facility/practice (§ 43-17-02.1(5)) — a PA outside such a setting seeking full independent practice must instead qualify via the rural/underserved pathway below.
What a Physician Assistant protocol covers in North Dakota
Not every Physician Assistant in North Dakota needs one; the conditions are under "Written agreement" below. When one is required, these are its clauses. The North Dakota Board of Medicine and the North Dakota State Board of Pharmacy governs physician assistants here.
Where the Physician Assistant ("PA") practices within a facility credentialed and privileged to use Physician Assistants, North Dakota law does not require a written agreement between the Physician Assistant and a specific physician; the facility's credentialing and privileging system substitutes for that agreement, and the Physician Assistant's scope is determined by the Physician Assistant's education, training, and experience within that setting, consistent with N.D.C.C. ch. 43-17. In that setting, this Agreement, together with the facility's credentialing determination, governs the Physician Assistant's working relationship with the Physician.
Source: N.D.C.C. ch. 43-17
Outside a credentialed facility, including a Physician Assistant-owned or private practice, North Dakota law imposes experience thresholds and collaboration-documentation requirements that should be confirmed against the North Dakota Board of Medicine's current rules before the Physician Assistant begins practicing in that setting.
- A voluntary protocol also carries 1 scope, 1 education and 1 registration clauses, authored in the document itself.
Statutes and rules these clauses cite
- N.D.C.C. ch. 43-17statute
North Dakota Physician Assistant practice act.
North Dakota's supervision rules
Ratio, proximity, chart review, meeting and prescribing rules for physician assistants, and the conditions under which a written protocol becomes required.
Proximity
PA below 4,000 practice hours, or outside a qualifying facility: No proximity requirement
No mile/minute radius or on-site requirement is codified. The only geographic element in ND law is the 'rural, medically underserved area' designation required for the independent-practice pathway (NDAC § 50-03-01-03.2(2)(a)) — a designation-based, not mileage-based, condition.
Supervision ratio
Not codified — no cap on file
Chart review
PA in the rural/underserved independent-practice pathway: Percentage set by agreement · As needed
NDAC § 50-03-01-03.2(2)(b) requires 'chart reviews at periodic intervals as required by the board' with no percentage or fixed interval specified in the rule text. Former ND ratio-cap rules (NDAC §§ 50-03-01-09, -09.1, -09.2) and the countersignature-adjacent § 50-03-01-04 were all repealed by 2020.
Meeting cadence
Not codified
Prescriptive authority
No agreement needed to prescribe · controlled substances permitted
May prescribe/dispense Schedule II-V substances and all legend drugs (§ 43-17-02.1(4)(c)); individual DEA registration required, no separate agreement needed beyond DEA compliance (§ 43-17-02.1(4)(f)). Dispensing itself is restricted to cases where pharmacy services aren't reasonably available, dispensing is in the patient's best interest, or an emergency exists (§ 43-17-02.1(4)(d)).
Written agreement
Not required
False reflects the default/most-common case (≥4,000 hours at a qualifying facility, where 'a written agreement...is not required,' § 43-17-02.1(3)) — but a PA below 4,000 hours, or practicing outside a qualifying facility, DOES need a written collaborative agreement (§ 43-17-02.1(6)) or board-approved rural/underserved arrangement with periodic chart review (NDAC § 50-03-01-03.2(2)).
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional corporation under N.D. Cent. Code ch. 10-31 (Professional Organizations Act); shareholders must be individuals licensed to render the same professional service. Secondary summaries of H.B. 1175 suggest a board-approval ownership pathway for PAs beyond practising at a physician-owned facility (§ 43-17-02.1(5))
Confirm PA independent ownership with the North Dakota Board of Medicine before relying on it.
Sources for the supervision rules (4)
- N.D. Cent. Code § 43-17-02.1 — Physician assistant practice
- N.D. Admin. Code § 50-03-01-03.2 — Independent practice (rural/underserved pathway)
- N.D. Admin. Code §§ 50-03-01-09, -09.1, -09.2 (repealed eff. Jan. 1, 2020) — former ratio caps
- H.B. 1175 (2019 session) — repeal of PA supervision-contract model, eff. Jan. 1, 2020
About North Dakota's rules
H.B. 1175 (2019, eff. 2020) and a 2022 rule amendment repealed ND's old PA supervision-contract/ratio/countersignature model — PAs are now CONDITIONAL only below 4,000 practice hours or outside a qualifying facility. All four APRN roles (NP, CRNA, CNM, CNS) are FULL independent practice with no collaboration agreement of any kind.
Other clinicians in North Dakota: see the state overview.