A summary of North Dakota’s collaboration, agreement, filing, supervision, prescribing, and specialty rules for PAs and the physicians who collaborate with them.
Collaborating Physician Required? No, in most settings. A collaborating physician is required only when a PA gets Board approval to practice outside the approved facility types.
Physician Involvement: None in approved practice settings. Low under the Board-approval route.
Agreement Name: Collaborative agreement
On-Site Requirements: None
Chart Review: None in approved practice settings
Controlled Substances: Allowed, Schedules II–V plus all legend drugs. Federal DEA registration required; no separate state credential.
Reduced Supervision / Transition Requirements: 4,000 practice hours. At that point no collaborative agreement is required, even at a site that needs Board approval.
North Dakota PA Collaboration Requirements Summary
North Dakota does not require PAs to have a collaborating physician in most practice settings. PAs practice independently as long as they work at a health care facility licensed by the Department of Health and Human Services, a facility with a credentialing and privileging system, a physician-owned facility or practice, or a correctional, state, or federal facility. A PA who wants to practice outside those settings must first get Board approval, which brings in a North Dakota-licensed physician for periodic chart review — and, if the PA has fewer than 4,000 practice hours, a written collaborative agreement. PAs are responsible for the care they provide. This page covers North Dakota’s rules on collaboration, the collaborative agreement, board filing, ongoing compliance, prescribing, and specialty and telehealth requirements.
Source: NDAC 50-03-01-03.2(2)
Type of Collaborative Relationship
North Dakota PAs practice independently, with no collaborating physician required in the standard approved practice settings. Oversight only enters the picture on the Board-approval route: a PA practicing outside those settings must collaborate with a North Dakota-licensed physician who performs periodic chart review, and a PA with fewer than 4,000 hours must also have a written collaborative agreement. There is no ongoing supervision structure beyond that.
Source: NDAC 50-03-01-03.2(2)
What is a PA’s scope of practice in North Dakota?
A PA in North Dakota is responsible for the care that PA provides. The state’s rules define practice through where a PA may work and what a PA may prescribe rather than through a physician-delegated task list. PAs may prescribe and dispense Schedule II through V controlled substances and all legend drugs.
Do PAs need a collaborating physician in North Dakota?
No, not in the standard approved practice settings. A collaborating physician is required only when a PA obtains Board approval to practice at a site outside those settings.
Can PAs practice independently in North Dakota?
Yes. PAs practice independently at a health care facility licensed by the Department of Health and Human Services, a facility with a credentialing and privileging system, a physician-owned facility or practice, or a correctional, state, or federal facility. Practicing outside those settings requires prior Board approval, and the site must be in a rural, medically underserved area as determined by the Board.
How many PAs can a physician collaborate with in North Dakota?
North Dakota sets no limit. The state’s rules are silent on how many PAs a physician may collaborate with.
Who can be a collaborating physician in North Dakota?
North Dakota sets no specific qualification requirements for a collaborating physician. Under the Board-approval route, the physician must hold a North Dakota medical license; the rules add no experience, specialty, or training requirement.
Are there proximity or in-person requirements in North Dakota?
No — North Dakota sets no proximity, travel, or in-person requirement. There is no on-site presence rule and no availability standard for a collaborating physician.
Collaboration Agreement Requirements
North Dakota only requires a written collaborative agreement in one situation: a PA with fewer than 4,000 practice hours who is approved to practice outside the standard approved facility types. The agreement must describe how collaboration with the North Dakota-licensed physician will occur, and the PA must provide it to the Board on request. There is no state-provided template, no on-site storage requirement, and no set review schedule.
Source: NDAC 50-03-01-03.2(2)(c)
What must be included in a PA collaborative agreement in North Dakota?
The agreement must describe how collaboration with the physician will occur. North Dakota does not specify further required content and does not provide a template. No agreement is required at all if the PA has more than 4,000 practice hours or is practicing in one of the approved facility types.
What is the collaborative agreement called in North Dakota?
It is called a collaborative agreement.
Who has to sign the collaborative agreement in North Dakota?
North Dakota’s rules are silent on signatures. The rules require the PA to execute a written agreement with a North Dakota-licensed physician but do not specify who must sign it.
How often must the agreement be reviewed or renewed in North Dakota?
North Dakota sets no review or renewal schedule. The rules are silent on how often the agreement must be updated.
Is a backup physician required in North Dakota?
No — North Dakota does not require a backup physician.
Board Filing Requirements
North Dakota does not require a collaborative agreement to be filed with the Board. The agreement only has to be provided to the Board on request. Separately, a PA who wants to practice outside the approved facility types must get Board approval before practicing there.
Source: NDAC 50-03-01-03.2(2)(c)
Do you have to file the collaborative agreement with the board in North Dakota?
No. The agreement does not have to be filed, though the PA must provide it to the Board upon request. No additional documents are required to be filed, and there are no recurring filing requirements.
Can a PA start practicing as soon as they file in North Dakota?
There is no filing requirement, so this does not apply in the standard approved practice settings. For the separate Board-approval route, though, prior Board approval is required before the PA begins practicing at that site.
What are the termination and notice requirements in North Dakota?
North Dakota sets no termination or notice requirement. Neither the PA nor the physician has to notify the Board when a collaboration ends.
Collaboration Compliance
North Dakota imposes no ongoing compliance obligations for PAs in the standard approved practice settings — no meeting cadence, no availability standard, no chart co-signature, and no documentation requirement. The one ongoing obligation applies to PAs approved to practice outside those settings, where the collaborating physician must perform chart reviews at periodic intervals as required by the Board.
Source: NDAC 50-03-01-03.2(2)(b)
How many charts must a collaborating physician review in North Dakota?
None in the standard approved practice settings. For a PA approved to practice outside those settings, the collaborating physician must perform chart reviews at periodic intervals as required by the Board; the Board describes this as 25 chart reviews per quarter.
How often must a PA and collaborating physician meet in North Dakota?
North Dakota sets no meeting requirement. There is no required meeting cadence and no availability or consultation standard for a collaborating physician.
How long must collaboration records be kept in North Dakota?
North Dakota sets no record retention period. The rules include no documentation requirement for collaboration records, though a PA with a collaborative agreement must be able to provide it to the Board on request.
Prescribing Rules
PAs in North Dakota may prescribe and dispense Schedule II through V controlled substances and all legend drugs. A PA prescribing or dispensing a controlled substance must register with the federal DEA and comply with applicable state and federal law. North Dakota adds no state-level prescribing credential, no formulary requirement, and no physician co-signature.
Source: NDAC 50-03-01-01.1(2)(c),(f)
Can a PA prescribe controlled substances in North Dakota?
Yes, Schedules II through V. The PA must register with the federal DEA and comply with applicable state and federal laws.
Can a PA prescribe Schedule II drugs in North Dakota?
Yes. North Dakota’s rules include Schedule II within a PA’s prescribing and dispensing authority, with no additional restriction.
What schedule drugs can a PA prescribe in North Dakota?
PAs may prescribe and dispense Schedules II, III, IV, and V, plus all legend drugs. North Dakota sets no formulary limits, quantity limits, or day-supply limits on PA prescribing.
Does a PA need a DEA license in North Dakota?
Yes, a PA who prescribes or dispenses controlled substances must register with the federal DEA. North Dakota does not require a separate state controlled-substance registration or additional state credential.
Can a PA prescribe independently (without physician sign-off) in North Dakota?
Yes. North Dakota requires no physician co-signature, formulary approval, or consultation before a PA prescribes, and sets no heightened oversight for controlled substances.
Specialty & Telehealth Requirements
North Dakota’s main telehealth rule for PAs concerns opioids: after a qualifying telemedicine examination or evaluation, a licensee may prescribe using their own professional judgment, but opioids may only be prescribed through telemedicine as an FDA-approved medication-assisted treatment for opioid use disorder, or to a patient in a hospital or long-term care facility. Note also that a solely telemedicine practice does not qualify for the Board-approval route to practice outside the approved facility types.
Source: N.D. Cent. Code 43-17-45(1)
Are there telehealth or telemedicine requirements for PAs in North Dakota?
Yes, and they center on opioid prescribing. Opioids may be prescribed through telemedicine only as an FDA-approved medication-assisted treatment for opioid use disorder, or to a patient in a hospital or long-term care facility; they may not be prescribed through a telemedicine encounter for any other purpose. Other medications may be prescribed according to the licensee’s professional discretion and judgment after a qualifying telemedicine examination.
Are there specialty-specific requirements for PAs in North Dakota?
North Dakota’s PA rules do not set out any specialty-specific requirements. The general practice-setting, prescribing, and telehealth rules apply across specialties.
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