North Dakota
Occupational Therapy	Physical Therapy
Telehealth/Telemedicine/Telecommunications Definition
Telemedicine means the practice of medicine by a practitioner, other than a pharmacist, who is at a location remote from the patient, and is communicating with the patient, or health care professional who is treating the patient, using a telecommunications system. Telehealth is a service delivery model that allows an occupational therapy practitioner to deliver evaluation, treatment, and consultation through telecommunication and information technologies overcoming distance, transportation expenses, and patient access barriers. Source:ND Board of Occupational Therapy Practice Practice-Related Information (Aug. 2018).	“Telehealth” is the use of electronic communications to provide and deliver a host of health related information and healthcare services, including, but not limited to physical therapy related information and services, over large and small distance. Telehealth encompasses a variety of healthcare and health promotion activities, including, but not limited to, education, advice, reminders, interventions, and monitoring of interventions. Source:N.D. Admin. Code 61.5-01-02
Modality
Telehealth includes the use of telecommunication and information technologies, which would include live video and audio and telephone. Source:ND Board of Occupational Therapy Practice Practice-Related Information (Aug. 2018).	Telehealth includes the use of audio, video, or data communications. Source:N.D. Admin. Code 61.5-01-02
Location- Type of site/Geography
The location of the patient at the time of the patient encounter determines the location of the service. Occupational therapy practitioners are required to be licensed in North Dakota if they are providing occupational therapy services to a client who is in North Dakota. If the therapist/assistant is connecting with a patient in another State at the time of the patient encounter, the therapist must be licensed in that state. Source:ND Board of Occupational Therapy Practice Practice-Related Information (Aug. 2018).	Physical therapists licensed in another US jurisdiction are exempt from North Dakota physical therapy licensure requirements if providing consultation by means of telecommunication to a physical therapist who is licensed in North Dakota. Source:N.D. Admin. Code 61.5-01-02
Type of Service
Occupational therapists may use telehealth for evaluation, treatment, and consultation with a patient or other provider. Source:ND Board of Occupational Therapy Practice Practice-Related Information (Aug. 2018). Occupational therapy services are provided for habilitation, rehabilitation, and the promotion of health and wellness, including methods delivered via telerehabilitation to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Source: ND Admin. Code 55.5-03-01-03.	A physical therapist may provide services that are legally or professionally authorized via telehealth. Source:N.D. Admin. Code 61.5-01-02 “Consultation by telecommunication” means that a physical therapist renders professional or expert opinion or advice to another physical therapist or health care provider via telecommunications or computer technology from a distant location. It includes the transfer or exchange of educational or related information by means of audio, video, or data communications. The physical therapist may use telehealth technology as a vehicle for providing only services that are legally or professionally authorized. All records used or resulting from a consultation by means of telecommunications are part of a patient’s record and are subject to applicable confidentiality requirements. Source:N.D. Admin. Code 61.5-01-02
Supervision
Direct supervision means face-to-face contact including videoconferencing. Indirect supervision means other than face-to-face contact, including telephonic and electronic communication, and other methods using secure telecommunication technology. An occupational therapy assistant must be directly supervised and indirectly supervised as necessary. Source:N.D. Admin Code 55.5-02-03-01.1 An occupational therapy practitioner may provide occupational therapy personnel supervision requiring direct supervision and indirect supervision through electronic medical record technology and video teleconferencing. The practitioner will be responsible for the appropriate use of teleconferencing mediums in the supervision of services and maintain the privacy standards in all patient related interactions. Source:ND Board of Occupational Therapy Practice Practice-Related Information (Aug. 2018).	A physical therapist may not provide direct supervision via telecommunications. Source:N.D. Admin. Code 61.5-01-02
Informed Consent
No reference found.	The patient’s written or verbal consent must be obtained and documented prior to a consultation by means of telecommunication. Source:N.D. Admin. Code 61.5-01-02
Patient-Provider-Relationship/In-Person Exam Required
No reference found.	No reference found.
Licensing
No reference found.	North Dakota is part of the Physical Therapy Licensure Compact. Physical therapists licensed through the compact may provide services in other compact states and in North Dakota. Source:ND Bill HB 1157 (Jan. 2017)
Other
Telehealth is a medium to deliver care. OT practitioners must adhere to the same standards as expected for on-site delivery service. Each practitioner must assess and determine if the service delivery method of telehealth meets the standard for each patient encounter using their clinical reasoning and ethical judgment. All legal, regulatory and ethical rules apply consistent with an on-site service. Confidentiality and HIPAA compliance with network connected security in place for video and non-video connections is an important factor. Source:ND Board of Occupational Therapy Practice Practice-Related Information (Aug. 2018).	No reference found.