# Title 43 — Occupations and Professions

## Chapter 43-26.1 — Physical Therapists

### § 43-26.1-01. Definitions.

In this chapter, unless the context otherwise requires:
1. "Board" means the North Dakota board of physical therapy.
2. "Competence" is the application of knowledge, skills, and behaviors required to
function effectively, safely, ethically, and legally within the context of the patient's or
client's environment.
3. "Continuing competence" is the lifelong process of maintaining and documenting
competence through ongoing self-assessment, development, and implementation of a
personal learning plan along with subsequent reassessment.
4. "Direct supervision" means the supervising physical therapist is physically present on
the premises and immediately available for direction and supervision, has direct
contact with the patient during each visit, and completes all components of care
requiring skilled therapy services. Telehealth does not meet the requirement for direct
supervision.
5. "Electronic communications" means the science and technology of communication
over a distance by electronic transmission of impulses, including activities involving or
using electronic communications to store, organize, send, retrieve, and convey
information.
6. "Examination" means a national examination approved by the board for the licensure
of a physical therapist or the licensure of a physical therapist assistant.
7. "General supervision" means the supervising physical therapist is onsite and present
where services are provided or is immediately available to the physical therapist
assistant being supervised by means of electronic communications, maintains
continual involvement in the appropriate aspects of patient care, and has primary
responsibility for all patient care services rendered by a physical therapist assistant.
8. "Manual therapy" means the use of techniques such as mobilization or manipulation,
manual lymphatic drainage, and manual traction on one or more regions of the body.
9. "Onsite supervision" means the supervising physical therapist is onsite and present in
the department or facility where services are provided, is immediately available to the
individual being supervised, and maintains continued involvement in appropriate
aspects of each treatment session in which a student physical therapist or a student
physical therapist assistant is involved in components of care.
10. "Physical therapist" means an individual licensed under this chapter to practice
physical therapy. The term "physiotherapist" is synonymous with "physical therapist"
under this chapter.
11. "Physical therapist assistant" means an individual licensed under this chapter and who
assists the physical therapist in selected components of physical therapy intervention.
12. "Physical therapy" means the care and services provided by or under the direction and
supervision of a physical therapist licensed under this chapter.
13. "Physical therapy aide" means an individual trained under the direction of a physical
therapist who performs designated and supervised routine tasks related to physical
therapy.
14. "Practice of physical therapy" means:
a. Examining, evaluating, and testing individuals with mechanical, physiological, and
developmental impairments, functional limitations in movement and mobility, and
disabilities or other health and movement-related conditions to determine a
diagnosis for physical therapy, prognosis, and plan of therapeutic intervention,
and to assess the ongoing effects of intervention. The term includes ordering
diagnostic imaging performed by a professional authorized by chapter 43-62 and
interpreted by a licensed physician trained in radiology interpretation, and using
these results to determine if a referral to another health care provider is
necessary or indicates the necessary treatment is within the physical therapist's
scope of practice.

b. Alleviating impairments, functional limitations in movement and mobility, and
disabilities by designing, implementing and modifying therapeutic interventions
that may include therapeutic exercise; neuromuscular education; functional
training related to positioning, movement, and mobility in self-care and in-home,
community, or work integration or reintegration; manual therapy; therapeutic
massage; prescription, application and, as appropriate, fabrication of assistive,
adaptive, orthotic, prosthetic, protective, and supportive devices and equipment
related to positioning, movement, and mobility; airway clearance techniques;
integumentary protection and repair techniques; debridement and wound care;
physiotherapy; physical agents or modalities; mechanical and electrotherapeutic
modalities; and patient-related instruction.
c. Engaging as a physical therapist in reducing the risk of injury, impairment,
functional limitation and disability, including the promotion and maintenance of
fitness, health, and wellness in populations of all ages.
d. Engaging as a physical therapist in administration, consultation, education, and
research.
15. "Restricted license" for a physical therapist or physical therapist assistant means a
license on which the board places restrictions or conditions, or both, as to scope of
practice, place of practice, supervision of practice, duration of licensed status, or type
or condition of patient or client to whom the licensee may provide services.
16. "Telehealth" is the use of electronic communications to provide and deliver
health-related information and health care services, including physical therapy related
information and services, over any distance. Telehealth encompasses health care and
health promotion activities, including education, advice, reminders, interventions, and
the monitoring of interventions.
17. "Testing" means standard methods and techniques used to gather data about the
patient.
### § 43-26.1-02. Board of physical therapy - Members - Appointments - Vacancies.

1. The board of physical therapy shall administer this chapter. The board consists of
three licensed physical therapists, one licensed physician, one licensed physical
therapist assistant, and two public members. The governor shall appoint board
members for a term of five years, staggered so the terms of no more than two
members expire each year. An individual may not serve more than two full consecutive
terms. Terms begin on July first. Appointments to the board to fill a vacancy occurring
for other than the expiration of a term may only be made for the remainder of the
unexpired term.
2. Each physical therapist and physical therapist assistant appointed must have had at
least three years of physical therapy experience in North Dakota immediately before
appointment and must practice in North Dakota during the term. The physician
appointed must have practiced medicine at least three years in North Dakota
immediately before appointment and must practice in North Dakota during the term.
Each board member shall take and file with the secretary of state the oath of office
prescribed for state officials before entering upon the discharge of the member's
duties.
3. Each board member is entitled to mileage reimbursement as provided in section
provided by law for state officers in section 44-08-04.
### § 43-26.1-03. Powers of the board.

The board may:
1. Evaluate the qualifications of applicants for licensure.
2. Provide for the examination of physical therapists and physical therapist assistants
and adopt passing scores for the examinations.
3. Issue licenses to persons who meet the requirements of this chapter.
4. Regulate the practice of physical therapy by interpreting and enforcing this chapter.

5. Adopt and revise rules consistent with this chapter.
6. Meet at least annually and other times as deemed necessary. A majority of board
members constitutes a quorum for the transaction of business.
7. Establish mechanisms for assessing the continuing professional competence of
physical therapists and physical therapist assistants to engage in the practice of
physical therapy.
8. Establish and collect fees for sustaining the necessary operation and expenses of the
board.
9. Elect officers from its members necessary for the operations and obligations of the
board. Terms of office are one year.
10. Provide for the timely orientation and training of new professional and public
appointees to the board regarding board licensing and disciplinary procedures, this
chapter, and board rules, policies, and procedures.
11. Maintain a current list of all individuals regulated under this chapter. This contact
information includes the individual's name, current business address, business
telephone number, electronic mail address, and board license number.
12. Provide information to the public regarding the complaint process.
13. Employ necessary personnel to carry out the administrative work of the board.
14. Enter contracts for services necessary for enforcement of this chapter.
15. Report final disciplinary action taken against a licensee to a national disciplinary
database recognized by the board or as required by law.
16. Review and investigate all complaints the board receives against licensees concerning
violations of this chapter. The board shall keep all information relating to the receipt
and investigation of the complaint confidential until the information is disclosed in the
course of the investigation or any subsequent proceeding or until disclosure is required
by law. However, patient records, including clinical records, files, any report or oral
statement relating to diagnostic findings of a patient or treatment of a patient, any
information from which a patient or the patient's family might be identified, or
information received and records or reports kept by the board as a result of its
investigation, are confidential.
### § 43-26.1-04. Qualifications for licensure.

1. Before being approved for a license as a physical therapist or physical therapist
assistant, an applicant:
a. Must be of good moral character.
b. Shall complete the application process.
c. Must be a graduate of a professional physical therapist or physical therapist
assistant education program accredited by a national accreditation agency
approved by the board.
d. Shall pass the examination approved by the board.
2. An applicant for a license as a physical therapist or a physical therapist assistant who
has been educated outside of the United States:
a. Must be of good moral character.
b. Shall complete the application process.
c. Shall provide satisfactory evidence the applicant's education is substantially
equivalent to the requirements of a physical therapist or physical therapist
assistant educated in an accredited education program as determined by the
board. For the purpose of this section, "substantially equivalent" means an
applicant for licensure educated outside the United States must have:
(1) Graduated from a physical therapist or physical therapist assistant
education program that prepares the applicant to engage in the practice of
physical therapy without restriction.
(2) Provided written proof the applicant's school of physical therapy or physical
therapy assistant education is recognized by its ministry of education or
other appropriate education agency.

(3) Undergone a credentials evaluation as directed by the board determining
the candidate has met uniform criteria for educational requirements as
further established by rule.
(4) Completed any additional education or clinical experience as required by the
board.
d. Shall pass the board-approved English proficiency examinations if the applicant's
native language is not English.
e. Shall pass the examination approved by the board.
f. Shall obtain a criminal background check as referenced in section 43-26.1-05.1
and required under article III of chapter 43-26.2.
3. Notwithstanding the provisions of subsection 2, if the applicant is educated outside the
United States and is a graduate of a professional physical therapist or physical
therapist assistant educational program accredited by a national accrediting agency
approved by the board, the board may waive the requirements in subdivision c of
subsection 2.
### § 43-26.1-05. Application and examination.

1. An applicant for licensure shall file a complete application as required by the board.
The applicant shall include application fees as provided in this chapter and under
applicable rules.
2. The board shall provide examinations at times and places the board determines. The
board shall determine the passing score.
3. An applicant for licensure as a physical therapist may take the examination after the
application process has been completed. The examination must test entry-level
competence related to physical therapy theory, examination and evaluation, diagnosis,
prognosis, treatment intervention, prevention, and consultation.
4. An applicant for licensure as a physical therapist assistant may take the examination
after the application process has been completed. The examination must test for
requisite knowledge and skills in the technical application of physical therapy services.
5. An applicant for licensure who does not pass the examination on the first attempt may
retake the examination, not to exceed six attempts. There is a limit of two attempts for
scores below four hundred.
6. If the board determines an applicant or examinee has engaged, or has attempted to
engage, in conduct that subverts or undermines the integrity of the examination
process, the board may disqualify the applicant or examinee from taking the
examination.
### § 43-26.1-05.1. Use of criminal history record checks.

The board may require a physical therapy or physical therapy assistant applicant, or a
licensee under investigation, to submit to a statewide and nationwide criminal history record
check, including a fingerprint-based criminal history background check. The criminal history
record check must be conducted in the manner provided by section 12-60-24. The criminal
history record check is an exempt record but may not be disseminated by the board to the
physical therapy compact commission or a similar entity. All costs associated with a criminal
history record check performed under this section are the responsibility of the applicant or
licensee.
### § 43-26.1-06. Licensure by endorsement.

The board shall issue a license to a physical therapist or physical therapist assistant who
has a license in good standing from another jurisdiction that imposes requirements for obtaining
and maintaining a license which are at least as stringent as the requirements imposed in this
state.

### § 43-26.1-07. Exemptions from licensure.

1. This chapter does not restrict a person licensed under any other law of this state from
engaging in the profession or practice for which that person is licensed as long as that
person does not represent, imply, or claim that that person is a physical therapist,
physical therapist assistant, or a provider of physical therapy.
2. The following persons are exempt from the licensure requirements of this chapter
when engaged in the following activities:
a. A person in a professional education program approved by the board who is
satisfying supervised clinical education requirements related to the person's
physical therapist or physical therapist assistant education while under onsite
supervision of a physical therapist.
b. A physical therapist who is practicing in the United States armed services, United
States public health service, or veterans administration pursuant to federal
regulations for state licensure of health care providers.
c. A physical therapist who is licensed in another jurisdiction of the United States or
credentialed to practice physical therapy in another country if that person is
teaching, demonstrating, or providing physical therapy in connection with
teaching or participating in an educational seminar in the state of no more than
sixty days in a calendar year.
d. A physical therapist who is licensed in another United States jurisdiction if that
person is providing services in accordance with section 43-51-03.
e. A physical therapist who is licensed in another United States jurisdiction or
credentialed in another country, if that person by contract or employment is
providing physical therapy to individuals affiliated with or employed by established
athletic teams, athletic organizations, or performing arts companies temporarily
practicing, competing, or performing in the state for no more than sixty days in a
calendar year.
f. A physical therapist assistant who is licensed in another United States jurisdiction
and is assisting a physical therapist engaged specifically in activities related to
subdivisions b, c, and e is exempt from the requirements of licensure under this
chapter.
### § 43-26.1-08. License renewal - Changes.

A licensee shall renew the license annually pursuant to board rules. A licensee who fails to
renew the license on or before the expiration date may not practice as a physical therapist or
physical therapist assistant in this state, and may be subject to a late renewal fee. A licensee
shall report to the board a name change and other changes in contact information within thirty
days of the date of change.
### § 43-26.1-09. Reinstatement of license.

1. The board may reinstate an expired license upon payment of a renewal fee and
reinstatement fee.
2. If a physical therapist's or physical therapist assistant's license has expired for more
than three consecutive years, that person shall reapply for licensure and shall
demonstrate to the board's satisfaction competence to practice physical therapy, by
one or more of the following as determined by the board:
a. Practice for a specified time under a restricted license.
b. Complete prescribed remedial courses.
c. Complete continuing competence requirements for the period of the expired
license.
d. Pass an examination.
### § 43-26.1-10. Fees.

The board shall establish and collect fees not to exceed:

1. Two hundred dollars for an application for an original license. This fee is
nonrefundable.
2. One hundred dollars for an annual renewal of the license.
3. Two hundred dollars for an application for reinstatement of a license.
4. Fifty dollars for late renewal of a license.
5. Forty dollars for the compact privilege.
### § 43-26.1-11. Patient care management.

1. A physical therapist shall manage all aspects of each patient's physical therapy. A
physical therapist shall provide:
a. Each patient's initial evaluation and documentation.
b. Periodic re-evaluation and documentation of each patient.
c. The documented discharge of the patient, including the response to therapeutic
intervention at the time of discharge.
2. If the diagnostic process reveals findings outside the scope of a physical therapist's
knowledge, experience, or expertise, a physical therapist shall inform the patient or
client and refer the patient or client to an appropriate practitioner.
3. A physical therapist shall assure the qualifications of a physical therapist assistant and
physical therapy aide under the physical therapist's direction and supervision.
4. For each patient on each date of service, a physical therapist shall provide all of the
therapeutic intervention that requires the expertise of a physical therapist and shall
determine the use of physical therapist assistants that provide for the delivery of care
that is safe, effective, and efficient.
a. A physical therapist assistant shall work under the supervision of a physical
therapist. A physical therapist assistant may document care provided without the
cosignature of the supervising physical therapist.
b. A physical therapist may use physical therapy aides for designated routine tasks.
A physical therapy aide shall work under the direct supervision of a physical
therapist. This supervision may extend to general supervision of the physical
therapy aide only when the physical therapy aide is accompanying and working
directly with a physical therapist assistant with a specific patient or when
performing non-patient-related tasks.
5. A physical therapist's or physical therapist assistant's responsibility for patient care
management includes accurate documentation and billing of the services provided.
6. The physical therapist shall communicate the overall plan of care with, and obtain
informed consent from, the patient or the patient's legally authorized representative.
### § 43-26.1-11.1. Ordering imaging.

1. A physical therapist may order diagnostic imaging if the physical therapist:
a. Holds a clinical doctorate degree in physical therapy; or
b. Completed a board-approved formal medical imaging training program.
2. A physical therapist ordering diagnostic imaging shall report the results to the patient's
designated specialty or primary care provider within seven days of receipt of the image
to ensure coordination of care, unless:
a. The patient does not have a specialty or primary care provider; or
b. The specialty or primary care provider received the images from the health care
professional who performed or interpreted the images.
### § 43-26.1-12. Consumers' rights.

1. The public shall have access to the following information:
a. A list of physical therapists that includes place of practice, license number, date of
license, and expiration and status of license.
b. A list of physical therapist assistants licensed in the state, including place of
employment, license number, date of license, and expiration and status of
license.

c. The board's address and telephone number.
2. A patient has freedom of choice in selection of services and products.
3. Information relating to the physical therapist-patient relationship is confidential and
may not be communicated to a third party who is not involved in that patient's care
without the written authorization of the patient or as permitted by law.
4. Any person may submit a complaint to the board regarding any licensee, or any other
person potentially in violation of this chapter.
### § 43-26.1-13. Grounds for disciplinary actions.

The board may refuse to license any physical therapist or physical therapist assistant, may
discipline, or may suspend or revoke the license of any physical therapist or physical therapist
assistant for any of the following grounds:
1. Violating any provision of this chapter, board rules, or a written order of the board.
2. Practicing or offering to practice beyond the scope of the practice of physical therapy.
3. Failing to refer a patient or client to an appropriate practitioner if the diagnostic process
reveals findings that are outside the scope of a physical therapist's knowledge,
experience, or expertise.
4. Obtaining or attempting to obtain a license by fraud or misrepresentation.
5. Engaging in the performance of substandard physical therapy care due to a deliberate
or negligent act or failure to act, regardless of whether actual injury to the patient is
established.
6. Engaging in the performance of substandard care by a physical therapist assistant,
including exceeding the authority to perform components of intervention selected by
the supervising physical therapist regardless of whether actual injury to the patient is
established.
7. Failing to supervise physical therapist assistants or physical therapy aides in
accordance with this chapter and board rules.
8. A determination by the board that a licensee's conviction of an offense has a direct
bearing on the licensee's ability to serve the public as a physical therapist or physical
therapist assistant or that, following conviction of any offense, the holder is not
sufficiently rehabilitated as provided under section 12.1-33-02.1.
9. Practicing as a physical therapist or working as a physical therapist assistant when
physical or mental abilities are impaired by the use of controlled substances or other
habit-forming drugs, chemicals, alcohol, or by other causes.
10. Having had a license revoked or suspended, other disciplinary action taken, or an
application for licensure refused, revoked, or suspended by the proper authorities of
another state, territory, or country.
11. Engaging in sexual misconduct. For the purpose of this subsection sexual misconduct
includes:
a. Engaging in or soliciting sexual relationships, whether consensual or
nonconsensual, while a physical therapist or physical therapist assistant-patient
relationship exists, except with a spouse.
b. Making sexual advances, requesting sexual favors, or engaging in other verbal
conduct or physical contact of a sexual nature with patients or clients.
c. Intentionally viewing a completely or partially disrobed patient in the course of
treatment if the viewing is not related to patient diagnosis or treatment under
current practice standards.
12. Failing to adhere to the standards of ethics of the physical therapy profession adopted
by rule by the board.
13. Charging unreasonable or fraudulent fees for services performed or not performed.
14. Making misleading, deceptive, untrue, or fraudulent representations in violation of this
chapter or in the practice of the profession.
15. Having been adjudged mentally incompetent by a court.
16. Aiding and abetting a person who is not licensed in this state in the performance of
activities requiring a license.

17. Failing to report to the board, when there is direct knowledge, any unprofessional,
incompetent, or illegal acts that appear to be in violation of this chapter or any rules
established by the board.
18. Interfering with an investigation or disciplinary proceeding by failure to cooperate, by
willful misrepresentation of facts, or by the use of threats or harassment against any
patient or witness to prevent that patient or witness from providing evidence in a
disciplinary proceeding or any legal action.
19. Failing to maintain adequate patient records. For the purposes of this subsection,
"adequate patient records" means legible records that contain at a minimum sufficient
information to identify the patient, an evaluation of objective findings, a diagnosis, a
plan of care, a treatment record, and a discharge plan.
20. Failing to maintain patient confidentiality without the written authorization of the patient
or unless otherwise permitted by law. All records used or resulting from a consultation
under section 43-51-03 are part of a patient's records and are subject to applicable
confidentiality requirements.
21. Promoting any unnecessary device, treatment intervention, or service resulting in the
financial gain of the practitioner or of a third party.
22. Providing treatment intervention unwarranted by the condition of the patient or
continuing treatment beyond the point of reasonable benefit.
23. Participating in underutilization or overutilization of physical therapy services for
personal or institutional financial gain.
24. Attempting to engage in conduct that subverts or undermines the integrity of the
examination or the examination process, including a violation of security and copyright
provisions related to the national licensure examination; utilizing recalled or
memorized examination questions from or with any person; communicating or
attempting to communicate with other examinees during the examination; or copying
or sharing examination questions or portions of questions.
### § 43-26.1-14. Lawful practice.

1. A physical therapist or physical therapist assistant licensed under this chapter is fully
authorized to practice physical therapy. The board shall require each licensee to
provide the board with evidence of competence regarding the various elements of
manual therapy the licensee practices so the board may determine satisfactory
competency levels and requirements as provided under section 43-26.1-03.
2. A physical therapist or physical therapist assistant shall adhere to the standards of
ethics of the physical therapy profession as established by rule.
3. A physical therapist may purchase, store, and administer topical medications, including
aerosol medications as part of the practice of physical therapy but may not dispense or
sell any of the medications to patients. A physical therapist shall comply with any
regulation adopted by the United States pharmacopoeia specifying protocols for
storage of medications.
### § 43-26.1-15. Terms and titles.

1. A physical therapist shall use the letters "PT" in connection with the physical therapist's
name or place of business to denote licensure under this chapter.
2. Except as otherwise provided by law, a person or business entity, and its employees,
agents, or representatives, shall not use in connection with that person's or entity's
name or activity the words "physical therapy", "physical therapist", "physiotherapist",
"registered physical therapist", the letters "PT", "MPT", "DPT", "LPT", "RPT", or any
other words, abbreviation, or insignia indicating or implying directly or indirectly that
physical therapy is provided or supplied, unless such services are provided by or
under the direction of a physical therapist licensed pursuant to this chapter. A person
or business entity shall not advertise or otherwise promote another person as being a
"physical therapist" or "physiotherapist" unless the individual so advertised or
promoted is licensed as a physical therapist under this chapter. A person or business
entity that offers, provides, or bills any other person for services shall not characterize

those services as "physical therapy" unless the individual performing that service is
licensed as a physical therapist under this chapter.
3. A physical therapist assistant shall use the letters "PTA" in connection with that
person's name to denote licensure under this chapter.
4. A person shall not use the title "physical therapist assistant", the letters "PTA", or any
other words, abbreviations, or insignia in connection with that person's name to
indicate or imply, directly or indirectly, that the person is a physical therapist assistant
unless that person is licensed under this chapter.
5. A physical therapist who graduated from a doctor of physical therapy program may use
the title "doctor of physical therapy". A physical therapist holding a doctor of physical
therapy or other doctoral degree may not use the title "doctor" without clearly informing
the public of the physical therapist's licensure as a physical therapist.
### § 43-26.1-16. Representations and billings without licensure prohibited - Enforcement -

Injunctions.
No person or business entities of any type shall practice physical therapy or hold
themselves out, represent themselves, or send out billings as providing physical therapy
services, without personal licensure or the use of licensed employees as provided in this
chapter. It shall be unlawful to employ an unlicensed physical therapist or physical therapist
assistant to provide physical therapy services. The board's executive officer, under the board's
direction, shall aid state's attorneys in the enforcement of this chapter and the prosecution of
any violations thereof. In addition to the criminal penalties provided by this chapter, the civil
remedy of injunction shall be available to restrain and enjoin violations of this chapter without
proof of actual damages sustained by any person.
### § 43-26.1-17. Penalty.

Any person violating any of the provisions of this chapter is guilty of a class B misdemeanor.
