23-01-01. State department of health — Officers. [Effective through August 31, 2022]

The state department of health consists of a health council, a state health officer, section chiefs, directors of divisions, and other employees of the department.

23-01-01. Health division — Officers. [Effective September 1, 2022]

The department of health and human services’ health division consists of a health council, a state health officer, and other designated employees of the department.

23-01-01.1. State department of health to replace state department of health and consolidated laboratories. [Effective through August 31, 2022]

Wherever the terms “North Dakota state department of health”, “department of health”, “health department”, “state department of health and consolidated laboratories”, “North Dakota state laboratories department”, “state laboratories department”, “state laboratories department director”, or “state laboratories director” appear in this code, the term “state department of health” must be substituted therefor.

23-01-01.1. Department of health and human services to replace state department of health and consolidated laboratories. [Effective September 1, 2022]

The legislative council shall replace, where appropriate, “North Dakota state department of health”, “department of health”, “health department”, “state department of health and consolidated laboratories”, “North Dakota state laboratories department”, “state laboratories department”, “state laboratories department director”, “state laboratories director”, “state department of health”, or any derivatives of those terms, which when used in context indicate an intention to refer to those terms, wherever they appear in this code, and in the North Dakota Administrative Code, with “department of health and human services” or an appropriate derivative of that phrase. The legislative council may replace references to the “state department of health” or any derivatives of that term with “department of health and human services” in any measure enacted by the sixty-seventh legislative assembly.

23-01-01.2. State department of health designated primary state environmental agency. [Repealed]

23-01-02. Health council — Members, terms of office, vacancies, compensation, officers, meetings.

The health council consists of nine members appointed by the governor including four persons from the health care field, and five persons representing consumer interests. The governor may select members to the council from recommendations submitted by trade, professional, and consumer organizations. On the expiration of the term of any member, the governor, in the manner provided by this section, shall appoint for a term of three years, persons to take the place of members whose terms on the council are about to expire. The officers of the council must be elected annually. Any state agency may serve in an advisory capacity to the health council at the discretion of the council. The council shall meet at least twice each year and at other times as the council or its chairman may direct. The health council shall have as standing committees any committees the council may find necessary. The chairman of the council shall select the members of these committees. The members of the council are entitled to receive compensation at the rate set for a member of the legislative assembly under subsection 1 of section 54-03-20 and their necessary mileage and travel expenses as provided in sections 44-08-04 and 54-06-09 while attending council meetings or in the performance of any special duties as the council may direct. The per diem and expenses must be audited and paid in the manner in which the expenses of state officers are audited and paid. The compensation provided for in this section may not be paid to any member of the council who received salary or other compensation as a regular employee of the state, or any of its political subdivisions, or any institution or industry operated by the state.

23-01-02.1. Hospital utilization committees — Internal quality assurance review committees — Reports — Immunity. [Repealed]

Repealed by S.L. 1997, ch. 234, § 5.

23-01-03. Powers and duties of the health council. [Effective through August 31, 2022]

The health council shall:

1. Fix, subject to the provisions of section 23-01-02, the time and place of the meetings of the council.
2. Make rules and regulations for the government of the council and its officers and meetings.
3. Establish standards, rules, and regulations which are found necessary for the maintenance of public health, including sanitation and disease control.
4. Provide for the development, establishment, and enforcement of basic standards for hospitals and related medical institutions which render medical and nursing care, and for the construction and maintenance of such institutions, such standards to cover matters pertaining to sanitation, building construction, fire protection measures, nursing procedures, and preservation of medical records. No rule may be adopted with respect to building construction of existing medical hospitals or related medical institutions unless the rule relates to safety factors or the hospital or related medical institution changes the scope of service in such a way that a different license is required from the department pursuant to rules adopted under chapter 23-16.
5. Hold hearings on all matters brought before it by applicants and licensees of medical hospitals with reference to the denial, suspension, or revocation of licenses and make appropriate determination as specified herein.

The council may direct the state health officer to do or cause to be done any or all of the things which may be required in the proper performance of the various duties placed upon the state department of health.

23-01-03. Powers and duties of the health council. [Effective September 1, 2022]

The health council shall:

1. Fix, subject to the provisions of section 23-01-02, the time and place of the meetings of the council.
2. Make regulations for the government of the council and its officers and meetings.
3. Establish standards and regulations, which are found necessary for the maintenance of public health, including sanitation and disease control.
4. Provide for the development, establishment, and enforcement of basic standards for hospitals and related medical institutions which render medical and nursing care, and for the construction and maintenance of such institutions, such standards to cover matters pertaining to sanitation, building construction, fire protection measures, nursing procedures, and preservation of medical records. No regulation may be adopted with respect to building construction of existing medical hospitals or related medical institutions unless the regulation relates to safety factors or the hospital or related medical institution changes the scope of service in such a way that a different license is required from the department pursuant to rules adopted under chapter 23-16.
5. Hold hearings on all matters brought before it by applicants and licensees of medical hospitals with reference to the denial, suspension, or revocation of licenses and make appropriate determination as specified herein.

The council may direct the state health officer to do or cause to be done any or all of the things which may be required in the proper performance of the various duties placed upon the department of health and human services.

23-01-03.1. Newborn metabolic and genetic disease screening tests. [Effective through August 31, 2022]

1. The health council shall adopt rules relating to the storage, maintenance, and disposal of blood spots or other newborn screening specimens.
2. The health council shall specify a panel of metabolic diseases and genetic diseases for which newborn screening must be performed. The screening panel must include disorders and diseases selected by the state health officer with input from an advisory committee that is approved by the health council.

23-01-03.1. Newborn metabolic and genetic disease screening tests. [Effective September 1, 2022]

1. The department of health and human services shall adopt rules relating to the storage, maintenance, and disposal of blood spots or other newborn screening specimens.
2. The health council shall specify a panel of metabolic diseases and genetic diseases for which newborn screening must be performed. The screening panel must include disorders and diseases selected by the state health officer with input from an advisory committee that is approved by the health council.

23-01-03.2. Duties of the health council. [Repealed]

23-01-03.3. Long-term care nursing scholarship and loan repayment grant program. [Effective through August 31, 2022]

1. The state health council, in cooperation with the North Dakota long term care association, shall administer the long-term care nursing scholarship and loan repayment grant program. The purpose of the program is to provide matching funds to nursing facilities for the facilities to use in recruiting and retaining nurses by providing scholarships to nursing facility staff and other individuals to obtain a nursing education and by assisting in the repayment of student loans for licensed nurses employed in a nursing facility. The state health council shall adopt rules necessary to administer the program, including rules establishing criteria regarding eligibility for and distribution of program grants.
2. An applicant for a program grant shall establish that the applicant:
   1. Is a licensed nursing facility;
   2. Has available matching funds equal to the amount of the grant request; and
   3. Meets the eligibility criteria established by rule.
3. An eligible applicant may receive a program grant not exceeding five thousand five hundred dollars in the first year of the biennium. Any funds appropriated by the legislative assembly for the grant program which are remaining after the first year of the biennium may be distributed to eligible applicants in the second year of the biennium in any amount determined by the state health council.

23-01-03.3. Long-term care nursing scholarship and loan repayment grant program. [Effective September 1, 2022]

1. The state health council, in cooperation with the North Dakota long term care association, shall administer the long-term care nursing scholarship and loan repayment grant program. The purpose of the program is to provide matching funds to nursing facilities for the facilities to use in recruiting and retaining nurses by providing scholarships to nursing facility staff and other individuals to obtain a nursing education and by assisting in the repayment of student loans for licensed nurses employed in a nursing facility. The department of health and human services shall adopt rules necessary to administer the program, including rules establishing criteria regarding eligibility for and distribution of program grants.
2. An applicant for a program grant shall establish that the applicant:
   1. Is a licensed nursing facility;
   2. Has available matching funds equal to the amount of the grant request; and
   3. Meets the eligibility criteria established by rule.
3. An eligible applicant may receive a program grant not exceeding five thousand five hundred dollars in the first year of the biennium. Any funds appropriated by the legislative assembly for the grant program which are remaining after the first year of the biennium may be distributed to eligible applicants in the second year of the biennium in any amount determined by the state health council.

23-01-04. Effect of rules and regulations. [Effective through August 31, 2022]

All rules and regulations promulgated by the health council under the powers granted by any provisions of this title are binding upon all county and municipal health officers, and upon all county, municipal, and private medical hospitals and upon related institutions, and have the force and effect of law.

23-01-04. Effect of rules and regulations. [Effective September 1, 2022]

All rules and regulations adopted by the department of health and human services under the powers granted by any provisions of this title are binding upon all county and municipal health officers, and upon all county, municipal, and private medical hospitals and upon related institutions, and have the force and effect of law.

23-01-04.1. Rulemaking authority and procedure. [Repealed]

23-01-04.2. Legislative intent — Health vaccination charges.

It is the intent of the legislative assembly that the state department of health adopt rules defining appropriate administration charges for vaccine provided by the department to physicians, private clinics, and hospitals.

23-01-04.3. Alternative health care services pilot project — Application — Notice — Hearing — Approval — Duration.

1. At any time that the health care needs of a city, township, or other geographic area are not being adequately met, any person may apply to the state health council for approval to conduct an alternative health care services pilot project. The application must address the need for and benefits of the pilot project. It must also contain a detailed description of the nature and scope of the project, quality control, organization, accountability, responsibility, and financial feasibility.
2. Upon receipt of an application under subsection 1, the state health council shall schedule a public hearing, send notice to all interested parties, and give public notice of the hearing by publication in the official newspaper of each county in the pilot project area. At the hearing, the council shall accept written and oral testimony. The council shall review the application and all testimony presented at the hearing and approve, disapprove, or modify and approve the application based on criteria established by the council. The criteria must address the availability and use of health personnel, facilities, and services.
3. Notwithstanding any other provisions of law, upon approval of an application submitted under subsection 1, the state health council, in consultation with the state health officer and any other public or private entity consulted by the state health council, shall set the standards for the delivery of health care services by the pilot project. The standards may not adversely affect the state’s participation in federal Medicare and Medicaid programs. No more than three separate projects may be operational at any time and no project may be operational for longer than five years.

23-01-05. Health officer — Qualifications, salary, term, duties. [Effective through August 31, 2022]

The governor shall appoint the state health officer who at the time of appointment must be a physician with substantive private or public administrative experience and public health experience. The state health officer is entitled to receive a salary commensurate with that individual’s training and experience. The governor shall set the salary of the state health officer within the limits of legislative appropriations to the department. The state health officer is entitled to receive all necessary traveling expenses incurred in the performance of official business. The state health officer may not engage in any other occupation or business that may conflict with the statutory duties of the state health officer and holds office for a term of four years. The state health officer is the administrative officer of the state department of health. When the office of the state health officer is temporarily filled, the governor shall appoint at least three licensed physicians recommended by the state medical association to serve as an advisory committee to the state health officer. Each member of the advisory committee is entitled to receive reimbursement of expenses in performing official duties in amounts provided by law for other state officers. The term of the advisory committee coincides with the term of the state health officer. A committee member serves at the pleasure of the governor. The duties of the state health officer are as follows:

1. Enforce all rules and regulations as promulgated by the health council.
2. Hold public health unit boards of health responsible for enforcement of state rules, serve in an advisory capacity to public health unit boards of health, and provide for coordination of health activities.
3. Establish and enforce minimum standards of performance of the work of the local department of health.
4. Study health problems and plan for their solution as may be necessary.
5. Collect, tabulate, and publish vital statistics for each important political or health administrative unit of the state and for the state as a whole.
6. Promote the development of local health services and recommend the allocation of health funds to local jurisdictions subject to the approval of the health council.
7. Collect and distribute health education material.
8. Maintain a central public health laboratory and where necessary, branch laboratories for the standard function of diagnostic, sanitary and chemical examinations, and production and procurement of therapeutic and biological preparations for the prevention of disease and their distribution for public health purposes.
9. Establish a service for medical hospitals and related institutions to include licensing of such institutions according to the standards promulgated by the health council and consultation service to communities planning the construction of new hospitals and related institutions.
10. Comply with the state merit system policies of personnel administration.
11. Establish a program to provide information to the surviving family of a child whose cause of death is suspected to have been the sudden infant death syndrome.
12. Issue a written order relating to a disease control measure necessary to prevent the spread of a communicable disease. A disease control measure may include a special immunization activity and decontamination measure.
    1. The state health officer shall limit a written order issued under this section to the geographical area affected by the communicable disease. The state health officer may not issue a statewide order under this section unless the governor has declared a statewide disaster or emergency under chapter 37-17.1 and the governor consents to the order. The statewide order is limited in duration to the duration of the declared disaster or emergency unless terminated earlier pursuant to chapter 37-17.1.
    2. A written order issued under this section has the same effect as a physician’s standing medical order.
    3. The state health officer shall apply to the district court in a judicial district in which a communicable disease is present for an injunction canceling a public event or closing a place of business. On application of the state health officer showing the necessity of the cancellation, the court may issue an ex parte preliminary injunction, pending a full hearing.
    4. Notwithstanding any other provision of law, an order issued pursuant to this subsection may not:
       1. Substantially burden a person’s exercise of religion unless the order is in furtherance of a compelling governmental interest and is the least restrictive means of furthering that compelling governmental interest;
       2. Treat religious conduct more restrictively than any secular conduct of reasonably comparable risk, unless the government demonstrates through clear and convincing scientific evidence that a particular religious activity poses an extraordinary health risk; or
       3. Treat religious conduct more restrictively than comparable secular conduct because of alleged economic need or benefit.
    5. A person claiming to be aggrieved by a violation of subdivision a may assert that violation as a claim or defense in a judicial proceeding and obtain appropriate relief, including costs and reasonable attorney’s fees.
13. Make bacteriological examination of bodily secretions and excretions and of waters and foods.
14. Make preparations and examinations of pathological tissues submitted by the state health officer, by any county superintendent of public health, or by any physician who has been regularly licensed to practice in this state.
15. Make all required analyses and preparations, and furnish the results thereof, as expeditiously and promptly as possible.
16. Cause sanitary statistics to be collected and tabulated, and cause to be ascertained by research work such methods as will lead to the improvement of the sanitation of the various parts of the state.
17. From time to time, cause to be issued bulletins and reports setting forth the results of the sanitary and pathological work done in the laboratories embodying all useful and important information resulting from the work carried on in the laboratories during the year, the substance of such bulletins and reports to be incorporated in the annual report of the state health officer.
18. Establish by rule a schedule of reasonable fees that may be charged for laboratory analysis. No charge may be made for any analysis conducted in connection with any public health incident affecting an entire region, community, or neighborhood.
19. 1. Establish a review process for instances in which the department is requested to conduct an epidemiological assessment of a commercial building. The epidemiological assessment must include:
       1. A statement of whether there are known environmental causes;
       2. If there are known environmental causes identified, a recommendation of how they can be remediated or mitigated; and
       3. If there are no known environmental causes identified, a statement that no known causes exist.
    2. Costs for remediation, mitigation, and consultant services are the responsibility of the building owner. Proof of remediation of any identified environmental concern related to the epidemiological assessment is the burden of the building owner.

23-01-05. Health officer — Qualifications, salary, term, duties. [Effective September 1, 2022]

The governor shall appoint the state health officer who at the time of appointment must be a physician with substantive private or public administrative experience and public health experience. The state health officer is entitled to receive a salary commensurate with that individual’s training and experience. The governor shall set the salary of the state health officer within the limits of legislative appropriations to the department. The state health officer is entitled to receive all necessary traveling expenses incurred in the performance of official business. The state health officer may not engage in any other occupation or business that may conflict with the statutory duties of the state health officer and holds office for a term of four years. If the office of the state health officer is filled temporarily, the governor shall appoint at least three licensed physicians recommended by the state medical association to serve as an advisory committee to the state health officer. Each member of the advisory committee is entitled to receive reimbursement of expenses in performing official duties in amounts provided by law for other state officers. The term of the advisory committee coincides with the term of the state health officer. A committee member serves at the pleasure of the governor. The duties of the state health officer are as follows:

1. Enforce all regulations as promulgated by the health council and all rules adopted by the department of health and human services.
2. Hold public health unit boards of health responsible for enforcement of state rules, serve in an advisory capacity to public health unit boards of health, and provide for coordination of health activities.
3. Establish and enforce minimum standards of performance of the work of the local department of health.
4. Study health problems and plan for their solution as may be necessary.
5. Collect, tabulate, and publish vital statistics for each important political or health administrative unit of the state and for the state as a whole.
6. Promote the development of local health services and recommend the allocation of health funds to local jurisdictions subject to the approval of the health council.
7. Collect and distribute health education material.
8. Maintain a central public health laboratory and where necessary, branch laboratories for the standard function of diagnostic, sanitary and chemical examinations, and production and procurement of therapeutic and biological preparations for the prevention of disease and their distribution for public health purposes.
9. Establish a service for medical hospitals and related institutions to include licensing of such institutions according to the standards promulgated by the health council and consultation service to communities planning the construction of new hospitals and related institutions.
10. Establish a program to provide information to the surviving family of a child whose cause of death is suspected to have been the sudden infant death syndrome.
11. Issue a written order relating to a disease control measure necessary to prevent the spread of a communicable disease. A disease control measure may include a special immunization activity and decontamination measure.
    1. The state health officer shall limit a written order issued under this section to the geographical area affected by the communicable disease. The state health officer may not issue a statewide order under this section unless the governor has declared a statewide disaster or emergency under chapter 37-17.1 and the governor consents to the order. The statewide order is limited in duration to the duration of the declared disaster or emergency unless terminated earlier pursuant to chapter 37-17.1.
    2. A written order issued under this section has the same effect as a physician’s standing medical order.
    3. The state health officer shall apply to the district court in a judicial district in which a communicable disease is present for an injunction canceling a public event or closing a place of business. On application of the state health officer showing the necessity of the cancellation, the court may issue an ex parte preliminary injunction, pending a full hearing.
    4. Notwithstanding any other provision of law, an order issued pursuant to this subsection may not:
       1. Substantially burden a person’s exercise of religion unless the order is in furtherance of a compelling governmental interest and is the least restrictive means of furthering that compelling governmental interest;
       2. Treat religious conduct more restrictively than any secular conduct of reasonably comparable risk, unless the government demonstrates through clear and convincing scientific evidence that a particular religious activity poses an extraordinary health risk; or
       3. Treat religious conduct more restrictively than comparable secular conduct because of alleged economic need or benefit.
    5. A person claiming to be aggrieved by a violation of subdivision a may assert that violation as a claim or defense in a judicial proceeding and obtain appropriate relief, including costs and reasonable attorney’s fees.
12. Make bacteriological examination of bodily secretions and excretions and of waters and foods.
13. Make preparations and examinations of pathological tissues submitted by the state health officer, by any county superintendent of public health, or by any physician who has been regularly licensed to practice in this state.
14. Make all required analyses and preparations, and furnish the results thereof, as expeditiously and promptly as possible.
15. Cause sanitary statistics to be collected and tabulated, and cause to be ascertained by research work such methods as will lead to the improvement of the sanitation of the various parts of the state.
16. From time to time, cause to be issued bulletins and reports setting forth the results of the sanitary and pathological work done in the laboratories embodying all useful and important information resulting from the work carried on in the laboratories during the year, the substance of such bulletins and reports to be incorporated in the annual report of the state health officer.
17. Establish by rule a schedule of reasonable fees that may be charged for laboratory analysis. No charge may be made for any analysis conducted in connection with any public health incident affecting an entire region, community, or neighborhood.
18. 1. Establish a review process for instances in which the department is requested to conduct an epidemiological assessment of a commercial building. The epidemiological assessment must include:
       1. A statement of whether there are known environmental causes;
       2. If there are known environmental causes identified, a recommendation of how they can be remediated or mitigated; and
       3. If there are no known environmental causes identified, a statement that no known causes exist.
    2. Costs for remediation, mitigation, and consultant services are the responsibility of the building owner. Proof of remediation of any identified environmental concern related to the epidemiological assessment is the burden of the building owner.

23-01-05.1. Organ or tissue transplant assistance administration — Standing appropriation. [Effective through August 31, 2022]

The state health officer shall select a private nonprofit patient-oriented organization incorporated in this state for the purpose of administering financial assistance to organ or tissue transplant patients who are residents of this state. The state health officer shall adopt rules governing administration of this section. The organization selected shall administer and provide grants from available funds to alleviate demonstrated financial needs of transplant patients for any costs associated with transplant operations, under guidelines based on current social service eligibility requirements. There is hereby created as a special fund in the state treasury an organ transplant support fund, the principal and income of which is hereby appropriated to the organization selected under this section. The organization administering the fund may solicit contributions from private or governmental sources and such contributions may be deposited in the fund.

23-01-05.1. Organ or tissue transplant assistance administration — Standing appropriation. [Effective September 1, 2022]

The executive director of the department of health and human services shall select a private nonprofit patient-oriented organization incorporated in this state for the purpose of administering financial assistance to organ or tissue transplant patients who are residents of this state. The department of health and human services shall adopt rules governing administration of this section. The organization selected shall administer and provide grants from available funds to alleviate demonstrated financial needs of transplant patients for any costs associated with transplant operations, under guidelines based on current social service eligibility requirements. There is hereby created as a special fund in the state treasury an organ transplant support fund, the principal and income of which is hereby appropriated to the organization selected under this section. The organization administering the fund may solicit contributions from private or governmental sources and such contributions may be deposited in the fund.

23-01-05.2. Epinephrine prescription, distribution, possession, or use — Immunity from liability.

1. As used in this section:
   1. “Epinephrine” means a single-use disposable device that automatically injects a premeasured dose of epinephrine.
   2. “Health care professional” means a licensed or certified health care professional who is working within the scope of practice for that profession. The term may include a physician, physician assistant, advanced practice registered nurse, and pharmacist acting in the professional’s scope of practice.
2. A health care professional acting in good faith may directly or by standing order prescribe, distribute, or dispense epinephrine, if the health care professional provides training to:
   1. An individual at risk of experiencing a severe allergic reaction; or
   2. A family member, friend, or other person in a position to assist an individual at risk of experiencing a severe allergic reaction.
3. A person acting in good faith may receive or possess epinephrine if that person is:
   1. An individual at risk of experiencing a severe allergic reaction; or
   2. A family member, friend, or other person in a position to assist an individual at risk of experiencing a severe allergic reaction.
4. An individual acting in good faith may self-administer epinephrine or administer epinephrine to another individual who the administering individual suspects is at risk of experiencing a severe allergic reaction.
5. A person may receive, possess, or administer epinephrine under subsection 3 or 4, regardless of whether the person is the individual for or the person to which the epinephrine is prescribed, distributed, or dispensed. A person in possession of epinephrine which is acting in good faith may provide training on how to use epinephrine.
6. A health care professional who prescribes, distributes, trains on the use of, or dispenses epinephrine as authorized under this section is not subject to professional discipline for such action. This section does not expand the scope of practice of a health care professional.
7. A person that prescribes, distributes, dispenses, receives, possesses, trains in the use of, or administers epinephrine as authorized under this section is immune from civil and criminal liability for such action. This subsection provides immunity to the person responsible for the site on which the epinephrine is located. Immunity from liability or discipline under this subsection does not apply if the person’s actions constitute recklessness, gross negligence, or intentional misconduct.

23-01-05.3. Immunization data. [Effective through August 31, 2022]

1. The state department of health may establish an immunization information system and may require the childhood immunizations specified in subsection 1 of section 23-07-17.1 and other information be reported to the department. The state department of health may only require the reporting of childhood immunizations and other data upon completion of the immunization information reporting system. A health care provider who administers a childhood immunization shall report the patient’s identifying information, the immunization that is administered, and other required information to the department. The report must be submitted using electronic media, and must contain the data content and use the format and codes specified by the department.
2. If a health care provider fails to submit an immunization report required under this section within four weeks of vaccination:
   1. That health care provider may not order or receive any vaccine from the North Dakota immunization program until that provider submits all reports required under this section.
   2. The state department of health shall make a report to that health care provider’s occupational licensing entity outlining that provider’s failure to comply with the reporting requirements under this section.
3. Notwithstanding any other provision of law, a health care provider, elementary or secondary school, early childhood facility, public or private postsecondary educational institution, city or county board of health, district health unit, and the state health officer may exchange immunization data in any manner with one another. Immunization data that may be exchanged under this section is limited to the date and type of immunization administered to a patient and may be exchanged regardless of the date of the immunization.
4. The state department of health may not create, administer, provide, or contract for electronic machine-readable code or a vaccine passport.

23-01-05.3. Immunization data. [Effective September 1, 2022]

1. The department of health and human services may establish an immunization information system and may require the childhood immunizations specified in subsection 1 of section 23-07-17.1 and other information be reported to the department. The department of health and human services may only require the reporting of childhood immunizations and other data upon completion of the immunization information reporting system. A health care provider who administers a childhood immunization shall report the patient’s identifying information, the immunization that is administered, and other required information to the department. The report must be submitted using electronic media, and must contain the data content and use the format and codes specified by the department.
2. If a health care provider fails to submit an immunization report required under this section within four weeks of vaccination:
   1. That health care provider may not order or receive any vaccine from the North Dakota immunization program until that provider submits all reports required under this section.
   2. The department of health and human services shall make a report to that health care provider’s occupational licensing entity outlining that provider’s failure to comply with the reporting requirements under this section.
3. Notwithstanding any other provision of law, a health care provider, elementary or secondary school, early childhood facility, public or private postsecondary educational institution, city or county board of health, district health unit, and the state health officer may exchange immunization data in any manner with one another. Immunization data that may be exchanged under this section is limited to the date and type of immunization administered to a patient and may be exchanged regardless of the date of the immunization.
4. The department of health and human services may not create, administer, provide, or contract for electronic machine-readable code or a vaccine passport.

23-01-05.4. Department to employ state forensic examiner — Qualifications — Duties. [Effective through August 31, 2022]

The state department of health may employ and establish the qualifications and compensation of the state forensic examiner. The state forensic examiner must be a physician who is board-certified or board-eligible in forensic pathology, who is licensed to practice in this state, and who is in good standing in the profession. The state forensic examiner shall:

1. Exercise all authority conferred upon the coroner under chapter 11-19.1 and any other law;
2. Consult with local coroners on the performance of their duties as coroners;
3. Conduct investigations into the cause of death of and perform autopsies on any deceased human body whenever requested to do so by the acting local county coroner or the local state’s attorney;
4. Provide training and educational materials to local county coroners, law enforcement, and any other person the state forensic examiner deems necessary;
5. Maintain complete records of the cause, manner, and mode of death necessary for accurate health statistics and for public health purposes; and
6. Perform other duties assigned by the state health officer.

23-01-05.4. Department to employ state forensic examiner — Qualifications — Duties. [Effective September 1, 2022]

The department of health and human services may employ and establish the qualifications and compensation of the state forensic examiner. The state forensic examiner must be a physician who is board-certified or board-eligible in forensic pathology, who is licensed to practice in this state, and who is in good standing in the profession. The state forensic examiner shall:

1. Exercise all authority conferred upon the coroner under chapter 11-19.1 and any other law;
2. Consult with local coroners on the performance of their duties as coroners;
3. Conduct investigations into the cause of death of and perform autopsies on any deceased human body whenever requested to do so by the acting local county coroner or the local state’s attorney;
4. Provide training and educational materials to local county coroners, law enforcement, and any other person the state forensic examiner deems necessary;
5. Maintain complete records of the cause, manner, and mode of death necessary for accurate health statistics and for public health purposes; and
6. Perform other duties assigned by the state health officer.

23-01-05.5. Autopsy reports — Confidential — Exceptions.

1. As used in this section:
   1. “Autopsy report” means the report of the forensic examiner or the examiner’s designee on the post-mortem examination of a deceased individual to determine the cause and manner of death, including any written analysis, diagram, photograph, or toxicological test results.
   2. “Report of death” means the official findings on the cause of death and manner of death issued by the state forensic examiner, the examiner’s designee, county coroner, or pathologist performing an autopsy ordered by a county coroner or by the state forensic examiner and which is the face page of the autopsy report identifying the decedent and stating the cause of death and manner of death.
2. An autopsy report and any working papers and notes relating to an autopsy report are confidential and may be disclosed only as permitted by this section. The report of death is subject to disclosure as follows:
   1. The next of kin or authorized representative requesting the report of death is responsible for providing to the state forensic examiner or the examiner’s designee satisfactory proof of relationship to the deceased and contact information for notification of the report of death.
   2. When in receipt of the information in subdivision a, the state forensic examiner, examiner’s designee, county coroner, or pathologist who performed the autopsy shall make a good faith effort to immediately notify the decedent’s next of kin or authorized representative of the availability of the report of death. The notification or attempts to notify the next of kin or authorized representative must be recorded and must precede any public disclosure of the report of death.
   3. The report of death becomes a public record eight days after the report of death is finalized.
3. Subject to the limitations on the disclosure of an autopsy photograph or other visual image or video or audio recording of an autopsy required under section 44-04-18.18, any working papers and notes relating to a final autopsy report may be disclosed pursuant to a court order and as otherwise expressly provided by law.
4. The state forensic examiner or the examiner’s designee shall disclose a copy of the autopsy report:
   1. To any county coroner, including a coroner in any state or Canadian province, with jurisdiction over the death, and the coroner may use or disclose these records for purposes of an investigation, inquest, or prosecution.
   2. To any state’s attorney or criminal justice agency, including a prosecutor or criminal justice agency of the United States, any state, or any Canadian province, with jurisdiction over an investigation of the death and the state’s attorney or criminal justice agency may use or disclose these records for the purposes of an investigation or prosecution.
   3. To workforce safety and insurance if the death is related to the decedent’s work, and to any other workers’ compensation or other similar program, established by law, that provides benefits for work-related injuries or illness without regard to fault if there is no criminal investigation.
   4. To the child fatality review panel if there is no active criminal investigation.
   5. In accordance with a court order.
5. The state forensic examiner or the examiner’s designee upon request shall disclose a copy of the autopsy report to:
   1. The decedent’s personal representative and to the decedent’s spouse, child, or parent, upon proof of the relationship, if there is no active criminal investigation.
   2. A physician or hospital who treated the deceased immediately prior to death if there is no active criminal investigation.
   3. An insurance company upon proof that the decedent’s life was covered by a policy issued by the company if there is no active criminal investigation.
   4. The food and drug administration, the national transportation safety board, the occupational health and safety administration, and any other federal or state agency with authority to obtain an autopsy report to investigate a death resulting from the decedent’s type of injury or illness.
   5. A professional or research organization collecting data to initiate or advance death investigation standards, after the identifiers necessary to create a limited data set under title 45, Code of Federal Regulations, part 164, section 514, subsection e have been removed from the report.
6. The forensic examiner, the examiner’s designee, any county coroner or county medical coroner, and any public employee who, in good faith, discloses autopsy findings, an autopsy report, or other information relating to an autopsy report or cause of death to a person who the public official or employee reasonably believes is entitled to that information under this section is immune from any liability, civil or criminal, for making that disclosure. For the purposes of any proceeding, the good faith of any public employee who makes a disclosure under this section is presumed.

23-01-06. Biennial report — Contents. [Effective through August 31, 2022]

The state health officer shall submit a biennial report to the governor and the secretary of state in accordance with section 54-06-04. In addition to any requirements established pursuant to section 54-06-04, the report must cover the following subjects:

1. The activities of the various divisions, the work accomplished during the two years covered by the report, and an analysis of the program of each of the divisions.
2. The expenditures of the state department of health.
3. The expenditures in each county board of health or the district board of health.
4. Any reports relating to the hospital program as required by the health council.

23-01-06. Biennial report — Contents. [Effective September 1, 2022]

The department of health and human services shall submit a biennial report to the governor and the secretary of state in accordance with section 54-06-04. In addition to any requirements established pursuant to section 54-06-04, the report must cover the following subjects:

1. The activities of the health division, the work accomplished during the two years covered by the report, and an analysis of the program of the health division.
2. The expenditures of the health division.
3. The expenditures in each county board of health or the district board of health.
4. Any reports relating to the hospital program as required by the health council.

23-01-07. Structure of department. [Repealed]

Repealed by S.L. 1993, ch. 218, § 10.

23-01-08. Directors of divisions — Deputy — Appointment, salary, duties. [Effective through August 31, 2022]

The state health officer shall appoint directors of the various divisions of the department and shall determine the salary, within the limits of legislative appropriations to the department and in conformity with the state merit system, to be received by such persons. The duties of such director must be those prescribed by the state health officer. The state health officer may appoint a deputy state health officer. A deputy state health officer who does not hold a health-related degree may not individually issue an order regarding public health unless the order is cosigned by a physician who is employed by the department or cosigned by the state epidemiologist. The deputy state health officer serves at the pleasure of the state health officer.

23-01-08. Directors of divisions — Deputy — Appointment, salary, duties. [Effective September 1, 2022]

The executive director of the department of health and human services or designee shall appoint directors of the various divisions of the department and shall determine the salary, within the limits of legislative appropriations to the department and in conformity with the state merit system, to be received by such persons. The duties of such director must be those prescribed by the executive director of the department of health and human services or designee. The executive director of the department of health and human services or designee may appoint a deputy state health officer. A deputy state health officer who does not hold a health-related degree may not individually issue an order regarding public health unless the order is cosigned by a physician who is employed by the department or cosigned by the state epidemiologist. The deputy state health officer serves at the pleasure of the executive director of the department of health and human services.

23-01-08.1. Criminal history background checks. [Effective through August 31, 2022]

The state department of health may require a final applicant for a job opening or a current employee with the department, as designated by the state health officer, complete a state and national criminal history record check as provided under section 12-60-24.

23-01-08.1. Criminal history background checks. [Effective September 1, 2022]

The department of health and human services may require a final applicant for a job opening or a current employee with the department, as designated by the state health officer, complete a state and national criminal history record check as provided under section 12-60-24.

23-01-09. Duties of director of consolidated laboratories branch. [Repealed]

Repealed by S.L. 1993, ch. 218, § 10.

23-01-09.1. Duties of state toxicologist. [Repealed]

Repealed by S.L. 2003, ch. 469, § 13.

23-01-10. Office space. [Effective through August 31, 2022]

The state shall provide suitable office space in Bismarck for housing and maintaining the state department of health. Special fireproof vaults must be provided for the storage of birth and death certificates.

23-01-10. Office space. [Effective September 1, 2022]

The state shall provide suitable office space in Bismarck for housing and maintaining the department of health and human services. Special fireproof vaults must be provided for the storage of birth and death certificates.

23-01-11. Acceptance of funds and right to qualify for benefits under federal laws authorized. [Effective through August 31, 2022]

The state department of health may:

1. Accept funds from cities, counties, the federal government, private organizations, and individuals for infancy and maternal hygiene, for other public health work and for the purpose of conducting a survey of existing medical hospitals and related institutions, planning of needed hospital construction and for construction and maintenance of such medical hospitals and related institutions. When approved by the governor of this state, the state department of health may match the same from any unexpended portion of its appropriation in accordance with specifications agreed to or required by congressional act. All infancy and maternal hygiene and public health work must be done under the supervision of the state department of health.
2. Adopt rules necessary to enable the state to be in compliance with any federal laws in order to qualify for any federal funds related to medical facilities or agencies licensed by the state department of health.

23-01-11. Acceptance of funds and right to qualify for benefits under federal laws authorized. [Effective September 1, 2022]

The department of health and human services may:

1. Accept funds from cities, counties, the federal government, private organizations, and individuals for infancy and maternal hygiene, for other public health work and for the purpose of conducting a survey of existing medical hospitals and related institutions, planning of needed hospital construction and for construction and maintenance of such medical hospitals and related institutions. When approved by the governor of this state, the department of health and human services may match the same from any unexpended portion of its appropriation in accordance with specifications agreed to or required by congressional act. All infancy and maternal hygiene and public health work must be done under the supervision of the department of health and human services.
2. Adopt rules necessary to enable the state to be in compliance with any federal laws in order to qualify for any federal funds related to medical facilities or agencies licensed by the department of health and human services.

23-01-12. Hospital records to be kept at direction of state health officer.

When any person is admitted into a lying-in hospital or other institution, public or private, to which persons resort for the treatment of disease or for confinement, or to which persons are committed by process of law, the superintendent, manager, or other person in charge of such institution shall make a record of all the personal and statistical particulars relative to such person. The record must be in such form as is directed by the state health officer. In the case of any person admitted or committed for medical treatment of disease, the physician in charge shall specify for entry in the records the nature of the disease and where, in the physician’s opinion, it was contracted. The personal particulars and information required for compliance with the provisions of this section must be obtained from the individual personally if practicable, and when the information cannot be obtained from the individual, from the individual’s relatives or friends or from any other person acquainted with the facts.

23-01-13. Blood plasma — Obtaining, storing, and distributing. [Repealed]

Repealed by S.L. 1991, ch. 263, § 1.

23-01-14. State department of health authorized to transfer future accumulated fees. [Effective through August 31, 2022]

As a continuing policy, the state department of health may automatically from time to time transfer unclaimed fees on deposit with the Bank of North Dakota or other authorized depository to the state general fund when the unclaimed status has existed for a period of at least three years.

23-01-14. Department of health and human services authorized to transfer future accumulated fees. [Effective September 1, 2022]

As a continuing policy, the department of health and human services may automatically from time to time transfer unclaimed fees on deposit with the Bank of North Dakota or other authorized depository to the state general fund when the unclaimed status has existed for a period of at least three years.

23-01-15. Research studies confidential — Penalty. [Effective through August 31, 2022]

1. All information, records of interviews, written reports, statements, notes, memoranda, or other data procured by the state department of health, in connection with studies conducted by the state department of health, or carried on by the department jointly with other persons, agencies, or organizations, or procured by such other persons, agencies, or organizations, for the purpose of reducing the morbidity or mortality from any cause or condition of health is confidential and must be used solely for the purposes of medical or scientific research.
2. Such information, records, reports, statements, notes, memoranda, or other data is not admissible as evidence in any action of any kind in any court or before any other tribunal, board, agency, or person. Such information, records, reports, statements, notes, memoranda, or other data may not be exhibited nor their contents disclosed in any way, in whole or in part, by any officer or representative of the state department of health, nor by any other person, except as may be necessary for the purpose of furthering the research project to which they relate. No person participating in such research project may disclose, in any manner, the information so obtained except in strict conformity with such research project. No officer or employee of said department may interview any patient named in any such report, nor a relative of any such patient, unless the consent of the attending physician and surgeon is first obtained.
3. The furnishing of such information to the state department of health or its authorized representative, or to any other cooperating agency in such research project, does not subject any person, hospital, sanitarium, rest home, nursing home, or other person or agency furnishing such information, to any action for damages or other relief.

23-01-15. Research studies confidential — Penalty. [Effective September 1, 2022]

1. All information, records of interviews, written reports, statements, notes, memoranda, or other data procured by the department of health and human services, in connection with studies conducted by the department of health and human services, or carried on by the department jointly with other persons, agencies, or organizations, or procured by such other persons, agencies, or organizations, for the purpose of reducing the morbidity or mortality from any cause or condition of health is confidential and must be used solely for the purposes of medical or scientific research.
2. Such information, records, reports, statements, notes, memoranda, or other data is not admissible as evidence in any action of any kind in any court or before any other tribunal, board, agency, or person. Such information, records, reports, statements, notes, memoranda, or other data may not be exhibited nor their contents disclosed in any way, in whole or in part, by any officer or representative of the department of health and human services, nor by any other person, except as may be necessary for the purpose of furthering the research project to which they relate. No person participating in such research project may disclose, in any manner, the information so obtained except in strict conformity with such research project. No officer or employee of said department may interview any patient named in any such report, nor a relative of any such patient, unless the consent of the attending physician and surgeon is first obtained.
3. The furnishing of such information to the department of health and human services or its authorized representative, or to any other cooperating agency in such research project, does not subject any person, hospital, sanitarium, rest home, nursing home, or other person or agency furnishing such information, to any action for damages or other relief.

23-01-16. Dairy products — Joint standards. [Effective through August 31, 2022]

The state department of health and the dairy department of the department of agriculture shall jointly adopt a set of uniform standards in relation to all matters falling within their joint jurisdiction regarding dairy products. The state department of health, district health units, municipal health departments or units, and the dairy department shall each be permitted to accept any inspection report of the other department or unit regarding the inspection of dairy products and the producers and processors of such products, when such report is based substantially upon standards conforming with the milk ordinance and code recommended by the United States public health service.

23-01-16. Dairy products — Joint standards. [Effective September 1, 2022]

The department of health and human services and the dairy department of the department of agriculture shall jointly adopt a set of uniform standards in relation to all matters falling within their joint jurisdiction regarding dairy products. The department of health and human services, district health units, municipal health departments or units, and the dairy department shall each be permitted to accept any inspection report of the other department or unit regarding the inspection of dairy products and the producers and processors of such products, when such report is based substantially upon standards conforming with the milk ordinance and code recommended by the United States public health service.

23-01-17. Noise harmful to health and safety — Power to regulate — Hearings — Appeal — Penalty — Injunction. [Repealed]

Repealed by S.L. 1991, ch. 264, § 1.

23-01-18. State department of health responsible for control of rabies. [Repealed]

Repealed by S.L. 1999, ch. 243, § 2.

23-01-19. Extermination of rabies. [Repealed]

Repealed by S.L. 1999, ch. 243, § 2.

23-01-20. Traumatic head injury defined. [Repealed]

Repealed by S.L. 1999, ch. 231, § 1.

Note.

Section 2 of chapter 231, S.L. 1999, effective August 1, 1999, provides:

“ APPLICATION OF ACT. This Act does not affect the confidentiality of any record received or created under former sections 23-01-20 and 23-01-21.”

23-01-21. Central registry of traumatic head injury — Establishment — Reports. [Repealed]

Repealed by S.L. 1999, ch. 231, § 1.

Note.

Section 2 of chapter 231, S.L. 1999, effective August 1, 1999, provides:

“ APPLICATION OF ACT. This Act does not affect the confidentiality of any record received or created under former sections 23-01-20 and 23-01-21.”

23-01-22. Department to employ waste management facility inspectors. [Effective through August 31, 2022]

The state department of health shall employ and establish the qualifications, duties, and compensation of at least one full-time inspector for each commercial, nonpublicly owned waste management disposal or incineration facility that accepts more than twenty-five thousand tons [22679.5 kilograms] per year of hazardous waste, industrial waste, nuclear waste, or ash resulting from the incineration of municipal solid waste. This section does not apply to any energy conversion facility or coal mining operation that disposes of its solid waste onsite. The department may require inspectors for those facilities that accept less than twenty-five thousand tons [22679.5 kilograms] per year. The facility inspector shall conduct regular inspections of the operating procedure and conditions of the facility and report the findings to the department on a regular basis. If an inspector discovers a condition at a facility that is likely to cause imminent harm to the health and safety of the public or environment, the inspector shall notify the department. The department shall proceed as provided by sections 23-29-10 and 23-29-11.

The department shall assess the owner or operator of a waste management facility that accepts hazardous waste, industrial waste, nuclear waste, or ash resulting from the incineration of municipal solid waste an annual fee to pay the salaries, wages, and operating expenses associated with employing an inspector for the facility. The owner or operator of the facility shall submit the fee to the department by July first of each year. Any fees collected must be deposited in the department’s operating fund in the state treasury and any expenditures from the fund are subject to appropriation by the legislative assembly. If a facility begins operation after July first of any year, the owner or operator of the facility shall pay to the department a prorated fee for the fiscal year before the facility may begin accepting waste. Moneys in the waste management facility account may be spent by the department within the limits of legislative appropriation.

23-01-22. Department to employ waste management facility inspectors. [Effective September 1, 2022]

The department of health and human services shall employ and establish the qualifications, duties, and compensation of at least one full-time inspector for each commercial, nonpublicly owned waste management disposal or incineration facility that accepts more than twenty-five thousand tons [22679.5 kilograms] per year of hazardous waste, industrial waste, nuclear waste, or ash resulting from the incineration of municipal solid waste. This section does not apply to any energy conversion facility or coal mining operation that disposes of its solid waste onsite. The department may require inspectors for those facilities that accept less than twenty-five thousand tons [22679.5 kilograms] per year. The facility inspector shall conduct regular inspections of the operating procedure and conditions of the facility and report the findings to the department on a regular basis. If an inspector discovers a condition at a facility that is likely to cause imminent harm to the health and safety of the public or environment, the inspector shall notify the department. The department shall proceed as provided by sections 23-29-10 and 23-29-11.

The department shall assess the owner or operator of a waste management facility that accepts hazardous waste, industrial waste, nuclear waste, or ash resulting from the incineration of municipal solid waste an annual fee to pay the salaries, wages, and operating expenses associated with employing an inspector for the facility. The owner or operator of the facility shall submit the fee to the department by July first of each year. Any fees collected must be deposited in the department’s operating fund in the state treasury and any expenditures from the fund are subject to appropriation by the legislative assembly. If a facility begins operation after July first of any year, the owner or operator of the facility shall pay to the department a prorated fee for the fiscal year before the facility may begin accepting waste. Moneys in the waste management facility account may be spent by the department within the limits of legislative appropriation.

23-01-23. Permit or investigatory hearings — Exemption from chapters 28-32 and 54-57. [Repealed]

23-01-24. Health care cost and quality review program — Penalty. [Effective through August 31, 2022]

The department of health shall conduct a continuous program to review and improve the quality of health care in the state. The department may contract with a qualified person or organization to develop and implement the program. The department shall use the program to compile relevant information about the quality of health care in this state which will allow the department to evaluate the cost, quality, and outcomes of health care. The department shall establish and consult a provider advisory committee composed of health care providers regarding the data that is a cost-effective process for collecting and evaluating the information. The state health officer may assess against a provider a penalty of one hundred dollars per day for each day the provider willfully refuses to provide the department with information requested for use with the program, but the penalty may not exceed one thousand dollars for each request. A provider against whom a fee is assessed may appeal that assessment to the state health council. If the provider fails to pay the penalty, the health council may, in the county where the provider’s principal place of business is located, initiate a civil action against the provider to collect the penalty. As used in this section, “provider” means a person who is licensed, certified, or otherwise authorized by the law of this state to administer health care in the ordinary course of business or professional practice. The department shall ensure that patient privacy is protected throughout the compilation and use of the information. The department shall evaluate data management capabilities in the state and shall organize its capabilities to provide information about the cost of care on an individual provider basis as well as a collective basis.

23-01-24. Health care cost and quality review program — Penalty. [Effective September 1, 2022]

The department of health and human services shall conduct a continuous program to review and improve the quality of health care in the state. The department may contract with a qualified person or organization to develop and implement the program. The department shall use the program to compile relevant information about the quality of health care in this state which will allow the department to evaluate the cost, quality, and outcomes of health care. The department shall establish and consult a provider advisory committee composed of health care providers regarding the data that is a cost-effective process for collecting and evaluating the information. The department may assess against a provider a penalty of one hundred dollars per day for each day the provider willfully refuses to provide the department with information requested for use with the program, but the penalty may not exceed one thousand dollars for each request. A provider against whom a fee is assessed may appeal that assessment to the department. If the provider fails to pay the penalty, the department may, in the county where the provider’s principal place of business is located, initiate a civil action against the provider to collect the penalty. As used in this section, “provider” means a person who is licensed, certified, or otherwise authorized by the law of this state to administer health care in the ordinary course of business or professional practice. The department shall ensure that patient privacy is protected throughout the compilation and use of the information. The department shall evaluate data management capabilities in the state and shall organize its capabilities to provide information about the cost of care on an individual provider basis as well as a collective basis.

23-01-25. Commercial feed, insecticide, fungicide, rodenticide, fertilizer, and soil conditioner laws — Laboratory function. [Effective through August 31, 2022]

Notwithstanding any other provision of law, any laboratory test or analysis required under chapter 4.1-34, 4.1-40, or 4.1-41 must be performed by the state department of health for the agriculture commissioner at no charge.

23-01-25. Commercial feed, insecticide, fungicide, rodenticide, fertilizer, and soil conditioner laws — Laboratory function. [Effective September 1, 2022]

Notwithstanding any other provision of law, any laboratory test or analysis required under chapter 4.1-34, 4.1-40, or 4.1-41 must be performed by the department of health and human services for the agriculture commissioner at no charge.

23-01-26. State department of health — Indirect cost recoveries. [Effective through August 31, 2022]

Notwithstanding section 54-44.1-15, the state department of health may deposit indirect cost recoveries in its operating account.

23-01-26. Department — Indirect cost recoveries. [Effective September 1, 2022]

Notwithstanding section 54-44.1-15, the department of health and human services may deposit indirect cost recoveries in its operating account.

23-01-27. Donated dental services program. [Effective through August 31, 2022]

The state department of health shall contract with the North Dakota dental association, or other appropriate and qualified organizations, to develop and administer a donated dental services program through which volunteer dentists provide comprehensive dental care for needy, disabled, aged, or medically compromised individuals. The volunteers will treat individuals through the program and, with the exception of certain dental laboratory costs, will fully donate their services and supplies. The contract must specify the responsibilities of the administering organization and include:

1. Establishment of a network of volunteer dentists, including dental specialists, volunteer dental laboratories, and other appropriate volunteer professionals to donate dental services to eligible individuals;
2. Establishment of a system to refer eligible individuals to appropriate volunteers;
3. Development and implementation of a public awareness campaign to educate eligible individuals about the availability of the program;
4. Provision of appropriate administrative and technical support to the program; and
5. Submission of an annual report to the state department of health that:
   1. Accounts for all program funds;
   2. Reports the number of individuals served by the program and the number of dentists and dental laboratories participating as providers in the program;
   3. Includes any other information required by the state department of health; and
   4. Performs, as required by the state department of health, any other duty relating to the program.

23-01-27. Donated dental services program. [Effective September 1, 2022]

The department of health and human services shall contract with the North Dakota dental association, or other appropriate and qualified organizations, to develop and administer a donated dental services program through which volunteer dentists provide comprehensive dental care for needy, disabled, aged, or medically compromised individuals. The volunteers will treat individuals through the program and, with the exception of certain dental laboratory costs, will fully donate their services and supplies. The contract must specify the responsibilities of the administering organization and include:

1. Establishment of a network of volunteer dentists, including dental specialists, volunteer dental laboratories, and other appropriate volunteer professionals to donate dental services to eligible individuals;
2. Establishment of a system to refer eligible individuals to appropriate volunteers;
3. Development and implementation of a public awareness campaign to educate eligible individuals about the availability of the program;
4. Provision of appropriate administrative and technical support to the program; and
5. Submission of an annual report to the department of health and human services that:
   1. Accounts for all program funds;
   2. Reports the number of individuals served by the program and the number of dentists and dental laboratories participating as providers in the program;
   3. Includes any other information required by the department of health and human services; and
   4. Performs, as required by the department of health and human services, any other duty relating to the program.

23-01-28. Combined purchasing with local public health units — Continuing appropriation. [Effective through August 31, 2022]

The state department of health may make combined or joint purchases with or on behalf of local public health units for items or services. Payments received by the state department of health from local public health units pursuant to a combined or joint purchase must be deposited in the operating fund and are appropriated as a standing and continuing appropriation to the state department of health for the purpose of this section.

23-01-28. Combined purchasing with local public health units — Continuing appropriation. [Effective September 1, 2022]

The department of health and human services may make combined or joint purchases with or on behalf of local public health units for items or services. Payments received by the department of health and human services from local public health units pursuant to a combined or joint purchase must be deposited in the operating fund and are appropriated as a standing and continuing appropriation to the department of health and human services for the purpose of this section.

23-01-29. Bone marrow donor education. [Effective through August 31, 2022]

The state department of health shall provide information and educational materials to the public regarding bone marrow donation through the national marrow donor program. The department shall seek assistance from the national marrow donor program to establish a system to distribute materials, ensure that the materials are updated periodically, and address the education and recruitment of minority populations.

23-01-29. Bone marrow donor education. [Effective September 1, 2022]

The department of health and human services shall provide information and educational materials to the public regarding bone marrow donation through the national marrow donor program. The department shall seek assistance from the national marrow donor program to establish a system to distribute materials, ensure that the materials are updated periodically, and address the education and recruitment of minority populations.

23-01-30. Zoning regulation of concentrated animal feeding operations — Central repository. [Repealed]

23-01-31. North Dakota health information technology steering committee. [Repealed]

Repealed by S.L. 2009, ch. 519, § 6.

23-01-32. Viral hepatitis program — Vaccination — Study. [Effective through August 31, 2022]

1. The state department of health shall establish and administer a viral hepatitis program with the goal of distributing to residents of the state who are at an increased risk for exposure to viral hepatitis information that addresses the higher incidence of hepatitis C exposure and infection among these populations, addresses the dangers presented by the disease, and provides contacts for additional information and referrals.
2. The department shall establish a list of classes of individuals by category that are at increased risk for viral hepatitis exposure. The list must be consistent with recommendations developed by the federal centers for disease control and prevention. The department shall determine the type of information the department will distribute under the program and the form and manner of distribution.
3. The department shall establish a vaccination and testing program, to be coordinated by the department through local public health units.

23-01-32. Viral hepatitis program — Vaccination — Study. [Effective September 1, 2022]

1. The department of health and human services shall establish and administer a viral hepatitis program with the goal of distributing to residents of the state who are at an increased risk for exposure to viral hepatitis information that addresses the higher incidence of hepatitis C exposure and infection among these populations, addresses the dangers presented by the disease, and provides contacts for additional information and referrals.
2. The department shall establish a list of classes of individuals by category that are at increased risk for viral hepatitis exposure. The list must be consistent with recommendations developed by the federal centers for disease control and prevention. The department shall determine the type of information the department will distribute under the program and the form and manner of distribution.
3. The department shall establish a vaccination and testing program, to be coordinated by the department through local public health units.

23-01-33. Human papilloma virus — Information. [Effective through August 31, 2022]

The state department of health shall educate the public about the human papilloma virus and the availability of a human papilloma virus vaccine; promote immunization against the human papilloma virus; and distribute informational material regarding the human papilloma virus and the human papilloma virus vaccine. The department shall distribute the informational material through relevant department programs and divisions, including breast and cervical cancer control programs; immunization programs; family planning programs; and human immunodeficiency virus and sexually transmitted disease programs. Informational materials distributed must include the recommendations of the advisory committee on immunization practices of the federal centers for disease control and prevention; contain information relevant to the target populations of each of the participating programs and divisions distributing the informational material; and contain information regarding the availability of the vaccine through the vaccines for children program operated by the department under 42 U.S.C. 1396s, and the medical assistance program.

23-01-33. Human papilloma virus — Information. [Effective September 1, 2022]

The department of health and human services shall educate the public about the human papilloma virus and the availability of a human papilloma virus vaccine; promote immunization against the human papilloma virus; and distribute informational material regarding the human papilloma virus and the human papilloma virus vaccine. The department shall distribute the informational material through relevant department programs and divisions, including breast and cervical cancer control programs; immunization programs; family planning programs; and human immunodeficiency virus and sexually transmitted disease programs. Informational materials distributed must include the recommendations of the advisory committee on immunization practices of the federal centers for disease control and prevention; contain information relevant to the target populations of each of the participating programs and divisions distributing the informational material; and contain information regarding the availability of the vaccine through the vaccines for children program operated by the department under 42 U.S.C. 1396s, and the medical assistance program.

23-01-34. Children with special health care needs — Program administration. [Effective through August 31, 2022]

The state department of health shall administer programs for children with special health care needs as may be necessary to conform to title 5, part 2, of the federal Social Security Act, as amended through July 1, 2007 [Pub. L. 74-271; 49 Stat. 620; 42 U.S.C. 701 et seq.], including providing services and assistance to children with special health care needs and their families and developing and operating clinics for the identification, screening, referral, and treatment of children with special health care needs.

23-01-34. Children with special health care needs — Program administration. [Effective September 1, 2022]

The department of health and human services shall administer programs for children with special health care needs as may be necessary to conform to title 5, part 2, of the federal Social Security Act, as amended through July 1, 2007 [Pub. L. 74-271; 49 Stat. 620; 42 U.S.C. 701 et seq.], including providing services and assistance to children with special health care needs and their families and developing and operating clinics for the identification, screening, referral, and treatment of children with special health care needs.

23-01-35. Tattooing, body piercing, branding, subdermal implants, or scarification — Permit — Fee — Adoption of rules — Exemptions — Injury reports. [Effective through August 31, 2022]

1. A person may not operate a facility providing tattooing, body piercing, branding, subdermal implant, or scarification services without a permit issued by the department under this section. The holder of a permit shall display the permit in a conspicuous place at the facility for which the permit is issued. A permit issued under this section expires annually. An applicant for a permit shall submit an application for a permit to the department, on a form provided by the department, with a permit fee established by the department. The application must include the name and complete mailing address and street address of the facility and any other information reasonably required by the department for the administration of this section.
2. The health council shall adopt rules to regulate any person that receives compensation for engaging in the practice of tattooing, body piercing, branding, subdermal implants, or scarification. The rules must establish health and safety requirements and limitations with respect to the age of an individual who may receive a tattoo, body piercing, or scarification and may prohibit any practice that the health council deems unsafe or a threat to public health.
3. A facility is exempt from subsection 1 if the facility provides body piercing that is limited to the piercing of the noncartilaginous perimeter or lobe of the ear and the facility does not provide tattooing, branding, scarification, or subdermal implants. A person is exempt from regulation under subsection 2 if the person’s practice under this section is limited to piercing of the noncartilaginous perimeter or lobe of the ear. A licensed health care professional acting within that professional’s scope of practice and the associated medical facility are exempt from this section.
4. If a customer of a facility regulated under this section reports to the facility an injury the customer or operator of the facility believes to have resulted from the tattooing, body piercing, branding, subdermal implanting, or scarification provided at the facility, the operator of the facility shall provide the customer with written information on how to report the alleged injury to the state department of health. If a licensed health care professional treats a patient for an injury the professional determines, in the exercise of professional judgment, occurred as a result of a service regulated under this section, the professional shall report the circumstances to the state department of health. A licensed health care professional is immune from liability for making or not making a report under this subsection.
5. The fees established by the department must be based on the cost of conducting routine and complaint inspections and enforcement actions and preparing and sending license renewals. Fees collected under this section must be deposited in the department’s operating fund in the state treasury and any expenditure from the fund is subject to appropriation by the legislative assembly. The department shall waive all or a portion of the fee for any facility that is subject to local jurisdiction.

23-01-35. Tattooing, body piercing, branding, subdermal implants, or scarification — Permit — Fee — Adoption of rules — Exemptions — Injury reports. [Effective September 1, 2022]

1. A person may not operate a facility providing tattooing, body piercing, branding, subdermal implant, or scarification services without a permit issued by the department under this section. The holder of a permit shall display the permit in a conspicuous place at the facility for which the permit is issued. A permit issued under this section expires annually. An applicant for a permit shall submit an application for a permit to the department, on a form provided by the department, with a permit fee established by the department. The application must include the name and complete mailing address and street address of the facility and any other information reasonably required by the department for the administration of this section.
2. The department of health and human services shall adopt rules to regulate any person that receives compensation for engaging in the practice of tattooing, body piercing, branding, subdermal implants, or scarification. The rules must establish health and safety requirements and limitations with respect to the age of an individual who may receive a tattoo, body piercing, or scarification and may prohibit any practice that the department of health and human services deems unsafe or a threat to public health.
3. A facility is exempt from subsection 1 if the facility provides body piercing that is limited to the piercing of the noncartilaginous perimeter or lobe of the ear and the facility does not provide tattooing, branding, scarification, or subdermal implants. A person is exempt from regulation under subsection 2 if the person’s practice under this section is limited to piercing of the noncartilaginous perimeter or lobe of the ear. A licensed health care professional acting within that professional’s scope of practice and the associated medical facility are exempt from this section.
4. If a customer of a facility regulated under this section reports to the facility an injury the customer or operator of the facility believes to have resulted from the tattooing, body piercing, branding, subdermal implanting, or scarification provided at the facility, the operator of the facility shall provide the customer with written information on how to report the alleged injury to the department of health and human services. If a licensed health care professional treats a patient for an injury the professional determines, in the exercise of professional judgment, occurred as a result of a service regulated under this section, the professional shall report the circumstances to the department of health and human services. A licensed health care professional is immune from liability for making or not making a report under this subsection.
5. The fees established by the department must be based on the cost of conducting routine and complaint inspections and enforcement actions and preparing and sending license renewals. Fees collected under this section must be deposited in the department’s operating fund in the state treasury and any expenditure from the fund is subject to appropriation by the legislative assembly. The department shall waive all or a portion of the fee for any facility that is subject to local jurisdiction.

23-01-36. Appeal from permit proceedings. [Repealed]

23-01-37. Survey program — Health facilities construction or renovation projects — Innovation waivers — Continuing appropriation. [Effective through August 31, 2022]

1. The state department of health shall conduct a life safety survey process for all health facilities licensed by the division of health facilities of the state department of health during and at the conclusion of a construction, renovation, or construction and renovation project.
   1. In conducting a survey under this section, if the department uses a third party to review construction and renovation plans, the licensed provider shall negotiate and approve the price of the review services, the department shall contract with the third party, and the licensed provider shall pay the department for the review services.
   2. The department shall deposit in the department’s operating account any payments received from a licensed provider under subdivision a. There is appropriated to the department on a continuing basis any funds deposited under subdivision a for the purpose of paying a third-party reviewer.
2. The department may charge a reasonable fee for the review of plans for construction, renovation, or construction and renovation projects performed under this section based on the size of the project. Revenues derived from the fees collected under this subsection must be deposited in the department’s operating fund in the state treasury.
3. The state department of health shall make an initial determination on a construction, renovation, or construction and renovation project of:
   1. No more than one million dollars within twenty-eight days of receipt of a complete application;
   2. More than one million dollars but no more than four million dollars within forty-two days of receipt of a complete application; and
   3. More than four million dollars within fifty-six days of receipt of a complete application.
4. Following an initial determination under subsection 3, the state department of health shall make any followup determination on a construction, renovation, or construction and renovation project within fourteen days of receipt of the licensed provider’s response to the initial determination.
5. The state department of health may approve a request for a waiver of a state law or rule relating to an innovative construction, renovation, or construction and renovation project if the lack of compliance does not adversely affect health or safety.
6. The department shall design and operate the program in a manner that will provide that the surveyor that performs a life safety survey under this section does not violate the federal requirements associated with Medicare-certified life safety surveys.

23-01-37. Survey program — Health facilities construction or renovation projects — Innovation waivers — Continuing appropriation. [Effective September 1, 2022]

1. The department of health and human services shall conduct a life safety survey process for all health facilities licensed by the division of health facilities of the department of health and human services during and at the conclusion of a construction, renovation, or construction and renovation project.
   1. In conducting a survey under this section, if the department uses a third party to review construction and renovation plans, the licensed provider shall negotiate and approve the price of the review services, the department shall contract with the third party, and the licensed provider shall pay the department for the review services.
   2. The department shall deposit in the department’s operating account any payments received from a licensed provider under subdivision a. There is appropriated to the department on a continuing basis any funds deposited under subdivision a for the purpose of paying a third-party reviewer.
2. The department may charge a reasonable fee for the review of plans for construction, renovation, or construction and renovation projects performed under this section based on the size of the project. Revenues derived from the fees collected under this subsection must be deposited in the department’s operating fund in the state treasury.
3. The department of health and human services shall make an initial determination on a construction, renovation, or construction and renovation project of:
   1. No more than one million dollars within twenty-eight days of receipt of a complete application;
   2. More than one million dollars but no more than four million dollars within forty-two days of receipt of a complete application; and
   3. More than four million dollars within fifty-six days of receipt of a complete application.
4. Following an initial determination under subsection 3, the department of health and human services shall make any followup determination on a construction, renovation, or construction and renovation project within fourteen days of receipt of the licensed provider’s response to the initial determination.
5. The department of health and human services may approve a request for a waiver of a state law or rule relating to an innovative construction, renovation, or construction and renovation project if the lack of compliance does not adversely affect health or safety.
6. The department shall design and operate the program in a manner that will provide that the surveyor that performs a life safety survey under this section does not violate the federal requirements associated with Medicare-certified life safety surveys.

23-01-38. Electronic drug prior authorization and transmission — Limitations.

1. Except as otherwise provided under this subsection, effective August 1, 2015, a drug prior authorization request must be accessible to a health care provider with the provider’s electronic prescribing software system and must be accepted electronically, through a secure electronic transmission, by the payer, by the insurance company, or by the pharmacy benefit manager responsible for implementing or adjudicating or for implementing and adjudicating the authorization or denial of the prior authorization request. For purposes of this section, a facsimile is not an electronic transmission. The requirements in this section do not apply to workforce safety and insurance.
2. Effective August 1, 2013, electronic transmission devices used to communicate a prescription to a pharmacist may not use any means or permit any other person to use any means, including advertising, commercial messaging, and popup advertisements, to influence or attempt to influence through economic incentives the prescribing decision of a prescribing practitioner at the point of care. Such means may not be triggered by or be in specific response to the input, selection, or act of a prescribing practitioner or the prescribing practitioner’s staff in prescribing a certain pharmaceutical or directing a patient to a certain pharmacy. Any electronic communication sent to the prescriber, including advertising, commercial messaging, or popup advertisements must be consistent with the product label, supported by scientific evidence, and meet the federal food and drug administration requirements for advertising pharmaceutical products.
3. Electronic prescribing software may show information regarding a payer’s formulary if the software is not designed to preclude or make more difficult the act of a prescribing practitioner or patient selecting any particular pharmacy or pharmaceutical.

23-01-39. Immunization program — Provider choice — Purchasing. [Effective through August 31, 2022]

1. As used in this section:
   1. “Department” means the state department of health.
   2. “North Dakota immunization advisory committee” means the group of private health care providers, local public health units, department staff, and other applicable individuals which makes immunization and vaccine selection recommendations to the North Dakota immunization program.
   3. “North Dakota immunization program” means the program administered by the department to provide vaccinations to North Dakota children consistent with state and federal law.
   4. “Program-eligible child” means any child, who is under nineteen years of age, whose custodial parent or legal guardian resides in this state.
   5. “Vaccine” means any vaccine recommended by the federal advisory committee on immunization practices of the centers for disease control and prevention.
   6. “Vaccines for children program” is a federally funded program that provides vaccines at no cost to eligible children pursuant to section 1928 of the Social Security Act [42 U.S.C. 1396s].
2. As part of the North Dakota immunization program:
   1. The department shall implement a provider choice system as part of the state’s implementation of the vaccines for children program. This provider choice system must provide a health care provider participating in the state’s vaccines for children program or in any other immunization program for children, adolescents, or adults which is administered through the state using federal or state funds, may select any licensed vaccine, including combination vaccines, and any dosage forms that have in effect a recommendation from the federal advisory committee on immunization practices. This subsection does not apply in the event of a shortage or delay in vaccine availability, disaster, public health emergency, terrorist attack, hostile military or paramilitary action, or extraordinary law enforcement emergency.
   2. The department may establish a program through which the department purchases vaccines through the federal vaccine purchasing contract.
      1. The department shall supply public health units with the purchased vaccines. A public health unit that receives vaccines under this subdivision shall administer the vaccines to program-eligible children.
      2. A public health unit that receives vaccines under this purchasing program may not bill an insurer for the cost of the vaccine but may charge an administration fee.
      3. The department shall fund this purchasing program through participation in the vaccines for children program, the federal section 317 vaccine program, and state funds appropriated for this purpose. If it appears there will be inadequate funds to fund this purchasing program, the department shall petition the emergency commission for a transfer from the state contingency fund. The emergency commission may grant the transfer request, or so much thereof as may be necessary, to fund this purchasing program.

23-01-39. Immunization program — Provider choice — Purchasing. [Effective September 1, 2022]

1. As used in this section:
   1. “Department” means the department of health and human services.
   2. “North Dakota immunization advisory committee” means the group of private health care providers, local public health units, department staff, and other applicable individuals which makes immunization and vaccine selection recommendations to the North Dakota immunization program.
   3. “North Dakota immunization program” means the program administered by the department to provide vaccinations to North Dakota children consistent with state and federal law.
   4. “Program-eligible child” means any child, who is under nineteen years of age, whose custodial parent or legal guardian resides in this state.
   5. “Vaccine” means any vaccine recommended by the federal advisory committee on immunization practices of the centers for disease control and prevention.
   6. “Vaccines for children program” is a federally funded program that provides vaccines at no cost to eligible children pursuant to section 1928 of the Social Security Act [42 U.S.C. 1396s].
2. As part of the North Dakota immunization program:
   1. The department shall implement a provider choice system as part of the state’s implementation of the vaccines for children program. This provider choice system must provide a health care provider participating in the state’s vaccines for children program or in any other immunization program for children, adolescents, or adults which is administered through the state using federal or state funds, may select any licensed vaccine, including combination vaccines, and any dosage forms that have in effect a recommendation from the federal advisory committee on immunization practices. This subsection does not apply in the event of a shortage or delay in vaccine availability, disaster, public health emergency, terrorist attack, hostile military or paramilitary action, or extraordinary law enforcement emergency.
   2. The department may establish a program through which the department purchases vaccines through the federal vaccine purchasing contract.
      1. The department shall supply public health units with the purchased vaccines. A public health unit that receives vaccines under this subdivision shall administer the vaccines to program-eligible children.
      2. A public health unit that receives vaccines under this purchasing program may not bill an insurer for the cost of the vaccine but may charge an administration fee.
      3. The department shall fund this purchasing program through participation in the vaccines for children program, the federal section 317 vaccine program, and state funds appropriated for this purpose. If it appears there will be inadequate funds to fund this purchasing program, the department shall petition the emergency commission for a transfer from the state contingency fund. The emergency commission may grant the transfer request, or so much thereof as may be necessary, to fund this purchasing program.

23-01-40. Diabetes goals and plans — Report to legislative management. [Effective through August 31, 2022]

1. The department of human services, state department of health, Indian affairs commission, and public employees retirement system shall collaborate to identify goals and benchmarks while also developing individual agency plans to reduce the incidence of diabetes in the state, improve diabetes care, and control complications associated with diabetes.
2. Before June first of each even-numbered year the department of human services, state department of health, Indian affairs commission, and public employees retirement system shall submit a report to the legislative management on the following:
   1. The financial impact and reach diabetes is having on the agency, the state, and localities. Items included in this assessment must include the number of lives with diabetes impacted or covered by the agency, the number of lives with diabetes and family members impacted by prevention and diabetes control programs implemented by the agency, the financial toll or impact diabetes and diabetes complications places on the agency’s programs, and the financial toll or impact diabetes and diabetes complications places on the agency’s programs in comparison to other chronic diseases and conditions.
   2. An assessment of the benefits of implemented programs and activities aimed at controlling diabetes and preventing the disease. This assessment must document the amount and source for any funding directed to the agency from the legislative assembly for programs and activities aimed at reaching those with diabetes.
   3. A description of the level of coordination existing between the agencies on activities, programmatic activities, and messaging on managing, treating, or preventing diabetes and diabetes complications.
   4. The development or revision of detailed action plans for battling diabetes with a range of actionable items for consideration by the legislative assembly. The plans must identify proposed action steps to reduce the impact of diabetes, prediabetes, and related diabetes complications. The plan must identify expected outcomes of the action steps proposed in the following biennium while also establishing benchmarks for controlling and preventing relevant forms of diabetes.
   5. The development of a detailed budget blueprint identifying needs, costs, and resources required to implement the plan identified in subdivision d. This blueprint must include a budget range for all options presented in the plan identified in subdivision d for consideration by the legislative assembly.

23-01-40. Diabetes goals and plans — Report to legislative management. [Effective September 1, 2022]

1. The department of health and human services, Indian affairs commission, and public employees retirement system shall collaborate to identify goals and benchmarks while also developing individual agency plans to reduce the incidence of diabetes in the state, improve diabetes care, and control complications associated with diabetes.
2. Before June first of each even-numbered year the department of health and human services, Indian affairs commission, and public employees retirement system shall submit a report to the legislative management on the following:
   1. The financial impact and reach diabetes is having on the agency, the state, and localities. Items included in this assessment must include the number of lives with diabetes impacted or covered by the agency, the number of lives with diabetes and family members impacted by prevention and diabetes control programs implemented by the agency, the financial toll or impact diabetes and diabetes complications places on the agency’s programs, and the financial toll or impact diabetes and diabetes complications places on the agency’s programs in comparison to other chronic diseases and conditions.
   2. An assessment of the benefits of implemented programs and activities aimed at controlling diabetes and preventing the disease. This assessment must document the amount and source for any funding directed to the agency from the legislative assembly for programs and activities aimed at reaching those with diabetes.
   3. A description of the level of coordination existing between the agencies on activities, programmatic activities, and messaging on managing, treating, or preventing diabetes and diabetes complications.
   4. The development or revision of detailed action plans for battling diabetes with a range of actionable items for consideration by the legislative assembly. The plans must identify proposed action steps to reduce the impact of diabetes, prediabetes, and related diabetes complications. The plan must identify expected outcomes of the action steps proposed in the following biennium while also establishing benchmarks for controlling and preventing relevant forms of diabetes.
   5. The development of a detailed budget blueprint identifying needs, costs, and resources required to implement the plan identified in subdivision d. This blueprint must include a budget range for all options presented in the plan identified in subdivision d for consideration by the legislative assembly.

23-01-41. Autism spectrum disorder database — Rulemaking — Confidentiality. [Effective through August 31, 2022]

1. The state department of health shall establish and administer an autism spectrum disorder database. The database must include a record of all reported cases of autism spectrum disorder in the state and any other information determined relevant and appropriate by the department in order to complete epidemiologic surveys of the autism spectrum disorder, enable research and analysis of the autism spectrum disorder, and provide services to individuals with an autism spectrum disorder.
2. The state department of health shall establish criteria regarding who is qualified to report a case of autism spectrum disorder to the database. In establishing this criteria, the department shall require that the reporter be a physician or psychologist or any other licensed or certified health care professional who is qualified by training and by licensure or certification to make the diagnosis of autism spectrum disorder.
3. The database established under this section must:
   1. Include the reported individual’s diagnoses under the most recent edition of the American psychiatric association’s diagnostic and statistical manual of mental disorders; and
   2. Indicate whether a complete physical evaluation was performed by a licensed independent practitioner as part of the diagnostic process for autism spectrum disorder.
4. The health council shall adopt rules to provide for mandatory reporting to the autism spectrum disorder database and to establish reporting requirements, including timeliness requirements. A reporter who makes the diagnosis an individual is affected with autism spectrum disorder, or the reporter’s designee, shall report this diagnosis in the form or manner prescribed by the state department of health.
5. The state department of health shall keep confidential all records of the database which could be used to identify a reported individual; however, the department may provide these records to other state agencies as necessary to effect the purposes of this database without regard to the confidential nature of the records. If the department provides confidential records of the database to a state agency, the department shall notify the receiving agency of the confidential nature of the records and the receiving agency shall treat these records as confidential.

23-01-41. Autism spectrum disorder database — Rulemaking — Confidentiality. [Effective September 1, 2022]

1. The department of health and human services shall establish and administer an autism spectrum disorder database. The database must include a record of all reported cases of autism spectrum disorder in the state and any other information determined relevant and appropriate by the department in order to complete epidemiologic surveys of the autism spectrum disorder, enable research and analysis of the autism spectrum disorder, and provide services to individuals with an autism spectrum disorder.
2. The department of health and human services shall establish criteria regarding who is qualified to report a case of autism spectrum disorder to the database. In establishing this criteria, the department shall require that the reporter be a physician or psychologist or any other licensed or certified health care professional who is qualified by training and by licensure or certification to make the diagnosis of autism spectrum disorder.
3. The database established under this section must:
   1. Include the reported individual’s diagnoses under the most recent edition of the American psychiatric association’s diagnostic and statistical manual of mental disorders; and
   2. Indicate whether a complete physical evaluation was performed by a licensed independent practitioner as part of the diagnostic process for autism spectrum disorder.
4. The department of health and human services shall adopt rules to provide for mandatory reporting to the autism spectrum disorder database and to establish reporting requirements, including timeliness requirements. A reporter who makes the diagnosis an individual is affected with autism spectrum disorder, or the reporter’s designee, shall report this diagnosis in the form or manner prescribed by the department of health and human services.
5. The department of health and human services shall keep confidential all records of the database which could be used to identify a reported individual; however, the department may provide these records to other state agencies as necessary to effect the purposes of this database without regard to the confidential nature of the records. If the department provides confidential records of the database to a state agency, the department shall notify the receiving agency of the confidential nature of the records and the receiving agency shall treat these records as confidential.

23-01-42. Opioid antagonist prescription, distribution, possession, or use — Immunity from liability. [Effective through August 31, 2022]

1. As used in this section:
   1. “Health care professional” means a licensed or certified health care professional who is working within the scope of practice for that profession. The term may include a physician, physician assistant, advanced practice registered nurse, and pharmacist acting in the professional’s scope of practice.
   2. “Opioid antagonist” means a drug:
      1. That is approved by the United States food and drug administration for the treatment of a drug overdose and is recognized by the state department of health for the treatment of a drug overdose; and
      2. That when administered negates or neutralizes, in whole or in part, the pharmacological effects of an opioid in the body.
2. A health care professional acting in good faith may directly or by standing order prescribe, distribute, or dispense an opioid antagonist, if the health care professional provides training to:
   1. An individual at risk of experiencing an opioid-related overdose; or
   2. A family member, friend, or other individual in a position to assist an individual at risk of experiencing an opioid-related overdose.
3. An individual acting in good faith may receive or possess an opioid antagonist if that individual is:
   1. An individual at risk of experiencing an opioid-related overdose; or
   2. A family member, friend, or other individual in a position to assist an individual at risk of experiencing an opioid-related overdose.
4. An individual acting in good faith may self-administer an opioid antagonist or administer an opioid antagonist to another individual who the administering individual suspects is at risk of experiencing an opioid overdose.
5. An individual may receive, possess, or administer an opioid antagonist under subsection 3 or 4, regardless of whether the individual is the individual for or to whom the opioid antagonist is prescribed, distributed, or dispensed.
6. An individual who prescribes, distributes, dispenses, receives, possesses, or administers an opioid antagonist as authorized under this section is immune from civil and criminal liability for such action. A health care professional who prescribes, distributes, or dispenses an opioid antagonist as authorized under this section is not subject to professional discipline for such action. This section does not expand the scope of practice of a health care professional. Immunity from liability or discipline under this subsection does not apply if the individual’s actions constitute recklessness, gross negligence, or intentional misconduct.

History. S.L. 2015, ch. 187, § 1, effective August 1, 2015.

23-01-42. Opioid antagonist prescription, distribution, possession, or use — Immunity from liability. [Effective September 1, 2022]

1. As used in this section:
   1. “Health care professional” means a licensed or certified health care professional who is working within the scope of practice for that profession. The term may include a physician, physician assistant, advanced practice registered nurse, and pharmacist acting in the professional’s scope of practice.
   2. “Opioid antagonist” means a drug:
      1. That is approved by the United States food and drug administration for the treatment of a drug overdose and is recognized by the department of health and human services for the treatment of a drug overdose; and
      2. That when administered negates or neutralizes, in whole or in part, the pharmacological effects of an opioid in the body.
2. A health care professional acting in good faith may directly or by standing order prescribe, distribute, or dispense an opioid antagonist, if the health care professional provides training to:
   1. An individual at risk of experiencing an opioid-related overdose; or
   2. A family member, friend, or other individual in a position to assist an individual at risk of experiencing an opioid-related overdose.
3. An individual acting in good faith may receive or possess an opioid antagonist if that individual is:
   1. An individual at risk of experiencing an opioid-related overdose; or
   2. A family member, friend, or other individual in a position to assist an individual at risk of experiencing an opioid-related overdose.
4. An individual acting in good faith may self-administer an opioid antagonist or administer an opioid antagonist to another individual who the administering individual suspects is at risk of experiencing an opioid overdose.
5. An individual may receive, possess, or administer an opioid antagonist under subsection 3 or 4, regardless of whether the individual is the individual for or to whom the opioid antagonist is prescribed, distributed, or dispensed.
6. An individual who prescribes, distributes, dispenses, receives, possesses, or administers an opioid antagonist as authorized under this section is immune from civil and criminal liability for such action. A health care professional who prescribes, distributes, or dispenses an opioid antagonist as authorized under this section is not subject to professional discipline for such action. This section does not expand the scope of practice of a health care professional. Immunity from liability or discipline under this subsection does not apply if the individual’s actions constitute recklessness, gross negligence, or intentional misconduct.

History. S.L. 2015, ch. 187, § 1, effective August 1, 2015; 2021, ch. 352, § 134, effective September 1, 2022.

23-01-43. Mammogram results. [Expired]

History. S.L. 2015, ch. 186, § 1, effective April 8, 2015; expired by 2015, ch. 186, § 2, effective August 1, 2017.

23-01-44. Syringe or needle exchange program — Authorization. [Effective through August 31, 2022]

1. As used in this section:
   1. “Program” means a syringe exchange program established and operated under this section.
   2. “Qualified entity” means:
      1. A local health department;
      2. A city that operates a program within the boundaries of the city; or
      3. An organization that has been authorized to operate a program by the state department of health, the board of county commissioners, or the governing body for the operation of a program within the boundaries of the city.
   3. “Supplies” include needles, syringes, sterile disposal preparation spoons, cotton, sterile filters, alcohol wipes, sterile water, saline, tourniquets, disposal containers, wound care, testing strips, naloxone, and other items recognized as supporting safe drug use.
2. The state department of health, in collaboration with the department of human services behavioral health division, shall design a syringe exchange program. The state department of health shall administer the program.
3. The state department of health may authorize a qualified entity to operate a program in a county if:
   1. The area to be served is at risk of an increase or potential increase in prevalence of viral hepatitis or human immunodeficiency virus;
   2. A syringe exchange program is medically appropriate as part of a comprehensive public health response; and
   3. The qualified entity conducted a public hearing and submitted a report of the findings and an administration plan for the program to the state health officer.
4. A qualified entity operating a program under this chapter shall:
   1. Register the program annually in the manner prescribed by the state department of health;
   2. Have a pharmacist, physician, or advanced practice registered nurse who is licensed in the state to provide oversight for the program;
   3. Store and dispose of all syringes, needles, and supplies collected in a safe and legal manner;
   4. Provide education and training on drug overdose response and treatment, including the administration of an overdose reversal medication;
   5. Provide education, referral, and linkage to human immunodeficiency virus, viral hepatitis, and sexually transmitted disease prevention, treatment, and care services;
   6. Provide addiction treatment information and referrals to drug treatment programs, including programs in the local area and programs that offer medication-assisted treatment that includes a federal food and drug administration approved long-acting, non-addictive medication for the treatment of opioid or alcohol use disorder;
   7. Provide syringe, needle, supply, and injection supply distribution and collection without collecting or recording personally identifiable information;
   8. Operate in a manner consistent with public health and safety; and
   9. Ensure the program is medically appropriate and part of a comprehensive public health response.
5. The state department of health may terminate a program for failure to comply with any of the provisions in this section.
6. A state agency may not provide general fund moneys to a program to purchase or otherwise acquire hypodermic syringes, needles, or injection supplies for a program under this section.
7. A law enforcement officer may not stop, search, or seize an individual based on the individual’s participation in a program under this section. Syringes, needles, and supplies appropriately collected under this section are not considered drug paraphernalia as provided in chapter 19-03.4 or possession of a controlled substance under section 19-03.1-23.
8. Each program shall file a semiannual report with the state department of health containing the following information listed on a daily basis and by location, identified by the postal zip code, where the program distributed and collected syringes, needles, and supplies:
   1. The number of individuals served;
   2. The number of syringes, needles, and supplies collected;
   3. The number of syringes and needles distributed; and
   4. Any additional information requested by the state department of health.

23-01-44. Syringe or needle exchange program — Authorization. [Effective September 1, 2022]

1. As used in this section:
   1. “Program” means a syringe exchange program established and operated under this section.
   2. “Qualified entity” means:
      1. A local health department;
      2. A city that operates a program within the boundaries of the city; or
      3. An organization that has been authorized to operate a program by the department of health and human services, the board of county commissioners, or the governing body for the operation of a program within the boundaries of the city.
   3. “Supplies” include needles, syringes, sterile disposal preparation spoons, cotton, sterile filters, alcohol wipes, sterile water, saline, tourniquets, disposal containers, wound care, testing strips, naloxone, and other items recognized as supporting safe drug use.
2. The department of health and human services shall design and administer a syringe exchange program.
3. The department of health and human services may authorize a qualified entity to operate a program in a county if:
   1. The area to be served is at risk of an increase or potential increase in prevalence of viral hepatitis or human immunodeficiency virus;
   2. A syringe exchange program is medically appropriate as part of a comprehensive public health response; and
   3. The qualified entity conducted a public hearing and submitted a report of the findings and an administration plan for the program to the state health officer.
4. A qualified entity operating a program under this chapter shall:
   1. Register the program annually in the manner prescribed by the department of health and human services;
   2. Have a pharmacist, physician, or advanced practice registered nurse who is licensed in the state to provide oversight for the program;
   3. Store and dispose of all syringes, needles, and supplies collected in a safe and legal manner;
   4. Provide education and training on drug overdose response and treatment, including the administration of an overdose reversal medication;
   5. Provide education, referral, and linkage to human immunodeficiency virus, viral hepatitis, and sexually transmitted disease prevention, treatment, and care services;
   6. Provide addiction treatment information and referrals to drug treatment programs, including programs in the local area and programs that offer medication-assisted treatment that includes a federal food and drug administration approved long-acting, non-addictive medication for the treatment of opioid or alcohol use disorder;
   7. Provide syringe, needle, supply, and injection supply distribution and collection without collecting or recording personally identifiable information;
   8. Operate in a manner consistent with public health and safety; and
   9. Ensure the program is medically appropriate and part of a comprehensive public health response.
5. The department of health and human services may terminate a program for failure to comply with any of the provisions in this section.
6. A state agency may not provide general fund moneys to a program to purchase or otherwise acquire hypodermic syringes, needles, or injection supplies for a program under this section.
7. A law enforcement officer may not stop, search, or seize an individual based on the individual’s participation in a program under this section. Syringes, needles, and supplies appropriately collected under this section are not considered drug paraphernalia as provided in chapter 19-03.4 or possession of a controlled substance under section 19-03.1-23.
8. Each program shall file a semiannual report with the department of health and human services containing the following information listed on a daily basis and by location, identified by the postal zip code, where the program distributed and collected syringes, needles, and supplies:
   1. The number of individuals served;
   2. The number of syringes, needles, and supplies collected;
   3. The number of syringes and needles distributed; and
   4. Any additional information requested by the department of health and human services.

23-01.1-01. Health data committee of state health council — Membership — Appointment by chairman of health council. [Repealed]

23-01.1-02. Powers of health data committee. [Repealed]

23-01.1-03. Publication of a directory of licensed physicians. [Repealed]

Repealed by S.L. 1991, ch. 262, § 4.

23-01.1-04. Administrative authority of health data committee — Administrative support — Authority to acquire data. [Repealed]

23-01.1-05. Confidentiality of certain records — Immunity for providing information. [Repealed]

23-01.1-06. Fees for providing extraordinary data or reports. [Repealed]

23-01.1-07. Civil penalty. [Repealed]

23-01.2-01. Trauma system established — Duties of health council. [Effective through August 31, 2022]

The health council, in conjunction with the state department of health, may establish and maintain a comprehensive trauma system for the state. The trauma system may include standards for the following components:

1. A system plan.
2. Prehospital emergency medical services.
3. Hospitals, for which the standards must include:
   1. Standards for designation, redesignation, and dedesignation of trauma centers.
   2. Standards for evaluation and quality improvement programs for designated trauma centers. The standards must require each trauma center to collect quality improvement data and to provide specified portions to the department for use in state and regional trauma quality improvement programs.
   3. Qualifications for trauma center personnel.
4. A trauma registry. Data in the trauma registry is not subject to subpoena or discovery or introduction into evidence in any civil action. Designated trauma centers must participate in the trauma registry. A hospital not designated as a trauma center must provide to the registry a minimum set of data elements for all trauma patients as determined by the health council.
5. A trauma quality improvement program to monitor the performance of the trauma system. The proceedings and records of the program are not subject to subpoena or discovery or introduction into evidence in any civil action arising out of any matter that is the subject of consideration by the program.

23-01.2-01. Trauma system established — Duties of health council. [Effective September 1, 2022]

The health council, in conjunction with the department of health and human services, may establish and maintain a comprehensive trauma system for the state. The trauma system may include standards for the following components:

1. A system plan.
2. Prehospital emergency medical services.
3. Hospitals, for which the standards must include:
   1. Standards for designation, redesignation, and dedesignation of trauma centers.
   2. Standards for evaluation and quality improvement programs for designated trauma centers. The standards must require each trauma center to collect quality improvement data and to provide specified portions to the department for use in state and regional trauma quality improvement programs.
   3. Qualifications for trauma center personnel.
4. A trauma registry. Data in the trauma registry is not subject to subpoena or discovery or introduction into evidence in any civil action. Designated trauma centers must participate in the trauma registry. A hospital not designated as a trauma center must provide to the registry a minimum set of data elements for all trauma patients as determined by the health council.
5. A trauma quality improvement program to monitor the performance of the trauma system. The proceedings and records of the program are not subject to subpoena or discovery or introduction into evidence in any civil action arising out of any matter that is the subject of consideration by the program.

23-01.2-02. Physician immunity for voluntary medical direction.

A physician is immune from liability while providing voluntary medical direction.

23-01.2-03. Trauma center designation. [Effective through August 31, 2022]

1. Effective January 1, 2011, a hospital that offers emergency services to the public shall meet trauma center designation standards and participate in the trauma system.
2. The state health council shall adopt rules that allow provisional trauma designation status for a hospital that is partially compliant with trauma designation standards. When issuing a provisional trauma designation, the state health council shall allow a reasonable amount of time, determined by the department, for a hospital to fully meet all trauma designation standards.

23-01.2-03. Trauma center designation. [Effective September 1, 2022]

1. Effective January 1, 2011, a hospital that offers emergency services to the public shall meet trauma center designation standards and participate in the trauma system.
2. The department of health and human services shall adopt rules that allow provisional trauma designation status for a hospital that is partially compliant with trauma designation standards. When issuing a provisional trauma designation, the state health council shall allow a reasonable amount of time, determined by the department, for a hospital to fully meet all trauma designation standards.

23-01.2-04. Medical director. [Effective through August 31, 2022]

The state health officer shall appoint an emergency medical services and trauma medical director to provide medical oversight and consultation in the development and administration of the state emergency medical services and trauma systems. The medical director must be a physician licensed in the state and must be contracted and paid by the state department of health.

23-01.2-04. Medical director. [Effective September 1, 2022]

The executive director of the department of health and human services or designee shall appoint an emergency medical services and trauma medical director to provide medical oversight and consultation in the development and administration of the state emergency medical services and trauma systems. The medical director must be a physician licensed in the state and must be contracted and paid by the department of health and human services.

23-01.3-01. Definitions. [Effective through August 31, 2022]

As used in this chapter:

1. “Confidential information” includes any confidential record as defined in subsection 3 of section 44-04-17.1, any protected health information, and any other information declared confidential by law.
2. “Disclose” means to disclose, transfer, permit access to, or otherwise divulge protected health information to any person other than the individual who is the subject of that information and includes the initial disclosure and any subsequent redisclosures of individually identifiable health care information.
3. “Institutional review board” means any board, committee, or other group formally designated by an institution or public health authority or authorized under federal or state law to review, approve the initiation of, or conduct a periodic review of research programs to assure the protection of the rights and welfare of human research subjects.
4. “Law enforcement inquiry” means any executive branch investigation or official proceeding inquiring into a violation of, or failure to comply with, any criminal or civil statute or any regulation, rule, or order issued pursuant to such a statute.
5. “Nonidentifiable health information” means any information that would otherwise be protected health information except that it does not reveal the identity of the individual whose health or health care is the subject of the information and there is no reasonable basis to believe that the information could be used to identify that individual.
6. “Person” means a government, governmental subdivision of an executive branch agency or authority, corporation, company, association, firm, partnership, society, estate, trust, joint venture, individual, individual representative, tribal government, and any other legal entity.
7. “Protected health information” means any information, including genetic information, demographic information, and fluid or tissue samples collected from an individual, diagnostic and test results, whether oral or recorded in any form or medium, which:
   1. Is created or received by a health care provider, health researcher, health plan, health oversight authority, public health authority, employer, health or life insurer, school or university; and
   2. 1. Relates to the past, present, or future physical or mental health or condition of an individual, including individual cells and their components; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual; and
      2. 1. Identifies an individual; or
         2. With respect to which there is a reasonable basis to believe that the information can be used to identify an individual.
8. “Public health authority” means the state department of health, department of environmental quality, a local public health unit, and any authority or instrumentality of the United States, a tribal government, a state, or a political subdivision of a state, a foreign nation, or a political subdivision of a foreign nation, which is:
   1. Primarily responsible for public health matters; and
   2. Primarily engaged in activities such as injury reporting, public health surveillance, and public health investigation or intervention.
9. “School or university” means an institution or place for instruction or education, including an elementary school, secondary school, or institution of higher learning, a college, or an assemblage of colleges united under one corporate organization or government.
10. “State” includes the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
11. “Writing” or “written” means writing in either a paper-based or computer-based form, including electronic signatures.

23-01.3-01. Definitions. [Effective September 1, 2022]

As used in this chapter:

1. “Confidential information” includes any confidential record as defined in subsection 3 of section 44-04-17.1, any protected health information, and any other information declared confidential by law.
2. “Disclose” means to disclose, transfer, permit access to, or otherwise divulge protected health information to any person other than the individual who is the subject of that information and includes the initial disclosure and any subsequent redisclosures of individually identifiable health care information.
3. “Institutional review board” means any board, committee, or other group formally designated by an institution or public health authority or authorized under federal or state law to review, approve the initiation of, or conduct a periodic review of research programs to assure the protection of the rights and welfare of human research subjects.
4. “Law enforcement inquiry” means any executive branch investigation or official proceeding inquiring into a violation of, or failure to comply with, any criminal or civil statute or any regulation, rule, or order issued pursuant to such a statute.
5. “Nonidentifiable health information” means any information that would otherwise be protected health information except that it does not reveal the identity of the individual whose health or health care is the subject of the information and there is no reasonable basis to believe that the information could be used to identify that individual.
6. “Person” means a government, governmental subdivision of an executive branch agency or authority, corporation, company, association, firm, partnership, society, estate, trust, joint venture, individual, individual representative, tribal government, and any other legal entity.
7. “Protected health information” means any information, including genetic information, demographic information, and fluid or tissue samples collected from an individual, diagnostic and test results, whether oral or recorded in any form or medium, which:
   1. Is created or received by a health care provider, health researcher, health plan, health oversight authority, public health authority, employer, health or life insurer, school or university; and
   2. 1. Relates to the past, present, or future physical or mental health or condition of an individual, including individual cells and their components; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual; and
      2. 1. Identifies an individual; or
         2. With respect to which there is a reasonable basis to believe that the information can be used to identify an individual.
8. “Public health authority” means the department of health and human services’ health division, department of environmental quality, a local public health unit, and any authority or instrumentality of the United States, a tribal government, a state, or a political subdivision of a state, a foreign nation, or a political subdivision of a foreign nation, which is:
   1. Primarily responsible for public health matters; and
   2. Primarily engaged in activities such as injury reporting, public health surveillance, and public health investigation or intervention.
9. “School or university” means an institution or place for instruction or education, including an elementary school, secondary school, or institution of higher learning, a college, or an assemblage of colleges united under one corporate organization or government.
10. “State” includes the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
11. “Writing” or “written” means writing in either a paper-based or computer-based form, including electronic signatures.

23-01.3-02. Disclosure of protected health information — In general.

Protected health information in possession of a public health authority may be disclosed only as authorized by this chapter or another law of this state explicitly authorizing the disclosure of that information, except that protected health information received or maintained under chapter 23-01.1 may be disclosed only as authorized by that chapter. Subject to section 23-01-15, subsection 1 of section 23-07-02.2, and any other requirements of this title, this chapter does not prohibit a public health authority from disclosing protected health information for use in a biomedical research project approved by an institutional review board or a privacy board or protected health information that has been transformed to protect the identity of the patient through coding or encryption if the information is disclosed for use in an epidemiological or statistical study.

23-01.3-03. Disclosure of a patient’s own record. [Repealed]

Repealed by S.L. 2003, ch. 211, § 27.

23-01.3-04. Nonpublic disclosure to a public health authority.

1. A health care provider, public health authority, law enforcement official, school or university, or the agent of any such individual or entity, may disclose protected health information concerning an individual to a public health authority if:
   1. There is a specific nexus between the individual’s identity and a threat of a specific disease, death, or injury to any individual or to the public health; and
   2. The individual’s identity would allow that public health authority to prevent or significantly reduce the possibility of disease, injury, or death to any individual or the public health.
2. An entity described in subsection 1 is not liable for the disclosure of protected health information:
   1. To a public health authority based upon a good-faith belief and credible representation made by that authority that this information is required to protect an individual or the public health from a threat of a specific disease, injury, or death; or
   2. If that disclosure is made pursuant to a federal or state law that is designed to protect the public health or safety.
3. Except for the failure to report information required by chapter 23-07, 23-07.1, 23-07.3, or 23-07.4, or any other law requiring disclosure of information regarding a disease or condition, an entity described in subsection 1 is not liable for the failure to disclose protected health information to a public health authority.
4. Any disclosure of protected health information under this section must be limited to the minimum amount of information necessary to achieve the purposes of this section.
5. A recipient of information pursuant to this section may use or disclose that information solely to achieve the purposes of this section.
6. Nothing in this section permitting the disclosure of protected health information may be construed to require that disclosure, unless disclosure is otherwise required by law.
7. Protected health information disclosed under this section must be clearly identified as protected health information that is subject to this chapter.

23-01.3-05. Nonpublic disclosure in emergency circumstances.

1. In the event of a threat of imminent physical or mental harm to the subject of protected health information, a public health authority, in order to allay or remedy that threat, may disclose protected health information about that subject to a health care practitioner, health care facility, law enforcement authority, or emergency medical personnel to protect the health or safety of that subject.
2. In the event of a threat of harm to an individual other than the subject of protected health information, a public health authority may disclose protected health information about that subject if:
   1. There is an identifiable threat of serious disease, injury, or death to an identifiable individual or group of individuals;
   2. The subject of the protected health information has the ability to carry out that threat; and
   3. The disclosure of that information is necessary to prevent or significantly reduce the possibility of that threat.
3. Any disclosure of protected health information under this section must be limited to the minimum amount of information necessary to achieve the purposes of this section.
4. A recipient of information pursuant to this section may use or disclose that information solely to carry out the purposes of this section.
5. Protected health information disclosed under this section must be clearly identified as protected health information that is subject to this section.

23-01.3-06. Disclosure for law enforcement purposes.

1. Notwithstanding any other law, a public health authority, or the agent of any such entity, may disclose protected health information to a law enforcement authority if the state health officer determines that:
   1. The protected health information is necessary to a legitimate law enforcement inquiry that has begun or may be initiated into a particular violation of a criminal law or public health law being conducted by the authority; and
   2. The investigative or evidentiary needs of the law enforcement authority cannot be satisfied by nonidentifiable health information or by any other information.
2. If a public health authority discloses protected health information under this section, that authority shall impose appropriate written safeguards to ensure the confidentiality of the information and to protect against unauthorized or improper use or disclosure.
3. Protected health information about an individual that is disclosed under this section may not be used in, or disclosed to any person for use in, any administrative, civil, or criminal action or investigation directed against the individual, unless the action or investigation arises out of, or is directly related to, the law enforcement inquiry for which the information was obtained.
4. When the matter or need for which protected health information was disclosed to a law enforcement authority or grand jury has concluded, including any derivative matters arising from that matter or need, the law enforcement authority or grand jury must either destroy the protected health information or return it to the person from whom it was obtained.
5. To the extent practicable, and consistent with the requirements of due process, a law enforcement authority shall redact personally identifying information from protected health information prior to the public disclosure of that protected information in a judicial or administrative proceeding.
6. Any disclosure of protected health information under this section must be limited to the minimum amount of information necessary to fulfill the purposes of this section.
7. A recipient of information pursuant to this section may use or disclose that information solely to fulfill the purposes of this section.
8. Protected health information disclosed under this section must be clearly identified as protected health information that is subject to this chapter.
9. This section may not be construed to limit or restrict the ability of law enforcement authorities to gain information while in hot pursuit of a suspect or if other exigent circumstances exist.

23-01.3-07. Disclosure of a public health incident.

1. Notwithstanding any other law, the state health officer may disclose confidential information or protected health information to a health care provider or the public if the state health officer determines that:
   1. Disclosure of information is required to prevent the spread of disease;
   2. Disclosure of information is required to identify the cause or source of disease; or
   3. Disclosure of information is required to allay fear and aid the public in understanding the risk of its exposure to disease.
2. The state health officer may disclose protected health information only to the extent necessary to accomplish the purposes of this section, and may require any health care provider receiving confidential or protected health information under this section to keep that information confidential under written terms.

23-01.3-08. Status of information in possession of a local public health authority. [Effective through August 31, 2022]

Any protected health information that is created or received by a local public health authority, and that is submitted or is required to be submitted to the state department of health, is confidential and subject to the protection of, and may be disclosed only as authorized by, this chapter.

23-01.3-08. Status of information in possession of a local public health authority. [Effective September 1, 2022]

Any protected health information that is created or received by a local public health authority, and that is submitted or is required to be submitted to the department of health and human services’ health division, is confidential and subject to the protection of, and may be disclosed only as authorized by, this chapter.

23-01.3-09. Penalty for unauthorized disclosure.

A person who knowingly discloses protected health information in violation of this chapter is guilty of a class A misdemeanor.

23-02.1-01. Definitions. [Effective through August 31, 2022]

As used in this chapter:

1. “Authorized representative” means a person that has the legal authority to act on behalf of the person named on a record, including a personal representative or guardian.
2. “Certified” means a copy of the original record on file with the state department of health which is signed and sealed by the state registrar or deputy state registrar.
3. “Dead body” means a lifeless human body or parts of such body or bones thereof from the state of which it may reasonably be concluded that death recently occurred.
4. “Electronic birth registration system” means the electronic birth registration system maintained by the state department of health.
5. “Electronic death registration system” means the electronic death registration system maintained by the state department of health.
6. “Facts of death” means the demographic and personal information pertaining to an individual’s death.
7. “Fetal death” or “birth resulting in stillbirth” means death occurring before the complete expulsion or extraction from its mother of a product of human conception. The death is indicated by the fact that after such expulsion or extraction the fetus does not breathe or show any evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.
8. “Filing” means the presentation of a record, report, or other information provided for in this chapter of a birth, death, fetal death, adoption, marriage, divorce, or other event as specified by the state health officer for registration by the state registrar.
9. “Final disposition” means the entombment, burial, interment, cremation, whole-body donation to a school of medicine, removal from the state, or other disposition of a dead body or fetus.
10. “Health statistics” means data derived from records of birth, death, fetal death, marriage, divorce, or other records relating to the health of the populace or the state of the environment.
11. “Institution” means any establishment, public or private, which provides inpatient medical, surgical, or diagnostic care or treatment, or nursing, custodial, or domiciliary care to two or more individuals unrelated by blood, or to which individuals are committed by law.
12. “Live birth” means the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy, which after such expulsion or extraction, breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached.
13. “Medical certification” means the medical information pertaining to an individual’s death, including the cause and manner of death.
14. “Miscarriage of birth” means the expulsion of a fetus from the womb, spontaneously or as a result of an accident, before twenty weeks gestation.
15. “Personal or real property interests” means ownership or other legal rights or duties concerning personal or real property.
16. “Physician” means an individual authorized or licensed to practice medicine or osteopathy under chapter 43-17.
17. “Registration” means the acceptance by the state registrar and incorporation into official records, reports, or other records provided for in this chapter, of birth, death, fetal death, marriage, divorce, or other records as may be determined by the state health officer.
18. “Relative” means an individual’s current or surviving spouse, a parent or legal guardian, a child, a grandparent, or a grandchild. The state registrar may require proof of the relationship.
19. “Subregistrar” means a funeral practitioner or other suitable individual from a licensed funeral home who is appointed by the state registrar for the purpose of issuing final disposition-transit permits.
20. “System of health statistics tabulation and analysis” includes the tabulation, analysis, and presentation or publication of statistical data derived from health statistics.
21. “System of vital records registration” includes the registration, collection, preservation, amendment, and certification of birth, death, fetal death, marriage, divorce, or other records as may be determined necessary by the state health officer or the state health officer’s designee.

23-02.1-01. Definitions. [Effective September 1, 2022]

As used in this chapter:

1. “Authorized representative” means a person that has the legal authority to act on behalf of the person named on a record, including a personal representative or guardian.
2. “Certified” means a copy of the original record on file with the department of health and human services which is signed and sealed by the state registrar or deputy state registrar.
3. “Dead body” means a lifeless human body or parts of such body or bones thereof from the state of which it may reasonably be concluded that death recently occurred.
4. “Electronic birth registration system” means the electronic birth registration system maintained by the department of health and human services.
5. “Electronic death registration system” means the electronic death registration system maintained by the department of health and human services.
6. “Facts of death” means the demographic and personal information pertaining to an individual’s death.
7. “Fetal death” or “birth resulting in stillbirth” means death occurring before the complete expulsion or extraction from its mother of a product of human conception. The death is indicated by the fact that after such expulsion or extraction the fetus does not breathe or show any evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.
8. “Filing” means the presentation of a record, report, or other information provided for in this chapter of a birth, death, fetal death, adoption, marriage, divorce, or other event as specified by the state health officer for registration by the state registrar.
9. “Final disposition” means the entombment, burial, interment, cremation, whole-body donation to a school of medicine, removal from the state, or other disposition of a dead body or fetus.
10. “Health statistics” means data derived from records of birth, death, fetal death, marriage, divorce, or other records relating to the health of the populace or the state of the environment.
11. “Institution” means any establishment, public or private, which provides inpatient medical, surgical, or diagnostic care or treatment, or nursing, custodial, or domiciliary care to two or more individuals unrelated by blood, or to which individuals are committed by law.
12. “Live birth” means the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy, which after such expulsion or extraction, breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached.
13. “Medical certification” means the medical information pertaining to an individual’s death, including the cause and manner of death.
14. “Miscarriage of birth” means the expulsion of a fetus from the womb, spontaneously or as a result of an accident, before twenty weeks gestation.
15. “Personal or real property interests” means ownership or other legal rights or duties concerning personal or real property.
16. “Physician” means an individual authorized or licensed to practice medicine or osteopathy under chapter 43-17.
17. “Registration” means the acceptance by the state registrar and incorporation into official records, reports, or other records provided for in this chapter, of birth, death, fetal death, marriage, divorce, or other records as may be determined by the state health officer.
18. “Relative” means an individual’s current or surviving spouse, a parent or legal guardian, a child, a grandparent, or a grandchild. The state registrar may require proof of the relationship.
19. “Subregistrar” means a funeral practitioner or other suitable individual from a licensed funeral home who is appointed by the state registrar for the purpose of issuing final disposition-transit permits.
20. “System of health statistics tabulation and analysis” includes the tabulation, analysis, and presentation or publication of statistical data derived from health statistics.
21. “System of vital records registration” includes the registration, collection, preservation, amendment, and certification of birth, death, fetal death, marriage, divorce, or other records as may be determined necessary by the state health officer or the state health officer’s designee.

23-02.1-02. Office of statistical services. [Effective through August 31, 2022]

There is hereby established in the state department of health an office of statistical services which shall install, maintain, and operate a system of health statistics tabulation and analysis and a system of vital records registration throughout the state. The state health officer may create within the office of statistical services such working divisions as may be necessary to comply with the provisions of this chapter and shall appoint the directors of such divisions in accordance with the merit system laws and regulations of the state of North Dakota.

23-02.1-02. Office of statistical services. [Effective September 1, 2022]

There is hereby established in the department of health and human services an office of statistical services which shall install, maintain, and operate a system of health statistics tabulation and analysis and a system of vital records registration throughout the state. The executive director of the department of health and human services or designee may create within the office of statistical services such working divisions as may be necessary to comply with the provisions of this chapter and shall appoint the directors of such divisions in accordance with the merit system laws and regulations of the state of North Dakota.

23-02.1-02.1. Birth, marriage, fetal death, and death records — Transition to electronic birth registration system and electronic death registration system.

1. Beginning January 1, 2008, all new birth, fetal death, and death certificates must be filed with the state registrar and maintained as birth, fetal death, or death records. The state registrar shall issue certified copies of any birth, fetal death, or death record, or informational copies of death and marriage records, to those persons entitled to the record in accordance with this chapter.
2. A certified copy of a birth, marriage, fetal death, or death record is considered to meet the requirements of any law requiring a birth, marriage, fetal death, or death certificate.
3. All birth, marriage, fetal death, and death certificates created or issued before January 1, 2008, remain legally valid if the certificate was valid under prior law.
4. Any reference to a birth, marriage, fetal death, and death record includes any birth, marriage, fetal death, and death certificate issued before January 1, 2008.
5. Amendments to birth records issued before 2006 and fetal death or death records issued before 2008 must be made according to the procedures and processes used at the time the original record was created.

23-02.1-03. Director of the office of statistical services and associative duties, state and deputy state registrars. [Effective through August 31, 2022]

The state health officer shall appoint a director of the office of statistical services, in accordance with the merit system laws and regulations of the state of North Dakota, who must be the ex officio state registrar of vital statistics. The deputy state registrar of vital statistics must also be appointed by the state health officer. The director of the office of statistical services shall administer and enforce this chapter and the rules and regulations issued hereunder, and issue instructions for the efficient administration of a statewide system of health statistics tabulation and analysis and a statewide system of vital records registration. The director of the office of statistical services may delegate such functions and duties vested in the director to the officers and employees of the office of statistical services as the director deems necessary and expedient.

23-02.1-03. Director of the office of statistical services and associative duties, state and deputy state registrars. [Effective September 1, 2022]

The executive director of the department of health and human services or designee shall appoint a director of the office of statistical services, in accordance with the merit system laws and regulations of the state of North Dakota, who must be the ex officio state registrar of vital statistics. The deputy state registrar of vital statistics must also be appointed by the executive director of the department of health and human services or designee. The director of the office of statistical services shall administer and enforce this chapter and the rules and regulations issued hereunder, and issue instructions for the efficient administration of a statewide system of health statistics tabulation and analysis and a statewide system of vital records registration. The director of the office of statistical services may delegate such functions and duties vested in the director to the officers and employees of the office of statistical services as the director deems necessary and expedient.

23-02.1-04. Duties of the state department of health. [Effective through August 31, 2022]

The state department of health is authorized to adopt, amend, and repeal rules and regulations for the purposes of carrying out the provisions of this chapter, in accordance with chapter 28-32.

23-02.1-04. Duties of the department. [Effective September 1, 2022]

The department of health and human services may adopt, amend, and repeal rules and regulations for the purposes of carrying out the provisions of this chapter, in accordance with chapter 28-32.

23-02.1-05. Duties of the state registrar. [Effective through August 31, 2022]

1. The state registrar shall:
   1. Direct and supervise the statewide system of vital records and registration and be the primary custodian of said records.
   2. Direct, supervise, and control the activities of subregistrars and the activities of other local officials related to the operation of the vital records registration system.
   3. Prescribe, with the approval of the state department of health, and distribute such forms as required by this chapter and the rules and regulations issued hereunder.
2. The deputy state registrar shall possess the powers of the state registrar during the registrar’s absence, delegation, inability to act, or during the time there is a vacancy in the office.

23-02.1-05. Duties of the state registrar. [Effective September 1, 2022]

1. The state registrar shall:
   1. Direct and supervise the statewide system of vital records and registration and be the primary custodian of said records.
   2. Direct, supervise, and control the activities of subregistrars and the activities of other local officials related to the operation of the vital records registration system.
   3. Prescribe, with the approval of the department of health and human services, and distribute such forms as required by this chapter and the rules and regulations issued hereunder.
2. The deputy state registrar shall possess the powers of the state registrar during the registrar’s absence, delegation, inability to act, or during the time there is a vacancy in the office.

23-02.1-06. Registration districts. [Repealed]

Repealed by S.L. 2007, ch. 234, § 29.

23-02.1-07. Duties of local registrars. [Repealed]

Repealed by S.L. 2007, ch. 234, § 29.

23-02.1-08. Duties of subregistrars.

A subregistrar may issue final disposition-transit permits for those counties served by the funeral home the subregistrar is employed by. The subregistrar or cemetery sexton shall file all completed final disposition-transit permits with the county recorder in the county where the final disposition took place within ten days after the date of final disposition or within the time prescribed by the local board of health. The subregistrar is subject to the supervision and control of the state registrar and may be removed by the state registrar for reasonable cause. The subregistrar is subject to the penalties for neglect of duties as provided in section 23-02.1-32.

23-02.1-09. Compensation of local registrars. [Repealed]

Repealed by S.L. 2007, ch. 234, § 29.

23-02.1-10. Payment of fees to the local registrar. [Repealed]

Repealed by S.L. 2007, ch. 234, § 29.

23-02.1-11. Form of records. [Effective through August 31, 2022]

The form of the records, reports, and other information required by this chapter is subject to the approval of and modification by the state department of health. In order to maintain uniformity in the system of vital records registration and the system of health statistics tabulation and analysis, substantial efforts should be made to ensure that information collected parallels that collected by other primary registration areas.

23-02.1-11. Form of records. [Effective September 1, 2022]

The form of the records, reports, and other information required by this chapter is subject to the approval of and modification by the department of health and human services. In order to maintain uniformity in the system of vital records registration and the system of health statistics tabulation and analysis, substantial efforts should be made to ensure that information collected parallels that collected by other primary registration areas.

23-02.1-12. Date of registration.

Each record, report, and other information required to be filed under this chapter must have entered upon its face the date of registration duly attested.

23-02.1-13. Birth registration. [Effective through August 31, 2022]

1. A birth record for each live birth that occurs in this state must be filed with the state registrar.
2. When a birth occurs in an institution, the person in charge of the institution or a designated representative must use the state department of health’s electronic birth registration system to report the birth, including all personal and medical facts, to the state registrar within five days after the birth.
3. When a birth occurs outside an institution, the required forms prescribed by the state department of health must be prepared and filed with the state registrar, within thirty days of the birth by one of the following in the indicated order of priority:
   1. The physician in attendance at or immediately after the birth, or in the absence of such an individual;
   2. Any other individual in attendance at or immediately after the birth, or in the absence of such an individual; or
   3. The father, the mother, or in the absence of the father and the inability of the mother, the individual in charge of the premises where the birth occurred.
4. If a man and the mother are or have been married or have attempted to marry each other in apparent compliance with law, although the attempted marriage is or could be declared invalid, and the child is born during the marriage or attempted marriage, or within three hundred days after the termination of cohabitation or after the marriage or attempted marriage is terminated by death, annulment, declaration of invalidity, or divorce, or after a decree of separation is entered by a court, the name of the man must be entered on the record as the father of the child unless the presumption of paternity has been rebutted by a court decree.
5. If the child is not born during the marriage of the mother, or within three hundred days after a marriage is terminated by death, annulment, declaration of invalidity, or divorce, or after a decree of separation is entered by a court, the name of the father may not be entered on the birth record unless:
   1. After the child’s birth, the father and the child’s natural mother have married, or attempted to marry, each other by a marriage solemnized in apparent compliance with law, although the attempted marriage is or could be declared invalid, and:
      1. He has acknowledged his paternity of the child in writing filed with the state registrar; or
      2. He is obligated to support the child under a written voluntary promise or by court order;
   2. After the child’s birth, the child’s natural mother and the father voluntarily acknowledge the child’s paternity on a form prescribed by the state department of health, signed by the child’s natural mother and biological father, and filed with the state registrar; or
   3. A court or other entity of competent jurisdiction has adjudicated paternity.
6. If, in accordance with subsections 4 and 5, the name of the father of the child is not entered on the birth record, the child’s surname must be shown on the birth record as the current legal surname of the mother at the time of birth unless an affidavit or an acknowledgment of paternity signed by both parents is filed with the state department of health.

23-02.1-13. Birth registration. [Effective September 1, 2022]

1. A birth record for each live birth that occurs in this state must be filed with the state registrar.
2. When a birth occurs in an institution, the person in charge of the institution or a designated representative must use the department of health and human services’ electronic birth registration system to report the birth, including all personal and medical facts, to the state registrar within five days after the birth.
3. When a birth occurs outside an institution, the required forms prescribed by the department of health and human services must be prepared and filed with the state registrar, within thirty days of the birth by one of the following in the indicated order of priority:
   1. The physician in attendance at or immediately after the birth, or in the absence of such an individual;
   2. Any other individual in attendance at or immediately after the birth, or in the absence of such an individual; or
   3. The father, the mother, or in the absence of the father and the inability of the mother, the individual in charge of the premises where the birth occurred.
4. If a man and the mother are or have been married or have attempted to marry each other in apparent compliance with law, although the attempted marriage is or could be declared invalid, and the child is born during the marriage or attempted marriage, or within three hundred days after the termination of cohabitation or after the marriage or attempted marriage is terminated by death, annulment, declaration of invalidity, or divorce, or after a decree of separation is entered by a court, the name of the man must be entered on the record as the father of the child unless the presumption of paternity has been rebutted by a court decree.
5. If the child is not born during the marriage of the mother, or within three hundred days after a marriage is terminated by death, annulment, declaration of invalidity, or divorce, or after a decree of separation is entered by a court, the name of the father may not be entered on the birth record unless:
   1. After the child’s birth, the father and the child’s natural mother have married, or attempted to marry, each other by a marriage solemnized in apparent compliance with law, although the attempted marriage is or could be declared invalid, and:
      1. He has acknowledged his paternity of the child in writing filed with the state registrar; or
      2. He is obligated to support the child under a written voluntary promise or by court order;
   2. After the child’s birth, the child’s natural mother and the father voluntarily acknowledge the child’s paternity on a form prescribed by the department of health and human services, signed by the child’s natural mother and biological father, and filed with the state registrar; or
   3. A court or other entity of competent jurisdiction has adjudicated paternity.
6. If, in accordance with subsections 4 and 5, the name of the father of the child is not entered on the birth record, the child’s surname must be shown on the birth record as the current legal surname of the mother at the time of birth unless an affidavit or an acknowledgment of paternity signed by both parents is filed with the department of health and human services.

23-02.1-14. Infants of unknown parentage — Foundling registration.

1. Whoever assumes custody of a living infant of unknown parentage shall report using the electronic birth registration system or on a form and in the manner prescribed by the state registrar within seven days to the state registrar the following information:
   1. The date and place of finding.
   2. Sex, color, or race, and approximate age of child and approximate date of birth.
   3. Name and address of the persons or institution with whom the child has been placed for care.
   4. Name given to the child by the custodian.
   5. Other data required by the state registrar.
2. The place where the child was found must be entered as the place of birth and the date of birth must be determined by approximation.
3. A report registered under this section constitutes the birth record for the infant.
4. If the child is identified and a birth record is found or obtained, any report registered under this section must be sealed and filed and may be opened only by order of a court of competent jurisdiction or as provided by regulation.

23-02.1-15. Delayed registration of birth. [Effective through August 31, 2022]

1. When the birth of an individual born in this state has not been registered, a record may be filed in accordance with the regulations of the state department of health. Such record must be registered subject to such evidentiary requirements as the state department of health shall prescribe to substantiate the alleged facts of birth.
2. Records of birth registered one year or more after the date of occurrence must be marked “delayed” and show on the face of the record the date of delayed registration.
3. A summary statement of the evidence submitted in support of the delayed registration must be endorsed on the record.
4. 1. When an applicant does not submit the minimum documentation required in the regulations for delayed registration or when the state registrar finds reason to question the validity or adequacy of the record or documentary evidence, the state registrar may not register the delayed record and shall advise the applicant of the reasons for this action. In the event that the deficiencies are not corrected, the state registrar shall advise the applicant of the right of appeal to a court of competent jurisdiction for a judicial determination of the birth facts.
   2. The state department of health may by regulation provide for the dismissal of an application that is more than one year old and is not being actively pursued.
5. A report of live birth may not be registered for a deceased individual one year or more after that individual’s date of birth.

23-02.1-15. Delayed registration of birth. [Effective September 1, 2022]

1. When the birth of an individual born in this state has not been registered, a record may be filed in accordance with the regulations of the department of health and human services. Such record must be registered subject to such evidentiary requirements as the department of health and human services shall prescribe to substantiate the alleged facts of birth.
2. Records of birth registered one year or more after the date of occurrence must be marked “delayed” and show on the face of the record the date of delayed registration.
3. A summary statement of the evidence submitted in support of the delayed registration must be endorsed on the record.
4. 1. When an applicant does not submit the minimum documentation required in the regulations for delayed registration or when the state registrar finds reason to question the validity or adequacy of the record or documentary evidence, the state registrar may not register the delayed record and shall advise the applicant of the reasons for this action. In the event that the deficiencies are not corrected, the state registrar shall advise the applicant of the right of appeal to a court of competent jurisdiction for a judicial determination of the birth facts.
   2. The department of health and human services may by regulation provide for the dismissal of an application that is more than one year old and is not being actively pursued.
5. A report of live birth may not be registered for a deceased individual one year or more after that individual’s date of birth.

23-02.1-16. Delayed registration of death. [Effective through August 31, 2022]

When a death occurring in this state has not been registered within the time period specified in section 23-02.1-19, a record may be filed in accordance with regulations of the state department of health.

1. Such records must be registered subject to such evidentiary requirements as the state department of health may by regulation prescribe to substantiate the alleged facts of death.
2. Records of death registered one year or more after the date of occurrence must be marked “delayed” and must show on their face the date of delayed registration.

23-02.1-16. Delayed registration of death. [Effective September 1, 2022]

When a death occurring in this state has not been registered within the time period specified in section 23-02.1-19, a record may be filed in accordance with regulations of the department of health and human services.

1. Such records must be registered subject to such evidentiary requirements as the department of health and human services may by regulation prescribe to substantiate the alleged facts of death.
2. Records of death registered one year or more after the date of occurrence must be marked “delayed” and must show on their face the date of delayed registration.

23-02.1-17. Court reports of adoption. [Effective through August 31, 2022]

1. For each adoption decreed by any court in this state, the court shall require the preparation of a report of adoption on a form prescribed and furnished by the state registrar. The report must include such facts as are necessary to locate and identify the birth record for the person adopted; provide information necessary to establish a new birth record for the person adopted; and must identify the order of adoption and be certified by the clerk of court.
2. Information in the possession of the petitioner necessary to prepare the adoption report must be furnished with the petition for adoption by each petitioner for adoption or petitioner’s attorney. The department of human services or other persons concerned shall supply the court with such additional information as may be necessary to complete the report. The provision of such information is a prerequisite to the issuance of a final decree.
3. Whenever an adoption decree is amended or annulled, the clerk of court shall prepare a report thereof, which must include the facts necessary to identify the original adoption report and the facts amended in the adoption decree as are necessary to properly amend the birth record.
4. Not later than the fifth day of each calendar month, the clerk of court shall forward to the state registrar reports of decrees of adoptions, annulment of adoption, or amendments thereof entered in the preceding month, together with such related reports as the state registrar shall require.
5. When the state registrar shall receive a report of adoption or annulment of adoption or amendment thereof from a court for a person born in the United States but outside this state, such report must be forwarded to the appropriate registration authority in the state of birth.

23-02.1-17. Court reports of adoption. [Effective September 1, 2022]

1. For each adoption decreed by any court in this state, the court shall require the preparation of a report of adoption on a form prescribed and furnished by the state registrar. The report must include such facts as are necessary to locate and identify the birth record for the person adopted; provide information necessary to establish a new birth record for the person adopted; and must identify the order of adoption and be certified by the clerk of court.
2. Information in the possession of the petitioner necessary to prepare the adoption report must be furnished with the petition for adoption by each petitioner for adoption or petitioner’s attorney. The department of health and human services or other persons concerned shall supply the court with such additional information as may be necessary to complete the report. The provision of such information is a prerequisite to the issuance of a final decree.
3. Whenever an adoption decree is amended or annulled, the clerk of court shall prepare a report thereof, which must include the facts necessary to identify the original adoption report and the facts amended in the adoption decree as are necessary to properly amend the birth record.
4. Not later than the fifth day of each calendar month, the clerk of court shall forward to the state registrar reports of decrees of adoptions, annulment of adoption, or amendments thereof entered in the preceding month, together with such related reports as the state registrar shall require.
5. When the state registrar shall receive a report of adoption or annulment of adoption or amendment thereof from a court for a person born in the United States but outside this state, such report must be forwarded to the appropriate registration authority in the state of birth.

23-02.1-18. New birth records following adoption, legitimation, and paternity determination. [Effective through August 31, 2022]

1. The state registrar shall establish a new birth record for a person born in this state when the registrar receives the following:
   1. An adoption report as provided in section 23-02.1-17 or a certified copy of the decree of adoption together with the information necessary to identify the original birth record and to establish a new birth record; except that a new birth record may not be established if so requested by the court decreeing the adoption, the adoptive parents, or the adoptive person.
   2. A request that a new record be established and such evidence as required by rules and regulations proving that such person has been legitimated or that a court of competent jurisdiction has determined the paternity of such person.
2. For a person born in a foreign country whose adoptive parents are residents of the state of North Dakota at the time of the adoption, the state registrar shall prepare a new birth record:
   1. In the case of a foreign-born person adopted in North Dakota, upon presentation of a report of adoption as required by section 23-02.1-17.
   2. In the case of a foreign-born person adopted outside the state of North Dakota or outside the United States, or in the state of North Dakota prior to July 1, 1979, upon presentation of a certified copy of the adoption decree, and:
      1. A certified copy of the birth record of the adopted person; or
      2. An affidavit of an adoptive parent setting forth the true or probable date and place of birth and parentage of the adopted person.
3. When a new birth record is established, the actual place and date of birth must be shown. The new birth record must be substituted for the original birth record:
   1. Thereafter, the original birth record and the evidence of adoption, paternity, or legitimation is not subject to inspection except upon order of a court of competent jurisdiction or as provided by rules and regulations.
   2. Upon receipt of a notice of annulment of adoption, the original birth record must be restored to its place in the files and the new birth record and evidence is not subject to inspection except upon order of a court of competent jurisdiction.
4. If no birth record is on file for the person for whom a new birth record is to be established under this section, an original birth record must be filed with the state registrar in accordance with the appropriate rules and regulations promulgated by the state department of health. The new record is also to be prepared on the standard forms in use at the time of the adoption, legitimation, or paternity determination.
5. When a new birth record is established by the state registrar, all copies of the original birth record in the custody of any custodian of permanent local records in the state must be sealed from inspection or forwarded to the state registrar, as the registrar directs.

Any certification of a birth record issued under this subsection must be in the same form as other certifications of birth records issued in this state except that it must state that it does not purport to be evidence of United States citizenship.

23-02.1-18. New birth records following adoption, legitimation, and paternity determination. [Effective September 1, 2022]

1. The state registrar shall establish a new birth record for a person born in this state when the registrar receives the following:
   1. An adoption report as provided in section 23-02.1-17 or a certified copy of the decree of adoption together with the information necessary to identify the original birth record and to establish a new birth record; except that a new birth record may not be established if so requested by the court decreeing the adoption, the adoptive parents, or the adoptive person.
   2. A request that a new record be established and such evidence as required by rules and regulations proving that such person has been legitimated or that a court of competent jurisdiction has determined the paternity of such person.
2. For a person born in a foreign country whose adoptive parents are residents of the state of North Dakota at the time of the adoption, the state registrar shall prepare a new birth record:
   1. In the case of a foreign-born person adopted in North Dakota, upon presentation of a report of adoption as required by section 23-02.1-17.
   2. In the case of a foreign-born person adopted outside the state of North Dakota or outside the United States, or in the state of North Dakota prior to July 1, 1979, upon presentation of a certified copy of the adoption decree, and:
      1. A certified copy of the birth record of the adopted person; or
      2. An affidavit of an adoptive parent setting forth the true or probable date and place of birth and parentage of the adopted person.
3. When a new birth record is established, the actual place and date of birth must be shown. The new birth record must be substituted for the original birth record:
   1. Thereafter, the original birth record and the evidence of adoption, paternity, or legitimation is not subject to inspection except upon order of a court of competent jurisdiction or as provided by rules and regulations.
   2. Upon receipt of a notice of annulment of adoption, the original birth record must be restored to its place in the files and the new birth record and evidence is not subject to inspection except upon order of a court of competent jurisdiction.
4. If no birth record is on file for the person for whom a new birth record is to be established under this section, an original birth record must be filed with the state registrar in accordance with the appropriate rules and regulations promulgated by the department of health and human services. The new record is also to be prepared on the standard forms in use at the time of the adoption, legitimation, or paternity determination.
5. When a new birth record is established by the state registrar, all copies of the original birth record in the custody of any custodian of permanent local records in the state must be sealed from inspection or forwarded to the state registrar, as the registrar directs.

Any certification of a birth record issued under this subsection must be in the same form as other certifications of birth records issued in this state except that it must state that it does not purport to be evidence of United States citizenship.

23-02.1-19. Death registration. [Effective through August 31, 2022]

1. A death record for each death that occurs in this state must be filed with the state registrar in accordance with the rules and regulations set forth by the state department of health using the electronic death registration system. All registration and issuing of copies of death records will be completed by the state department of health.
2. The funeral director shall obtain the facts of death from the next of kin or the best qualified individual or source available and must file the facts of death information using the electronic death registration system within three days after assuming custody of the dead body. The funeral director shall obtain the medical certification of death from the individual responsible for the medical certification.
3. The medical certification must be completed and filed using the electronic death registration system within ten days after death by the physician, physician assistant, or nurse practitioner in charge of the patient’s care for the illness or condition which resulted in death except when inquiry is required by the local health officer or coroner.
4. When death occurred without medical attendance or when inquiry is required by the local health officer or coroner, the county coroner shall investigate the cause of death, and shall obtain medical information about the individual from the individual’s medical records or last-known physician or physician assistant, and shall complete and file the medical certification within ten days after taking charge of the case using the electronic death registration system.
5. If the cause of death cannot be determined within ten days after death, the medical certification may be filed after the prescribed period, in accordance with rules adopted by the state department of health. The attending physician, physician assistant, nurse practitioner, or coroner shall give the funeral director in custody of the body notice of the reason for the delay and final disposition may not be made until authorized by the attending physician, physician assistant, nurse practitioner, or coroner.
6. When a death is presumed to have occurred within this state but the body cannot be located, a death record may be prepared by the state registrar upon receipt of findings of a court of competent jurisdiction, including the facts of death and medical certification required to complete the death record. The death record must be marked “presumptive” and must show on the face of the death record the date of registration and must identify the court and the date of the decree.
7. Each death registration must include the social security number of the decedent, if the information is available. A social security number included on a death record is confidential and may be disclosed only to a relative or authorized representative of the individual named on the record, to a person with personal or real property interests that depend upon information contained in the death record, or by an order of a court of competent jurisdiction.

23-02.1-19. Death registration. [Effective September 1, 2022]

1. A death record for each death that occurs in this state must be filed with the state registrar in accordance with the rules and regulations set forth by the department of health and human services using the electronic death registration system. All registration and issuing of copies of death records will be completed by the department of health and human services.
2. The funeral director shall obtain the facts of death from the next of kin or the best qualified individual or source available and must file the facts of death information using the electronic death registration system within three days after assuming custody of the dead body. The funeral director shall obtain the medical certification of death from the individual responsible for the medical certification.
3. The medical certification must be completed and filed using the electronic death registration system within ten days after death by the physician, physician assistant, or nurse practitioner in charge of the patient’s care for the illness or condition which resulted in death except when inquiry is required by the local health officer or coroner.
4. When death occurred without medical attendance or when inquiry is required by the local health officer or coroner, the county coroner shall investigate the cause of death, and shall obtain medical information about the individual from the individual’s medical records or last-known physician or physician assistant, and shall complete and file the medical certification within ten days after taking charge of the case using the electronic death registration system.
5. If the cause of death cannot be determined within ten days after death, the medical certification may be filed after the prescribed period, in accordance with rules adopted by the department of health and human services. The attending physician, physician assistant, nurse practitioner, or coroner shall give the funeral director in custody of the body notice of the reason for the delay and final disposition may not be made until authorized by the attending physician, physician assistant, nurse practitioner, or coroner.
6. When a death is presumed to have occurred within this state but the body cannot be located, a death record may be prepared by the state registrar upon receipt of findings of a court of competent jurisdiction, including the facts of death and medical certification required to complete the death record. The death record must be marked “presumptive” and must show on the face of the death record the date of registration and must identify the court and the date of the decree.
7. Each death registration must include the social security number of the decedent, if the information is available. A social security number included on a death record is confidential and may be disclosed only to a relative or authorized representative of the individual named on the record, to a person with personal or real property interests that depend upon information contained in the death record, or by an order of a court of competent jurisdiction.

23-02.1-20. Fetal death registration. [Effective through August 31, 2022]

1. A fetal death record for each fetal death that occurs in this state after a gestation period of twenty completed weeks or more must be filed with the state registrar.
2. When a fetal death occurs in an institution, the person in charge of the institution or a designated representative shall use the state department of health’s electronic fetal death registration system to report the fetal death, including all personal and medical facts, to the state registrar within ten days after the delivery. If a fetal death occurs outside of an institution, a funeral director or other individual in attendance at or after delivery shall file the fetal death record.
3. When inquiry is required by the local health officer or coroner or in the absence of medical attendance, the county coroner shall investigate the cause of fetal death, and shall obtain medical information about the individual from that individual’s medical records or last-known physician or physician assistant and file the medical certification within ten days after taking charge of the case using the electronic death registration system.
4. If the cause of fetal death cannot be determined within ten days after death, the medical certification may be filed after the prescribed period of time in accordance with rules adopted by the state department of health. The attending physician, physician assistant, nurse practitioner, or coroner shall give the funeral director in custody of the fetus the notice of the reason for the delay and final disposition may not be made until authorized by the attending physician, physician assistant, nurse practitioner, or coroner.
5. The provision for entering the name of the father of the fetus on the fetal death record and the reporting of out-of-wedlock fetal deaths concur exactly with those set forth in section 23-02.1-13.

23-02.1-20. Fetal death registration. [Effective September 1, 2022]

1. A fetal death record for each fetal death that occurs in this state after a gestation period of twenty completed weeks or more must be filed with the state registrar.
2. When a fetal death occurs in an institution, the person in charge of the institution or a designated representative shall use the department of health and human services’ electronic fetal death registration system to report the fetal death, including all personal and medical facts, to the state registrar within ten days after the delivery. If a fetal death occurs outside of an institution, a funeral director or other individual in attendance at or after delivery shall file the fetal death record.
3. When inquiry is required by the local health officer or coroner or in the absence of medical attendance, the county coroner shall investigate the cause of fetal death, and shall obtain medical information about the individual from that individual’s medical records or last-known physician or physician assistant and file the medical certification within ten days after taking charge of the case using the electronic death registration system.
4. If the cause of fetal death cannot be determined within ten days after death, the medical certification may be filed after the prescribed period of time in accordance with rules adopted by the department of health and human services. The attending physician, physician assistant, nurse practitioner, or coroner shall give the funeral director in custody of the fetus the notice of the reason for the delay and final disposition may not be made until authorized by the attending physician, physician assistant, nurse practitioner, or coroner.
5. The provision for entering the name of the father of the fetus on the fetal death record and the reporting of out-of-wedlock fetal deaths concur exactly with those set forth in section 23-02.1-13.

23-02.1-20.1. Fetal loss. [Effective through August 31, 2022]

The state registrar may issue a certified copy of a fetal loss to an individual who experiences a documented miscarriage of birth, if the individual provides to the state registrar a completed fetal loss request form established by the state department of health which is signed by the mother or the father and a letter signed by a hospital, physician, or other medical attendant documenting proof of pregnancy and fetal loss.

23-02.1-20.1. Fetal loss. [Effective September 1, 2022]

The state registrar may issue a certified copy of a fetal loss to an individual who experiences a documented miscarriage of birth, if the individual provides to the state registrar a completed fetal loss request form established by the department of health and human services which is signed by the mother or the father and a letter signed by a hospital, physician, or other medical attendant documenting proof of pregnancy and fetal loss.

23-02.1-21. Permits.

1. The funeral practitioner who first obtains custody of a dead body or fetus shall obtain a final disposition-transit permit before final disposition or removal from this state of the body or fetus.
2. The final disposition-transit permits must be issued by the state registrar or a subregistrar and must be filed in the office of the county recorder where the final disposition occurs in accordance with the requirements of sections 23-02.1-19 and 23-02.1-20.
3. A final disposition-transit permit issued under the laws of another state which accompanies a dead body or fetus brought into this state is authority for final disposition of the body or fetus in this state.
4. A permit for disinterment and reinterment is required before disinterment of a dead body or fetus except as authorized by rules or otherwise provided by law. The permit must be issued by the state registrar to a funeral practitioner upon proper application.

23-02.1-22. Extension of time. [Effective through August 31, 2022]

1. The state department of health may, by regulation and upon such conditions as it may prescribe to assure compliance with the purposes of this chapter, provide for the extension of the periods of time prescribed in sections 23-02.1-19, 23-02.1-20, and 23-02.1-21 for the filing of death records, fetal death records, medical certification of death, and for the obtaining of final disposition-transit permits in cases in which compliance with the applicable prescribed period would result in undue hardship.
2. Regulations of the state department of health may provide for the issuance of a final disposition-transit permit under section 23-02.1-21 before the filing of a record of death or fetal death upon conditions designed to assure compliance with the purposes of this chapter in cases in which compliance with the requirement that the records be filed before the issuance of the permit would result in undue hardship.

23-02.1-22. Extension of time. [Effective September 1, 2022]

1. The department of health and human services may, by regulation and upon such conditions as it may prescribe to assure compliance with the purposes of this chapter, provide for the extension of the periods of time prescribed in sections 23-02.1-19, 23-02.1-20, and 23-02.1-21 for the filing of death records, fetal death records, medical certification of death, and for the obtaining of final disposition-transit permits in cases in which compliance with the applicable prescribed period would result in undue hardship.
2. Regulations of the department of health and human services may provide for the issuance of a final disposition-transit permit under section 23-02.1-21 before the filing of a record of death or fetal death upon conditions designed to assure compliance with the purposes of this chapter in cases in which compliance with the requirement that the records be filed before the issuance of the permit would result in undue hardship.

23-02.1-23. Marriage registration.

1. A record of each marriage performed in this state must be filed with the state registrar as provided in this section.
2. The officer who issues the marriage license shall prepare the record on the form prescribed and furnished by the state registrar upon the basis of information obtained from the parties to be married, who shall attest to information by their signatures.
3. Every person who performs a marriage shall certify the fact of marriage and file the record with the officer who issued the license within seven days after the ceremony.
4. Every officer issuing a marriage license shall complete and forward to the state registrar, on or before the fifth day of each calendar month, a copy of the marriage records specified in subsection 1 for marriages filed with that officer during the preceding calendar month.

23-02.1-24. Court reports of divorce and annulment of marriage.

1. For each divorce and annulment of marriage granted by any court in this state, a report must be prepared and filed by the clerk of court with the state registrar. The information necessary to prepare the report must be furnished, with the petition, to the clerk of court by the parties or their legal representatives on forms prescribed and furnished by the state registrar.
2. On or before the fifth day of each month, the clerk of court shall forward to the state registrar the report of each divorce and annulment granted during the preceding calendar month and such related reports as may be required by regulations issued under this chapter.

23-02.1-25. Correction and amendment of vital records. [Effective through August 31, 2022]

1. A record registered under this chapter may be amended only in accordance with this chapter and regulations under this chapter adopted by the state department of health to protect the integrity and accuracy of vital records.
2. A record that is amended under this section must be marked “amended” except as provided in subsection 4. The date of amendment and a summary description of the evidence submitted in support of the amendment must be endorsed on or made a part of the record. The state department of health shall prescribe by regulation the conditions under which additions or minor corrections may be made to birth records within one year after the date of birth without the record being considered as amended.
3. Upon receipt of a certified copy of a court order that is amending a birth, death, or fetal death record and upon request of such individual or the individual’s parent, guardian, or legal representative, the state registrar shall amend the record as directed in the court order; however, if the state registrar has information to believe the facts of the court order are false or inaccurate, the state registrar shall provide the court and any known parties with the correct information.
4. Upon receipt of a sworn acknowledgment of paternity of a child born out of wedlock signed by both parents and upon request, the state registrar shall amend a record of birth to show such paternity if paternity is not shown on the record. Upon request of the parents, the surname of the child must be changed on the appropriate record to the surname designated by the parents on the acknowledgment of paternity. Such record may not be marked as “amended”. The provisions of this subsection apply also in their entirety to records of fetal death.

23-02.1-25. Correction and amendment of vital records. [Effective September 1, 2022]

1. A record registered under this chapter may be amended only in accordance with this chapter and regulations under this chapter adopted by the department of health and human services to protect the integrity and accuracy of vital records.
2. A record that is amended under this section must be marked “amended” except as provided in subsection 4. The date of amendment and a summary description of the evidence submitted in support of the amendment must be endorsed on or made a part of the record. The department of health and human services shall prescribe by regulation the conditions under which additions or minor corrections may be made to birth records within one year after the date of birth without the record being considered as amended.
3. Upon receipt of a certified copy of a court order that is amending a birth, death, or fetal death record and upon request of such individual or the individual’s parent, guardian, or legal representative, the state registrar shall amend the record as directed in the court order; however, if the state registrar has information to believe the facts of the court order are false or inaccurate, the state registrar shall provide the court and any known parties with the correct information.
4. Upon receipt of a sworn acknowledgment of paternity of a child born out of wedlock signed by both parents and upon request, the state registrar shall amend a record of birth to show such paternity if paternity is not shown on the record. Upon request of the parents, the surname of the child must be changed on the appropriate record to the surname designated by the parents on the acknowledgment of paternity. Such record may not be marked as “amended”. The provisions of this subsection apply also in their entirety to records of fetal death.

23-02.1-26. Reproduction of records.

To preserve original documents, the state registrar is authorized to prepare typewritten, photographic, electronic, or other reproductions of original records and files in the state registrar’s office. These reproductions when certified by the state registrar must be accepted as the original record.

23-02.1-27. Disclosure of records. [Effective through August 31, 2022]

Birth, death, and fetal death records, filings, data, or other information related to birth, death, and fetal death records are confidential and may not be disclosed except as authorized under this chapter. The state registrar shall restrict access to all vital records to protect vital records from loss, mutilation, or destruction and to prevent disclosure of the information contained in these records except as authorized under this chapter.

1. A certified copy of a birth record may be issued to the individual named on the record if that individual is at least sixteen years old, to a parent named on the record, to an authorized representative, or by the order of a court of competent jurisdiction. If the individual named on a birth record is deceased, a certified copy of that record may also be issued to a relative. If the date of birth on any birth record is more than one hundred and twenty-five years old, that record is an open record and a certified copy may be issued to anyone, except that adoption records remain confidential.
2. A certified copy of a complete death record may be issued to a relative, an authorized representative, the child fatality review board, a licensed physician, or a genetic sibling for the purposes of researching family medical history, a funeral director reporting the facts of death, or a person with personal or real property interests that depend upon information contained in the complete death record or by the order of a court of competent jurisdiction and may include the cause of death and the social security number. A certified copy of the facts of death record that includes the facts of death and the social security number may be issued to any person that may obtain a certified copy of a complete death record or to any licensed attorney who requires the copy for a bona fide legal determination. A certified copy of an informational death record may be issued to the general public, but the copy may not contain the cause of death or the social security number.
3. A certified copy of a fetal death record may be issued to a parent named on the record, an authorized representative, or by the order of a court of competent jurisdiction. A person authorized to receive a certified copy of a fetal death record may request the certified copy be issued in the form of a certification of birth resulting in stillbirth.
4. A noncertified informational copy of a marriage record may be issued to the general public.
5. A person authorized to receive a certified copy of any specific record may grant another person the same authority by completing a written authorization on a form prescribed by the state department of health.
6. The state department of health may grant limited access to birth and death information to divisions and programs of the state department of health, the department of transportation, the protection and advocacy project, the information technology department, and to the department of human services necessary for the purpose of completing their respective official duties.
7. The state department of health may issue, through electronic means determined by the state department of health, verifications of information contained on birth or death records filed with the state registrar when such information is provided and a verification is requested by a governmental agency, whether foreign or domestic, in the conduct of the agency’s official duties. The state department of health may also issue these electronic verifications for a negotiated and agreed-upon fee to:
   1. Benefit-paying parties, such as annuity companies, pension plans, and life insurance companies, that demonstrate a need for such information to determine whether the benefits the benefit-paying party are paying should be terminated or distributed to a beneficiary;
   2. Physicians licensed to practice in the United States who demonstrate such information is needed to determine whether a patient the physician is treating has been lost to care;
   3. Attorneys licensed to practice in the United States who demonstrate that the information is necessary to administer the attorneys’ client’s estate; or
   4. Other entities for fraud prevention as determined by the state registrar.

23-02.1-27. Disclosure of records. [Effective September 1, 2022]

Birth, death, and fetal death records, filings, data, or other information related to birth, death, and fetal death records are confidential and may not be disclosed except as authorized under this chapter. The state registrar shall restrict access to all vital records to protect vital records from loss, mutilation, or destruction and to prevent disclosure of the information contained in these records except as authorized under this chapter.

1. A certified copy of a birth record may be issued to the individual named on the record if that individual is at least sixteen years old, to a parent named on the record, to an authorized representative, or by the order of a court of competent jurisdiction. If the individual named on a birth record is deceased, a certified copy of that record may also be issued to a relative. If the date of birth on any birth record is more than one hundred and twenty-five years old, that record is an open record and a certified copy may be issued to anyone, except that adoption records remain confidential.
2. A certified copy of a complete death record may be issued to a relative, an authorized representative, the child fatality review board, a licensed physician, or a genetic sibling for the purposes of researching family medical history, a funeral director reporting the facts of death, or a person with personal or real property interests that depend upon information contained in the complete death record or by the order of a court of competent jurisdiction and may include the cause of death and the social security number. A certified copy of the facts of death record that includes the facts of death and the social security number may be issued to any person that may obtain a certified copy of a complete death record or to any licensed attorney who requires the copy for a bona fide legal determination. A certified copy of an informational death record may be issued to the general public, but the copy may not contain the cause of death or the social security number.
3. A certified copy of a fetal death record may be issued to a parent named on the record, an authorized representative, or by the order of a court of competent jurisdiction. A person authorized to receive a certified copy of a fetal death record may request the certified copy be issued in the form of a certification of birth resulting in stillbirth.
4. A noncertified informational copy of a marriage record may be issued to the general public.
5. A person authorized to receive a certified copy of any specific record may grant another person the same authority by completing a written authorization on a form prescribed by the state department of health.
6. The department of health and human services may grant limited access to birth and death information to divisions and programs of the department of health and human services, the department of transportation, the protection and advocacy project, and the information technology department necessary for the purpose of completing their respective official duties.
7. The department of health and human services may issue, through electronic means determined by the department of health and human services, verifications of information contained on birth or death records filed with the state registrar when such information is provided and a verification is requested by a governmental agency, whether foreign or domestic, in the conduct of the agency’s official duties. The department of health and human services may also issue these electronic verifications for a negotiated and agreed-upon fee to:
   1. Benefit-paying parties, such as annuity companies, pension plans, and life insurance companies, that demonstrate a need for such information to determine whether the benefits the benefit-paying party are paying should be terminated or distributed to a beneficiary;
   2. Physicians licensed to practice in the United States who demonstrate such information is needed to determine whether a patient the physician is treating has been lost to care;
   3. Attorneys licensed to practice in the United States who demonstrate that the information is necessary to administer the attorneys’ client’s estate; or
   4. Other entities for fraud prevention as determined by the state registrar.

23-02.1-28. Copies of data from vital records. [Effective through August 31, 2022]

In accordance with section 23-02.1-27 and the regulations adopted pursuant thereto:

1. The state registrar shall, upon request of a person entitled to a copy under section 23-02.1-27, issue a certified copy of any record or part of a record in the registrar’s custody. Each copy issued must show the date of registration; and copies issued from records marked “delayed”, “amended”, or “court order” must be similarly marked and show the effective date of filing.
2. A certified copy of a record or any part of the record issued in accordance with subsection 1 must be considered evidence of the facts stated in the record, provided that the evidentiary value of a record filed more than one year after the event, or a record which has been amended, must be determined by the judicial or administrative body or official before whom the record is offered as evidence.
3. Data or copies may be furnished for statistical purposes to federal, state, local, or other public or private agencies, including the federal agency responsible for national vital statistics, upon such terms and conditions as may be prescribed by the state department of health through rules and regulations adopted pursuant to this chapter.
4. No person may prepare or issue any certificate or record which purports to be an original, certified copy, or copy of a certificate or record of birth, death, or fetal death, except as provided in this chapter, or regulations adopted under this chapter.
5. A certified copy may not disclose an individual’s social security number unless the copy is being provided to the individual to whom it pertains, a relative or authorized representative, or by order of a court of competent jurisdiction.

23-02.1-28. Copies of data from vital records. [Effective September 1, 2022]

In accordance with section 23-02.1-27 and the regulations adopted pursuant thereto:

1. The state registrar shall, upon request of a person entitled to a copy under section 23-02.1-27, issue a certified copy of any record or part of a record in the registrar’s custody. Each copy issued must show the date of registration; and copies issued from records marked “delayed”, “amended”, or “court order” must be similarly marked and show the effective date of filing.
2. A certified copy of a record or any part of the record issued in accordance with subsection 1 must be considered evidence of the facts stated in the record, provided that the evidentiary value of a record filed more than one year after the event, or a record which has been amended, must be determined by the judicial or administrative body or official before whom the record is offered as evidence.
3. Data or copies may be furnished for statistical purposes to federal, state, local, or other public or private agencies, including the federal agency responsible for national vital statistics, upon such terms and conditions as may be prescribed by the department of health and human services through rules and regulations adopted pursuant to this chapter.
4. No person may prepare or issue any certificate or record which purports to be an original, certified copy, or copy of a certificate or record of birth, death, or fetal death, except as provided in this chapter, or regulations adopted under this chapter.
5. A certified copy may not disclose an individual’s social security number unless the copy is being provided to the individual to whom it pertains, a relative or authorized representative, or by order of a court of competent jurisdiction.

23-02.1-29. Fees. [Effective through August 31, 2022]

1. The state department of health shall prescribe the fees, if any, not to exceed fifteen dollars, to be paid for the following:
   1. Each certified copy of a record.
   2. Each certified statement of the facts of birth other than a copy of the original birth record.
   3. Each filing of a new record of birth or fetal death following adoption.
   4. Each filing of a delayed record of birth or death except as provided for in subsection 4 of section 23-02.1-18.
   5. Each filing of an amendment to a birth or death record.
   6. A search of the files or records when no copy is made.
   7. A noncertified informational copy of a death or marriage record.
2. Except as otherwise provided in subsection 3, fees collected under this section by the state registrar must be deposited in the operating fund of the state department of health, according to procedures established by the state treasurer.
3. The state department of health shall quarterly pay fees in the amount of two dollars for the issuance of each certified copy of a birth record, authorized by subsection 1, into the children’s trust fund created by section 50-27-01.
4. All fees collected in excess of the fees appropriated must be transferred to the general fund of this state at the end of each biennium.

The fee for each additional copy of a death or fetal death record, requested at the same time, may not exceed ten dollars.

23-02.1-29. Fees. [Effective September 1, 2022]

1. The department of health and human services shall prescribe the fees, if any, not to exceed fifteen dollars, to be paid for the following:
   1. Each certified copy of a record.
   2. Each certified statement of the facts of birth other than a copy of the original birth record.
   3. Each filing of a new record of birth or fetal death following adoption.
   4. Each filing of a delayed record of birth or death except as provided for in subsection 4 of section 23-02.1-18.
   5. Each filing of an amendment to a birth or death record.
   6. A search of the files or records when no copy is made.
   7. A noncertified informational copy of a death or marriage record.
2. Except as otherwise provided in subsection 3, fees collected under this section by the state registrar must be deposited in the operating fund of the department of health and human services, according to procedures established by the state treasurer.
3. The department of health and human services shall quarterly pay fees in the amount of two dollars for the issuance of each certified copy of a birth record, authorized by subsection 1, into the children’s trust fund created by section 50-27-01.
4. All fees collected in excess of the fees appropriated must be transferred to the general fund of this state at the end of each biennium.

The fee for each additional copy of a death or fetal death record, requested at the same time, may not exceed ten dollars.

23-02.1-30. Persons required to keep records. [Effective through August 31, 2022]

1. Every person in charge of an institution as defined in this chapter shall keep a record of personal particulars and data concerning each person admitted or confined to such institution. This record must include all information required by the standard record of birth, death, and fetal death forms issued under the provisions of this chapter. The record must be made at the time of admission from information provided by such person, but when it cannot be obtained from that person, the information must be obtained from relatives or other persons acquainted with the facts. The name and address of the person providing the information must be a part of the record.
2. When a dead body or fetus is released or disposed of by an institution, the person in charge of the institution shall keep a record showing the name of the deceased, date of death, name and address of the person to whom the body is released, date of removal from the institution, or if finally disposed of by the institution, the date, place, and manner of disposition must be recorded.
3. A funeral director, embalmer, or other person who removed from the place of death or transports or finally disposes of a dead body or fetus, in addition to filing any record or other form required by this chapter, shall keep a record which must identify the body, and the information pertaining to receipt, removal, and delivery of the body as may be prescribed in regulations adopted by the state department of health.
4. Records maintained under this section must be made available to the state registrar or the registrar’s representative for inspection upon demand.
5. On or before the fifth day of each month, each hospital, institution, funeral director, embalmer, or person acting as such in this state shall report to the state registrar, on forms provided for this purpose, information required by the state registrar regarding each birth, death, or fetal death handled during the preceding calendar month.

23-02.1-30. Persons required to keep records. [Effective September 1, 2022]

1. Every person in charge of an institution as defined in this chapter shall keep a record of personal particulars and data concerning each person admitted or confined to such institution. This record must include all information required by the standard record of birth, death, and fetal death forms issued under the provisions of this chapter. The record must be made at the time of admission from information provided by such person, but when it cannot be obtained from that person, the information must be obtained from relatives or other persons acquainted with the facts. The name and address of the person providing the information must be a part of the record.
2. When a dead body or fetus is released or disposed of by an institution, the person in charge of the institution shall keep a record showing the name of the deceased, date of death, name and address of the person to whom the body is released, date of removal from the institution, or if finally disposed of by the institution, the date, place, and manner of disposition must be recorded.
3. A funeral director, embalmer, or other person who removed from the place of death or transports or finally disposes of a dead body or fetus, in addition to filing any record or other form required by this chapter, shall keep a record which must identify the body, and the information pertaining to receipt, removal, and delivery of the body as may be prescribed in regulations adopted by the department of health and human services.
4. Records maintained under this section must be made available to the state registrar or the registrar’s representative for inspection upon demand.
5. On or before the fifth day of each month, each hospital, institution, funeral director, embalmer, or person acting as such in this state shall report to the state registrar, on forms provided for this purpose, information required by the state registrar regarding each birth, death, or fetal death handled during the preceding calendar month.

23-02.1-31. Duties to furnish information relative to vital events.

Any person having knowledge of the facts shall furnish such information as the person may possess regarding any birth, death, fetal death, marriage, or divorce upon demand of the state registrar.

23-02.1-32. Penalties.

1. 1. Any person who willfully and knowingly makes any false statement in a report, record, or certificate required to be filed under this chapter, or in application for an amendment thereof, or who willfully and knowingly supplies false information intending that such information be used in the preparation of any such report, record, or certificate, or amendment thereof;
   2. Any person who, without lawful authority and with the intent to deceive, makes, alters, or mutilates any report, record, or certificate required to be filed under this chapter or a certified copy of a report, record, or certificate;
   3. Any person who willfully and knowingly uses or attempts to use or to furnish to another for use, for any purpose of deception, any certificate, record, report, or certified copy thereof so made, altered, amended, or mutilated;
   4. Any person who, with the intention to deceive, willfully uses or attempts to use any certificate of birth or certified copy of a record of birth knowing that such certificate or certified copy was issued upon a record which is false in whole or in part or which relates to the birth of another person;
   5. Any person who willfully and knowingly furnishes a certificate of birth or certified copy of a record of birth with the intention that it be used by a person other than the person to whom the record of birth relates; or
   6. Any person who knowingly prepares, delivers, or uses a fraudulent or forged copy of a vital record;
2. 1. Any person who refuses to provide information required by this chapter;
   2. Any person who knowingly transports or accepts for transportation, interment, or other final disposition of a dead body or fetus without an accompanying final disposition-transit permit as provided in this chapter; or
   3. Any person who willfully neglects or violates any of the provisions of this chapter or refuses to perform any of the duties imposed upon the person by this chapter;

is guilty of a class C felony.

is guilty of an infraction.

23-02.1-33. Short title.

This chapter may be cited as the “Health Statistics Act”.

23-06-01. Right to dispose of one’s own body. [Repealed]

Repealed by S.L. 1969, ch. 255, § 12.

23-06-01.1. Immunity from liability. [Repealed]

Repealed by S.L. 1989, ch. 303, § 5.

23-06-01.2. Application of other laws.

Sections 23-06-03, 23-06-04, 23-06-05, 23-06-06, 23-06-07, 23-06-08, 23-06-09, 23-06-10, 23-06-11, 23-06-12, 23-06-16, 23-06-17, and 23-06-19 do not apply to any body or parts thereof disposed of after death pursuant to the authorization for disposal of a body or parts thereof provided in and for the purposes of chapter 23-06.6.

23-06-02. Custody of body.

The person charged with the duty of final disposition of the body of a deceased person is entitled to the custody of such body for the purpose of arranging for final disposition. When the coroner is required to hold an inquest, however, the coroner is entitled to the custody of the body until such inquest has been completed.

23-06-03. Duty of final disposition — Indigent burial — Decedent’s instructions. [Effective through August 31, 2022]

1. The duty of disposition of the body of a deceased individual devolves upon the following individual in the order of priority:
   1. Any legally competent adult given the duty of final disposition by the deceased individual in a statement conforming with section 23-06-31, except the legally competent adult specified in the statement conforming with section 23-06-31 may decline the duty of final disposition unless the individual would otherwise have the duty of final disposition under this section;
   2. The surviving spouse if the deceased was married;
   3. If the deceased was not married but left kindred, upon the majority of the adult children of the decedent; however, in the absence of actual knowledge to the contrary, a funeral director or mortician may rely on instructions given by the child who represents to be the sole surviving child or the children who represent to constitute a majority of the surviving children;
   4. The surviving parent or parents of the decedent, each having equal authority;
   5. The adult sibling or the majority of the adult siblings of the decedent; however, in the absence of actual knowledge to the contrary, a funeral director or mortician may rely on instructions given by the sibling who represents to be the sole surviving sibling or the siblings who represent to constitute a majority of the surviving siblings;
   6. The adult grandchild or the majority of the adult grandchildren of the decedent; however, in the absence of actual knowledge to the contrary, a funeral director or mortician may rely on instructions given by a grandchild who represents to be the only grandchild reasonably available to control final disposition of the decedent’s remains or the grandchildren who represent to constitute a majority of grandchildren reasonably available to control final disposition of the decedent’s remains;
   7. The grandparent or the grandparents of the decedent, each having equal authority;
   8. The adult nieces and nephews of the decedent or a majority of the adult nieces and nephews; however, in the absence of actual knowledge to the contrary, a funeral director or mortician may rely on instructions given by a niece or nephew, who represents to be the only niece or nephew reasonably available to control final disposition of the decedent’s remains or the nieces and nephews who represent to constitute a majority of the nieces and nephews reasonably available to control final disposition of the decedent’s remains;
   9. An individual who was acting as the guardian of the decedent with authority to make health care decisions for the decedent at the time of death;
   10. An adult who exhibited special care and concern for the decedent;
   11. An individual respectively in the next degree of kinship in the order named by law to inherit the estate of the decedent; or
   12. The appropriate public or court authority, as required by law. For purposes of this subdivision, the appropriate public or court authority includes the human service zone of the county in which the death occurred if the individual dies without apparent financial means to provide for final disposition or the district court in the county in which the death occurred.
2. If there is only one individual in a degree of relationship to the decedent described in subsection 1, and a district court determines the person and the decedent were estranged at the time of death, the right to control and the duty of disposition devolves to the next degree of relationship under subsection 1. For purposes of this subsection, “estranged” means having a relationship characterized by mutual enmity, hostility, or indifference.
3. If an individual to whom the right to control and duty of disposition devolves under subsection 1, refuses to accept or declines to act upon the right or duty, that right and duty passes as follows:
   1. To another individual with the same degree of relationship to the decedent as the individual refusing to accept or declining to act; or
   2. To the individual in the next degree of relationship to the decedent under subsection 1.
4. If a dispute exists regarding the right to control or duty of disposition, the parties in dispute or the mortician or funeral director may file a petition in the district court in the county of residence of the decedent requesting the court make a determination in the matter. If the right to control and duty of disposition devolves to more than one individual with the same degree of relationship to the decedent and those individuals do not, by majority vote, make a decision regarding arrangements and final disposition and a district court has been petitioned to make a determination, the court shall consider the following factors in making a determination:
   1. The reasonableness, practicality, and resources available for payment of the proposed arrangements and final disposition;
   2. The degree of the personal relationship between the decedent and each of the individuals in the same degree of relationship to the decedent;
   3. The expressed wishes and directions of the decedent and the extent to which the decedent provided resources for the purpose of carrying out the wishes or directions; and
   4. The degree to which the arrangements and final disposition will allow for participation by all who wish to pay respect to the decedent.
5. If the individual who has the duty of final disposition does not arrange for final disposition of the body within the time required by this chapter, the individual next specified shall bury or otherwise dispose of the body within the requirements of this chapter.
6. 1. If the deceased did not leave sufficient means to pay for expenses of final disposition, including the cost of a casket, and is not survived by an individual described by subsection 1 and identified for financial responsibility within the human service zone’s general assistance policy, within fifteen days of application for services the human service zone of the county in which the deceased had residence for general assistance purposes or, if residence cannot be established, within fifteen days of application for assistance the human service zone of the county in which the death occurs shall employ a person to arrange for and supervise the final disposition. If the deceased was a resident or inmate of a public institution, within fifteen days of application for assistance the human service zone in which the deceased was a resident for general assistance purposes immediately before entering the institution shall employ a person to arrange for and supervise the final disposition.
   2. The department of human services may negotiate with the interested funeral directors or funeral homes regarding cremation expenses and burial expenses but the total charges for burial services, including transportation of the deceased to the place of burial, the grave box or vault, grave space, and grave opening and closing expenses, may not be less than one thousand five hundred dollars.
   3. The department of human services may provide for the use of a military casket or urn, if the deceased was a veteran as defined in section 37-01-40, unless the additional cost exceeds the negotiated expenses of this section or a surviving spouse or the nearest of kin of the deceased elects a nonmilitary casket.
   4. The human service zone shall pay the charge for funeral expenses as negotiated by the department of human services. The human service zone may not decrease the human service zone payment due to a nominal amount left by the deceased or contributed by kin or any other party to defray the expenses of burial or cremation. Funds adequate to allow for burial instead of cremation are considered nominal under this section.
7. If the individual with the duty of final disposition under this section, or the personal representative of the decedent’s estate, if any, is aware of the decedent’s instructions regarding the disposition of the remains, that person shall honor those instructions, to the extent reasonable and possible, to the extent the instructions do not impose an economic or emotional hardship. A decedent’s instructions may be reflected in a variety of methods, including pre-need funeral arrangements a deceased articulated and funded in a pre-need funeral service contract, a health care directive, a durable power of attorney for health care, a power of attorney, a will, a document created under section 23-06-31, or a document of gift for an anatomical gift.
8. If the decedent died while serving in any branch of the United States armed forces, the United States reserve forces, or the national guard, as provided by 10 U.S.C. 1481 section (a)(1) through (8) as effective through December 2001, and completed a United States department of defense record of emergency data, DD form 93, or its successor form or its equivalent branch’s form, the duty to bury or cremate the decedent or to provide other funeral and disposition arrangements for the decedent devolves on the person authorized by the decedent pursuant to that form.
9. A funeral director or mortician has complete authority to control the final disposition and to proceed under this chapter to recover reasonable charges for the final disposition if:
   1. The funeral director or mortician has actual knowledge none of the individuals described in subsection 1 exist, can be found after reasonable inquiry, or can be contacted by reasonable means; and
   2. Within thirty-six hours after having been given written notice of the facts, the appropriate court or public authority fails to assume responsibility for disposition of the remains. Written notice may be delivered by hand, United States mail, or facsimile transmission.

23-06-03. Duty of final disposition — Indigent burial — Decedent’s instructions. [Effective September 1, 2022]

1. The duty of disposition of the body of a deceased individual devolves upon the following individual in the order of priority:
   1. Any legally competent adult given the duty of final disposition by the deceased individual in a statement conforming with section 23-06-31, except the legally competent adult specified in the statement conforming with section 23-06-31 may decline the duty of final disposition unless the individual would otherwise have the duty of final disposition under this section;
   2. The surviving spouse if the deceased was married;
   3. If the deceased was not married but left kindred, upon the majority of the adult children of the decedent; however, in the absence of actual knowledge to the contrary, a funeral director or mortician may rely on instructions given by the child who represents to be the sole surviving child or the children who represent to constitute a majority of the surviving children;
   4. The surviving parent or parents of the decedent, each having equal authority;
   5. The adult sibling or the majority of the adult siblings of the decedent; however, in the absence of actual knowledge to the contrary, a funeral director or mortician may rely on instructions given by the sibling who represents to be the sole surviving sibling or the siblings who represent to constitute a majority of the surviving siblings;
   6. The adult grandchild or the majority of the adult grandchildren of the decedent; however, in the absence of actual knowledge to the contrary, a funeral director or mortician may rely on instructions given by a grandchild who represents to be the only grandchild reasonably available to control final disposition of the decedent’s remains or the grandchildren who represent to constitute a majority of grandchildren reasonably available to control final disposition of the decedent’s remains;
   7. The grandparent or the grandparents of the decedent, each having equal authority;
   8. The adult nieces and nephews of the decedent or a majority of the adult nieces and nephews; however, in the absence of actual knowledge to the contrary, a funeral director or mortician may rely on instructions given by a niece or nephew, who represents to be the only niece or nephew reasonably available to control final disposition of the decedent’s remains or the nieces and nephews who represent to constitute a majority of the nieces and nephews reasonably available to control final disposition of the decedent’s remains;
   9. An individual who was acting as the guardian of the decedent with authority to make health care decisions for the decedent at the time of death;
   10. An adult who exhibited special care and concern for the decedent;
   11. An individual respectively in the next degree of kinship in the order named by law to inherit the estate of the decedent; or
   12. The appropriate public or court authority, as required by law. For purposes of this subdivision, the appropriate public or court authority includes the human service zone of the county in which the death occurred if the individual dies without apparent financial means to provide for final disposition or the district court in the county in which the death occurred.
2. If there is only one individual in a degree of relationship to the decedent described in subsection 1, and a district court determines the person and the decedent were estranged at the time of death, the right to control and the duty of disposition devolves to the next degree of relationship under subsection 1. For purposes of this subsection, “estranged” means having a relationship characterized by mutual enmity, hostility, or indifference.
3. If an individual to whom the right to control and duty of disposition devolves under subsection 1, refuses to accept or declines to act upon the right or duty, that right and duty passes as follows:
   1. To another individual with the same degree of relationship to the decedent as the individual refusing to accept or declining to act; or
   2. To the individual in the next degree of relationship to the decedent under subsection 1.
4. If a dispute exists regarding the right to control or duty of disposition, the parties in dispute or the mortician or funeral director may file a petition in the district court in the county of residence of the decedent requesting the court make a determination in the matter. If the right to control and duty of disposition devolves to more than one individual with the same degree of relationship to the decedent and those individuals do not, by majority vote, make a decision regarding arrangements and final disposition and a district court has been petitioned to make a determination, the court shall consider the following factors in making a determination:
   1. The reasonableness, practicality, and resources available for payment of the proposed arrangements and final disposition;
   2. The degree of the personal relationship between the decedent and each of the individuals in the same degree of relationship to the decedent;
   3. The expressed wishes and directions of the decedent and the extent to which the decedent provided resources for the purpose of carrying out the wishes or directions; and
   4. The degree to which the arrangements and final disposition will allow for participation by all who wish to pay respect to the decedent.
5. If the individual who has the duty of final disposition does not arrange for final disposition of the body within the time required by this chapter, the individual next specified shall bury or otherwise dispose of the body within the requirements of this chapter.
6. 1. If the deceased did not leave sufficient means to pay for expenses of final disposition, including the cost of a casket, and is not survived by an individual described by subsection 1 and identified for financial responsibility within the human service zone’s general assistance policy, within fifteen days of application for services the human service zone of the county in which the deceased had residence for general assistance purposes or, if residence cannot be established, within fifteen days of application for assistance the human service zone of the county in which the death occurs shall employ a person to arrange for and supervise the final disposition. If the deceased was a resident or inmate of a public institution, within fifteen days of application for assistance the human service zone in which the deceased was a resident for general assistance purposes immediately before entering the institution shall employ a person to arrange for and supervise the final disposition.
   2. The department of health and human services may negotiate with the interested funeral directors or funeral homes regarding cremation expenses and burial expenses but the total charges for burial services, including transportation of the deceased to the place of burial, the grave box or vault, grave space, and grave opening and closing expenses, may not be less than one thousand five hundred dollars.
   3. The department of health and human services may provide for the use of a military casket or urn, if the deceased was a veteran as defined in section 37-01-40, unless the additional cost exceeds the negotiated expenses of this section or a surviving spouse or the nearest of kin of the deceased elects a nonmilitary casket.
   4. The human service zone shall pay the charge for funeral expenses as negotiated by the department of health and human services. The human service zone may not decrease the human service zone payment due to a nominal amount left by the deceased or contributed by kin or any other party to defray the expenses of burial or cremation. Funds adequate to allow for burial instead of cremation are considered nominal under this section.
7. If the individual with the duty of final disposition under this section, or the personal representative of the decedent’s estate, if any, is aware of the decedent’s instructions regarding the disposition of the remains, that person shall honor those instructions, to the extent reasonable and possible, to the extent the instructions do not impose an economic or emotional hardship. A decedent’s instructions may be reflected in a variety of methods, including pre-need funeral arrangements a deceased articulated and funded in a pre-need funeral service contract, a health care directive, a durable power of attorney for health care, a power of attorney, a will, a document created under section 23-06-31, or a document of gift for an anatomical gift.
8. If the decedent died while serving in any branch of the United States armed forces, the United States reserve forces, or the national guard, as provided by 10 U.S.C. 1481 section (a)(1) through (8) as effective through December 2001, and completed a United States department of defense record of emergency data, DD form 93, or its successor form or its equivalent branch’s form, the duty to bury or cremate the decedent or to provide other funeral and disposition arrangements for the decedent devolves on the person authorized by the decedent pursuant to that form.
9. A funeral director or mortician has complete authority to control the final disposition and to proceed under this chapter to recover reasonable charges for the final disposition if:
   1. The funeral director or mortician has actual knowledge none of the individuals described in subsection 1 exist, can be found after reasonable inquiry, or can be contacted by reasonable means; and
   2. Within thirty-six hours after having been given written notice of the facts, the appropriate court or public authority fails to assume responsibility for disposition of the remains. Written notice may be delivered by hand, United States mail, or facsimile transmission.

23-06-03.1. Payments on pre-need funeral contracts to be deposited — Depository shall keep record of deposit — Personal property storage — Penalty. [Repealed]

Repealed by S.L. 2001, ch. 368, § 7.

23-06-04. Time within which final disposition must be made — Exceptions. [Effective through August 31, 2022]

1. The dead body of a human being must be disposed of by the person charged with that duty within eight days after the death of such person except when any of the following occur:
   1. The right to dissect the body is expressly conferred by law.
   2. The body is being carried through this state.
   3. The body is being removed from this state for the purpose of final disposition in some other state.
   4. A permit is obtained from the local health officer or the state department of health allowing a longer time during which the body need not be disposed. The permit shall state the additional length of time during which the body need not be disposed.
   5. The body is being stored for an extended period of time in a vault determined suitable by the state department of health, but the body may not be stored in a vault for a period of more than eight days during the months of June through October unless a permit is obtained from the local health officer or the state department of health.
2. The date of final disposition must be the date of the committal service or date of placement in a storage vault or school of medicine.

23-06-04. Time within which final disposition must be made — Exceptions. [Effective September 1, 2022]

1. The dead body of a human being must be disposed of by the person charged with that duty within eight days after the death of such person except when any of the following occur:
   1. The right to dissect the body is expressly conferred by law.
   2. The body is being carried through this state.
   3. The body is being removed from this state for the purpose of final disposition in some other state.
   4. A permit is obtained from the local health officer or the department of health and human services allowing a longer time during which the body need not be disposed. The permit shall state the additional length of time during which the body need not be disposed.
   5. The body is being stored for an extended period of time in a vault determined suitable by the department of health and human services, but the body may not be stored in a vault for a period of more than eight days during the months of June through October unless a permit is obtained from the local health officer or the department of health and human services.
2. The date of final disposition must be the date of the committal service or date of placement in a storage vault or school of medicine.

23-06-05. Failure to dispose within required time — Penalty.

Any person that fails to comply with or who violates any of the provisions of section 23-06-04, or that refuses or neglects promptly to obey any order or instruction of the local board of health, is guilty of a class B misdemeanor.

23-06-06. Neglect of final disposition — Penalty.

Every person upon which the duty of making final disposition of the remains of a deceased person is imposed by law that omits to perform that duty as required in this chapter is guilty of a class B misdemeanor.

23-06-07. Regulation of final disposition — Issuance of final disposition-transit permit regulated. [Effective through August 31, 2022]

The body of any individual whose death occurs in this state may not be interred, deposited in a vault or tomb, cremated, donated to a school of medicine, or otherwise disposed as authorized by law, until a final disposition-transit permit has been properly issued by a subregistrar. If the certificate is incorrect or incomplete, the subregistrar may not issue the permit until it is corrected or completed. In the case of any death outside of this state, a final disposition-transit permit issued in accordance with the law and the health regulations in force in the state where the death occurred, when accompanying a body shipped through or into this state, may be accepted with the same effect as a permit from a subregistrar. If the death occurred from some disease that is held to be communicable by the state department of health, the subregistrar shall refuse to issue a permit for the removal or other disposition of the body except under the conditions prescribed by the state department of health and the local board of health.

23-06-07. Regulation of final disposition — Issuance of final disposition-transit permit regulated. [Effective September 1, 2022]

The body of any individual whose death occurs in this state may not be interred, deposited in a vault or tomb, cremated, donated to a school of medicine, or otherwise disposed as authorized by law, until a final disposition-transit permit has been properly issued by a subregistrar. If the certificate is incorrect or incomplete, the subregistrar may not issue the permit until it is corrected or completed. In the case of any death outside of this state, a final disposition-transit permit issued in accordance with the law and the health regulations in force in the state where the death occurred, when accompanying a body shipped through or into this state, may be accepted with the same effect as a permit from a subregistrar. If the death occurred from some disease that is held to be communicable by the department of health and human services, the subregistrar shall refuse to issue a permit for the removal or other disposition of the body except under the conditions prescribed by the department of health and human services and the local board of health.

23-06-08. Final disposition-transit permit — Contents.

The final disposition-transit permit must be on the form prescribed by the state registrar of vital statistics, must be signed by the subregistrar issuing it, and may be limited to a statement by the subregistrar showing:

1. That a satisfactory death record has been filed with the state registrar as required by law.
2. That permission is granted to inter, remove, or otherwise dispose of as authorized by law the body of the deceased.
3. The name, age, and sex of the deceased and any other necessary details.

23-06-09. Disposition of final disposition-transit permit.

The funeral practitioner, or individual acting as funeral practitioner, shall secure the final disposition-transit permit from the subregistrar. The funeral practitioner, or person acting as funeral practitioner, shall deliver such permit to the sexton or person in charge of the place of final disposition before interring the body, cremating the body, donating the body to a medical school, or otherwise disposing of the body as authorized by law, or shall attach it to the box containing the corpse when the same is shipped by any transportation company. Such permit must be accepted by the sexton or person in charge as authority for the final disposition of the body. A body may not be accepted for carriage by a common carrier unless the permit is attached as required in this section.

23-06-10. Sextons to endorse and return final disposition-transit permit — Record of burials.

Each sexton or person in charge of the burial ground shall endorse the date of interment upon the final disposition-transit permit over the person’s signature, and return the final disposition-transit permit to the county recorder. The subregistrar or sexton shall file all completed permits, so endorsed, with the county recorder within ten days after the date of interment or within the time prescribed by the local board of health.

The sexton shall keep a record of all interments made in the premises under the sexton’s charge, stating the name of the deceased individual, the place of death, the date of burial, and the name and address of the funeral practitioner. Such record at all times must be open to public inspection.

In the absence of a sexton, the funeral director making the burial shall endorse and return the final disposition-transit permit to the subregistrar.

23-06-11. Burial without final disposition-transit permit — Penalty.

It is unlawful for a person, acting as a funeral practitioner, to inter, remove, or otherwise dispose of as authorized by law the body of any deceased individual without having received a final disposition-transit permit.

23-06-12. Transporting body without final disposition-transit permit.

It is unlawful for a transportation company or common carrier to transport, or accept for transportation, the body of any deceased individual unless that body is accompanied by a final disposition-transit permit issued in accordance with the provisions of this chapter.

23-06-13. Dissection — When allowed.

The dead body of a human being may be dissected:

1. When the death occurs under circumstances in which a coroner is authorized by law to hold an inquest upon the body, and a coroner authorizes such dissection for the purposes of the inquest;
2. If the spouse, or one of the next of kin of a deceased individual, charged by law with the duty of final disposition, authorizes such dissection for the purposes of ascertaining the cause of death; or
3. When permission has been given therefor by deceased.

23-06-14. What bodies may be used for dissection.

Any medical association, licensed physician and surgeon, or medical school, upon request, may receive and remove free of charge the bodies of the following deceased persons, if such bodies are to be used within the state for the advancement of anatomical knowledge and medical science and if proper notice is given to the relatives or guardian of the deceased:

1. A person executed pursuant to sentence of law.
2. A person dying in the penitentiary or county jail while under sentence for a crime.
3. A person required to be buried at public expense.

Preference must be given to medical schools, and such schools shall furnish the bodies to the students of medicine and surgery.

23-06-15. When body not to be used for dissection.

If a person mentioned in section 23-06-14 has requested, during that person’s last illness, that that person be buried, that person’s body may not be surrendered for dissection but must be buried. If any friend, relative, or guardian of any such person requests, within thirty-six hours after that person’s death, that the body be turned over to such friend, relative, or guardian for interment, such request must be complied with.

23-06-16. Bond given by person receiving body.

Every physician or surgeon and every medical school, before receiving any dead body, shall give to the officer surrendering the same a sufficient bond conditioned that the body shall be used only for the promotion of anatomical science and medical knowledge within this state and so as not to outrage public feeling, and that after having been so used, the remains thereof shall be disposed of in accordance with the provisions of section 23-06-17.

23-06-17. Bodies required to be buried or cremated after being dissected.

Any person who receives for dissection any dead body, in pursuance of the provisions of this chapter, shall decently bury the body in some public cemetery or shall cremate the same in a furnace properly constructed for that purpose after the dissection has been made.

23-06-18. Dissection — Removal of body — Sale — Penalty.

Any person who receives a body for use under the provisions of section 23-06-14 and uses the same for any other purpose, or who removes the same beyond the limits of this state, or who buys or sells any such body, or traffics in the same, is guilty of a class B misdemeanor. It is unlawful for an officer to refuse to deliver the remains or body of any deceased person, when demanded under the provisions of section 23-06-14.

23-06-19. Interference with burial of dead limb or member of body — Penalty.

All provisions of this chapter requiring the burial of a dead body or punishing interference with or injuries to a dead body apply equally to any dead limb or member of a human body, separated therefrom during lifetime.

23-06-20. Where body may be buried. [Effective through August 31, 2022]

No dead human body may be buried in this state except in a properly registered cemetery or in some other place requested by the relatives and friends of the deceased if the same is authorized by the state department of health and all rules and regulations promulgated by the department in that connection have been complied with.

23-06-20. Where body may be buried. [Effective September 1, 2022]

No dead human body may be buried in this state except in a properly registered cemetery or in some other place requested by the relatives and friends of the deceased if the same is authorized by the department of health and human services and all rules and regulations promulgated by the department in that connection have been complied with.

23-06-21. Regulation of cemeteries. [Effective through August 31, 2022]

All persons, corporations, municipalities, associations, and organizations owning, conducting, or maintaining a cemetery or plot for the burial of dead human bodies shall:

1. Provide for a sexton or secretary.
2. Cause the lot or parcel of ground used and designated as a cemetery to be platted into orderly blocks and lots, alleys and streets or driveways, giving to each a distinctive name or number that must be a permanent designation of its location.
3. File the original plat with the recorder of the county in which the cemetery or place of burial is located and the copy or blueprint thereof with the sexton or secretary.
4. Register with the state department of health the name and location of the cemetery or place of burial, the name and address of the sexton, and the name and address of other officers of the cemetery association, corporation, or organization.
5. Furnish such information and reports as the state department of health may require including the submission of plans and specifications for review and approval before constructing, erecting, or placing on the burial site for the burial or disposition of any human remains any interment structure or device constructed or placed wholly or partially above the natural surface of the ground.
6. Keep a local register of all burials showing as to each burial the name of the deceased, the date and location of burial, the date of death, and the name and address of the undertaker.

23-06-21. Regulation of cemeteries. [Effective September 1, 2022]

All persons, corporations, municipalities, associations, and organizations owning, conducting, or maintaining a cemetery or plot for the burial of dead human bodies shall:

1. Provide for a sexton or secretary.
2. Cause the lot or parcel of ground used and designated as a cemetery to be platted into orderly blocks and lots, alleys and streets or driveways, giving to each a distinctive name or number that must be a permanent designation of its location.
3. File the original plat with the recorder of the county in which the cemetery or place of burial is located and the copy or blueprint thereof with the sexton or secretary.
4. Register with the department of health and human services the name and location of the cemetery or place of burial, the name and address of the sexton, and the name and address of other officers of the cemetery association, corporation, or organization.
5. Furnish such information and reports as the department of health and human services may require including the submission of plans and specifications for review and approval before constructing, erecting, or placing on the burial site for the burial or disposition of any human remains any interment structure or device constructed or placed wholly or partially above the natural surface of the ground.
6. Keep a local register of all burials showing as to each burial the name of the deceased, the date and location of burial, the date of death, and the name and address of the undertaker.

23-06-21.1. Title to burial plots reverts after sixty years — Procedure — Abandonment.

Any entity owning, conducting, or maintaining a cemetery or plot for the burial of dead human bodies may use the procedures in this section to reinvest itself with the title to a portion of a cemetery which was conveyed by deed to a person but which has not been used for purposes of burial for more than sixty years.

1. The entity owning, conducting, or maintaining a cemetery may pass a resolution demanding that the owner of a portion of a cemetery which has been unused for more than sixty years express an interest in the cemetery plot. The entity shall personally serve a copy of its resolution on the owner in the same manner as personal service of process in a civil action. The resolution must notify the owner that the owner must, within sixty days after service of the resolution on the owner, express an interest in retaining the unused cemetery plot.
2. If the owner of the unused plot cannot personally be served with a copy of the resolution of the entity because the owner cannot be found in this state or for any other valid reason, the entity shall publish its resolution for three consecutive weeks in the official newspaper of the county where the cemetery is located and shall mail a copy of the resolution within fourteen days after the third publication to the owner’s last-known address.
3. If within sixty days after personal service or after publication of the board’s resolution is completed, the owner or person with a legal interest in the cemetery plot fails to express an interest in retaining the unused cemetery plot, the owner’s rights are terminated and title to that person’s plot reverts to the entity owning, conducting, or maintaining the cemetery.
4. It is a conclusive presumption that an owner has abandoned a cemetery plot if for a period of more than sixty years the owner has not used any portion of the lot for purposes of burial and has not made provision for care of the lot beyond that provided uniformly to all lots within the cemetery and if the owner has failed to express an interest in retaining the cemetery plot after notice provided in this section.

23-06-22. Sexton — Term of office, records, duties. [Effective through August 31, 2022]

The sexton or secretary appointed by the person, corporation, municipality, association, or organization conducting a cemetery for the burial of dead human bodies shall hold office until a successor is appointed and qualified. The sexton or secretary shall transfer all records to the successor. The sexton or secretary shall enforce the laws of the state and the rules and regulations of the state department of health with respect to the burial of dead human bodies within the cemetery under the sexton’s or secretary’s charge.

23-06-22. Sexton — Term of office, records, duties. [Effective September 1, 2022]

The sexton or secretary appointed by the person, corporation, municipality, association, or organization conducting a cemetery for the burial of dead human bodies shall hold office until a successor is appointed and qualified. The sexton or secretary shall transfer all records to the successor. The sexton or secretary shall enforce the laws of the state and the rules and regulations of the department of health and human services with respect to the burial of dead human bodies within the cemetery under the sexton’s or secretary’s charge.

23-06-23. State department of health to enforce regulation of cemeteries — Injunction. [Effective through August 31, 2022]

The state department of health shall make and enforce such rules and regulations as are necessary to carry out the laws relating to the regulation of cemeteries and may, through injunction or other legal process, enforce compliance.

23-06-23. Department to enforce regulation of cemeteries — Injunction. [Effective September 1, 2022]

The department of health and human services shall make and enforce such rules and regulations as are necessary to carry out the laws relating to the regulation of cemeteries and may, through injunction or other legal process, enforce compliance.

23-06-24. Unlawful removal of dead body — Penalty.

Every person who removes any part of the dead body of a human being from any grave or other place where the same has been buried, or from any place where the same is deposited while awaiting burial, except as provided by law, is guilty of a class C felony.

23-06-24.1. Endangered gravesites — County action authorized.

Notwithstanding any other provisions of this chapter, the county commissioners of each county may move graves or cremate the bodies in any graves which are located in the county and maintained by the county when the gravesites are in imminent danger of destruction by natural elements. The county commissioners shall, to the extent possible, give personal notice to a relative of a deceased person whose grave is to be moved or whose body is to be cremated if the identity of that person and the identity of the relative are known. The county commissioners shall provide at least thirty days’ prior notice in a legal newspaper of the county of the commissioners’ intended action to be taken pursuant to this section.

23-06-25. When body may be removed from cemetery — Penalty for failure to remove.

Whenever a cemetery or other place of burial is lawfully authorized to be removed from one place to another, the right and duty to disinter, remove, and rebury the remains of bodies there lying buried devolves upon the persons whose duty it is to bury the bodies, in the order in which they are named in section 23-06-03. If all such persons fail to act, the duty devolves upon the lawful custodians of the place of burial so removed. Every omission of such duty is punishable in the same manner as other omissions to perform the duty of making burial are punishable.

23-06-26. Purchasing body forbidden — Penalty.

Every person who purchases or who receives, except for the purpose of final disposition, any dead body of a human being, knowing that the same has been removed contrary to the provisions of this chapter, is guilty of a class C felony.

23-06-27. Protection of human burial sites, human remains, and burial goods — Unlawful acts — Penalties — Exceptions. [Effective through August 31, 2022]

1. As used in this section:
   1. “Burial goods” means any objects or items interred with human remains at the time of burial.
   2. “Disturb” means move, open, expose, dig up, disinter, excavate, remove, carry away, damage, injure, deface, desecrate, loot, vandalize, mutilate, or destroy.
   3. “Human burial site” means any place of interment, by any means, of human remains or burial goods, which is designated by a grave marker or other burial structure or which is not so designated, but is, in fact, discovered or believed to exist on the basis of archaeological or historical evidence.
   4. “Human remains” means any part of the body of a deceased human being in any stage of decomposition.
   5. “Land” means all lands, including submerged lands, located within the state of North Dakota which are owned by the state or its political subdivisions, agencies, or instrumentalities, or by any private person.
   6. “Person” means a natural person, corporation, unincorporated association, partnership, proprietorship, or governmental entity.
2. A person is guilty of a class C felony who, without authority of law, breaks open any building wherein any body of a deceased human being is deposited while awaiting burial, with the intent of either removing such human body, or any part thereof, or stealing the coffin, or any part thereof, or anything attached thereto or connected therewith, or the vestments or other articles intended to be buried with the human body.
3. A person is guilty of a felony who, without authority of law, willfully, as defined in section 12.1-02-02, disturbs a human burial site, human remains, or burial goods found in or on any land, or attempts to do the same, or incites or procures the same to be done.
   1. A person is guilty of a class B felony if the offense in this subsection was committed for monetary gain, whether or not such monetary gain was related to the use of the land in or on which the burial, remains, or goods were disturbed.
   2. A person is guilty of a class C felony if the offense in this subsection was not committed for monetary gain.
4. Any person who knows or has reasonable grounds to believe that a human burial site, human remains, or burial goods, found in or on any land, are being disturbed or may be disturbed, by human activity without authority of law or by natural forces, shall immediately notify the local law enforcement agency with jurisdiction in the area in which the burial, remains, or goods are located. A person is guilty of a class B misdemeanor who is required to provide such notification and willfully, as defined in section 12.1-02-02, fails to provide the same.
5. Any person who knows or has reasonable grounds to believe that that person has encountered or discovered a human burial site, human remains, or burial goods associated with a human burial, in or on any land, shall refrain from any activity which might disturb or immediately cease any continued activity which might cause further disturbance of such burial, remains, or goods and shall, as soon as practicable, report the presence or discovery of the burial, remains, or goods to the local law enforcement agency with jurisdiction in the area in which the burial, remains, or goods are located. A person is guilty of a class B misdemeanor who is required to make such report and willfully, as defined in section 12.1-02-02, fails to make the same. The requirements imposed in this subsection do not apply to any person engaged in the salvaging excavation or other disinterment of a human burial under authority of law.
6. Any person having been found guilty or having pleaded guilty, as a result of having been charged with an offense under subsection 2 or 3, must be ordered to forfeit to the state any and all human remains and burial goods acquired in connection with the commission of the offense and may be ordered to forfeit to the state any and all equipment used in connection with the commission of the offense. In addition, any such person having been charged with an offense under subsection 3 must be ordered to pay all reasonable costs actually incurred in the reinterment of the human remains and burial goods so forfeited. In conjunction with the prosecution of any offense under this subsection, the remains in question in the prosecution may, as deemed necessary, be subjected to nonintrusive, nondestructive professional study for the exclusive purpose of determining whether the remains are human.
7. Subsection 3 does not apply to the inadvertent disturbance of a human burial site, human remains, or burial goods when the state department of health and the state historical society have been notified of the disturbance and the human remains and burial goods must be studied and reinterred pursuant to rules adopted by the state department of health and the state historical society. Subsection 3 also does not apply to situations in which the state department of health and the state historical society are notified of the need to disinter and move the contents of human burial sites that are recorded with the state historical society to prevent the destruction of the human burial sites by actions including the construction of highways, dams, reservoirs, coal mines, power generation and transmission facilities, pipelines, farming practices, and other developments. Where feasible, the developments should avoid disturbance of the human burial sites. In these situations the disinterred human remains and burial goods must be studied and reinterred pursuant to rules adopted by the state department of health and the state historical society.

23-06-27. Protection of human burial sites, human remains, and burial goods — Unlawful acts — Penalties — Exceptions. [Effective September 1, 2022]

1. As used in this section:
   1. “Burial goods” means any objects or items interred with human remains at the time of burial.
   2. “Disturb” means move, open, expose, dig up, disinter, excavate, remove, carry away, damage, injure, deface, desecrate, loot, vandalize, mutilate, or destroy.
   3. “Human burial site” means any place of interment, by any means, of human remains or burial goods, which is designated by a grave marker or other burial structure or which is not so designated, but is, in fact, discovered or believed to exist on the basis of archaeological or historical evidence.
   4. “Human remains” means any part of the body of a deceased human being in any stage of decomposition.
   5. “Land” means all lands, including submerged lands, located within the state of North Dakota which are owned by the state or its political subdivisions, agencies, or instrumentalities, or by any private person.
   6. “Person” means a natural person, corporation, unincorporated association, partnership, proprietorship, or governmental entity.
2. A person is guilty of a class C felony who, without authority of law, breaks open any building wherein any body of a deceased human being is deposited while awaiting burial, with the intent of either removing such human body, or any part thereof, or stealing the coffin, or any part thereof, or anything attached thereto or connected therewith, or the vestments or other articles intended to be buried with the human body.
3. A person is guilty of a felony who, without authority of law, willfully, as defined in section 12.1-02-02, disturbs a human burial site, human remains, or burial goods found in or on any land, or attempts to do the same, or incites or procures the same to be done.
   1. A person is guilty of a class B felony if the offense in this subsection was committed for monetary gain, whether or not such monetary gain was related to the use of the land in or on which the burial, remains, or goods were disturbed.
   2. A person is guilty of a class C felony if the offense in this subsection was not committed for monetary gain.
4. Any person who knows or has reasonable grounds to believe that a human burial site, human remains, or burial goods, found in or on any land, are being disturbed or may be disturbed, by human activity without authority of law or by natural forces, shall immediately notify the local law enforcement agency with jurisdiction in the area in which the burial, remains, or goods are located. A person is guilty of a class B misdemeanor who is required to provide such notification and willfully, as defined in section 12.1-02-02, fails to provide the same.
5. Any person who knows or has reasonable grounds to believe that that person has encountered or discovered a human burial site, human remains, or burial goods associated with a human burial, in or on any land, shall refrain from any activity which might disturb or immediately cease any continued activity which might cause further disturbance of such burial, remains, or goods and shall, as soon as practicable, report the presence or discovery of the burial, remains, or goods to the local law enforcement agency with jurisdiction in the area in which the burial, remains, or goods are located. A person is guilty of a class B misdemeanor who is required to make such report and willfully, as defined in section 12.1-02-02, fails to make the same. The requirements imposed in this subsection do not apply to any person engaged in the salvaging excavation or other disinterment of a human burial under authority of law.
6. Any person having been found guilty or having pleaded guilty, as a result of having been charged with an offense under subsection 2 or 3, must be ordered to forfeit to the state any and all human remains and burial goods acquired in connection with the commission of the offense and may be ordered to forfeit to the state any and all equipment used in connection with the commission of the offense. In addition, any such person having been charged with an offense under subsection 3 must be ordered to pay all reasonable costs actually incurred in the reinterment of the human remains and burial goods so forfeited. In conjunction with the prosecution of any offense under this subsection, the remains in question in the prosecution may, as deemed necessary, be subjected to nonintrusive, nondestructive professional study for the exclusive purpose of determining whether the remains are human.
7. Subsection 3 does not apply to the inadvertent disturbance of a human burial site, human remains, or burial goods when the department of health and human services and the state historical society have been notified of the disturbance and the human remains and burial goods must be studied and reinterred pursuant to rules adopted by the department of health and human services and the state historical society. Subsection 3 also does not apply to situations in which the department of health and human services and the state historical society are notified of the need to disinter and move the contents of human burial sites that are recorded with the state historical society to prevent the destruction of the human burial sites by actions including the construction of highways, dams, reservoirs, coal mines, power generation and transmission facilities, pipelines, farming practices, and other developments. Where feasible, the developments should avoid disturbance of the human burial sites. In these situations the disinterred human remains and burial goods must be studied and reinterred pursuant to rules adopted by the department of health and human services and the state historical society.

23-06-28. Arresting or attaching dead body — Penalty.

Every person who arrests or attaches any dead body of a human being upon any debt or demand whatever, or who detains or claims to detain it for any debt or demand or upon any pretended lien or charge, is guilty of a class B misdemeanor.

23-06-29. Penalty for violating provisions relating to dissections and general penalty.

Every person who violates any provision of this chapter relative to the dissection of dead bodies of human beings, or who makes or procures to be made any dissection of the body of a human being except by authority of law or in pursuance of permission given in accordance with the provision of this chapter, is guilty of a class B misdemeanor. Every person who violates any provision of this chapter for the violation of which another penalty is not specifically provided is guilty of an infraction.

23-06-30. Abandoned cemeteries to be maintained by counties. [Effective through August 31, 2022]

The board of county commissioners of each county may provide for the identification, cataloging, recording, and shall provide for the general maintenance and upkeep of each abandoned cemetery located within such county using revenues derived from its general fund levy authority. The board shall, at least once each year, proceed to have the weeds and grass cut, restore gravestones to their original placement, and perform any other general maintenance necessary to maintain the dignity and appearance of the grounds. For the purposes of this section, a cemetery means any tract of land used as a burial plot and which is filed with the recorder of the county as a public burying place. The board of county commissioners of each county shall provide for the registration, with the state department of health, of each abandoned cemetery within such county unless such cemetery has been previously registered. Such registration must take place within one year of notification being made to the board, by any interested party of the existence of such abandoned cemetery.

23-06-30. Abandoned cemeteries to be maintained by counties. [Effective September 1, 2022]

The board of county commissioners of each county may provide for the identification, cataloging, recording, and shall provide for the general maintenance and upkeep of each abandoned cemetery located within such county using revenues derived from its general fund levy authority. The board shall, at least once each year, proceed to have the weeds and grass cut, restore gravestones to their original placement, and perform any other general maintenance necessary to maintain the dignity and appearance of the grounds. For the purposes of this section, a cemetery means any tract of land used as a burial plot and which is filed with the recorder of the county as a public burying place. The board of county commissioners of each county shall provide for the registration, with the department of health and human services, of each abandoned cemetery within such county unless such cemetery has been previously registered. Such registration must take place within one year of notification being made to the board, by any interested party of the existence of such abandoned cemetery.

23-06-31. Cremation or other lawful disposition of a body — Authorization document — Immunity.

1. A legally competent adult may prepare a written statement directing the cremation or other lawful disposition of that adult’s own remains pursuant to section 23-06-03. The written statement must be signed and dated by the legally competent adult and may be part of the legally competent adult’s will.
2. A document that conforms to this section authorizes a crematorium or funeral establishment to carry out the instructions of the legally competent adult who is the subject of the document. It is not necessary for a crematorium or funeral establishment to obtain the consent or concurrence of any other person when the crematorium or funeral establishment cremates or otherwise provides for the lawful disposition of a body pursuant to instructions contained in a document that conforms to this section.
3. This section does not mandate that a crematorium or funeral establishment cremate or otherwise provide for the lawful disposition of a body pursuant to the document unless the legally competent adult who executed the document articulated and funded in a pre-need funeral service contract the legally competent adult’s instructions as expressed in the document.
4. A crematorium or funeral establishment that cremates or otherwise provides for the lawful disposition of a body in good-faith reliance upon instructions of a decedent or an individual to whom the crematorium or funeral establishment reasonably believes is entitled to control final disposition pursuant to section 23-06-03 or on an apparently genuine document executed pursuant to this section is not subject to criminal prosecution, civil liability, or professional discipline. The decision of a crematorium or funeral establishment to cremate or otherwise provide for the lawful disposition of a body in reliance on a document executed pursuant to this section is presumed to be made in good faith.

23-06.2-01. Definitions. [Repealed]

Repealed by S.L. 2007, ch. 237, § 7.

23-06.2-02. Making, amending, revoking, and refusing to make anatomical gifts by individual. [Repealed]

Repealed by S.L. 2007, ch. 237, § 7.

23-06.2-03. Making, revoking, and objecting to anatomical gifts by others. [Repealed]

Repealed by S.L. 2007, ch. 237, § 7.

23-06.2-04. Authorization by coroner or local public health official. [Repealed]

Repealed by S.L. 2007, ch. 237, § 7.

23-06.2-05. Request for consent to an anatomical gift — Protocol — Exceptions. [Repealed]

Repealed by S.L. 2007, ch. 237, § 7.

23-06.2-06. Persons who may become donees — Purposes for which anatomical gifts may be made. [Repealed]

Repealed by S.L. 2007, ch. 237, § 7.

23-06.2-07. Delivery of document of gift. [Repealed]

Repealed by S.L. 2007, ch. 237, § 7.

23-06.2-08. Rights and duties at death. [Repealed]

Repealed by S.L. 2007, ch. 237, § 7.

23-06.2-09. Coordination of procurement and utilization. [Repealed]

Repealed by S.L. 2007, ch. 237, § 7.

23-06.2-10. Sale or purchase prohibited — Penalty. [Repealed]

Repealed by S.L. 2007, ch. 237, § 7.

23-06.2-11. Examination — Autopsy — Liability. [Repealed]

Repealed by S.L. 2007, ch. 237, § 7.

23-06.2-11.1. Anatomical parts testing — Exception. [Repealed]

Repealed by S.L. 2007, ch. 237, § 7.

23-06.2-12. Application. [Repealed]

Repealed by S.L. 2007, ch. 237, § 7.

23-06.3-01. Determination of death.

An individual who has sustained either irreversible cessation of circulatory and respiratory functions or irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.

23-06.3-02. Notice to family in case of imminent death.

If it appears to a physician who has primary responsibility for the treatment and care of an individual that the death of the individual is imminent, the physician shall make reasonable efforts to notify the individual’s next of kin. If after making reasonable efforts the next of kin are not notified, the physician shall document in the medical records of the individual the efforts made to notify the next of kin. If notice is given, the physician shall provide the next of kin with appropriate information regarding the individual’s medical condition and available medical therapies.

23-06.5-01. Statement of purpose.

Every competent adult has the right and responsibility to make the decisions relating to the adult’s own health care, including the decision to have health care provided, withheld, or withdrawn. The purpose of this chapter is to enable adults to retain control over their own health care during periods of incapacity through health directives and the designation of an individual to make health care decisions on their behalf. This chapter does not condone, authorize, or approve mercy killing, or permit an affirmative or deliberate act or omission to end life, other than to allow the natural process of dying.

23-06.5-02. Definitions.

In this chapter, unless the context otherwise requires:

1. “Agent” means an adult to whom authority to make health care decisions is delegated under a health care directive for the individual granting the power.
2. “Attending physician” means the physician, selected by or assigned to a patient, who has primary responsibility for the treatment and care of the patient.
3. “Capacity to make health care decisions” means the ability to understand and appreciate the nature and consequences of a health care decision, including the significant benefits and harms of and reasonable alternatives to any proposed health care, and the ability to communicate a health care decision.
4. “Health care decision” means consent to, refusal to consent to, withdrawal of consent to, or request for any care, treatment, service, or procedure to maintain, diagnose, or treat an individual’s physical or mental condition, including:
   1. Selection and discharge of health care providers and institutions;
   2. Approval or disapproval of diagnostic tests, surgical procedures, programs of medication, and orders not to resuscitate;
   3. Directions to provide, withhold, or withdraw artificial nutrition and hydration and all other forms of health care; and
   4. Establishment of an individual’s abode within or without the state and personal security safeguards for an individual, to the extent decisions on these matters relate to the health care needs of the individual.
5. “Health care directive” means a written instrument that complies with this chapter and includes one or more health care instructions, a power of attorney for health care, or both.
6. “Health care instruction” means an individual’s direction concerning a health care decision for the individual, including a written statement of the individual’s values, preferences, guidelines, or directions regarding health care directed to health care providers, others assisting with health care, family members, an agent, or others.
7. “Health care provider” means an individual or facility licensed, certified, or otherwise authorized or permitted by law to administer health care, for profit or otherwise, in the ordinary course of business or professional practice.
8. “Long-term care facility” or “long-term care services provider” means a long-term care facility as defined in section 50-10.1-01.
9. “Principal” means an adult who has executed a health care directive.

23-06.5-03. Health care directive.

1. A principal may execute a health care directive. A health care directive may include one or more health care instructions to health care providers, others assisting with health care, family members, and a health care agent. A health care directive may include a power of attorney to appoint an agent to make health care decisions for the principal when the principal lacks the capacity to make health care decisions, unless otherwise specified in the health care directive. Subject to the provisions of this chapter and any express limitations set forth by the principal in the health care directive, the agent has the authority to make any and all health care decisions on the principal’s behalf that the principal could make.
2. After consultation with the attending physician and other health care providers, the agent shall make health care decisions:
   1. In accordance with the agent’s knowledge of the principal’s wishes and religious or moral beliefs, as stated orally, or as contained in the principal’s health care directive; or
   2. If the principal’s wishes are unknown, in accordance with the agent’s assessment of the principal’s best interests. In determining the principal’s best interests, the agent shall consider the principal’s personal values to the extent known to the agent.
3. A health care directive, including the agent’s authority, is in effect only when the principal lacks capacity to make health care decisions, as certified in writing by the principal’s attending physician and filed in the principal’s medical record, and ceases to be effective upon a determination that the principal has recovered capacity.
4. Notwithstanding subsection 3, the principal may authorize in a health care directive that the agent make health care decisions for the principal even though the principal retains capacity to make health care decisions. In that case, the health care directive is in effect as stated in the health care directive under any conditions the principal may impose. The principal’s authorization under this subsection may be revoked in the same manner as a health care directive may be revoked under section 23-06.5-07.
5. The principal’s attending physician shall make reasonable efforts to inform the principal of any proposed treatment, or of any proposal to withdraw or withhold treatment.
6. Nothing in this chapter permits an agent to consent to admission to a mental health facility or state institution for a period of more than forty-five days without a mental health proceeding or other court order, or to psychosurgery, abortion, or sterilization, unless the procedure is first approved by court order.

23-06.5-04. Restrictions on who can act as agent.

A person may not exercise the authority of agent while serving in one of the following capacities:

1. The principal’s health care provider;
2. A nonrelative of the principal who is an employee of the principal’s health care provider;
3. The principal’s long-term care services provider; or
4. A nonrelative of the principal who is an employee of the principal’s long-term care services provider.

23-06.5-05. Health care directive requirements — Execution and witnesses.

1. To be legally sufficient in this state, a health care directive must:
   1. Be in writing;
   2. Be dated;
   3. State the principal’s name;
   4. Be executed by a principal with capacity to do so with the signature of the principal or with the signature of another person authorized by the principal to sign on behalf of the principal;
   5. Contain verification of the principal’s signature or the signature of the person authorized by the principal to sign on behalf of the principal, either by a notary public or by witnesses as provided under this chapter; and
   6. Include a health care instruction or a power of attorney for health care, or both.
2. A health care directive must be signed by the principal and that signature must be verified by a notary public or at least two or more subscribing witnesses who are at least eighteen years of age. A person notarizing the document may be an employee of a health care or long-term care provider providing direct care to the principal. At least one witness to the execution of the document must not be a health care or long-term care provider providing direct care to the principal or an employee of a health care or long-term care provider providing direct care to the principal on the date of execution. The notary public or any witness may not be, at the time of execution, the agent, the principal’s spouse or heir, a person related to the principal by blood, marriage, or adoption, a person entitled to any part of the estate of the principal upon the death of the principal under a will or deed in existence or by operation of law, any other person who has, at the time of execution, any claims against the estate of the principal, a person directly financially responsible for the principal’s medical care, or the attending physician of the principal. If the principal is physically unable to sign, the directive may be signed by the principal’s name being written by some other person in the principal’s presence and at the principal’s express direction.

23-06.5-05.1. Suggested health care directive form.

A health care directive may include provisions consistent with this chapter, including:

1. The designation of one or more alternate agents to act if the named agent is not reasonably available to serve;
2. Directions to joint agents regarding the process or standards by which the agents are to reach a health care decision for the principal, and a statement whether joint agents may act independently of one another;
3. Limitations, if any, on the right of the agent or any alternate agents to receive, review, obtain copies of, and consent to the disclosure of the principal’s medical records;
4. Limitations, if any, on the nomination of the agent as guardian under chapter 30.1-28;
5. A document of gift for the purpose of making an anatomical gift, as set forth in chapter 23-06.6 or an amendment to, revocation of, or refusal to make an anatomical gift;
6. Limitations, if any, regarding the effect of dissolution or annulment of marriage on the appointment of an agent;
7. Health care instructions regarding artificially administered nutrition or hydration; and
8. The designation of an agent authorized to make health care decisions for the principal even though the principal retains the capacity to make health care decisions.

23-06.5-06. Acceptance of appointment — Withdrawal.

To be effective, the agent must accept the appointment in writing. Subject to the right of the agent to withdraw, the acceptance creates authority for the agent to make health care decisions on behalf of the principal at such time as the principal becomes incapacitated. Until the principal becomes incapacitated, the agent may withdraw by giving notice to the principal. After the principal becomes incapacitated, the agent may withdraw by giving notice to the attending physician. The attending physician shall cause the withdrawal to be recorded in the principal’s medical record.

23-06.5-07. Revocation.

1. A health care directive is revoked:
   1. By notification by the principal to the agent or a health care or long-term care services provider orally, or in writing, or by any other act evidencing a specific intent to revoke the directive; or
   2. By execution by the principal of a subsequent health care directive.
2. A principal’s health care or long-term care services provider who is informed of or provided with a revocation of a health care directive shall immediately record the revocation in the principal’s medical record and notify the agent, if any, the attending physician, and staff responsible for the principal’s care of the revocation.
3. Unless otherwise provided in the health care directive, if the spouse is the principal’s agent, the divorce of the principal and spouse revokes the appointment of the divorced spouse as the principal’s agent.

23-06.5-08. Inspection and disclosure of medical information.

Subject to any limitations set forth in the health care directive by the principal, an agent whose authority is in effect may for the purpose of making health care decisions:

1. Request, review, and receive any information, oral or written, regarding the principal’s physical or mental health, including medical and hospital records;
2. Execute any releases or other documents which may be required in order to obtain such medical information; and
3. Consent to the disclosure of such medical information.

23-06.5-09. Duties of provider.

1. A principal’s health care or long-term care services provider, and employees thereof, having knowledge of the principal’s health care directive, are bound to follow the health care decisions of the principal’s designated agent or a health care instruction to the extent they are consistent with this chapter and the health care directive.
2. A principal’s health care or long-term care services provider may decline to comply with a health care decision of a principal’s designated agent or a health care instruction for reasons of conscience or other conflict. A provider that declines to comply with a health care decision or instruction shall take all reasonable steps to transfer care of the principal to another health care provider who is willing to honor the agent’s health care decision, or instruction or directive, and shall provide continuing care to the principal until a transfer can be effected.
3. This chapter does not require any physician or other health care provider to take any action contrary to reasonable medical standards.
4. This chapter does not affect the responsibility of the attending physician or other health care provider to provide treatment for a patient’s comfort, care, or alleviation of pain.
5. Notwithstanding a contrary direction contained in a health care directive executed under this chapter, health care must be provided to a pregnant principal unless, to a reasonable degree of medical certainty as certified on the principal’s medical record by the attending physician and an obstetrician who has examined the principal, such health care will not maintain the principal in such a way as to permit the continuing development and live birth of the unborn child or will be physically harmful or unreasonably painful to the principal or will prolong severe pain that cannot be alleviated by medication.
6. In the absence of a direction to the contrary contained in a health care directive prepared under this chapter, nothing in this chapter requires a physician to withhold, withdraw, or administer nutrition or hydration, or both, from or to the principal. Nutrition or hydration, or both, must be withdrawn, withheld, or administered, if the principal for whom the administration of nutrition or hydration is considered, has directed in a health care directive the principal’s desire that nutrition or hydration, or both, be withdrawn, withheld, or administered. If a health care directive prepared under this chapter does not indicate the principal’s direction with respect to nutrition or hydration, nutrition or hydration, or both, may be withdrawn or withheld if the attending physician has determined that the administration of nutrition or hydration is inappropriate because the nutrition or hydration cannot be physically assimilated by the principal or would be physically harmful or would cause unreasonable physical pain to the principal.

23-06.5-10. Freedom from influence.

A health care provider, long-term care services provider, health care service plan, insurer issuing disability insurance, self-insured employee welfare benefit plan, or nonprofit hospital service plan may not charge a person a different rate or require any person to execute a health care directive as a condition of admission to a hospital or long-term care facility nor as a condition of being insured for, or receiving, health care or long-term care services. Health care or long-term care services may not be refused because a person has executed a health care directive.

23-06.5-11. Reciprocity.

This chapter does not limit the enforceability of a health care directive or similar instrument executed in another state or jurisdiction in compliance with the law of that state or jurisdiction.

23-06.5-12. Immunity.

1. A person acting as agent pursuant to a health care directive or person authorized to provide informed consent pursuant to section 23-12-13 may not be subjected to criminal or civil liability for making a health care decision in good faith pursuant to the provisions of this chapter or section 23-12-13.
2. A health care or long-term care services provider, or any other person acting for the provider or under the provider’s control may not be subjected to civil or criminal liability, or be deemed to have engaged in unprofessional conduct, for any act or intentional failure to act done in good faith and with ordinary care if the act or intentional failure to act is done pursuant to the dictates of a health care directive, the directives of the patient’s agent, or other provisions of this chapter or section 23-12-13.
3. A health care provider who administers health care necessary to keep the principal alive, despite a health care decision of the agent to withhold or withdraw that health care, or a health care provider who withholds health care that the provider has determined to be contrary to reasonable medical standards, despite a health care decision of the agent to provide the health care, may not be subjected to civil or criminal liability or be deemed to have engaged in unprofessional conduct if that health care provider promptly took all reasonable steps to:
   1. Notify the agent of the health care provider’s unwillingness to comply;
   2. Document the notification in the principal’s medical record; and
   3. Arrange to transfer care of the principal to another health care provider willing to comply with the decision of the agent.

23-06.5-13. Presumptions and application.

1. Unless a court of competent jurisdiction determines otherwise, the appointment of an agent in a health care directive executed pursuant to this chapter takes precedence over any authority to make medical decisions granted to a guardian pursuant to chapter 30.1-28.
2. To the extent that health care directives conflict, the instrument executed later in time controls.
3. The principal is presumed to have the capacity to execute a health care directive and to revoke a health care directive, absent clear and convincing evidence to the contrary.
4. A health care provider or agent may presume that a health care directive is legally sufficient absent actual knowledge to the contrary. A health care directive is presumed to be properly executed, absent clear and convincing evidence to the contrary.
5. An agent and a health care provider acting pursuant to the direction of an agent are presumed to be acting in good faith, absent clear and convincing evidence to the contrary.
6. A health care directive is presumed to remain in effect until the principal modifies or revokes it, absent clear and convincing evidence to the contrary.
7. This chapter does not create a presumption concerning the intention of an individual who has not executed a health care directive and does not impair or supersede any right or responsibility of an individual to consent, refuse to consent, or withdraw consent to health care on behalf of another in the absence of a health care directive.
8. A copy of a health care directive is presumed to be a true and accurate copy of the executed original, absent clear and convincing evidence to the contrary, and must be given the same effect as an original.
9. Death resulting from the withholding or withdrawal of health care pursuant to a health care directive in accordance with this chapter does not constitute, for any purpose, a suicide or homicide.
10. The making of a health care directive under this chapter does not affect in any manner the sale, procurement, or issuance of any policy of life insurance or annuity, nor does it affect, impair, or modify the terms of an existing policy of life insurance or annuity. A policy of life insurance or annuity is not legally impaired or invalidated in any manner by the withholding or withdrawal of health care from an insured principal, notwithstanding any term to the contrary.
11. A person may not prohibit or require the execution of a health care directive as a condition for being insured for, or receiving, health care services.
12. This chapter does not affect the right of a patient to make decisions regarding use of health care, so long as the patient is able to do so, or impair or supersede any right or responsibility that a person has to effect the provision, withholding, or withdrawal of health care.
13. Health care directives prepared under this chapter which direct the withholding of health care do not apply to emergency treatment performed in a prehospital situation.

23-06.5-14. Liability for health care costs.

Liability for the cost of health care provided pursuant to the agent’s decision is the same as if the health care were provided pursuant to the principal’s decision.

23-06.5-15. Validity of previously executed durable powers of attorney or other directives.

A health care directive executed before August 1, 2005, which complies with the law in effect at the time it was executed, including former chapter 23-06.4, must be given effect pursuant to this chapter. This chapter does not affect the validity or enforceability of a durable power of attorney for health care executed before August 1, 2005.

23-06.5-16. Use of statutory form.

The statutory health care directive form described in section 23-06.5-17 may be used and is an optional form, but not a required form, by which a person may execute a health care directive pursuant to this chapter. Another form may be used if it complies with this chapter.

23-06.5-17. Optional health care directive form.

The following is an optional form of a health care directive and is not a required form:

HEALTH CARE DIRECTIVE

I _____________________________________________________________________ , understand this document allows me to do ONE OR ALL of the following:

PART I: Name another person (called the health care agent) to make health care decisions for me if I am unable to make and communicate health care decisions for myself. My health care agent must make health care decisions for me based on the instructions I provide in this document (Part II), if any, the wishes I have made known to him or her, or my agent must act in my best interest if I have not made my health care wishes known.

AND/OR

PART II: Give health care instructions to guide others making health care decisions for me. If I have named a health care agent, these instructions are to be used by the agent. These instructions may also be used by my health care providers, others assisting with my health care and my family, in the event I cannot make and communicate decisions for myself.

AND/OR

PART III: Allows me to make an organ and tissue donation upon my death by signing a document of anatomical gift.

PART I: APPOINTMENT OF HEALTH CARE AGENT THIS IS WHO I WANT TO MAKE HEALTH CARE DECISIONS FOR ME IF I AM UNABLE TO MAKE AND COMMUNICATE HEALTH CARE DECISIONS FOR MYSELF (I know I can change my agent or alternate agent at any time and I know I do not have to appoint an agent or an alternate agent)

NOTE: If you appoint an agent, you should discuss this health care directive with your agent and give your agent a copy. If you do not wish to appoint an agent, you may leave Part I blank and go to Part II and/or Part III. None of the following may be designated as your agent: your treating health care provider, a nonrelative employee of your treating health care provider, an operator of a long-term care facility, or a nonrelative employee of a long-term care facility.

When I am unable to make and communicate health care decisions for myself, I trust and appoint _____________________________________________________________________ to make health care decisions for me. This person is called my health care agent.

Relationship of my health care agent to me: _________

Telephone number of my health care agent: _________

Address of my health care agent: _________

(OPTIONAL) APPOINTMENT OF ALTERNATE HEALTH CARE AGENT: If my health care agent is not reasonably available, I trust and appoint _____________________________________________________________________ to be my health care agent instead.

Relationship of my alternate health care agent to me: _________

Telephone number of my alternate health care agent: _________

Address of my alternate health care agent: _________

THIS IS WHAT I WANT MY HEALTH CARE AGENT TO BE ABLE TO DO IF I AM UNABLE TO MAKE AND COMMUNICATE HEALTH CARE DECISIONS FOR MYSELF (I know I can change these choices)

My health care agent is automatically given the powers listed below in (A) through (D). My health care agent must follow my health care instructions in this document or any other instructions I have given to my agent. If I have not given health care instructions, then my agent must act in my best interest.

Whenever I am unable to make and communicate health care decisions for myself, my health care agent has the power to:

(A) Make any health care decision for me. This includes the power to give, refuse, or withdraw consent to any care, treatment, service, or procedures. This includes deciding whether to stop or not start health care that is keeping me or might keep me alive and deciding about mental health treatment.

(B) Choose my health care providers.

(C) Choose where I live and receive care and support when those choices relate to my health care needs.

(D) Review my medical records and have the same rights that I would have to give my medical records to other people.

If I DO NOT want my health care agent to have a power listed above in (A) through (D) OR if I want to LIMIT any power in (A) through (D), I MUST say that here:

_________

_________

_________

My health care agent is NOT automatically given the powers listed below in (1) and (2). If I WANT my agent to have any of the powers in (1) and (2), I must INITIAL the line in front of the power; then my agent WILL HAVE that power.

_________ (1) To decide whether to donate any parts of my body, including organs, tissues, and eyes, when I die.

_________ (2) To decide what will happen with my body when I die (burial, cremation).

If I want to say anything more about my health care agent’s powers or limits on the powers, I can say it here:

_________

_________

_________

PART II: HEALTH CARE INSTRUCTIONS

NOTE: Complete this Part II if you wish to give health care instructions. If you appointed an agent in Part I, completing this Part II is optional but would be very helpful to your agent. However, if you chose not to appoint an agent in Part I, you MUST complete, at a minimum, Part II (B) if you wish to make a valid health care directive.

These are instructions for my health care when I am unable to make and communicate health care decisions for myself. These instructions must be followed (so long as they address my needs).

(A) THESE ARE MY BELIEFS AND VALUES ABOUT MY HEALTH CARE (I know I can change these choices or leave any of them blank)

I want you to know these things about me to help you make decisions about my health care:

My goals for my health care:

_________

_________

_________

My fears about my health care:

_________

_________

_________

My spiritual or religious beliefs and traditions:

_________

_________

_________

My beliefs about when life would be no longer worth living:

_________

_________

_________

My thoughts about how my medical condition might affect my family:

_________

_________

_________

(B) THIS IS WHAT I WANT AND DO NOT WANT FOR MY HEALTHCARE (I know I can change these choices or leave any of them blank)

Many medical treatments may be used to try to improve my medical condition or to prolong my life. Examples include artificial breathing by a machine connected to a tube in the lungs, artificial feeding or fluids through tubes, attempts to start a stopped heart, surgeries, dialysis, antibiotics, and blood transfusions. Most medical treatments can be tried for a while and then stopped if they do not help.

I have these views about my health care in these situations:

(Note: You can discuss general feelings, specific treatments, or leave any of them blank).

If I had a reasonable chance of recovery and were temporarily unable to make and communicate health care decisions for myself, I would want:

_________

_________

_________

If I were dying and unable to make and communicate health care decisions for myself, I would want:

_________

_________

_________

If I were permanently unconscious and unable to make and communicate health care decisions for myself, I would want:

_________

_________

_________

If I were completely dependent on others for my care and unable to make and communicate health care decisions for myself, I would want:

_________

_________

_________

In all circumstances, my health care providers will try to keep me comfortable and reduce my pain. This is how I feel about pain relief if it would affect my alertness or if it could shorten my life:

_________

_________

_________

There are other things that I want or do not want for my health care, if possible:

Who I would like to be my health care provider:

_________

_________

_________

Where I would like to live to receive health care:

_________

_________

_________

Where I would like to die and other wishes I have about dying:

_________

_________

_________

My wishes about what happens to my body when I die (cremation, burial, whole body donation):

_________

_________

_________

Any other things:

_________

_________

_________

PART III: MAKING AN ANATOMICAL GIFT

(A) I WANT TO BE AN ORGAN DONOR

[] I would like to be an organ donor at the time of my death. I have told my family my decision and ask my family to honor my wishes. I wish to donate the following (initial one statement):

[] Any needed organs and tissue.

[] Only the following organs and tissue: _____________________________________

(B) I DO NOT WANT TO BE AN ORGAN DONOR

[] I do not want to be an organ donor at the time of my death. I have told my family my decision and ask my family to honor my wishes.

PART IV: MAKING THE DOCUMENT LEGAL PRIOR DESIGNATIONS REVOKED. I revoke any prior health care directive.

DATE AND SIGNATURE OF PRINCIPAL (YOU MUST DATE AND SIGN THIS HEALTH CARE DIRECTIVE)

I sign my name to this Health Care Directive Form on _____________________________________ at

(date)

_____________________________________________________________________

(city)

_____________________________________________________________________

(state)

_____________________________________________________________________

(you sign here)

(THIS HEALTH CARE DIRECTIVE WILL NOT BE VALID UNLESS IT IS NOTARIZED OR SIGNED BY TWO QUALIFIED WITNESSES WHO ARE PRESENT WHEN YOU SIGN OR ACKNOWLEDGE YOUR SIGNATURE. IF YOU HAVE ATTACHED ANY ADDITIONAL PAGES TO THIS FORM, YOU MUST DATE AND SIGN EACH OF THE ADDITIONAL PAGES AT THE SAME TIME YOU DATE AND SIGN THIS HEALTH CARE DIRECTIVE.)

NOTARY PUBLIC OR STATEMENT OF WITNESSES

This document must be (1) notarized or (2) witnessed by two qualified adult witnesses. The person notarizing this document may be an employee of a health care or long-term care provider providing your care. At least one witness to the execution of the document must not be a health care or long-term care provider providing you with direct care or an employee of the health care or long-term care provider providing you with direct care. None of the following may be used as a notary or witness:

1. A person you designate as your agent or alternate agent;
2. Your spouse;
3. A person related to you by blood, marriage, or adoption;
4. A person entitled to inherit any part of your estate upon your death; or
5. A person who has, at the time of executing this document, any claim against your estate.

Option 1: Notary Public

State of _____________________________________________________________________

County of _____________________________________________________________________

In my presence on _______________________________________ (date), _____________________________________ (name of declarant) acknowledged the declarant’s signature on this document or acknowledged that the declarant directed the person signing this document to sign on the declarant’s behalf.

_____________________________________________________________________

(Signature of Notary Public)

My commission expires _____________________________________________________________________ , 20 _________ .

Option 2: Two Witnesses

Witness One:

1. In my presence on  _____________  (date),  _____________________________________  (name of declarant) acknowledged the declarant’s signature on this document or acknowledged that the declarant directed the person signing this document to sign on the declarant’s behalf.
2. I am at least eighteen years of age.
3. If I am a health care provider or an employee of a health care provider giving direct care to the declarant, I must initial this box: [ ].

I certify that the information in (1) through (3) is true and correct.

_____________________________________________________________________

(Signature of Witness One)

_____________________________________________________________________

(Address)

Witness Two:

(1) In my presence on _____________ (date), _____________________________________ (name of declarant) acknowledged the declarant’s signature on this document or acknowledged that the declarant directed the person signing this document to sign on the declarant’s behalf.

(2) I am at least eighteen years of age.

(3) If I am a health care provider or an employee of a health care provider giving direct care to the declarant, I must initial this box: [ ].

I certify that the information in (1) through (3) is true and correct.

_____________________________________________________________________

(Signature of Witness Two)

_____________________________________________________________________

(Address)

ACCEPTANCE OF APPOINTMENT OF POWER OF ATTORNEY. I accept this appointment and agree to serve as agent for health care decisions. I understand I have a duty to act consistently with the desires of the principal as expressed in this appointment. I understand that this document gives me authority over health care decisions for the principal only if the principal becomes incapacitated. I understand that I must act in good faith in exercising my authority under this power of attorney. I understand that the principal may revoke this power of attorney at any time in any manner.

If I choose to withdraw during the time the principal is competent, I must notify the principal of my decision. If I choose to withdraw when the principal is not able to make health care decisions, I must notify the principal’s health care provider.

_____________________________________________________________________

(Signature of agent/date)

_____________________________________________________________________

(Signature of alternate agent/date)

PRINCIPAL’S STATEMENT

I have read a written explanation of the nature and effect of an appointment of a health care agent that is attached to my health care directive.

Dated this _________ day of _________ , 20 _________ . _____________________________________________________________________

(Signature of Principal)

23-06.5-18. Penalties.

1. A person who, without authorization of the principal, willfully alters or forges a health care directive or willfully conceals or destroys a revocation with the intent and effect of causing a withholding or withdrawal of life-sustaining procedures which hastens the death of the principal is guilty of a class C felony.
2. A person who, without authorization of the principal, willfully alters, forges, conceals, or destroys a health care directive or willfully alters or forges a revocation of a health care directive is guilty of a class A misdemeanor.
3. The penalties provided in this section do not preclude application of any other penalties provided by law.

23-06.5-19. Health care record registry — Fees.

1. As used in this section:
   1. “Health care record” means a health care directive or a revocation of a health care directive executed in accordance with this chapter.
   2. “Registration form” means a form prescribed by the information technology department to facilitate the filing of a health care record.
2. 1. The information technology department may establish and maintain a health care record registry, through which a health care record may be filed. The registry must be accessible through a website maintained by the information technology department.
   2. An individual who is the subject of a health care record, or that individual’s agent, may submit to the information technology department for registration, using a registration form, a health care record executed in accordance with this chapter.
3. Failure to register a health care record with the information technology department under this section does not affect the validity of the health care record. Failure to notify the information technology department of the revocation of a health care record filed under this section does not affect the validity of a revocation that otherwise meets the statutory requirements for revocation.
4. 1. Upon receipt of a health care record and completed registration form, the information technology department shall create a digital reproduction of the health care record, enter the reproduced health care record into the health care record registry database, and assign each registration a unique file number. The information technology department is not required to review a health care record to ensure the health care record complies with any particular statutory requirements that may apply to the health care record.
   2. The information technology department shall delete a health care record filed with the registry under this section upon receipt of a revocation of the health care record along with that document’s file number.
   3. The entry of a health care record under this section does not affect or otherwise create a presumption regarding the validity of the health care record or the accuracy of the information contained in the health care record.
5. 1. The registry must be accessible by entering the file number and password on the internet website. Registration forms, file numbers, and other information maintained by the information technology department under this section are confidential and the state may not disclose this information to any person other than the subject of the document, or the subject’s agent. A health care record may be released to the subject of the document, the subject’s agent, or the subject’s health care provider. The information technology department may not use information contained in the registry except as provided under this chapter.
   2. At the request of the subject of the health care record, or the subject’s agent, the information technology department may transmit the information received regarding the health care record to the registry system of another jurisdiction as identified by the requester.
   3. This section does not require a health care provider to seek to access registry information about whether a patient has executed a health care record that may be registered under this section. A health care provider who makes good-faith health care decisions in reliance on the provisions of an apparently genuine health care record received from the registry is immune from criminal and civil liability to the same extent and under the same conditions as prescribed in section 23-06.5-12. This section does not affect the duty of a health care provider to provide information to a patient regarding health care directives as may be required under federal law.
6. The information technology department may charge and collect a reasonable fee for filing a health care record and a revocation of a health care record.

23-06.6-01. Definitions.

As used in this chapter, unless the context requires otherwise:

1. “Adult” means an individual who is eighteen years of age or older.
2. “Agent” means an individual:
   1. Authorized to make health care decisions on the principal’s behalf by a power of attorney for health care; or
   2. Expressly authorized to make an anatomical gift on the principal’s behalf by any other record signed by the principal.
3. “Anatomical gift” means a donation of all or part of a human body to take effect after the donor’s death for the purpose of transplantation, therapy, research, or education.
4. “Decedent” means a deceased individual whose body or part is or may be the source of an anatomical gift. The term includes a stillborn infant and, subject to restrictions imposed by law other than this chapter, a fetus.
5. “Disinterested witness” means a witness other than the spouse, child, parent, sibling, grandchild, grandparent, or guardian of the individual who makes, amends, revokes, or refuses to make an anatomical gift or another adult who exhibited special care and concern for the individual. The term does not include a person to which an anatomical gift could pass under section 23-06.6-10.
6. “Document of gift” means a donor card or other record used to make an anatomical gift. The term includes a statement or symbol on a driver’s license, identification card, or donor registry.
7. “Donor” means an individual whose body or part is the subject of an anatomical gift.
8. “Donor registry” means a database that contains records of anatomical gifts and amendments to or revocations of anatomical gifts.
9. “Driver’s license” means a license or permit issued by the department of transportation to operate a vehicle regardless of whether conditions are attached to the license or permit.
10. “Eye bank” means a person that is licensed, accredited, or regulated under federal or state law to engage in the recovery, screening, testing, processing, storage, or distribution of human eyes or portions of human eyes.
11. “Guardian” means a person appointed by a court to make decisions regarding the support, care, education, health, or welfare of an individual. The term does not include a guardian ad litem.
12. “Hospital” means a facility licensed as a hospital under the law of any state or a facility operated as a hospital by the United States, a state, or a subdivision of a state.
13. “Identification card” means an identification card issued by the department of transportation.
14. “Know” means to have actual knowledge.
15. “Minor” means an individual who is under eighteen years of age.
16. “Organ procurement organization” means a person designated by the secretary of the United States department of health and human services as an organ procurement organization.
17. “Parent” means a parent whose parental rights have not been terminated.
18. “Part” means an organ, an eye, or tissue of a human being. The term does not include the whole body.
19. “Physician” means an individual authorized to practice medicine or osteopathy under the law of any state.
20. “Procurement organization” means an eye bank, an organ procurement organization, or a tissue bank.
21. “Prospective donor” means an individual who is dead or near death and has been determined by a procurement organization to have a part that could be medically suitable for transplantation, therapy, research, or education. The term does not include an individual who has made a refusal.
22. “Reasonably available” means able to be contacted by a procurement organization without undue effort and willing and able to act in a timely manner consistent with existing medical criteria necessary for the making of an anatomical gift.
23. “Recipient” means an individual into whose body a decedent’s part has been or is intended to be transplanted.
24. “Record” means information that is inscribed on a tangible medium or that is stored in an electronic or other medium and is retrievable in perceivable form.
25. “Refusal” means an intention not to make an anatomical gift of an individual’s body or part expressed by the individual in accordance with section 23-06.6-06 or which expressly states an intent to bar other persons from making an anatomical gift of an individual’s body or part.
26. “Sign” means, with the present intent to authenticate or adopt a record:
    1. To execute or adopt a tangible symbol; or
    2. To attach to or logically associate with the record an electronic symbol, sound, or process.
27. “Technician” means an individual determined to be qualified to remove or process parts by an appropriate organization that is licensed, accredited, or regulated under federal or state law. The term includes an enucleator.
28. “Tissue” means a portion of the human body other than an organ or an eye. The term does not include blood unless the blood is donated for the purpose of research or education.
29. “Tissue bank” means a person that is licensed, accredited, or regulated under federal or state law to engage in the recovery, screening, testing, processing, storage, or distribution of tissue.
30. “Transplant hospital” means a hospital that furnishes organ transplants and other medical and surgical specialty services required for the care of transplant patients.

23-06.6-02. Applicability.

This chapter applies to an anatomical gift or amendment to, revocation of, or refusal to make an anatomical gift, whenever made.

23-06.6-03. Who may make an anatomical gift before donor’s death.

Subject to section 23-06.6-07, an anatomical gift of a donor’s body or part may be made during the life of the donor for the purpose of transplantation, therapy, research, or education in the manner provided in section 23-06.6-04 by:

1. The donor, if the donor is an adult or if the donor is a minor and is:
   1. Emancipated; or
   2. Authorized under state law to apply for a driver’s license because the donor is at least fourteen years of age;
2. An agent of the donor, unless the power of attorney for health care or other record prohibits the agent from making an anatomical gift;
3. A parent of the donor, if the donor is an unemancipated minor; or
4. The donor’s guardian.

23-06.6-04. Manner of making anatomical gift before donor’s death.

1. A donor may make an anatomical gift:
   1. By authorizing a statement or symbol indicating that the donor has made an anatomical gift to be imprinted on the donor’s driver’s license or identification card;
   2. In a will;
   3. During a terminal illness or injury of the donor, by any form of communication addressed to at least two adults, at least one of whom is a disinterested witness; or
   4. As provided in subsection 2.
2. A donor or other person authorized to make an anatomical gift under section 23-06.6-03 may make a gift by a donor card or other record signed by the donor or other person making the gift or by authorizing that a statement or symbol indicating that the donor has made an anatomical gift be included on a donor registry. If the donor or other person is physically unable to sign a record, the record may be signed by another individual at the direction of the donor or other person and must:
   1. Be witnessed by at least two adults, at least one of whom is a disinterested witness, who have signed at the request of the donor or the other person; and
   2. State that it has been signed and witnessed as provided in subdivision a.
3. Revocation, suspension, expiration, or cancellation of a driver’s license or identification card upon which an anatomical gift is indicated does not invalidate the gift.
4. An anatomical gift made by will takes effect upon the donor’s death whether or not the will is probated. Invalidation of the will after the donor’s death does not invalidate the gift.

23-06.6-05. Amending or revoking anatomical gift before donor’s death.

1. Subject to section 23-06.6-07, a donor or other person authorized to make an anatomical gift under section 23-06.6-03 may amend or revoke an anatomical gift by:
   1. A record signed by:
      1. The donor;
      2. The other person; or
      3. Subject to subsection 2, another individual acting at the direction of the donor or the other person if the donor or other person is physically unable to sign; or
   2. A later-executed document of gift that amends or revokes a previous anatomical gift or portion of an anatomical gift, either expressly or by inconsistency.
2. A record signed pursuant to paragraph 3 of subdivision a of subsection 1 must:
   1. Be witnessed by at least two adults, at least one of whom is a disinterested witness, who have signed at the request of the donor or the other person; and
   2. State that it has been signed and witnessed as provided in subdivision a.
3. Subject to section 23-06.6-07, a donor or other person authorized to make an anatomical gift under section 23-06.6-03 may revoke an anatomical gift by the destruction or cancellation of the document of gift, or the portion of the document of gift used to make the gift, with the intent to revoke the gift.
4. A donor may amend or revoke an anatomical gift that was not made in a will by any form of communication during a terminal illness or injury addressed to at least two adults, at least one of whom is a disinterested witness.
5. A donor who makes an anatomical gift in a will may amend or revoke the gift in the manner provided for amendment or revocation of wills or as provided in subsection 1.

23-06.6-06. Refusal to make anatomical gift — Effect of refusal.

1. An individual may refuse to make an anatomical gift of the individual’s body or part by:
   1. A record signed by:
      1. The individual; or
      2. Subject to subsection 2, another individual acting at the direction of the individual if the individual is physically unable to sign;
   2. The individual’s will regardless of whether the will is admitted to probate or invalidated after the individual’s death; or
   3. Any form of communication made by the individual during the individual’s terminal illness or injury addressed to at least two adults, at least one of whom is a disinterested witness.
2. A record signed pursuant to paragraph 2 of subdivision a of subsection 1 must:
   1. Be witnessed by at least two adults, at least one of whom is a disinterested witness, who have signed at the request of the individual; and
   2. State that it has been signed and witnessed as provided in subdivision a.
3. An individual who has made a refusal may amend or revoke the refusal:
   1. In the manner provided in subsection 1 for making a refusal;
   2. By subsequently making an anatomical gift pursuant to section 23-06.6-04 which is inconsistent with the refusal; or
   3. By destroying or canceling the record evidencing the refusal, or the portion of the record used to make the refusal, with the intent to revoke the refusal.
4. Except as otherwise provided in subsection 8 of section 23-06.6-07, in the absence of an express, contrary indication by the individual set forth in the refusal, an individual’s unrevoked refusal to make an anatomical gift of the individual’s body or part bars all other persons from making an anatomical gift of the individual’s body or part.

23-06.6-07. Preclusive effect of anatomical gift, amendment, or revocation.

1. Except as otherwise provided in subsection 7 and subject to subsection 6, in the absence of an express, contrary indication by the donor, a person other than the donor is barred from making, amending, or revoking an anatomical gift of a donor’s body or part if the donor made an anatomical gift of the donor’s body or part under section 23-06.6-04 or an amendment to an anatomical gift of the donor’s body or part under section 23-06.6-05.
2. A donor’s revocation of an anatomical gift of the donor’s body or part under section 23-06.6-05 is not a refusal and does not bar another person specified in section 23-06.6-03 or 23-06.6-08 from making an anatomical gift of the donor’s body or part under section 23-06.6-04 or 23-06.6-09.
3. If a person other than the donor makes an unrevoked anatomical gift of the donor’s body or part under section 23-06.6-04 or an amendment to an anatomical gift of the donor’s body or part under section 23-06.6-05, another person may not make, amend, or revoke the gift of the donor’s body or part under section 23-06.6-09.
4. A revocation of an anatomical gift of a donor’s body or part under section 23-06.6-05 by a person other than the donor does not bar another person from making an anatomical gift of the body or part under section 23-06.6-04 or 23-06.6-09.
5. In the absence of an express, contrary indication by the donor or other person authorized to make an anatomical gift under section 23-06.6-03, an anatomical gift of a part is neither a refusal to give another part nor a limitation on the making of an anatomical gift of another part at a later time by the donor or another person.
6. In the absence of an express, contrary indication by the donor or other person authorized to make an anatomical gift under section 23-06.6-03, an anatomical gift of a part for one or more of the purposes set forth in section 23-06.6-03 is not a limitation on the making of an anatomical gift of the part for any of the other purposes by the donor or any other person under section 23-06.6-04 or 23-06.6-09.
7. If a donor who is an unemancipated minor dies, a parent of the donor who is reasonably available may revoke or amend an anatomical gift of the donor’s body or part.
8. If an unemancipated minor who signed a refusal dies, a parent of the minor who is reasonably available may revoke the minor’s refusal.

23-06.6-08. Who may make anatomical gift of decedent’s body or part.

1. Subject to subsections 2 and 3 and unless barred by section 23-06.6-06 or 23-06.6-07, an anatomical gift of a decedent’s body or part for the purpose of transplantation, therapy, research, or education may be made by any member of the following classes of persons who is reasonably available, in the order of priority listed:
   1. An agent of the decedent at the time of death who could have made an anatomical gift under subsection 2 of section 23-06.6-03 immediately before the decedent’s death;
   2. The spouse of the decedent;
   3. Adult children of the decedent;
   4. Parents of the decedent;
   5. Adult siblings of the decedent;
   6. Adult grandchildren of the decedent;
   7. Grandparents of the decedent;
   8. An adult who exhibited special care and concern for the decedent;
   9. The persons who were acting as the guardians of the decedent at the time of death; and
   10. Any other person having the authority to dispose of the decedent’s body.
2. If there is more than one member of a class listed in subdivision a, c, d, e, f, g, or i of subsection 1 entitled to make an anatomical gift, an anatomical gift may be made by a member of the class unless that member or a person to which the gift may pass under section 23-06.6-10 knows of an objection by another member of the class. If an objection is known, the gift may be made only by a majority of the members of the class who are reasonably available.
3. A person may not make an anatomical gift if, at the time of the decedent’s death, a person in a prior class under subsection 1 is reasonably available to make or to object to the making of an anatomical gift.

23-06.6-09. Manner of making, amending, or revoking anatomical gift of decedent’s body or part.

1. A person authorized to make an anatomical gift under section 23-06.6-08 may make an anatomical gift by a document of gift signed by the person making the gift or by that person’s oral communication that is electronically recorded or is contemporaneously reduced to a record and signed by the individual receiving the oral communication.
2. Subject to subsection 3, an anatomical gift by a person authorized under section 23-06.6-08 may be amended or revoked orally or in a record by any member of a prior class who is reasonably available. If more than one member of the prior class is reasonably available, the gift made by a person authorized under section 23-06.6-08 may be:
   1. Amended only if a majority of the reasonably available members agree to the amending of the gift; or
   2. Revoked only if a majority of the reasonably available members agree to the revoking of the gift or if they are equally divided as to whether to revoke the gift.
3. A revocation under subsection 2 is effective only if, before an incision has been made to remove a part from the donor’s body or before invasive procedures have begun to prepare the recipient, the procurement organization, transplant hospital, or physician or technician knows of the revocation.

23-06.6-10. Persons that may receive anatomical gift — Purpose of anatomical gift.

1. An anatomical gift may be made to the following persons named in the document of gift:
   1. A hospital; accredited medical school, dental school, college, or university; organ procurement organization; or other appropriate person for research or education;
   2. Subject to subsection 2, an individual designated by the person making the anatomical gift if the individual is the recipient of the part; or
   3. An eye bank or tissue bank.
2. If an anatomical gift to an individual under subdivision b of subsection 1 cannot be transplanted into the individual, the part passes in accordance with subsection 7 in the absence of an express, contrary indication by the person making the anatomical gift.
3. If an anatomical gift of one or more specific parts or of all parts is made in a document of gift that does not name a person described in subsection 1 but identifies the purpose for which an anatomical gift may be used, the following rules apply:
   1. If the part is an eye and the gift is for the purpose of transplantation or therapy, the gift passes to the appropriate eye bank.
   2. If the part is tissue and the gift is for the purpose of transplantation or therapy, the gift passes to the appropriate tissue bank.
   3. If the part is an organ and the gift is for the purpose of transplantation or therapy, the gift passes to the appropriate organ procurement organization as custodian of the organ.
   4. If the part is an organ, an eye, or tissue and the gift is for the purpose of research or education, the gift passes to the appropriate procurement organization.
4. For the purpose of subsection 3, if there is more than one purpose of an anatomical gift set forth in the document of gift but the purposes are not set forth in any priority, the gift must be used for transplantation or therapy, if suitable. If the gift cannot be used for transplantation or therapy, the gift may be used for research or education.
5. If an anatomical gift of one or more specific parts is made in a document of gift that does not name a person described in subsection 1 and does not identify the purpose of the gift, the gift may be used only for transplantation or therapy, and the gift passes in accordance with subsection 7.
6. If a document of gift specifies only a general intent to make an anatomical gift by words such as “donor”, “organ donor”, or “body donor”, or by a symbol or statement of similar import, the gift may be used only for transplantation or therapy, and the gift passes in accordance with subsection 7.
7. For purposes of subsections 2, 5, and 6 the following rules apply:
   1. If the part is an eye, the gift passes to the appropriate eye bank.
   2. If the part is tissue, the gift passes to the appropriate tissue bank.
   3. If the part is an organ, the gift passes to the appropriate organ procurement organization as custodian of the organ.
8. An anatomical gift of an organ for transplantation or therapy, other than an anatomical gift under subdivision b of subsection 1, passes to the organ procurement organization as custodian of the organ.
9. If an anatomical gift does not pass pursuant to subsection 1, 2, 3, 4, 5, 6, 7, or 8 or the decedent’s body or part is not used for transplantation, therapy, research, or education, custody of the body or part passes to the person under obligation to dispose of the body or part.
10. A person may not accept an anatomical gift if the person knows that the gift was not effectively made under section 23-06.6-04 or 23-06.6-09 or if the person knows that the decedent made a refusal under section 23-06.6-06 that was not revoked. For purposes of this subsection, if a person knows that an anatomical gift was made on a document of gift, the person is deemed to know of any amendment or revocation of the gift or any refusal to make an anatomical gift on the same document of gift.
11. Except as otherwise provided in subdivision b of subsection 1, nothing in this chapter affects the allocation of organs for transplantation or therapy.

23-06.6-11. Search and notification.

1. The following persons shall make a reasonable search of an individual who the person reasonably believes is dead or near death for a document of gift or other information identifying the individual as a donor or as an individual who made a refusal:
   1. A law enforcement officer, firefighter, paramedic, or other emergency rescuer finding the individual; and
   2. If no other source of the information is immediately available, a hospital, as soon as practical after the individual’s arrival at the hospital.
2. If a document of gift or a refusal to make an anatomical gift is located by the search required by subdivision a of subsection 1 and the individual or deceased individual to whom it relates is taken to a hospital, the person responsible for conducting the search shall send the document of gift or refusal to the hospital.
3. A person is not subject to criminal or civil liability for failing to discharge the duties imposed by this section but may be subject to administrative sanctions.

23-06.6-12. Delivery of document of gift not required — Right to examine.

1. A document of gift need not be delivered during the donor’s lifetime to be effective.
2. Upon or after an individual’s death, a person in possession of a document of gift or a refusal to make an anatomical gift with respect to the individual shall allow examination and copying of the document of gift or refusal by a person authorized to make or object to the making of an anatomical gift with respect to the individual or by a person to which the gift could pass under section 23-06.6-10.

23-06.6-13. Rights and duties of procurement organization and others.

1. When a hospital refers an individual at or near death to a procurement organization, the organization shall make a reasonable search of the records of the department of transportation and any donor registry that it knows exists for the geographical area in which the individual resides to ascertain whether the individual has made an anatomical gift.
2. A procurement organization must be allowed reasonable access to information in the records of the department of transportation to ascertain whether an individual at or near death is a donor.
3. When a hospital refers an individual at or near death to a procurement organization, the organization may conduct any reasonable examination necessary to ensure the medical suitability of a part that is or could be the subject of an anatomical gift for transplantation, therapy, research, or education from a donor or a prospective donor. During the examination period, measures necessary to ensure the medical suitability of the part may not be withdrawn unless the hospital or procurement organization knows that the individual expressed a contrary intent or the measures are contrary to reasonable medical standards.
4. Unless prohibited by law other than this chapter, at any time after a donor’s death, the person to which a part passes under section 23-06.6-10 may conduct any reasonable examination necessary to ensure the medical suitability of the body or part for its intended purpose.
5. Unless prohibited by law other than this chapter, an examination under subsection 3 or 4 may include an examination of all medical and dental records of the donor or prospective donor.
6. Upon the death of a minor who was a donor or had signed a refusal, unless a procurement organization knows the minor is emancipated, the procurement organization shall conduct a reasonable search for the parents of the minor and provide the parents with an opportunity to revoke or amend the anatomical gift or revoke the refusal.
7. Upon referral by a hospital under subsection 1, a procurement organization shall make a reasonable search for any person listed in section 23-06.6-08 having priority to make an anatomical gift on behalf of a prospective donor. If a procurement organization receives information that an anatomical gift to any other person was made, amended, or revoked, it shall promptly advise the other person of all relevant information.
8. Subject to subsection 9 of section 23-06.6-10 and section 23-06.6-22, the rights of the person to which a part passes under section 23-06.6-10 are superior to the rights of all others with respect to the part. The person may accept or reject an anatomical gift in whole or in part. Subject to the terms of the document of gift and this chapter, a person that accepts an anatomical gift of an entire body may allow embalming, burial or cremation, whole-body donation to a school of medicine, and use of remains in a funeral service. If the gift is of a part, the person to which the part passes under section 23-06.6-10, upon the death of the donor and before embalming, burial, whole-body donation to a school of medicine, or cremation, shall cause the part to be removed without unnecessary mutilation.
9. Neither the physician who attends the decedent at death nor the physician who determines the time of the decedent’s death may participate in the procedures for removing or transplanting a part from the decedent.
10. A physician or technician may remove a donated part from the body of a donor which the physician or technician is qualified to remove.

23-06.6-14. Coordination of procurement and use.

Each hospital in this state shall enter into agreements or affiliations with procurement organizations for coordination of procurement and use of anatomical gifts.

23-06.6-15. Sale or purchase of parts prohibited — Penalty.

1. Except as otherwise provided in subsection 2, a person that for valuable consideration knowingly purchases or sells a part for transplantation or therapy if removal of a part from an individual is intended to occur after the individual’s death commits a class B misdemeanor.
2. A person may charge a reasonable amount for the removal, processing, preservation, quality control, storage, transportation, implantation, or disposal of a part.

23-06.6-16. Other prohibited act — Penalty.

A person that, in order to obtain a financial gain, intentionally falsifies, forges, conceals, defaces, or obliterates a document of gift, an amendment or revocation of a document of gift, or a refusal commits a class B misdemeanor.

23-06.6-17. Immunity.

1. A person that acts in accordance with this chapter or with the applicable anatomical gift law of another state, or attempts in good faith to do so, is not liable for the act in a civil action, criminal prosecution, or administrative proceeding.
2. Neither the person making an anatomical gift nor the donor’s estate is liable for any injury or damage that results from the making or use of the gift.
3. In determining whether an anatomical gift has been made, amended, or revoked under this chapter, a person may rely upon representations of an individual listed in subdivision b, c, d, e, f, g, or h of subsection 1 of section 23-06.6-08 relating to the individual’s relationship to the donor or prospective donor unless the person knows that the representation is untrue.

23-06.6-18. Law governing validity — Choice of law as to execution of document of gift — Presumption of validity.

1. A document of gift is valid if executed in accordance with:
   1. This chapter;
   2. The laws of the state or country where the document of gift was executed; or
   3. The laws of the state or country where the person making the anatomical gift was domiciled, has a place of residence, or was a national at the time the document of gift was executed.
2. If a document of gift is valid under this section, the law of this state governs the interpretation of the document of gift.
3. A person may presume that a document of gift or amendment of an anatomical gift is valid unless that person knows that it was not validly executed or was revoked.

23-06.6-19. Donor registry. [Effective through August 31, 2022]

1. The state department of health may establish or contract for the establishment of a donor registry.
2. The department of transportation shall cooperate with a person that administers any donor registry that this state establishes, contracts for, or recognizes for the purpose of transferring to the donor registry all relevant information regarding a donor’s making, amendment to, or revocation of an anatomical gift.
3. A donor registry must:
   1. Allow a donor or other person authorized under section 23-06.6-03 to include on the donor registry a statement or symbol that the donor has made, amended, or revoked an anatomical gift;
   2. Be accessible to a procurement organization to allow it to obtain relevant information on the donor registry to determine, at or near death of the donor or a prospective donor, whether the donor or prospective donor has made, amended, or revoked an anatomical gift; and
   3. Be accessible for purposes of subdivisions a and b seven days a week on a twenty-four-hour basis.
4. Personally identifiable information on a donor registry about a donor or prospective donor may not be used or disclosed without the express consent of the donor, prospective donor, or person that made the anatomical gift for any purpose other than to determine, at or near death of the donor or prospective donor, whether the donor or prospective donor has made, amended, or revoked an anatomical gift.
5. This section does not prohibit any person from creating or maintaining a donor registry that is not established by or under contract with the state. Any such registry must comply with subsections 3 and 4.

23-06.6-19. Donor registry. [Effective September 1, 2022]

1. The department of health and human services may establish or contract for the establishment of a donor registry.
2. The department of transportation shall cooperate with a person that administers any donor registry that this state establishes, contracts for, or recognizes for the purpose of transferring to the donor registry all relevant information regarding a donor’s making, amendment to, or revocation of an anatomical gift.
3. A donor registry must:
   1. Allow a donor or other person authorized under section 23-06.6-03 to include on the donor registry a statement or symbol that the donor has made, amended, or revoked an anatomical gift;
   2. Be accessible to a procurement organization to allow it to obtain relevant information on the donor registry to determine, at or near death of the donor or a prospective donor, whether the donor or prospective donor has made, amended, or revoked an anatomical gift; and
   3. Be accessible for purposes of subdivisions a and b seven days a week on a twenty-four-hour basis.
4. Personally identifiable information on a donor registry about a donor or prospective donor may not be used or disclosed without the express consent of the donor, prospective donor, or person that made the anatomical gift for any purpose other than to determine, at or near death of the donor or prospective donor, whether the donor or prospective donor has made, amended, or revoked an anatomical gift.
5. This section does not prohibit any person from creating or maintaining a donor registry that is not established by or under contract with the state. Any such registry must comply with subsections 3 and 4.

23-06.6-20. Effect of anatomical gift on advance health care directive.

1. In this section:
   1. “Advance health care directive” means a health care directive under chapter 23-06.5, a power of attorney for health care, or a record signed or authorized by a prospective donor containing the prospective donor’s direction concerning a health care decision for the prospective donor.
   2. “Declaration” means a record signed by a prospective donor specifying the circumstances under which a life support system may be withheld or withdrawn from the prospective donor.
   3. “Health care decision” means any decision regarding the health care of the prospective donor.
2. If a prospective donor has a declaration or advance health care directive and the terms of the declaration or directive and the express or implied terms of a potential anatomical gift are in conflict with regard to the administration of measures necessary to ensure the medical suitability of a part for transplantation or therapy, the prospective donor’s attending physician and prospective donor shall confer to resolve the conflict. If the prospective donor is incapable of resolving the conflict, an agent acting under the prospective donor’s declaration or directive or, if none or the agent is not reasonably available, another person authorized by law other than this chapter to make health care decisions on behalf of the prospective donor shall act for the donor to resolve the conflict. If involved in resolving the conflict, the agent or other person authorized by law shall make the decision in accordance with the agent’s or person’s knowledge of the prospective donor’s wishes and religious or moral beliefs as stated orally or as contained in the declaration or advance health care directive. The conflict must be resolved as expeditiously as possible. If the conflict is not resolved expeditiously, the direction of the declaration or advance directive controls. Information relevant to the resolution of the conflict may be obtained from the appropriate procurement organization and any other person authorized to make an anatomical gift for the prospective donor under section 23-06.6-08. Before resolution of the conflict, measures necessary to ensure the medical suitability of the part may not be withheld or withdrawn from the prospective donor if withholding or withdrawing the measures is not contrary to reasonable medical standards.

23-06.6-21. Cooperation between coroner or medical examiner and a procurement organization.

1. A coroner or medical examiner shall cooperate with procurement organizations to maximize the opportunity to recover anatomical gifts for the purpose of transplantation, therapy, research, or education.
2. If a coroner or medical examiner receives notice from a procurement organization that an anatomical gift might be available or was made with respect to a decedent whose body is under the jurisdiction of the coroner or medical examiner and a post-mortem examination is going to be performed, unless the coroner or medical examiner denies recovery in accordance with section 23-06.6-22, the coroner or medical examiner or designee of the coroner or medical examiner shall conduct a post-mortem examination of the body or the part in a manner and within a period compatible with its preservation for the purposes of the gift.
3. A part may not be removed from the body of a decedent under the jurisdiction of a coroner or medical examiner for transplantation, therapy, research, or education unless the part is the subject of an anatomical gift. The body of a decedent under the jurisdiction of the coroner or medical examiner may not be delivered to a person for research or education unless the body is the subject of an anatomical gift. This subsection does not preclude a coroner or medical examiner from performing the medicolegal investigation upon the body or parts of a decedent under the jurisdiction of the coroner or medical examiner.

23-06.6-22. Facilitation of anatomical gift from decedent whose body is under jurisdiction of coroner or medical examiner.

1. Upon request of a procurement organization, a coroner or medical examiner shall release to the procurement organization the name, contact information, and available medical and social history of a decedent whose body is under the jurisdiction of the coroner or medical examiner. If the decedent’s body or part is medically suitable for transplantation, therapy, research, or education, the coroner or medical examiner shall release post-mortem examination results to the procurement organization. The procurement organization may make a subsequent disclosure of the post-mortem examination results or other information received from the coroner or medical examiner only if relevant to transplantation or therapy.
2. The coroner or medical examiner may conduct a medicolegal examination by reviewing all medical records, laboratory test results, x-rays, other diagnostic results, and other information that any person possesses about a donor or prospective donor whose body is under the jurisdiction of the coroner or medical examiner which the coroner or medical examiner determines may be relevant to the investigation.
3. A person that has any information requested by a coroner or medical examiner pursuant to subsection 2 shall provide that information as expeditiously as possible to allow the coroner or medical examiner to conduct the medicolegal investigation within a period compatible with the preservation of parts for the purpose of transplantation, therapy, research, or education.
4. If an anatomical gift has been or might be made of a part of a decedent whose body is under the jurisdiction of the coroner or medical examiner and a post-mortem examination is not required, or the coroner or medical examiner determines that a post-mortem examination is required but that the recovery of the part that is the subject of an anatomical gift will not interfere with the examination, the coroner or medical examiner and procurement organization shall cooperate in the timely removal of the part from the decedent for the purpose of transplantation, therapy, research, or education.
5. If an anatomical gift of a part from the decedent under the jurisdiction of the coroner or medical examiner has been or might be made, but the coroner or medical examiner initially believes that the recovery of the part could interfere with the post-mortem investigation into the decedent’s cause or manner of death, the coroner or medical examiner shall consult with the procurement organization or physician or technician designated by the procurement organization about the proposed recovery. The procurement organization shall provide the coroner or medical examiner with all information the organization has which could relate to the cause or manner of the decedent’s death. After consultation, the coroner or medical examiner may allow the recovery.
6. Following the consultation under subsection 5, in the absence of mutually agreed-upon protocols to resolve conflict between the coroner or medical examiner and the procurement organization, if the coroner or medical examiner intends to deny recovery of an organ for transplantation, the coroner or medical examiner or designee of the coroner or medical examiner, at the request of the procurement organization, shall attend the removal procedure for the part before making a final determination not to allow the procurement organization to recover the part. During the removal procedure, the coroner or medical examiner or designee of the coroner or medical examiner may allow recovery by the procurement organization to proceed, or, if the coroner or medical examiner or designee of the coroner or medical examiner reasonably believes that the part may be involved in determining the decedent’s cause or manner of death, deny recovery by the procurement organization.
7. If the coroner or medical examiner or designee of the coroner or medical examiner denies recovery under subsection 6, the coroner or medical examiner or designee of the coroner or medical examiner shall:
   1. Explain in a record the specific reasons for not allowing recovery of the part;
   2. Include the specific reasons in the records of the coroner or medical examiner; and
   3. Provide a record with the specific reasons to the procurement organization.
8. If the coroner or medical examiner or designee of the coroner or medical examiner allows recovery of a part under subsection 4, 5, or 6, the procurement organization, upon request, shall cause the physician or technician who removes the part to provide the coroner or medical examiner with a record describing the condition of the part, a biopsy, a photograph, and any other information and observations that would assist in the post-mortem examination.
9. If a coroner or medical examiner or designee of a coroner or medical examiner is required to be present at a removal procedure under subsection 6, upon request the procurement organization requesting the recovery of the part shall reimburse the coroner or medical examiner or designee of the coroner or medical examiner for the additional costs incurred in complying with subsection 6.

23-06.6-23. Relation to Electronic Signatures in Global and National Commerce Act.

This chapter modifies, limits, and supersedes the federal Electronic Signatures in Global and National Commerce Act [15 U.S.C. 7001 et seq.], but does not modify, limit, or supersede section 101(a) of that Act [15 U.S.C. 7001], or authorize electronic delivery of any of the notices described in section 103(b) of that Act [15 U.S.C. 7003(b)].

23-07-01. State department of health — Collection of public health information. [Effective through August 31, 2022]

The state department of health shall designate the diseases or conditions that must be reported. Such diseases or conditions may include contagious, infectious, sexually transmitted, or chronic diseases or any illness or injury which may have a significant impact on public health. The state department of health shall maintain a uniform statewide population-based registry system for the collection of data pertaining to the incidence, prevalence, risk factors, management, survival, mortality, and geographic distribution of cancer and reportable benign tumors.

23-07-01. Department — Collection of public health information. [Effective September 1, 2022]

The department of health and human services shall designate the diseases or conditions that must be reported. Such diseases or conditions may include contagious, infectious, sexually transmitted, or chronic diseases or any illness or injury which may have a significant impact on public health. The department of health and human services shall maintain a uniform statewide population-based registry system for the collection of data pertaining to the incidence, prevalence, risk factors, management, survival, mortality, and geographic distribution of cancer and reportable benign tumors.

23-07-01.1. Reporting of physical or mental disorders. [Effective through August 31, 2022]

The state department of health shall define disorders characterized by lapses of consciousness, gross physical or mental impairments for the purposes of the reports hereinafter referred to:

1. A physician or other health care provider may report immediately to the department of transportation in writing, the name, date of birth, and address of every individual fourteen years of age or over coming before them for examination, attendance, care, or treatment if there is reasonable cause to believe that the individual due to physical or mental reason is incapable of safely operating a motor vehicle or diagnosed as a case of a disorder defined as characterized by lapses of consciousness, gross physical or mental impairments, and the report is necessary to prevent or lessen a serious and imminent threat to the health or safety of the individual or the public.
2. Such reports as required in this section are for the information of the director of the department of transportation in determining the eligibility of any person to operate a motor vehicle on the highways of this state and must be kept confidential and not divulged to any person or used as evidence in any trial, except that the reports may be admitted in proceedings under section 39-06-33.
3. The physician-patient privilege provided for by rules 501 and 503 of the North Dakota Rules of Evidence may not be asserted to exclude evidence regarding the mental or physical incapacity of a person to safely operate a motor vehicle in the reports as required under the provisions of this section.
4. Any physician or other medical professional who fails to make a report or who in good faith makes a report, gives an opinion or recommendation pursuant to this section, or participates in any proceeding founded upon this section is immune from any liability, civil or criminal, that might otherwise be incurred, as a result of such report, except for perjury.

23-07-01.1. Reporting of physical or mental disorders. [Effective September 1, 2022]

The department of health and human services shall define disorders characterized by lapses of consciousness, gross physical or mental impairments for the purposes of the reports hereinafter referred to:

1. A physician or other health care provider may report immediately to the department of transportation in writing, the name, date of birth, and address of every individual fourteen years of age or over coming before them for examination, attendance, care, or treatment if there is reasonable cause to believe that the individual due to physical or mental reason is incapable of safely operating a motor vehicle or diagnosed as a case of a disorder defined as characterized by lapses of consciousness, gross physical or mental impairments, and the report is necessary to prevent or lessen a serious and imminent threat to the health or safety of the individual or the public.
2. Such reports as required in this section are for the information of the director of the department of transportation in determining the eligibility of any person to operate a motor vehicle on the highways of this state and must be kept confidential and not divulged to any person or used as evidence in any trial, except that the reports may be admitted in proceedings under section 39-06-33.
3. The physician-patient privilege provided for by rules 501 and 503 of the North Dakota Rules of Evidence may not be asserted to exclude evidence regarding the mental or physical incapacity of a person to safely operate a motor vehicle in the reports as required under the provisions of this section.
4. Any physician or other medical professional who fails to make a report or who in good faith makes a report, gives an opinion or recommendation pursuant to this section, or participates in any proceeding founded upon this section is immune from any liability, civil or criminal, that might otherwise be incurred, as a result of such report, except for perjury.

23-07-01.2. Rules.

The department may adopt rules under chapter 28-32 for the efficient enforcement of this chapter.

23-07-02. Who to report reportable diseases. [Effective through August 31, 2022]

Except as otherwise provided by section 23-07-02.1, the following persons or their designees shall report to the state department of health any reportable disease coming to their knowledge:

1. All health care providers, including physicians, physician assistants, nurse practitioners, nurses, dentists, medical examiners or coroners, pharmacists, emergency medical service providers, and local health officers.
2. The director, principal manager, or chief executive officer of:
   1. Health care institutions, including hospitals, medical centers, clinics, long-term care facilities, assisted living facilities, or other institutional facilities;
   2. Medical or diagnostic laboratories;
   3. Blood bank collection or storage centers;
   4. Public and private elementary and secondary schools;
   5. Public and private universities and colleges;
   6. Health or correctional institutions operated or regulated by municipal, county or multicounty, state, or federal governments;
   7. Funeral establishments and mortuaries; and
   8. Child care facilities or camps.
3. The state veterinarian, if the disease may be transmitted directly or indirectly to or between humans and animals.
4. A person having knowledge that a person or persons are suspected of having a reportable disease may notify the department and provide all information known to the person reporting concerning the reportable disease or condition of the person or persons.

If the person reporting is the attending physician or the physician’s designee, the physician or the physician’s designee shall report not less than twice a week, in the form and manner directed by the state department of health, the condition of the person afflicted and the state of the disease. A person making a report in good faith is immune from liability for any damages which may be caused by that act.

23-07-02. Who to report reportable diseases. [Effective September 1, 2022]

Except as otherwise provided by section 23-07-02.1, the following persons or their designees shall report to the department of health and human services any reportable disease coming to their knowledge:

1. All health care providers, including physicians, physician assistants, nurse practitioners, nurses, dentists, medical examiners or coroners, pharmacists, emergency medical service providers, and local health officers.
2. The director, principal manager, or chief executive officer of:
   1. Health care institutions, including hospitals, medical centers, clinics, long-term care facilities, assisted living facilities, or other institutional facilities;
   2. Medical or diagnostic laboratories;
   3. Blood bank collection or storage centers;
   4. Public and private elementary and secondary schools;
   5. Public and private universities and colleges;
   6. Health or correctional institutions operated or regulated by municipal, county or multicounty, state, or federal governments;
   7. Funeral establishments and mortuaries; and
   8. Child care facilities or camps.
3. The state veterinarian, if the disease may be transmitted directly or indirectly to or between humans and animals.
4. A person having knowledge that a person or persons are suspected of having a reportable disease may notify the department and provide all information known to the person reporting concerning the reportable disease or condition of the person or persons.

If the person reporting is the attending physician or the physician’s designee, the physician or the physician’s designee shall report not less than twice a week, in the form and manner directed by the department of health and human services, the condition of the person afflicted and the state of the disease. A person making a report in good faith is immune from liability for any damages which may be caused by that act.

23-07-02.1. Reports of human immunodeficiency virus infection — Penalty. [Effective through August 31, 2022]

Every attending physician treating an individual known by the physician to have a diagnosis of human immunodeficiency virus infection, acquired immune deficiency syndrome, or human immunodeficiency virus-related illness, including death from human immunodeficiency virus infection, shall make a report on that individual to the state department of health. A person treating an individual known to have human immunodeficiency virus infection in a hospital, a clinic, a sanitarium, the physical custody of the department of corrections and rehabilitation, a regional or local correctional facility or juvenile detention center, the North Dakota youth correctional center, or other private or public institution shall make a report on that individual to the facility administrator or the facility administrator’s designee. Further disclosure of information on any individual known to have human immunodeficiency virus infection may only be provided to medical personnel providing direct care to the individual or as otherwise authorized by law. The designated official shall, if satisfied that the report is valid, make a report to the department on each individual having a diagnosis of human immunodeficiency virus infection, acquired immune deficiency syndrome, or human immunodeficiency virus-related illness, including death from human immunodeficiency virus infection, unless the diagnosed individual’s attending physician has made such a report. The reports required under this section must contain the name, date of birth, sex, and address of the individual reported on and the name and address of the physician or designated official making the report. Failure by a facility to designate an official to whom reports must be made is an infraction. Any person who in good faith complies with this section is immune from civil and criminal liability for any action taken in compliance with this section.

23-07-02.1. Reports of human immunodeficiency virus infection — Penalty. [Effective September 1, 2022]

Every attending physician treating an individual known by the physician to have a diagnosis of human immunodeficiency virus infection, acquired immune deficiency syndrome, or human immunodeficiency virus-related illness, including death from human immunodeficiency virus infection, shall make a report on that individual to the department of health and human services. A person treating an individual known to have human immunodeficiency virus infection in a hospital, a clinic, a sanitarium, the physical custody of the department of corrections and rehabilitation, a regional or local correctional facility or juvenile detention center, the North Dakota youth correctional center, or other private or public institution shall make a report on that individual to the facility administrator or the facility administrator’s designee. Further disclosure of information on any individual known to have human immunodeficiency virus infection may only be provided to medical personnel providing direct care to the individual or as otherwise authorized by law. The designated official shall, if satisfied that the report is valid, make a report to the department on each individual having a diagnosis of human immunodeficiency virus infection, acquired immune deficiency syndrome, or human immunodeficiency virus-related illness, including death from human immunodeficiency virus infection, unless the diagnosed individual’s attending physician has made such a report. The reports required under this section must contain the name, date of birth, sex, and address of the individual reported on and the name and address of the physician or designated official making the report. Failure by a facility to designate an official to whom reports must be made is an infraction. Any person who in good faith complies with this section is immune from civil and criminal liability for any action taken in compliance with this section.

23-07-02.2. Confidentiality of reports. [Effective through August 31, 2022]

A report required by section 23-07-02.1 and held by the state department of health is confidential information. The information may not be disclosed, shared with any agency or institution, or made public, upon subpoena, search warrant, discovery proceedings, or otherwise, except that:

1. Disclosure may be made of medical or epidemiological information for statistical purposes in a manner such that no individual person can be identified;
2. Disclosure may be made of medical or epidemiological information to the extent necessary to enforce section 23-07-02.1 and this section and related rules concerning the treatment, control, and investigation of human immunodeficiency virus infection by public health officials; or
3. Disclosure may be made of medical or epidemiological information to medical personnel to the extent necessary to protect the health or life of any individual.

No officer or employee of the state department of health may be examined in any judicial, executive, legislative, or other proceeding regarding the existence or content of any individual’s report retained by the department under section 23-07-02.1.

23-07-02.2. Confidentiality of reports. [Effective September 1, 2022]

A report required by section 23-07-02.1 and held by the department of health and human services is confidential information. The information may not be disclosed, shared with any agency or institution, or made public, upon subpoena, search warrant, discovery proceedings, or otherwise, except that:

1. Disclosure may be made of medical or epidemiological information for statistical purposes in a manner such that no individual person can be identified;
2. Disclosure may be made of medical or epidemiological information to the extent necessary to enforce section 23-07-02.1 and this section and related rules concerning the treatment, control, and investigation of human immunodeficiency virus infection by public health officials; or
3. Disclosure may be made of medical or epidemiological information to medical personnel to the extent necessary to protect the health or life of any individual.

No officer or employee of the department of health and human services may be examined in any judicial, executive, legislative, or other proceeding regarding the existence or content of any individual’s report retained by the department under section 23-07-02.1.

23-07-02.3. Emergency reporting. [Effective through August 31, 2022]

1. The state health officer may issue a temporary order for emergency reporting of disease conditions or information if the state health officer finds probable cause to believe there is a threat caused by an imminent or emerging condition affecting the public health, including actual or threatened terrorism.
2. The state health officer may designate who must report, what conditions or information must be reported, what information must be contained in the report, the methods and frequency of reporting, and may make any other pertinent requirement.
3. The temporary order may be issued and is effective without regard to chapter 28-32 for a period of ninety days, unless earlier revoked by the state health officer. Emergency rulemaking must be initiated under chapter 28-32 within ninety days of the order or the order expires. The temporary order and any emergency rulemaking under this section are effective without the necessity of approval from the health council.
4. If the governor declares an emergency or a disaster based on an epidemic under chapter 37-17.1, the state health officer shall consider whether to issue a temporary order or the health council shall consider whether to adopt rules or emergency rules to include this infectious disease as a reportable disease or condition or as a post-mortem communicable disease.

23-07-02.3. Emergency reporting. [Effective September 1, 2022]

1. The state health officer may issue a temporary order for emergency reporting of disease conditions or information if the state health officer finds probable cause to believe there is a threat caused by an imminent or emerging condition affecting the public health, including actual or threatened terrorism.
2. The state health officer may designate who must report, what conditions or information must be reported, what information must be contained in the report, the methods and frequency of reporting, and may make any other pertinent requirement.
3. The temporary order may be issued and is effective without regard to chapter 28-32 for a period of ninety days, unless earlier revoked by the state health officer. Emergency rulemaking must be initiated under chapter 28-32 within ninety days of the order or the order expires. The temporary order and any emergency rulemaking under this section are effective without the necessity of approval from the department of health and human services.
4. If the governor declares an emergency or a disaster based on an epidemic under chapter 37-17.1, the state health officer shall consider whether to issue a temporary order or the health council shall consider whether to adopt rules or emergency rules to include this infectious disease as a reportable disease or condition or as a post-mortem communicable disease.

23-07-03. Report of cases of sexually transmitted disease. [Effective through August 31, 2022]

The superintendent of a hospital, dispensary, or charitable or penal institution, in which there is a case of sexually transmitted disease, or the superintendent’s designee, shall report such case to the nearest health officer having jurisdiction. The report must be made in the form and manner directed by the state department of health.

23-07-03. Report of cases of sexually transmitted disease. [Effective September 1, 2022]

The superintendent of a hospital, dispensary, or charitable or penal institution, in which there is a case of sexually transmitted disease, or the superintendent’s designee, shall report such case to the nearest health officer having jurisdiction. The report must be made in the form and manner directed by the department of health and human services.

23-07-04. Report of reportable disease by township board of health. [Repealed]

Repealed by S.L. 1999, ch. 242, § 7.

23-07-05. Local health officers to report reportable disease to state department of health. [Effective through August 31, 2022]

At such time as may be required by the state department of health, each local health officer shall submit to such department, on blanks furnished by the department for that purpose, a summarized report of the reportable diseases reported to the health officer during the week. When no cases have been reported during the week, the report must be made with the notation “No cases reported”.

23-07-05. Local health officers to report reportable disease to department of health and human services. [Effective September 1, 2022]

At such time as may be required by the department of health and human services, each local health officer shall submit to such department, on blanks furnished by the department for that purpose, a summarized report of the reportable diseases reported to the health officer during the week. When no cases have been reported during the week, the report must be made with the notation “No cases reported”.

23-07-06. Contagious or infectious diseases — Power of local board of health to quarantine.

Whenever a local board of health knows that a case of a contagious or infectious disease exists within its jurisdiction, the board immediately shall examine the facts of the case and may adopt such quarantine and sanitary measures as in its judgment tend to prevent the spread of such disease. The board immediately may cause any person infected with such disease to be removed to a separate house if, in the opinion of the health officer, such person can be removed without danger to that person’s health. If the infected person cannot be removed without danger to that person’s health, the local board shall make such quarantine regulations as it deems proper with reference to the house within which such infected person is, and may cause the persons in the neighborhood to be removed, and may take such other measures as it deems necessary for the safety of the inhabitants within its jurisdiction. Quarantine measures adopted under this section must be in compliance with chapter 23-07.6.

23-07-07. Sexually transmitted diseases — Additional powers and duties of health officers.

The state health officer, and each district, county, and city health officer within the officer’s jurisdiction, when necessary for the protection of public health, shall:

1. Make examination of any person reasonably suspected of being infected with a sexually transmitted disease and detain that person until the results of the examination are known.
2. Require any person infected with a sexually transmitted disease to report for treatment to a reputable physician and to continue such treatment until cured or, if incurable, continue indefinitely such treatment as recommended by the physician.
3. Investigate sources of infection of sexually transmitted diseases.
4. Cooperate with the proper officials whose duty it is to enforce laws directed against prostitution, and otherwise to use every proper means for the repression of prostitution, including providing proper officials with all relevant information available concerning individuals who are infected with the human immunodeficiency virus and who are engaged in prostitution.

23-07-07.1. Blood sample of pregnant woman must be submitted for serological test for syphilis. [Repealed]

Repealed by S.L. 1991, ch. 263, § 1.

23-07-07.2. Definitions. [Repealed]

Repealed by S.L. 1991, ch. 263, § 1.

23-07-07.3. Certificates reporting births and stillbirths to state whether blood test made. [Repealed]

Repealed by S.L. 1991, ch. 263, § 1.

23-07-07.4. Penalty. [Repealed]

Repealed by S.L. 1991, ch. 263, § 1.

23-07-07.5. Testing of inmates and convicted individuals for exposure to the human immunodeficiency virus — Reporting — Liability. [Effective through August 31, 2022]

1. The following individuals must be examined or tested for the presence of antibodies to or antigens of the human immunodeficiency virus:
   1. Every individual convicted of a crime who is imprisoned for fifteen days or more in a grade one or grade two jail, a regional correctional facility, or the state penitentiary;
   2. Every individual, whether imprisoned or not, who is convicted of a sexual offense under chapter 12.1-20, except for those convicted of violating sections 12.1-20-12.1 and 12.1-20-13; and
   3. Every individual, whether imprisoned or not, who is convicted of an offense involving the use of a controlled substance, as defined in chapter 19-03.1, and the offense involved the use of paraphernalia, including any type of syringe or hypodermic needle, that creates an epidemiologically demonstrated risk of transmission of the human immunodeficiency virus.
2. The results of any positive or reactive test must be reported to the state department of health in the manner prescribed by the department and to the individual tested. Subsection 1 does not require the testing of an individual before sentencing or the testing of an individual held in a jail or correctional facility awaiting transfer to the state penitentiary.
3. A licensed physician, nurse, technician, or employee of a hospital or clinic who draws blood from any person for the purpose of conducting a test required by this section is not liable in any civil action for damages arising out of such action except for an act or omission that constitutes gross negligence.

23-07-07.5. Testing of inmates and convicted individuals for exposure to the human immunodeficiency virus — Reporting — Liability. [Effective September 1, 2022]

1. The following individuals must be examined or tested for the presence of antibodies to or antigens of the human immunodeficiency virus:
   1. Every individual convicted of a crime who is imprisoned for fifteen days or more in a grade one or grade two jail, a regional correctional facility, or the state penitentiary;
   2. Every individual, whether imprisoned or not, who is convicted of a sexual offense under chapter 12.1-20, except for those convicted of violating sections 12.1-20-12.1 and 12.1-20-13; and
   3. Every individual, whether imprisoned or not, who is convicted of an offense involving the use of a controlled substance, as defined in chapter 19-03.1, and the offense involved the use of paraphernalia, including any type of syringe or hypodermic needle, that creates an epidemiologically demonstrated risk of transmission of the human immunodeficiency virus.
2. The results of any positive or reactive test must be reported to the department of health and human services in the manner prescribed by the department and to the individual tested. Subsection 1 does not require the testing of an individual before sentencing or the testing of an individual held in a jail or correctional facility awaiting transfer to the state penitentiary.
3. A licensed physician, nurse, technician, or employee of a hospital or clinic who draws blood from any person for the purpose of conducting a test required by this section is not liable in any civil action for damages arising out of such action except for an act or omission that constitutes gross negligence.

23-07-07.6. Report of testing result of imprisoned individuals. [Effective through August 31, 2022]

1. Notwithstanding any other provision of law, the state department of health or any other agency shall release the results of any testing for any reportable disease performed on an individual convicted of a crime who is imprisoned if the request is made by any individual and the individual provides written proof from the administrator of the facility with control over the individual imprisoned which states that the individual has had a significant exposure.
2. For purposes of this section, “significant exposure” means:
   1. Contact of broken skin or mucous membrane with a patient’s or other individual’s blood or bodily fluids other than tears or perspiration;
   2. The occurrence of a needle stick or scalpel or instrument wound in the process of caring for a patient; or
   3. Exposure that occurs by any other method of transmission defined by the state department of health as a significant exposure.

23-07-07.6. Report of testing result of imprisoned individuals. [Effective September 1, 2022]

1. Notwithstanding any other provision of law, the department of health and human services or any other agency shall release the results of any testing for any reportable disease performed on an individual convicted of a crime who is imprisoned if the request is made by any individual and the individual provides written proof from the administrator of the facility with control over the individual imprisoned which states that the individual has had a significant exposure.
2. For purposes of this section, “significant exposure” means:
   1. Contact of broken skin or mucous membrane with a patient’s or other individual’s blood or bodily fluids other than tears or perspiration;
   2. The occurrence of a needle stick or scalpel or instrument wound in the process of caring for a patient; or
   3. Exposure that occurs by any other method of transmission defined by the department of health and human services as a significant exposure.

23-07-08. Persons in prison examined and treated for sexually transmitted diseases.

Every person convicted of a crime who is imprisoned fifteen days or more in a state, county, or city prison must be examined for sexually transmitted disease and, if infected, must be treated therefor by the health officer within whose jurisdiction the person is imprisoned.

23-07-09. Sexually transmitted diseases — Persons isolated in prison — Exceptions.

The prison authorities of any state, county, or city prison shall make available to the health officers such portion of the prison as may be necessary for a clinic or hospital wherein the following persons may be isolated and treated:

1. Persons who are imprisoned in the prison and who are infected with a sexually transmitted disease.
2. Persons who are suffering with a sexually transmitted disease at the time of the expiration of their term of imprisonment.
3. Persons isolated or quarantined by the health officer when no other suitable place for isolation or quarantine is available.

In lieu of such isolation, any of such persons, in the discretion of the health officer, may be required to report for treatment to a licensed physician. This section may not be construed to interfere with the service of any sentence imposed by a court as punishment for the commission of crime.

23-07-10. Preventing infant blindness — Duty of physician or midwife.

All physicians, midwives, or other persons in professional attendance upon a birth always shall examine the eyes of the infant carefully. If there is the least reason to suspect the presence of a disease of the eyes, such person shall apply such prophylactic treatment as may be recognized as efficient in medical science.

23-07-11. Duty of parent to report to health officer.

If one or both eyes of an infant becomes inflamed, swollen, or reddened, or shows any unnatural discharge or secretion at any time within two weeks after birth, and if no legally qualified physician is in attendance upon the infant at that time, the parents of the child, or in their absence, whoever is caring for said infant, shall report the fact in writing, within six hours after discovery, to the health officer having jurisdiction. Such report need not be made from a recognized hospital.

23-07-12. Health officer to place reported infant in charge of physician.

Upon receipt of a report as provided for in section 23-07-11, the health officer shall direct the parents or whoever has charge of the infant suffering from inflammation, swelling, redness, or unnatural secretion or discharge of the eyes, to place it immediately in charge of a legally qualified physician.

23-07-12.1. Limitations on requirements to wear a mask.

A statewide elected official or the state health officer may not mandate an individual in this state use a face mask, face shield, or other face covering. This section applies, notwithstanding authority granted under other provisions of law, including section 23-01-05 and chapter 37-17.1.

23-07-13. Contagious or infectious diseases — Local board may establish temporary hospital.

Each local board of health may provide such temporary hospital or place of reception for persons afflicted with any contagious or infectious disease as it judges best for their accommodation and the safety of the inhabitants. It may provide a means of transportation to such hospital for persons suffering from any such disease. All such hospitals, and all private houses or other places in which exists any contagious or infectious disease, during the existence of such disease, are under the control and subject to the regulations of the local board of health.

23-07-14. Contagious or infectious diseases — Local board may destroy or disinfect infected clothing.

Any local board of health may cause to be destroyed any bed, bedding, clothing, carpets, or other articles which have been exposed to infection from a contagious or infectious disease and may allow reasonable compensation for the same. The board also may provide a proper place with all necessary apparatus and attendants for the disinfection of such articles and may cause all such articles to be conveyed to such place to be disinfected.

23-07-15. Removal of individual with reportable disease or condition — Removal of body of individual who died of reportable disease or condition — Prohibited — Declaration of emergency or disaster — Rulemaking authority. [Effective through August 31, 2022]

1. Unless the person has a permit from the local board of health or state department of health, a person may not remove or cause to be removed from without this state into this state, from one building to another within this state, or from or to any railroad car or motor vehicle, an individual with a reportable disease or condition, or the body of an individual who died of a reportable disease or condition.
2. If the governor declares an emergency or a disaster based on an epidemic under chapter 37-17.1, the health council shall consider whether to adopt rules or emergency rules directing the state department of health to notify emergency medical services personnel of the presence of a reportable disease or condition and any person taking possession of a dead body of a post-mortem communicable disease. Notwithstanding state laws to the contrary, rules adopted under this section may provide for the disclosure of personally identifiable information.

23-07-15. Removal of individual with reportable disease or condition — Removal of body of individual who died of reportable disease or condition — Prohibited — Declaration of emergency or disaster — Rulemaking authority. [Effective September 1, 2022]

1. Unless the person has a permit from the local board of health or department of health and human services, a person may not remove or cause to be removed from without this state into this state, from one building to another within this state, or from or to any railroad car or motor vehicle, an individual with a reportable disease or condition, or the body of an individual who died of a reportable disease or condition.
2. If the governor declares an emergency or a disaster based on an epidemic under chapter 37-17.1, the health council shall consider whether to adopt rules or emergency rules directing the department of health and human services to notify emergency medical services personnel of the presence of a reportable disease or condition and any person taking possession of a dead body of a post-mortem communicable disease. Notwithstanding state laws to the contrary, rules adopted under this section may provide for the disclosure of personally identifiable information.

23-07-16. Child having contagious or infectious disease prohibited from attending school — Exception.

Except as provided by section 23-07-16.1, no principal, superintendent, or teacher of any school, and no parent or guardian of any minor child, may permit any child having any significant contagious or infectious disease, or any child residing in any house in which any such disease exists or has recently existed, to attend any public or private school until permitted to do so under the regulations of the local board of health.

23-07-16.1. School district to adopt policy relating to significant contagious diseases.

Each school district shall adopt a policy governing the disposition of children attending school within the school district, employees of the school district, or independent contractors under contract with the school district who are diagnosed as having a significant contagious disease. The state department of health shall, with advice from the superintendent of public instruction, adopt rules establishing guidelines for the policy. The guidelines may include methods and procedures relating to a determination of whether and under what conditions a child with a significant contagious disease may not continue attending school or whether and under what conditions an employee or an independent contractor with a significant contagious disease may not continue in a work assignment.

23-07-17. Vaccination or inoculation not required for admission to any school or for the exercise of a right. [Repealed]

Repealed by S.L. 1975, ch. 224, § 2.

23-07-17.1. Inoculation required before admission to school. [Effective through August 31, 2022]

1. A child may not be admitted to any public, private, or parochial school, or day care center, child care facility, head start program, or nursery school operating in this state or be supervised through home-based instruction unless the child’s parent or guardian presents to the institution authorities a certification from a licensed physician or authorized representative of the state department of health that the child has received age-appropriate immunization against diphtheria, pertussis, tetanus, measles, rubella (German measles), mumps, hepatitis B, haemophilus influenza type b (Hib), varicella (chickenpox), poliomyelitis, pneumococcal disease, meningococcal disease, rotovirus, and hepatitis A. In the case of a child receiving home-based instruction, the child’s parent or legal guardian shall file the certification with the public school district in which the child resides.
2. A child may enter an institution upon submitting written proof from a licensed physician or authorized representative of the state department of health stating that the child has started receiving the required immunization or has a written consent by the child’s parent or guardian for a local health service or department to administer the needed immunization without charge or has complied with the requirements for certificate of exemption as provided for in subsection 3.
3. Any minor child, through the child’s parent or guardian, may submit to the institution authorities either a certificate from a licensed physician stating that the physical condition of the child is such that immunization would endanger the life or health of the child or a certificate signed by the child’s parent or guardian whose religious, philosophical, or moral beliefs are opposed to such immunization. The minor child is then exempt from the provisions of this section.
4. The enforcement of subsections 1, 2, and 3 is the responsibility of the designated institution authority.
5. The immunizations required, and the procedure for their administration, as prescribed by the state department of health, must conform to recognized standard medical practices in the state. The state department of health shall administer the provisions of this section and shall promulgate rules and regulations in the manner prescribed by chapter 28-32 for the purpose of administering this section.
6. When, in the opinion of the health officer, danger of an epidemic exists from any of the communicable diseases for which immunization is required under this section, the exemptions from immunization against such disease may not be recognized and children not immunized must be excluded from an institution listed in subsection 1 until, in the opinion of the health officer, the danger of the epidemic is over. The designated institution authority shall notify those parents or guardians taking legal exception to the immunization requirements that their children are excluded from school during an epidemic as determined by the state department of health.
7. When, in the opinion of the health officer, extenuating circumstances make it difficult or impossible to comply with immunization requirements, the health officer may authorize children who are not immunized to be admitted to an institution listed in subsection 1 until the health officer determines that the extenuating circumstances no longer exist. Extenuating circumstances include a shortage of vaccine and other temporary circumstances.

23-07-17.1. Inoculation required before admission to school. [Effective September 1, 2022]

1. A child may not be admitted to any public, private, or parochial school, or day care center, child care facility, head start program, or nursery school operating in this state or be supervised through home-based instruction unless the child’s parent or guardian presents to the institution authorities a certification from a licensed physician or authorized representative of the department of health and human services that the child has received age-appropriate immunization against diphtheria, pertussis, tetanus, measles, rubella (German measles), mumps, hepatitis B, haemophilus influenza type b (Hib), varicella (chickenpox), poliomyelitis, pneumococcal disease, meningococcal disease, rotovirus, and hepatitis A. In the case of a child receiving home-based instruction, the child’s parent or legal guardian shall file the certification with the public school district in which the child resides.
2. A child may enter an institution upon submitting written proof from a licensed physician or authorized representative of the department of health and human services stating that the child has started receiving the required immunization or has a written consent by the child’s parent or guardian for a local health service or department to administer the needed immunization without charge or has complied with the requirements for certificate of exemption as provided for in subsection 3.
3. Any minor child, through the child’s parent or guardian, may submit to the institution authorities either a certificate from a licensed physician stating that the physical condition of the child is such that immunization would endanger the life or health of the child or a certificate signed by the child’s parent or guardian whose religious, philosophical, or moral beliefs are opposed to such immunization. The minor child is then exempt from the provisions of this section.
4. The enforcement of subsections 1, 2, and 3 is the responsibility of the designated institution authority.
5. The immunizations required, and the procedure for their administration, as prescribed by the department of health and human services, must conform to recognized standard medical practices in the state. The department of health and human services shall administer the provisions of this section and shall promulgate rules and regulations in the manner prescribed by chapter 28-32 for the purpose of administering this section.
6. When, in the opinion of the health officer, danger of an epidemic exists from any of the communicable diseases for which immunization is required under this section, the exemptions from immunization against such disease may not be recognized and children not immunized must be excluded from an institution listed in subsection 1 until, in the opinion of the health officer, the danger of the epidemic is over. The designated institution authority shall notify those parents or guardians taking legal exception to the immunization requirements that their children are excluded from school during an epidemic as determined by the department of health and human services.
7. When, in the opinion of the health officer, extenuating circumstances make it difficult or impossible to comply with immunization requirements, the health officer may authorize children who are not immunized to be admitted to an institution listed in subsection 1 until the health officer determines that the extenuating circumstances no longer exist. Extenuating circumstances include a shortage of vaccine and other temporary circumstances.

23-07-18. Physician to report death from contagious or infectious disease to local board of health.

Each practicing physician in this state shall report to the local board of health within the jurisdiction of which the death occurred, in writing, the death of any of the physician’s patients who has died of any contagious or infectious disease. The report must be made within twenty-four hours after such death and must state the specific name and character of the disease.

23-07-19. Appropriation made on report showing action necessary to prevent spread of tuberculosis.

If any society or association organized and existing for the purpose of controlling the spread of tuberculosis in this state considers it necessary to secure the services of a visiting nurse or nurses, or to disinfect any building, room, residence, hotel, or other place infected with tuberculosis, the society shall report such fact to the president of the county board of health and to the board of county commissioners. The report must recommend the course of action advisable to be adopted by the board of county commissioners in relation thereto and in accordance with the provisions of this chapter, and such board, at its next meeting, shall consider such report and recommendation and act on the same. The board may audit and allow bills for services rendered in carrying into effect any action taken by it under the provisions of this section.

23-07-20. Board of county commissioners may appropriate money to prevent the spread of tuberculosis.

The board of county commissioners of any county in this state may appropriate county money and levy taxes within the county levy limitations for the purpose of paying for the services of visiting nurses or other necessary medical attention or advice in preventing the spread of tuberculosis in the county, or for the purpose of disinfecting any building, room, residence, hotel, or other place in such county infected with tuberculosis, and may cooperate with neighboring counties to establish homes or hospitals for incurable tuberculosis patients.

23-07-20.1. Disclosure of records.

To protect the integrity of disease control records, to ensure their proper use, and to ensure efficient and proper administration of the department’s disease control function, it is unlawful for any person to permit inspection of or to disclose information contained in disease control records, including results of laboratory tests, or to copy or issue a copy of all or part of any such record except as authorized by rules.

23-07-21. Penalties. [Effective through August 31, 2022]

Except as otherwise provided in this section, a person is guilty of an infraction:

1. Who violates or fails to obey any provision of this chapter, any lawful rule made by the state department of health, or any order issued by any state, district, county, or municipal health officer;
2. Who violates any quarantine law or regulation, or who leaves a quarantined area without being discharged; or
3. Who, knowing that the person is infected with a sexually transmitted disease, willfully exposes another person to infection.

Any person required to make a report under section 23-07-02.1 who releases or makes public confidential information or otherwise breaches the confidentiality requirements of section 23-07-02.2 is guilty of a class C felony.

23-07-21. Penalties. [Effective September 1, 2022]

Except as otherwise provided in this section, a person is guilty of an infraction:

1. Who violates or fails to obey any provision of this chapter, any lawful rule made by the department of health and human services, or any order issued by any state, district, county, or municipal health officer;
2. Who violates any quarantine law or regulation, or who leaves a quarantined area without being discharged; or
3. Who, knowing that the person is infected with a sexually transmitted disease, willfully exposes another person to infection.

Any person required to make a report under section 23-07-02.1 who releases or makes public confidential information or otherwise breaches the confidentiality requirements of section 23-07-02.2 is guilty of a class C felony.

23-07.1-01. Declaration of legislative intent. [Repealed]

Repealed by S.L. 2011, ch. 187, § 4.

23-07.1-01.1. Definitions. [Effective through August 31, 2022]

As used in this chapter:

1. “Appropriate facility” includes a licensed hospital, a public or private outpatient clinic, a long-term care facility, a correctional facility, or an individual’s home, and may also include directly observed therapy under the supervision of the department.
2. “Department” means the state department of health, including local public health units.
3. “Infectious tuberculosis” means tuberculosis disease in any part of the body, capable of producing infection or disease in others as demonstrated by laboratory evidence of tuberculosis bacteria in a specimen from any source in an individual’s body or by radiographic or clinical findings.
4. “Medically approved course of treatment” means ongoing monitoring for a disease, treatment regimen, or therapy prescribed by a licensed physician and approved by the department.
5. “Noninfectious tuberculosis” or “latent TB infection” means the presence of tuberculosis bacteria in the body of an individual as evidenced by testing, such as significant reaction to a tuberculin skin test or a positive interferon gamma release assay, but without any other clinical findings of illness and without the capability of producing infection or disease in others.
6. “Substantial threat to the public health” means an individual with infectious or suspect tuberculosis who has not completed a medically approved course of therapy and does not adhere or threatens to not adhere to a recommended treatment regimen or does not adhere or threatens to not adhere to infection control measures.
7. “Suspect tuberculosis” means an illness marked by symptoms and laboratory tests that may be indicative of tuberculosis, such as a prolonged cough, prolonged fever, hemoptysis, compatible roentgenographic findings, or other appropriate medical imaging findings.
8. “Tuberculosis” includes infectious tuberculosis, suspect tuberculosis, noninfectious tuberculosis, and any other case in which an individual is found to have tuberculosis based upon laboratory testing, clinical evidence, or as diagnosed by a physician, the department, or a local health officer.

23-07.1-01.1. Definitions. [Effective September 1, 2022]

As used in this chapter:

1. “Appropriate facility” includes a licensed hospital, a public or private outpatient clinic, a long-term care facility, a correctional facility, or an individual’s home, and may also include directly observed therapy under the supervision of the department.
2. “Department” means the department of health and human services, including local public health units.
3. “Infectious tuberculosis” means tuberculosis disease in any part of the body, capable of producing infection or disease in others as demonstrated by laboratory evidence of tuberculosis bacteria in a specimen from any source in an individual’s body or by radiographic or clinical findings.
4. “Medically approved course of treatment” means ongoing monitoring for a disease, treatment regimen, or therapy prescribed by a licensed physician and approved by the department.
5. “Noninfectious tuberculosis” or “latent TB infection” means the presence of tuberculosis bacteria in the body of an individual as evidenced by testing, such as significant reaction to a tuberculin skin test or a positive interferon gamma release assay, but without any other clinical findings of illness and without the capability of producing infection or disease in others.
6. “Substantial threat to the public health” means an individual with infectious or suspect tuberculosis who has not completed a medically approved course of therapy and does not adhere or threatens to not adhere to a recommended treatment regimen or does not adhere or threatens to not adhere to infection control measures.
7. “Suspect tuberculosis” means an illness marked by symptoms and laboratory tests that may be indicative of tuberculosis, such as a prolonged cough, prolonged fever, hemoptysis, compatible roentgenographic findings, or other appropriate medical imaging findings.
8. “Tuberculosis” includes infectious tuberculosis, suspect tuberculosis, noninfectious tuberculosis, and any other case in which an individual is found to have tuberculosis based upon laboratory testing, clinical evidence, or as diagnosed by a physician, the department, or a local health officer.

23-07.1-02. Care and treatment of tuberculosis patients or suspects provided without charge by state.

Care and treatment provided by the state of North Dakota for persons suffering from tuberculosis, including diagnosis, tests, studies, and analyses for the discovery of tuberculosis, must be available without cost or charge to anyone who is suffering from tuberculosis or is suspected of having tuberculosis. Any such person who volunteers to assume and pay for the cost of such care and treatment or for the cost of such diagnosis, test, studies, or analyses must be permitted to do so; but no state, county, or other public official may request or require such payment or make or cause to be made any inquiry or investigation for the purpose of determining the ability of such person or of the person’s legally responsible relatives to pay therefor. This section in no way bars freedom of the individual to seek treatment from a physician or in an institution of the individual’s choice at the individual’s own expense.

23-07.1-03. State has prior claim on patient benefits.

Notwithstanding any provision in this chapter, this state has prior claim on benefits for the care and treatment of tuberculosis, including diagnosis, tests, studies, and analyses, accruing to patients for whom care and treatment is provided by the state of North Dakota under entitlement by the federal government, medical or hospital insurance contracts, workforce safety and insurance, or the medical care and disability provisions of programs under the supervision of the department of human services.

23-07.1-04. State health officer — Designee — Responsibility. [Effective through August 31, 2022]

The state health officer or designee is responsible for the inpatient and outpatient care of persons afflicted or suspected of being afflicted with tuberculosis. If the state health officer determines that suspected or actual tuberculous patients may be adequately cared for on an inpatient basis by contract with general hospitals or other appropriate facilities, authority for contracting with such facilities is granted to the state health officer. In addition, the state health officer is authorized to establish and maintain the necessary outpatient clinics for diagnostic workup and evaluation on all suspected or actual tuberculous patients in the state. The state health officer shall pay the contract fee to general hospitals or other appropriate facilities and provide funds to the outpatient evaluation clinics from funds to be appropriated for this purpose by the legislative assembly. The state’s claim on patient benefits as provided in section 23-07.1-03 applies insofar as applicable to tuberculous patients in general hospitals and for services rendered in outpatient clinics. The state health officer or a designee has the power to:

1. Do any act necessary and proper in the performance of the functions imposed upon the state health officer by the provisions of this chapter.
2. Issue orders and compel obedience thereto.
3. Administer oaths.

23-07.1-04. State health officer — Designee — Responsibility. [Effective September 1, 2022]

The state health officer or designee is responsible for the inpatient and outpatient care of persons afflicted or suspected of being afflicted with tuberculosis. If the state health officer determines that suspected or actual tuberculous patients may be adequately cared for on an inpatient basis by contract with general hospitals or other appropriate facilities, authority for contracting with such facilities is granted to the department of health and human services. In addition, the department of health and human services is authorized to establish and maintain the necessary outpatient clinics for diagnostic workup and evaluation on all suspected or actual tuberculous patients in the state. The department of health and human services shall pay the contract fee to general hospitals or other appropriate facilities and provide funds to the outpatient evaluation clinics from funds to be appropriated for this purpose by the legislative assembly. The state’s claim on patient benefits as provided in section 23-07.1-03 applies insofar as applicable to tuberculous patients in general hospitals and for services rendered in outpatient clinics. The state health officer or a designee has the power to:

1. Do any act necessary and proper in the performance of the functions imposed upon the state health officer by the provisions of this chapter.
2. Issue orders and compel obedience thereto.
3. Administer oaths.

23-07.1-05. Reports — Orders for the custody of individuals.

1. Upon the receipt of a report that any individual is reasonably suspected to have or to have been exposed to tuberculosis, the state health officer shall investigate the matter and if the state health officer determines that the individual may have, or may have been exposed to, tuberculosis, the state health officer shall request the individual to voluntarily seek appropriate evaluation and care and a medically approved course of treatment. If the individual refuses to accept voluntary evaluation and care and a medically approved course of treatment, and the individual has infectious or suspect tuberculosis, the state health officer may order the individual or group of individuals into confinement under sections 23-07.6-02 and 23-07.6-03, and may order further isolation or quarantine as authorized under chapter 23-07.6. An order under this section may designate an appropriate facility for confinement, including the individual’s home.
2. The state health officer may immediately investigate all reported or suspected cases of tuberculosis in the state and determine the sources of those infections.
3. The state health officer may conduct screening programs of populations that are at increased risk of developing tuberculosis or having latent tuberculosis infection and offer treatment as appropriate. Any such screening program may be implemented by a local health officer with the approval of the state health officer.

23-07.1-06. Physician’s examination — Findings — Final order. [Repealed]

Repealed by S.L. 2011, ch. 187, § 4.

23-07.1-07. Sheriff’s execution of state health officer’s final order. [Repealed]

Repealed by S.L. 2011, ch. 187, § 4.

23-07.1-08. Hearing — Order. [Repealed]

Repealed by S.L. 2011, ch. 187, § 4.

23-07.1-09. Appeal to supreme court — Habeas corpus — Hearing. [Repealed]

Repealed by S.L. 2011, ch. 187, § 4.

23-07.1-10. Discharge — Release. [Repealed]

Repealed by S.L. 2011, ch. 187, § 4.

23-07.1-11. Liability of officers. [Repealed]

Repealed by S.L. 2011, ch. 187, § 4.

23-07.1-12. Confinement exception — Quarantine. [Repealed]

Repealed by S.L. 2011, ch. 187, § 4.

23-07.1-13. Indian jurisdiction.

Nothing in this chapter requires the admission of an enrolled Indian, resident on any reservation in this state, to any off-reservation institution except upon written request and authorization of the superintendent of the reservation on which said Indian is enrolled. However, in the public interest and with the objective of eradication of tuberculosis in the state of North Dakota, an Indian with tuberculosis off any reservation is subject to this chapter. It is the responsibility of the Indian affairs commission pursuant to the commission’s powers and duties, stated in section 54-36-03, to work closely with the tribal councils and other reservation officials to adopt any agreements found necessary in assisting the state health officer in carrying out responsibilities under this chapter so that all residents of this state will benefit, and eradication of tuberculosis in North Dakota can be achieved.

23-07.1-14. Care of tubercular patients — Acceptance of federal funds — General hospital. [Effective through August 31, 2022]

The state health officer, or a designee, is hereby authorized to contract with public or private agencies for the care of persons having tuberculosis. The state health officer is hereby authorized to accept any federal funds or to enter into any federal programs on behalf of persons having tuberculosis in North Dakota. The state health officer may also utilize general hospitals or other appropriate facilities in the placement of recalcitrant persons having tuberculosis.

23-07.1-14. Care of tubercular patients — Acceptance of federal funds — General hospital. [Effective September 1, 2022]

The department may contract with public or private agencies for the care of persons having tuberculosis. The department is hereby authorized to accept any federal funds or to enter into any federal programs on behalf of persons having tuberculosis in North Dakota. The department may also utilize general hospitals or other appropriate facilities in the placement of recalcitrant persons having tuberculosis.

23-07.1-15. Penalty.

1. An individual is guilty of a class A misdemeanor if:
   1. That individual fails to undertake diagnostic examination for tuberculosis upon the request of the state health officer which is based upon the reasonable suspicion that the individual has or has been exposed to tuberculosis;
   2. That individual has been diagnosed with infectious or suspect tuberculosis and fails to undertake a medically approved course of treatment for tuberculosis; or
   3. That individual is the parent of a minor or guardian of an individual who violates subdivision a or b.
2. Upon conviction, the court may order that individual to obtain a supervised medically approved course of treatment for tuberculosis until the treatment is completed, in addition to other penalties or conditions provided by law.

23-07.2-01. Definitions.

As used in this chapter, unless the context or subject matter otherwise requires:

1. “Hemophilia” means a bleeding tendency resulting from a genetically determined deficiency or abnormality of a blood plasma factor or component.
2. “State health officer” means the state health officer as defined in this title.

23-07.2-02. Blood disorder assistance program. [Effective through August 31, 2022]

The state health officer shall establish a program of financial assistance to persons suffering from hemophilia and other related congenital bleeding disorders. The program shall assist those persons to purchase the blood derivatives and supplies necessary for home care.

23-07.2-02. Blood disorder assistance program. [Effective September 1, 2022]

The department of health and human services shall establish a program of financial assistance to persons suffering from hemophilia and other related congenital bleeding disorders. The program shall assist those persons to purchase the blood derivatives and supplies necessary for home care.

23-07.2-03. Recovery from other sources. [Effective through August 31, 2022]

The state health officer may enter into agreements with third parties, including any insurer or private sources, for recovery of payments for blood products and supplies used in home care by persons participating in the program.

23-07.2-03. Recovery from other sources. [Effective September 1, 2022]

The department of health and human services may enter into agreements with third parties, including any insurer or private sources, for recovery of payments for blood products and supplies used in home care by persons participating in the program.

23-07.2-04. Rulemaking authority. [Effective through August 31, 2022]

The state health officer shall:

1. Establish a reasonable cost for blood products and supplies used in home care as a basis of reimbursement under this chapter.
2. Determine when reimbursement may not be made under this chapter for any blood products or supplies which are not purchased in compliance with regulations promulgated pursuant to this chapter. Reimbursement may not be made under this chapter for any portion of the costs of blood products or supplies which are payable under any other state or federal program or under any grant, contract, or any other contractual arrangement.
3. Define what constitutes “home care”.
4. Define what constitutes “income”, “net worth”, and “patient eligibility” for assistance.
5. Provide guidelines to determine individual liability.
6. Adopt all rules necessary to implement subsections 1 through 5 pursuant to chapter 28-32.

23-07.2-04. Rulemaking authority. [Effective September 1, 2022]

The department of health and human services shall:

1. Establish a reasonable cost for blood products and supplies used in home care as a basis of reimbursement under this chapter.
2. Determine when reimbursement may not be made under this chapter for any blood products or supplies which are not purchased in compliance with regulations promulgated pursuant to this chapter. Reimbursement may not be made under this chapter for any portion of the costs of blood products or supplies which are payable under any other state or federal program or under any grant, contract, or any other contractual arrangement.
3. Define what constitutes “home care”.
4. Define what constitutes “income”, “net worth”, and “patient eligibility” for assistance.
5. Provide guidelines to determine individual liability.
6. Adopt all rules necessary to implement subsections 1 through 5 pursuant to chapter 28-32.

23-07.4-01. Public health procedures for persons with human immunodeficiency virus infection. [Effective through August 31, 2022]

Subject to this chapter, the state health officer or a designee of the state health officer may examine or cause to be examined a person reasonably believed to be infected with or to have been exposed to the human immunodeficiency virus.

1. Orders or restrictive measures directed to a person with human immunodeficiency virus infection must be used as the last resort when other measures to protect the public health have failed, including all reasonable efforts, which must be documented, to obtain the voluntary cooperation of the person who may be subject to the order or measure. The orders and measures must be applied serially with the least intrusive measures used first. The burden of proof is on the state health officer or a designee of the state health officer to show that specified grounds exist for the issuance of the orders or restrictive measures and that the terms and conditions imposed are no more restrictive than necessary to protect the public health.
2. When the state health officer or a designee of the state health officer knows or has reason to believe, because of medical or epidemiological information, that a person within that official’s jurisdiction has human immunodeficiency virus infection and is a danger to the public health, that official may issue an order, according to the following priority, to:
   1. Require the person to be examined and tested to determine whether the person has human immunodeficiency virus infection;
   2. Require a person with human immunodeficiency virus infection to report to a qualified physician or health worker for counseling on the disease and for information on how to avoid infecting others; or
   3. Direct a person with human immunodeficiency virus infection to cease and desist from specified conduct that endangers the health of others, but only if that official has determined that clear and convincing evidence exists to believe that the person has been ordered to report for counseling as provided in subdivision b and continues to demonstrate behavior that endangers the health of others.
3. If a person violates an order issued under subdivision c of subsection 2 and it is shown that the person is a danger to others, the state health officer or a designee of the state health officer may enforce the order by imposing such restrictions upon the person as are necessary to prevent the specific conduct that endangers the health of others. Restrictions must be in writing, setting forth the name of the person to be restricted and the initial period of time, not to exceed ninety days, during which the order remains effective, the terms of the restrictions, and any other conditions as may be necessary to protect the public health. Restrictions must be imposed in the least restrictive manner necessary to protect the public health.
4. Upon issuance of any order under subsection 2 or 3, the state health officer or a designee of the state health officer shall promptly, personally, and confidentially notify the person who is the subject of the order, stating the grounds and provisions of the order and the right to contest the order, the right to be present at a judicial hearing in the district court serving the county in which the person resides to review the order, and the right to be represented by counsel during the hearing. If the person who is the subject of the order refuses to comply with the order and refuses to cooperate voluntarily with the state health officer or a designee of the state health officer, the state health officer or designee may petition the district court serving the county in which the person resides for an order of compliance. The state health officer or designee shall request the state’s attorney in the county in which the person resides to file the petition in the district court. If an order of compliance is requested, the court shall hear the matter within ten days after the request. Notice of the place, date, and time of the court hearing must be made by personal service or, if the person is not available, must be mailed to the person who is the subject of the order by certified mail at the person’s last-known address. Proof of mailing by the state health officer or designee is sufficient notice under this section. The burden of proof is on the state health officer or designee to show by clear and convincing evidence that the specified grounds exist for the issuance of the order and for the need for compliance and that the terms and conditions imposed in the order are no more restrictive than necessary to protect the public health. Upon conclusion of the hearing, the court shall issue appropriate orders affirming, modifying, or dismissing the order. If the court dismisses the order, the fact that the order was issued must be expunged from the records of the state department of health. If the court affirms or modifies the order and the person subject to the order is infected with the human immunodeficiency virus, the court shall require the person to disclose the names and addresses, if known, of persons with whom the person has had contact that poses an epidemiologically demonstrated risk of transmission of the human immunodeficiency virus. Failure to comply with court-ordered disclosure constitutes contempt of court.
5. A person who is the subject of an order authorized under this section is entitled to representation by legal counsel during any hearing to review the issuance of the order.

23-07.4-01. Public health procedures for persons with human immunodeficiency virus infection. [Effective September 1, 2022]

Subject to this chapter, the state health officer or a designee of the state health officer may examine or cause to be examined a person reasonably believed to be infected with or to have been exposed to the human immunodeficiency virus.

1. Orders or restrictive measures directed to a person with human immunodeficiency virus infection must be used as the last resort when other measures to protect the public health have failed, including all reasonable efforts, which must be documented, to obtain the voluntary cooperation of the person who may be subject to the order or measure. The orders and measures must be applied serially with the least intrusive measures used first. The burden of proof is on the state health officer or a designee of the state health officer to show that specified grounds exist for the issuance of the orders or restrictive measures and that the terms and conditions imposed are no more restrictive than necessary to protect the public health.
2. When the state health officer or a designee of the state health officer knows or has reason to believe, because of medical or epidemiological information, that a person within that official’s jurisdiction has human immunodeficiency virus infection and is a danger to the public health, that official may issue an order, according to the following priority, to:
   1. Require the person to be examined and tested to determine whether the person has human immunodeficiency virus infection;
   2. Require a person with human immunodeficiency virus infection to report to a qualified physician or health worker for counseling on the disease and for information on how to avoid infecting others; or
   3. Direct a person with human immunodeficiency virus infection to cease and desist from specified conduct that endangers the health of others, but only if that official has determined that clear and convincing evidence exists to believe that the person has been ordered to report for counseling as provided in subdivision b and continues to demonstrate behavior that endangers the health of others.
3. If a person violates an order issued under subdivision c of subsection 2 and it is shown that the person is a danger to others, the state health officer or a designee of the state health officer may enforce the order by imposing such restrictions upon the person as are necessary to prevent the specific conduct that endangers the health of others. Restrictions must be in writing, setting forth the name of the person to be restricted and the initial period of time, not to exceed ninety days, during which the order remains effective, the terms of the restrictions, and any other conditions as may be necessary to protect the public health. Restrictions must be imposed in the least restrictive manner necessary to protect the public health.
4. Upon issuance of any order under subsection 2 or 3, the state health officer or a designee of the state health officer shall promptly, personally, and confidentially notify the person who is the subject of the order, stating the grounds and provisions of the order and the right to contest the order, the right to be present at a judicial hearing in the district court serving the county in which the person resides to review the order, and the right to be represented by counsel during the hearing. If the person who is the subject of the order refuses to comply with the order and refuses to cooperate voluntarily with the state health officer or a designee of the state health officer, the state health officer or designee may petition the district court serving the county in which the person resides for an order of compliance. The state health officer or designee shall request the state’s attorney in the county in which the person resides to file the petition in the district court. If an order of compliance is requested, the court shall hear the matter within ten days after the request. Notice of the place, date, and time of the court hearing must be made by personal service or, if the person is not available, must be mailed to the person who is the subject of the order by certified mail at the person’s last-known address. Proof of mailing by the state health officer or designee is sufficient notice under this section. The burden of proof is on the state health officer or designee to show by clear and convincing evidence that the specified grounds exist for the issuance of the order and for the need for compliance and that the terms and conditions imposed in the order are no more restrictive than necessary to protect the public health. Upon conclusion of the hearing, the court shall issue appropriate orders affirming, modifying, or dismissing the order. If the court dismisses the order, the fact that the order was issued must be expunged from the records of the department of health and human services. If the court affirms or modifies the order and the person subject to the order is infected with the human immunodeficiency virus, the court shall require the person to disclose the names and addresses, if known, of persons with whom the person has had contact that poses an epidemiologically demonstrated risk of transmission of the human immunodeficiency virus. Failure to comply with court-ordered disclosure constitutes contempt of court.
5. A person who is the subject of an order authorized under this section is entitled to representation by legal counsel during any hearing to review the issuance of the order.

23-07.4-02. Emergency public health procedures. [Effective through August 31, 2022]

1. When the procedures under section 23-07.4-01 have been exhausted or cannot be satisfied and the state health officer or designee knows or has reason to believe, because of medical or epidemiological information, that a person within that official’s jurisdiction has human immunodeficiency virus infection and that the person continues to engage in behavior that presents an imminent danger to the public health, the state health officer or designee may bring an action in the district court serving the county in which the person resides to enjoin the person from engaging in or continuing to engage in such behavior. The state health officer or designee shall request the state’s attorney to file the action in district court.
2. In addition to issuance of an injunction order requested under subsection 1, the court may issue other appropriate orders including an order to take the person into custody, for a period not to exceed ninety days and place the person in a facility designated or approved by the state health officer. A custody order issued for the purpose of counseling and testing to determine whether the person has human immunodeficiency virus infection must provide for the immediate release from custody and from the facility for any person whose confirmed test results are negative and may provide for counseling or other appropriate measures to be imposed on any person whose confirmed test results are positive. The person who is the subject of the order must be given prompt, personal, and confidential notice of the order stating the grounds and provisions of the order and notifying the person of the right to contest the order, the right to be present at a judicial hearing in the district court serving the county in which the person resides to review the order, and the right to be represented by counsel during the hearing. If the person contests testing or treatment, no invasive medical procedures may be carried out before a hearing is held under subsection 3.
3. Any order issued by the district court under subsection 2 is subject to review in a court hearing. Prompt, personal, and confidential notice of the place, date, and time of the court hearing and of the person’s right to be present at the hearing and the right to representation by counsel during the hearing must be given to the person who is the subject of the court order. The hearing must be conducted by the court within forty-eight hours after the order is issued. The burden of proof is on the state health officer or designee to show by clear and convincing evidence that grounds exist for the order issued by the court under subsection 2 and that the terms and conditions imposed in the order are no more restrictive than necessary to protect the public health. Upon conclusion of the hearing, the court shall issue appropriate orders affirming, modifying, or dismissing the order. If the court dismisses the order, the fact that the order was issued must be expunged from the records of the state department of health. If the court affirms or modifies the order and the person subject to the order is infected with the human immunodeficiency virus, the court shall require the person to disclose the names and addresses, if known, of persons with whom the person subject to the order has had contact that poses an epidemiologically demonstrated risk of transmission of the human immunodeficiency virus. Failure to comply with court-ordered disclosure constitutes contempt of court.
4. A person who is the subject of an order authorized under this section is entitled to representation by legal counsel during any hearing to review the issuance of the order.

23-07.4-02. Emergency public health procedures. [Effective September 1, 2022]

1. When the procedures under section 23-07.4-01 have been exhausted or cannot be satisfied and the state health officer or designee knows or has reason to believe, because of medical or epidemiological information, that a person within that official’s jurisdiction has human immunodeficiency virus infection and that the person continues to engage in behavior that presents an imminent danger to the public health, the state health officer or designee may bring an action in the district court serving the county in which the person resides to enjoin the person from engaging in or continuing to engage in such behavior. The state health officer or designee shall request the state’s attorney to file the action in district court.
2. In addition to issuance of an injunction order requested under subsection 1, the court may issue other appropriate orders including an order to take the person into custody, for a period not to exceed ninety days and place the person in a facility designated or approved by the state health officer. A custody order issued for the purpose of counseling and testing to determine whether the person has human immunodeficiency virus infection must provide for the immediate release from custody and from the facility for any person whose confirmed test results are negative and may provide for counseling or other appropriate measures to be imposed on any person whose confirmed test results are positive. The person who is the subject of the order must be given prompt, personal, and confidential notice of the order stating the grounds and provisions of the order and notifying the person of the right to contest the order, the right to be present at a judicial hearing in the district court serving the county in which the person resides to review the order, and the right to be represented by counsel during the hearing. If the person contests testing or treatment, no invasive medical procedures may be carried out before a hearing is held under subsection 3.
3. Any order issued by the district court under subsection 2 is subject to review in a court hearing. Prompt, personal, and confidential notice of the place, date, and time of the court hearing and of the person’s right to be present at the hearing and the right to representation by counsel during the hearing must be given to the person who is the subject of the court order. The hearing must be conducted by the court within forty-eight hours after the order is issued. The burden of proof is on the state health officer or designee to show by clear and convincing evidence that grounds exist for the order issued by the court under subsection 2 and that the terms and conditions imposed in the order are no more restrictive than necessary to protect the public health. Upon conclusion of the hearing, the court shall issue appropriate orders affirming, modifying, or dismissing the order. If the court dismisses the order, the fact that the order was issued must be expunged from the records of the department of health and human services. If the court affirms or modifies the order and the person subject to the order is infected with the human immunodeficiency virus, the court shall require the person to disclose the names and addresses, if known, of persons with whom the person subject to the order has had contact that poses an epidemiologically demonstrated risk of transmission of the human immunodeficiency virus. Failure to comply with court-ordered disclosure constitutes contempt of court.
4. A person who is the subject of an order authorized under this section is entitled to representation by legal counsel during any hearing to review the issuance of the order.

23-07.4-03. Closed hearing — Confidentiality of information.

A hearing conducted under this chapter must be closed and any report, transcript, record, or other information relating to actions taken under this chapter is confidential.

23-07.5-01. Definitions.

In this chapter, unless the context otherwise requires:

1. “Bloodborne pathogen” means a micro-organism that is present in human blood or in other bodily fluid or tissue which can cause a disease in humans, including the hepatitis B virus, the hepatitis C virus, and the human immunodeficiency virus, and for which testing is recommended by the United States public health service.
2. “Exposed individual” means an individual, including a patient, health care provider, firefighter, peace officer, correctional officer, court officer, law enforcement officer, emergency medical technician, laboratory personnel, or an individual trained and authorized by law or rule to render emergency medical assistance or treatment, including an individual rendering aid under chapter 32-03.1, who is exposed to a bloodborne pathogen.
3. “Exposure” means a percutaneous injury, including a needle stick or cut with a sharp object; contact with blood, bodily fluid, or tissue of a mucous membrane or nonintact skin, including exposed skin that is chapped, abraded, or afflicted with dermatitis; or contact with other bodily fluids that are potentially infectious as determined under guidelines of the United States public health service.
4. “Health care” means any services included in the furnishing to an individual of hospitalization, or medical or dental care, or any services incident to the furnishing of that care or hospitalization, as well as the furnishing to an individual of any other services for the purpose of preventing, alleviating, curing, or healing human illness or injury.
5. “Health care provider” means an individual licensed, certified, or otherwise authorized by the law of this state to provide health care and includes personnel at the state crime laboratory or any commercial or research laboratory that handles blood, bodily fluid, or tissues.
6. “Informed consent for testing” means that the individual to be tested for bloodborne pathogens has been informed of the nature of the testing; the reason for the testing; the relevant risks, benefits, and potential alternatives for testing; and the individual has granted permission to be tested.
7. “Personal representative” means any person who has authority under law to act on behalf of an individual or deceased individual in making decisions related to health care or health information.
8. “Test subject” means the individual who is the source of the blood, other bodily fluids, or tissue that caused the exposure.

23-07.5-02. Informed consent for testing — Exception.

1. Except when testing is otherwise permitted by law, a health care provider, blood bank, blood center, or plasma center may not subject an individual who is the source of an exposure to a test for bloodborne pathogens unless the subject of the test or the subject’s personal representative if the subject is a minor or is incapacitated first provides informed consent for testing.
2. If an individual who is the source of an exposure has had blood drawn that is available for testing and the individual has refused to grant consent to have that individual’s blood tested for bloodborne pathogens, that individual’s blood may be subjected to a test for the presence of bloodborne pathogens, without that individual’s consent, if a physician or other qualified health care provider based on available information determines and certifies in writing that the individual had an exposure and before testing the test subject is informed that the test subject’s blood may be tested for the presence of bloodborne pathogens; that the test results may not be disclosed without the test subject’s authorization, except to the exposed individual, the individual’s health care provider, and any other person as authorized by law; that if the exposed individual knows the identity of the test subject, the exposed individual may not disclose the identity of the test subject except for the purpose of having the test performed; and that a record of the test results may be kept in the exposed individual’s medical record only if the record does not reveal the test subject’s identity. Each exposed individual who had an exposure and to whom test results are disclosed must first be given a document indicating the exposed individual’s understanding that the exposed individual may not disclose the test subject’s identity and that disclosing this information constitutes a class C felony.
3. If an individual who is the subject of an exposure is incapable of giving informed consent for testing under this section, that consent may be obtained from the individual’s personal representative. If an individual who is the subject of an exposure dies without an opportunity to consent to testing, collection of appropriate specimens and testing for the presence of bloodborne pathogens must be conducted as soon as reasonably possible. Results of these tests must be provided to the physician providing care for the individual who experienced the exposure. If a facility that received the individual who died fails to test for the presence of bloodborne pathogens as required under this subsection because the facility was not aware of the exposure or it was not reasonably possible to conduct testing, the facility shall provide the physician providing care for the exposed individual or health care provider testing results of any bloodborne pathogen present in any medical records of the deceased individual which are in the facility’s control as soon as reasonably possible. If there are no testing results for bloodborne pathogens within that facility and there is reason to believe that results are available from another facility, the facility that received the deceased individual shall attempt to obtain testing results of bloodborne pathogens of the deceased individual as soon as reasonably possible from the facility where it is believed results exist. The test results must be provided to the physician providing care for the individual who experienced the exposure.
4. A test for bloodborne pathogens must be conducted according to recommendations of the United States public health service. Any testing done pursuant to subsection 2 or 3 must be conducted in a reasonably expedient manner. The district court in the county where the alleged exposure occurred or in which the individual to be tested resides shall issue an order directing the individual who was the source of an exposure to have blood drawn to be tested for bloodborne pathogens. An affidavit from a physician or other qualified health care provider showing that an exposure has occurred is prima facie evidence of those facts. The affidavit may not be excluded as hearsay if the affidavit is based on evidence generally relied on by a health care provider, including statements from the provider’s patient. The record of any court hearing conducted under this subsection is confidential. The court shall issue an order requiring testing under this subsection if:
   1. The court finds probable cause to believe that the individual petitioning for the testing had an exposure with the test subject;
   2. The petition substitutes a pseudonym for the true name of the test subject;
   3. The court provides the test subject with notice and reasonable opportunity to participate in the proceeding if the person is not already a party to the proceeding;
   4. The proceedings are conducted in camera; and
   5. The court imposes appropriate safeguards against unauthorized disclosure which must specify the individuals who have access to the information, the purposes for which the information may be used, and appropriate prohibition on future disclosure.
5. If the court issues an order for testing, the court may order the confinement of the test subject until blood is drawn for testing or issue an order establishing reasonable security for the individual’s attendance at the test site. This order may be modified or extended.
6. A health care provider who subjects an individual to an exposure must notify the individual of the exposure. A health care provider witnessing an exposure may report the exposure pursuant to any appropriate facility or employer guidelines to which the provider may be subject. The knowing failure to inform an individual of an exposure or refusal to submit to testing as required under this chapter may be considered by a health care provider’s licensing board to constitute conduct that may subject the licensee to disciplinary action.
7. The exposed individual shall pay the expense of testing. However, if the exposure occurs at an employee’s workplace, the worker’s employer shall pay the expense of testing unless otherwise provided by subdivision b of subsection 11 of section 65-01-02. If the individual to be tested is convicted of a crime relating to the exposure or the exposure occurred during an arrest or other contact with the exposed individual in the course of that individual’s official duties, a court may order the individual to be tested to pay for the testing.

23-07.5-03. Written consent to disclosure. [Repealed]

Repealed by S.L. 2003, ch. 211, § 27.

23-07.5-04. Record maintenance.

A health care provider who collects a specimen of body fluids or tissues for the purpose of testing for the presence of bloodborne pathogens caused by an exposure shall obtain from the test subject or the test subject’s personal representative if the subject is a minor or is incapacitated, informed consent for testing unless testing is otherwise authorized by law. In addition, the health care provider shall maintain a record of the test results obtained.

23-07.5-05. Confidentiality of test results. [Repealed]

Repealed by S.L. 2003, ch. 211, § 27.

23-07.5-06. Expanded disclosure of test results prohibited.

1. The results of a test for bloodborne pathogens may be disclosed only to the individual who was tested; to an exposed individual for whom a test was conducted; and to the exposed individual’s health care provider as provided by this chapter, and as permitted under title 45, Code of Federal Regulations, part 164, section 512.
2. An exposed individual to whom the results of a test for bloodborne pathogens have been disclosed under this chapter may not disclose the test results except as permitted under subsection 3, or as otherwise authorized by law.
3. If the test results are disclosed under this chapter to a law enforcement officer who was exposed to a bloodborne pathogen, the officer may disclose the test results to any other law enforcement officer who has direct physical contact with the test subject, if in the professional judgment of the officer the disclosure is necessary for the health and safety of the other officer and the disclosure is limited to the minimum amount of information needed to protect the health and safety of that officer.

23-07.5-07. Civil liability.

An individual who knowingly violates section 23-07.5-06 is liable to the subject of the test for actual damages and costs plus exemplary damages. A conviction for violation of this chapter is not a condition precedent to bringing an action under this section.

23-07.5-08. Penalty.

A person who knowingly discloses the results of a blood test in violation of this chapter is guilty of a class C felony, if the offense is committed with intent to disclose the identity of the individual who was tested.

23-07.6-01. Definitions.

As used in this chapter, unless the context otherwise requires:

1. “Communicable disease” means a disease or condition that causes serious illness, serious disability, or death, the infectious agent of which may pass or be carried, directly or indirectly, from the body of one person to the body of another.
2. “Confinement” means quarantine or isolation.
3. “Isolation” means the physical separation and restrictions on movement or travel of an individual or groups of individuals who are infected or reasonably believed to be infected with a contagious or possibly contagious disease from nonisolated individuals, to prevent or limit the transmission of the disease to nonisolated individuals.
4. “Local board” means a board of health as defined under section 23-35-01.
5. “Local health officer” means the health officer of a local board.
6. “Quarantine” means the physical separation and restrictions on movement or travel of an individual or groups of individuals, who are or may have been exposed to a contagious or possibly contagious disease and who do not show signs or symptoms of a contagious disease, from nonquarantined individuals to prevent or limit the transmission of the disease to nonquarantined individuals.
7. “Respondent” means the person or group of persons ordered to be confined or restricted under this chapter.

23-07.6-02. Confinement order — Penalty.

1. The state health officer or any local health officer may order any person or group into confinement by a written directive if there are reasonable grounds to believe that the person or group is infected with any communicable disease, the state health officer or local health officer determines that the person or group poses a substantial threat to the public health, and confinement is necessary and is the least restrictive alternative to protect or preserve the public health.
2. Conditions and principles. The state or local health officer shall adhere to the following conditions and principles when isolating or quarantining individuals or groups of individuals:
   1. Isolation and quarantine must be by the least restrictive means necessary to prevent the spread of a contagious or possibly contagious disease to others and may include confinement to private homes or other private and public premises.
   2. Isolated individuals must be confined separately from quarantined individuals.
   3. The health status of isolated and quarantined individuals must be monitored regularly to determine if they require isolation or quarantine.
   4. If a quarantined individual subsequently becomes infected or is reasonably believed to have become infected with a contagious or possibly contagious disease the individual must promptly be removed to isolation.
   5. Isolated and quarantined individuals must be immediately released when they pose no substantial risk of transmitting a contagious or possibly contagious disease to others.
   6. The needs of persons isolated and quarantined must be addressed in a systematic and competent fashion, including providing adequate food, clothing, shelter, means of communication with those in isolation or quarantine and outside these settings, medication, and competent medical care.
   7. Premises used for isolation and quarantine must be maintained in a safe and hygienic manner and be designed to minimize the likelihood of further transmission of infection or other harm to persons isolated and quarantined.
   8. To the extent possible, cultural and religious beliefs must be considered in addressing the needs of individuals and establishing and maintaining isolation and quarantine premises.
3. Cooperation. Persons subject to isolation or quarantine shall obey the health officer’s rules and orders and must not go beyond the isolation or quarantine premises. Failure to obey these provisions is a class B misdemeanor.
4. Entry into isolation or quarantine premises.
   1. Authorized entry. The state or local health officer may authorize physicians, health care workers, or others access to individuals in isolation or quarantine as necessary to meet the needs of isolated or quarantined individuals.
   2. Unauthorized entry. A person, other than a person authorized by the state or local health officer, must not enter isolation or quarantine premises. Failure to obey this provision is a class B misdemeanor.
   3. Potential isolation or quarantine. A person entering an isolation or quarantine premises with or without authorization of the state or local health officer may be isolated or quarantined pursuant to subsection 1.
5. This section does not authorize the state health officer or a local public health officer to commandeer, in whole or in part, any hospital or other medical facility.

23-07.6-03. Procedures for isolation and quarantine.

The isolation and quarantine of an individual or groups of individuals shall be undertaken in accordance with the following procedures:

1. Temporary isolation and quarantine without notice.
   1. Authorization. The state or a local health officer, within that officer’s jurisdiction, may temporarily isolate or quarantine an individual or groups of individuals through a written directive if delay in imposing the isolation or quarantine would significantly jeopardize the health officer’s ability to prevent or limit the transmission of a contagious or possibly contagious disease to others.
   2. Content of directive. The written directive must specify the identity of the individual or groups of individuals subject to isolation or quarantine, including identification by characteristics if actual identification is impossible or impracticable; the premises subject to isolation or quarantine; the date and time at which isolation or quarantine commences; the suspected contagious disease if known; and decontamination, treatment, or prevention measures that must be followed. The directive must be accompanied by a copy of this chapter and relevant definitions.
   3. Copies. A copy of the written directive must be given to the individual to be isolated or quarantined or, if the order applies to a group of individuals and it is impractical to provide individual copies, it may be posted in a conspicuous place in the isolation or quarantine premises. The state or local health officer may also use any available mass media, including broadcasting, to provide notice and information about the written directive.
   4. Petition for continued isolation or quarantine. Within ten days after issuing the written directive, the state or local health officer shall file a petition under subsection 2 for a court order authorizing the continued isolation or quarantine of the isolated or quarantined individual or groups of individuals.
2. Isolation or quarantine with notice.
   1. Authorization. The state or a local health officer may make a written petition to the trial court for an order authorizing the isolation or quarantine of an individual or groups of individuals.
   2. Content of petition. A petition under subdivision a must specify the identity of the individual or groups of individuals subject to isolation or quarantine, including identification by characteristics if actual identification is impossible or impractical; the premises subject to isolation or quarantine; the date and time at which isolation or quarantine commences; the suspected contagious disease if known; recommended decontamination, treatment, or preventative measures for the suspected contagious disease; a statement of compliance with the conditions and principles authorizing isolation and quarantine under this chapter; and a statement of the basis upon which isolation or quarantine is justified in compliance with this chapter. The petition must be accompanied by the sworn affidavit of the state or local health officer attesting to the facts asserted in the petition, with any further information that may be relevant and material to the court’s consideration.
   3. Notice. Notice to the individuals or groups of individuals identified in the petition must be accomplished within twenty-four hours in accordance with the North Dakota Rules of Civil Procedure. The notice must include a statement that the respondent has the right to counsel, including counsel provided at public expense if indigent and must include a copy of this chapter.

23-07.6-04. Place of confinement. [Effective through August 31, 2022]

A respondent must be confined in a place designated in the written directive until the health officer who issued the written directive determines that the respondent no longer poses a substantial threat to the public health or until a court of competent jurisdiction orders the release of the respondent. The state department of health or the local board may establish and maintain places of confinement.

23-07.6-04. Place of confinement. [Effective September 1, 2022]

A respondent must be confined in a place designated in the written directive until the health officer who issued the written directive determines that the respondent no longer poses a substantial threat to the public health or until a court of competent jurisdiction orders the release of the respondent. The department of health and human services or the local board may establish and maintain places of confinement.

23-07.6-05. Court hearing.

A hearing must be held on a petition filed under subsection 2 of section 23-07.6-03 within five days of filing the petition. For a good cause shown, the court may continue the hearing for up to ten days. A respondent has the right to a court hearing in the district court serving the county in which the respondent resides. A record of the proceedings pursuant to this section must be made and retained. If parties cannot personally appear before the court due to risks of contamination or the spread of disease, proceedings may be conducted by their authorized representatives and be held via any means that allows all parties to fully participate. The respondent has a right to counsel and if the respondent is indigent, the respondent has the right to have counsel provided at public expense. The respondent, respondent’s representative, or respondent’s counsel has the right to cross-examine witnesses testifying at the hearing. A petition for a hearing does not stay a written directive ordering confinement. The court shall determine by a preponderance of the evidence if the respondent is infected with a communicable disease, if the respondent poses a substantial threat to the public health, and if confinement is necessary and is the least restrictive alternative to protect or preserve the public health. The court shall also determine whether to order the respondent to follow the state or local health officer’s directive for decontamination, treatment, or preventative measures if the petition is granted. If the written directive was issued by a local health officer, the state health officer has the right to be made a party to the proceedings.

23-07.6-06. Notice of hearing.

Notice of the hearing must be given to the respondent and must inform the respondent of the respondent’s right to counsel or counsel at public expense under this chapter and must include a copy of this chapter.

23-07.6-07. Access to records.

Before a hearing conducted under this chapter, the respondent, respondent’s representative, or respondent’s counsel, and the attorney for the state or local health officer must be afforded access to all records including hospital records if the respondent is hospitalized. If the respondent is hospitalized at the time of the hearing, the hospital shall make available at the hearing for use by the respondent, respondent’s representative, respondent’s counsel, and the attorney for the state or local health officer all records in its possession relating to the conditions of the respondent.

23-07.6-08. Burden of proof.

At a hearing conducted under this chapter, the health officer who ordered confinement has the burden of showing by a preponderance of the evidence that the respondent is infected with a communicable disease, poses a substantial threat to the public health, and that confinement of the respondent is necessary and is the least restrictive alternative to protect or preserve the public health.

23-07.6-09. Court findings and orders.

If the court finds by a preponderance of the evidence that the respondent is infected with a communicable disease, poses a substantial threat to the public health, and that confinement of the respondent is necessary and is the least restrictive alternative to protect or preserve the public health, the court may order the continued confinement of the respondent under any conditions and restrictions the court determines appropriate for decontamination, treatment, or prevention, including remand to the health officer that petitioned the court or issued the original directive, until the health officer that issued the original written directive for confinement determines that the respondent’s release would not constitute a substantial threat to the public health, or may order the release of the respondent under any conditions and restrictions the court determines appropriate to protect the public health. If the court fails to find that the conditions required for an order for confinement have been proven, the court shall order the immediate release of the respondent.

23-07.6-10. Request to terminate or modify an order — Review of confinement orders.

A respondent may, at any time, request the court to terminate or modify an order of the court, in which case a hearing must be held in accordance with this chapter. Upon its own motion, the court may conduct a hearing to determine if the conditions requiring the confinement or restriction of the respondent continue to exist. Notice of at least five days, but no more than ten business days, must be provided to all parties to the hearing under this section. If the court, at a hearing held upon motion of the respondent or its own motion, finds that the conditions requiring confinement or restriction no longer exist, the court shall order the immediate release of the respondent. If the court finds that the conditions continue to exist but that a different remedy is appropriate under this chapter, the court may modify its order accordingly.

23-07.6-11. Closed hearing — Confidentiality of information.

At the request of the respondent, a hearing conducted under this chapter must be closed and any report, transcript, record, or other information relating to actions taken under this chapter must be kept confidential. Deidentified information may be released to the public under chapter 23-01.3.

23-07.6-12. Right of appeal.

Any party aggrieved by an order of the district court under this section may appeal to the supreme court. An order of confinement continues in effect while the matter is on appeal.

23-07.7-01. Court-ordered sexual offense medical testing.

1. The court may order any defendant charged with a sex offense under chapter 12.1-20 and any alleged juvenile offender with respect to whom a petition has been filed in a juvenile court alleging violation of chapter 12.1-20 to undergo medical testing to determine whether the defendant or alleged juvenile offender has any sexually transmitted diseases, including a test for infection with the human immunodeficiency virus or any other identified positive agent of acquired immunodeficiency syndrome. The court may not order a defendant charged with violating section 12.1-20-12.1 or 12.1-20-13 or an alleged juvenile offender with respect to when a petition has been filed in a juvenile court alleging violation of section 12.1-20-12.1 or 12.1-20-13 to undergo the testing authorized by this section. The court may order the testing only if the court receives a petition from the alleged victim of the offense or from the prosecuting attorney if the alleged victim has made a written request to the prosecuting attorney to petition the court for an order authorized under this section. On receipt of a petition, the court shall determine, without a hearing, if probable cause exists to believe that a possible transfer of a sexually transmitted disease or human immunodeficiency virus took place between the defendant or alleged juvenile offender and the alleged victim. If the court determines probable cause exists, the court shall order the defendant or alleged juvenile offender to submit to testing and that a copy of the test results be released to the defendant’s or alleged juvenile offender’s physician and each requesting victim’s physician.
2. If a defendant is charged with a sexual offense under chapter 12.1-20 in which the alleged victim is compelled by force or threat to engage in sexual activity or sexual contact, the prosecuting attorney shall inform the alleged victim that the alleged victim may request that a test for infection with the human immunodeficiency virus or any other identified agent of acquired immunodeficiency syndrome be administered to the defendant. If the alleged victim requests that the test be administered, the prosecuting attorney shall notify the court. The court shall order that the test be administered within forty-eight hours after the date the complaint or information is filed or after the defendant’s initial appearance.
3. If a test is ordered under subsection 1 or 2, the physicians for the defendant or alleged juvenile offender and requesting alleged victim must be specifically named in the court order, and the court order must be served on the physicians before any test.

23-07.7-02. Testing procedures — Results of test — Penalty. [Effective through August 31, 2022]

1. If testing is ordered by a court under section 23-07.7-01, only a health care provider, blood bank, blood center, or plasma center may obtain a specimen of bodily fluids or tissues for the purpose of testing.
2. The court shall order that the specimen be transmitted to a licensed medical laboratory and that tests be conducted for medically accepted indications of exposure to or infection by acquired immunodeficiency syndrome virus, acquired immunodeficiency syndrome-related conditions, and sexually transmitted diseases for which medically approved testing is readily and economically available as determined by the court.
3. The laboratory shall send a copy of the test results to the physicians designated in the court order, who shall then release the test results to the defendant or alleged juvenile offender and each requesting victim as designated in the court order. The court order must be served on the physicians before any test. The laboratory also shall send a copy of test results that indicate exposure to or infection by acquired immunodeficiency syndrome virus, acquired immunodeficiency syndrome-related conditions, or other sexually transmitted diseases to the state department of health.
4. Every copy of the test results must include the following disclaimer:
5. The court shall order all persons, other than the test subject, who receive test results pursuant to section 23-07.7-01, to maintain the confidentiality of personal identifying data relating to the test results except for disclosure that may be necessary to obtain medical or psychological care or advice. A person who intentionally discloses the results of any test in violation of this subsection and thereby causes bodily or psychological harm to the subject of the test is guilty of a class C felony.
6. The specimens and the results of tests ordered pursuant to section 23-07.7-01 are not admissible evidence in any civil, criminal, or juvenile proceeding.
7. Any person who performs testing, transmits test results, or discloses information pursuant to this chapter is immune from civil liability for any action undertaken in accordance with this chapter, except for an act or omission that constitutes gross negligence.
8. The county in which the alleged violation of chapter 12.1-20 occurred shall pay for the testing. A defendant who is convicted of the offense shall reimburse the county for the costs of testing.

The testing was conducted in a medically approved manner, but tests cannot determine exposure to or infection by acquired immunodeficiency syndrome or other sexually transmitted diseases with absolute accuracy. Anyone receiving this test result should continue to monitor their own health and should consult a physician as appropriate.

23-07.7-02. Testing procedures — Results of test — Penalty. [Effective September 1, 2022]

1. If testing is ordered by a court under section 23-07.7-01, only a health care provider, blood bank, blood center, or plasma center may obtain a specimen of bodily fluids or tissues for the purpose of testing.
2. The court shall order that the specimen be transmitted to a licensed medical laboratory and that tests be conducted for medically accepted indications of exposure to or infection by acquired immunodeficiency syndrome virus, acquired immunodeficiency syndrome-related conditions, and sexually transmitted diseases for which medically approved testing is readily and economically available as determined by the court.
3. The laboratory shall send a copy of the test results to the physicians designated in the court order, who shall then release the test results to the defendant or alleged juvenile offender and each requesting victim as designated in the court order. The court order must be served on the physicians before any test. The laboratory also shall send a copy of test results that indicate exposure to or infection by acquired immunodeficiency syndrome virus, acquired immunodeficiency syndrome-related conditions, or other sexually transmitted diseases to the department of health and human services.
4. Every copy of the test results must include the following disclaimer:
5. The court shall order all persons, other than the test subject, who receive test results pursuant to section 23-07.7-01, to maintain the confidentiality of personal identifying data relating to the test results except for disclosure that may be necessary to obtain medical or psychological care or advice. A person who intentionally discloses the results of any test in violation of this subsection and thereby causes bodily or psychological harm to the subject of the test is guilty of a class C felony.
6. The specimens and the results of tests ordered pursuant to section 23-07.7-01 are not admissible evidence in any civil, criminal, or juvenile proceeding.
7. Any person who performs testing, transmits test results, or discloses information pursuant to this chapter is immune from civil liability for any action undertaken in accordance with this chapter, except for an act or omission that constitutes gross negligence.
8. The county in which the alleged violation of chapter 12.1-20 occurred shall pay for the testing. A defendant who is convicted of the offense shall reimburse the county for the costs of testing.

The testing was conducted in a medically approved manner, but tests cannot determine exposure to or infection by acquired immunodeficiency syndrome or other sexually transmitted diseases with absolute accuracy. Anyone receiving this test result should continue to monitor their own health and should consult a physician as appropriate.

23-09-01. Definitions. [Effective through August 31, 2022]

In this chapter, unless the context otherwise requires:

1. “Assisted living facility” means a building or structure containing a series of at least five living units operated as one entity to provide services for five or more individuals who are not related by blood, marriage, or guardianship to the owner or manager of the entity and which is kept, used, maintained, advertised, or held out to the public as a place that provides or coordinates individualized support services to accommodate the individual’s needs and abilities to maintain as much independence as possible. An assisted living facility in this chapter includes a facility that is defined as an assisted living facility in any other part of the code. An assisted living facility does not include a facility that is a congregate housing facility, licensed as a basic care facility, or licensed under chapter 23-16, chapter 23-17.7, chapter 25-16, or section 50-11-01.4.
2. “Bakery” means an establishment or any part of an establishment that manufactures or prepares bread or bread products, pies, cakes, cookies, crackers, doughnuts, or other similar products, or candy, whether plain; chocolate or chocolate coated; mixed with nuts, fruits, or other fillers; covered with chocolate or other coating; and shaped, molded, or formed in various shapes. The term does not include food service establishments nor home cake decorators.
3. “Commissary” means a catering establishment, restaurant, or any other place in which food, containers, or supplies are kept, handled, prepared, packaged, or stored, including a service center or base of operations directly from which mobile food units are supplied or serviced. The term does not include an area or conveyance at a vending machine location used for the temporary storage of packaged food or beverages.
4. “Department” means the state department of health.
5. “Food establishment” means any fixed restaurant, limited restaurant, coffee shop, cafeteria, short-order cafe, luncheonette, grill, tearoom, sandwich shop, soda fountain, tavern, bar, catering kitchen, delicatessen, bakery, grocery store, meat market, food processing plant, school, child care, or similar place in which food or drink is prepared for sale or service to the public on the premises or elsewhere with or without charge.
6. “Food processing plant” means a commercial operation that manufactures, packages, labels, or stores food for human consumption and does not provide food directly to a consumer.
7. “Limited restaurant” means a food service establishment that is restricted to a specific menu as determined by the department or an establishment serving only prepackaged foods, such as frozen pizza and sandwiches, which receive no more than heat treatment and are served directly in the package or on single-serve articles.
8. “Lodging establishment” includes every building or structure, or any part thereof, which is kept, used, maintained, or held out to the public as a place where sleeping accommodations are furnished for pay to transient guests. The term does not include a facility providing personal care services directly or through contract services as defined in section 23-09.3-01 or 50-32-01.
9. “Mobile food unit” means a vehicle-mounted food service establishment designed to be readily movable.
10. “Proprietor” includes the person in charge of a food establishment, lodging establishment, or assisted living facility, whether as owner, lessee, manager, or agent.
11. “Pushcart” means a non-self-propelled vehicle limited to serving nonpotentially hazardous food or commissary-wrapped food maintained at proper temperatures.
12. “Restaurant” includes every building or other structure, or any part thereof, and all buildings in connection therewith, that are permanently kept, used, maintained, advertised, or held out to the public as a place where meals or lunches are served, but where sleeping accommodations are not furnished. The term includes a limited restaurant restricted to a specified menu.
13. “Retail food store” means any establishment or section of an establishment where food and food products are offered to the consumer and intended for offpremise consumption. The term includes a delicatessen that offers prepared food in bulk quantities only. The term does not include an establishment that handles only prepackaged nonpotentially hazardous foods, roadside market that offers only fresh fruits and vegetables for sale, food service establishment, or food and beverage vending machine.
14. “Retail meat market” means a commercial establishment and buildings or structures connected with it, used to process, store, or display meat or meat products for retail sale to the public for human consumption. The term does not include a meat establishment operating under the federal or state meat inspection program.
15. “Salvage processing facility” means an establishment engaged in the business of reconditioning or by other means salvaging distressed merchandise for human consumption or use.
16. “Temporary food service establishment” means any food service establishment that operates at a fixed location for not more than fourteen consecutive days. The term does not include a nonprofit public-spirited organization or person providing a limited type of food service as defined in chapter 23-09.2.

23-09-01. Definitions. [Effective September 1, 2022]

In this chapter, unless the context otherwise requires:

1. “Assisted living facility” means a building or structure containing a series of at least five living units operated as one entity to provide services for five or more individuals who are not related by blood, marriage, or guardianship to the owner or manager of the entity and which is kept, used, maintained, advertised, or held out to the public as a place that provides or coordinates individualized support services to accommodate the individual’s needs and abilities to maintain as much independence as possible. An assisted living facility in this chapter includes a facility that is defined as an assisted living facility in any other part of the code. An assisted living facility does not include a facility that is a congregate housing facility, licensed as a basic care facility, or licensed under chapter 23-16, chapter 23-17.7, chapter 25-16, or section 50-11-01.4.
2. “Bakery” means an establishment or any part of an establishment that manufactures or prepares bread or bread products, pies, cakes, cookies, crackers, doughnuts, or other similar products, or candy, whether plain; chocolate or chocolate coated; mixed with nuts, fruits, or other fillers; covered with chocolate or other coating; and shaped, molded, or formed in various shapes. The term does not include food service establishments nor home cake decorators.
3. “Commissary” means a catering establishment, restaurant, or any other place in which food, containers, or supplies are kept, handled, prepared, packaged, or stored, including a service center or base of operations directly from which mobile food units are supplied or serviced. The term does not include an area or conveyance at a vending machine location used for the temporary storage of packaged food or beverages.
4. “Department” means the department of health and human services.
5. “Food establishment” means any fixed restaurant, limited restaurant, coffee shop, cafeteria, short-order cafe, luncheonette, grill, tearoom, sandwich shop, soda fountain, tavern, bar, catering kitchen, delicatessen, bakery, grocery store, meat market, food processing plant, school, child care, or similar place in which food or drink is prepared for sale or service to the public on the premises or elsewhere with or without charge.
6. “Food processing plant” means a commercial operation that manufactures, packages, labels, or stores food for human consumption and does not provide food directly to a consumer.
7. “Limited restaurant” means a food service establishment that is restricted to a specific menu as determined by the department or an establishment serving only prepackaged foods, such as frozen pizza and sandwiches, which receive no more than heat treatment and are served directly in the package or on single-serve articles.
8. “Lodging establishment” includes every building or structure, or any part thereof, which is kept, used, maintained, or held out to the public as a place where sleeping accommodations are furnished for pay to transient guests. The term does not include a facility providing personal care services directly or through contract services as defined in section 23-09.3-01 or 50-32-01.
9. “Mobile food unit” means a vehicle-mounted food service establishment designed to be readily movable.
10. “Proprietor” includes the person in charge of a food establishment, lodging establishment, or assisted living facility, whether as owner, lessee, manager, or agent.
11. “Pushcart” means a non-self-propelled vehicle limited to serving nonpotentially hazardous food or commissary-wrapped food maintained at proper temperatures.
12. “Restaurant” includes every building or other structure, or any part thereof, and all buildings in connection therewith, that are permanently kept, used, maintained, advertised, or held out to the public as a place where meals or lunches are served, but where sleeping accommodations are not furnished. The term includes a limited restaurant restricted to a specified menu.
13. “Retail food store” means any establishment or section of an establishment where food and food products are offered to the consumer and intended for offpremise consumption. The term includes a delicatessen that offers prepared food in bulk quantities only. The term does not include an establishment that handles only prepackaged nonpotentially hazardous foods, roadside market that offers only fresh fruits and vegetables for sale, food service establishment, or food and beverage vending machine.
14. “Retail meat market” means a commercial establishment and buildings or structures connected with it, used to process, store, or display meat or meat products for retail sale to the public for human consumption. The term does not include a meat establishment operating under the federal or state meat inspection program.
15. “Salvage processing facility” means an establishment engaged in the business of reconditioning or by other means salvaging distressed merchandise for human consumption or use.
16. “Temporary food service establishment” means any food service establishment that operates at a fixed location for not more than fourteen consecutive days. The term does not include a nonprofit public-spirited organization or person providing a limited type of food service as defined in chapter 23-09.2.

23-09-02. State department of health to enforce provisions of chapter. [Effective through August 31, 2022]

The department shall enforce the provisions of this chapter. Under no circumstances may any other state agency adopt rules that relate in any way to the provisions of this chapter.

23-09-02. Department to enforce provisions of chapter. [Effective September 1, 2022]

The department shall enforce the provisions of this chapter. Under no circumstances may any other state agency adopt rules that relate in any way to the provisions of this chapter.

23-09-02.1. Smoke detection devices or other approved alarm systems — Administrative procedure and judicial review.

Each lodging establishment and assisted living facility shall install smoke detection devices or other approved alarm systems of a type and in the number approved by the department, in cooperation with the state fire marshal. The department, in cooperation with the state fire marshal, shall adopt reasonable rules governing the spacing and minimum specifications for approved smoke detection devices or other approved alarm systems. The department and state fire marshal shall provide all reasonable assistance required in complying with the provisions of this section.

23-09-03. Exiting requirements.

Every lodging establishment and assisted living facility constructed in the state shall have adequate exiting as defined by the state building code in chapter 54-21.3 with the following exceptions:

1. All lodging establishments and assisted living facilities in existence at the time of implementation of this section are required to continue with fire escapes previously provided for within this section providing that they are deemed adequate by the local fire authority having approval, or by the state fire marshal’s office.
2. If the lodging establishment or assisted living facility is provided with exterior access balconies connecting the main entrance door of each unit to two stairways remote from each other.

23-09-04. Fire escapes in hotels and lodginghouses not more than two stories high. [Repealed]

Repealed by S.L. 1985, ch. 292, § 5.

23-09-05. Fire escapes to be kept clear — Notice of location and use of fire escapes required.

Access to fire escapes required under this chapter must be kept free and clear at all times of all obstructions of any nature. The proprietor of the lodging establishment or assisted living facility shall provide for adequate exit lighting and exit signs as defined in the state building code, chapter 54-21.3.

23-09-06. Chemical fire extinguishers — Standpipes.

Each lodging establishment or assisted living facility must be provided with fire extinguishers as defined by the national fire protection association standard number ten in quantities as defined by the state building code and the state fire code. Standpipe and sprinkler systems must be installed as required by the state building code and state fire code. Fire extinguishers, sprinkler systems, and standpipe systems must conform with rules adopted by the state fire marshal. A contract for sale or a sale of a fire extinguisher installation in a public building is not enforceable, if the fire extinguisher or extinguishing system is of a type not approved by the state fire marshal for such installation. No fire extinguisher of a type not approved by the state fire marshal may be sold or offered for sale within the state.

23-09-07. Lodging establishments or assisted living facilities with elevators — Protection to prevent spread of fire.

All new construction of, remodeling of, or additions to lodging establishments or assisted living facilities equipped with passenger or freight elevators must comply with state building code fire protection requirements.

23-09-08. Bolts or locks to be supplied on doors of sleeping rooms.

The doors of all rooms used for sleeping purposes in any lodging establishment within this state must be equipped with proper bolts or locks to permit the occupants of such rooms to lock or bolt the doors securely from within the rooms. The locks or bolts must be constructed in a manner that renders it impossible to unbolt or unlock the door from the outside with a key or otherwise, or to remove the key therefrom from the outside, while the room is bolted or locked from within. Any lodging establishment proprietor who fails to comply with this section is guilty of a class B misdemeanor.

23-09-09. Sanitation and safety.

Every food establishment, lodging establishment, and assisted living facility must be operated with strict regard for the health, safety, and comfort of its patrons. The following sanitary and safety regulations must be followed:

1. Every food establishment, lodging establishment, and assisted living facility must be well constructed, drained, and provided with plumbing equipment according to established sanitary principles and must be kept free from effluvia arising from any sewerage, drain, privy, or other source within the control of the proprietor.
2. In municipalities in which a system of public water supply and sewerage is maintained, every food establishment, lodging establishment, and assisted living facility must be equipped with suitable toilets for the accommodation of its guests, and such toilets must be ventilated and connected by proper means of flushing with the water of said system. All lavatories, bathtubs, sinks, drains, and toilets must be connected with such sewerage system and installed according to all applicable plumbing codes.
3. When a sewerage system is not available, open toilets must be located not less than forty feet [12.19 meters] from all kitchens, dining rooms, and pantry openings and must be properly cleaned, screened, and disinfected as often as may be necessary to keep them in a sanitary condition.
4. All garbage and kitchen refuse must be kept in watertight containers with tight-fitting covers to prevent decomposition. No dishwater or other substance which is or may become foul or offensive may be thrown upon the ground near any food establishment, lodging establishment, or assisted living facility.
5. All bedrooms must be kept free from insects and rodents, and the bedding in use must be clean and sufficient in quantity and quality.
6. Each food establishment, lodging establishment, or assisted living facility shall keep in its main public washroom and available at all hours individual disposable paper towels, a continuous towel system that supplies the user with a clean towel, or a heated air hand drying device for the use of its guests.
7. Bathrooms, toilet rooms, and laundry rooms must be provided with either natural or mechanical ventilation connected directly to the outside.
8. All food establishments, lodging establishments, or assisted living facilities shall equip operable windows during the summer months with screens adequate to keep out insects.
9. Neither the dining room nor kitchen of any food establishment, lodging establishment, or assisted living facility may be used as a sleeping or dressing room by any employee of the hotel or restaurant or by any other person.

23-09-10. Drinking water standards.

Every person operating a food establishment, lodging establishment, or assisted living facility shall see that the drinking water supplied therein is obtained from an approved source that is a public water system or a nonpublic water system that is constructed, maintained, and operated according to law.

23-09-11. Inspection — Reports.

Every lodging establishment, food establishment, or assisted living facility must be inspected at least once every two years by the department. Food establishments and assisted living facilities must be inspected based on a system of risk categorization which involves types of foods served, the preparation steps these foods require, volume of food, population served, and previous compliance history. The department and its inspectors may enter any such establishment at reasonable hours to determine compliance with this chapter.

23-09-12. Certificate of inspection — When issued — Posting. [Repealed]

Repealed by S.L. 1997, ch. 33, § 25.

23-09-13. False certificate — Penalty. [Repealed]

Repealed by S.L. 1975, ch. 106, § 673.

23-09-14. Department to report to state fire marshal.

The department, before the sixth day of each month, shall report to the state fire marshal on all food establishments, lodging establishments, or assisted living facilities inspected by the department during the preceding month, paying particular attention in the report to the violation of any provision of this chapter relating to fire escapes and the installation and maintenance of automatic or other fire alarms and fire extinguishing equipment and to any other condition that might constitute a fire hazard in the premises so inspected. If no such violation or condition is found, the report must so state.

23-09-15. Obstructing inspection — Penalty. [Repealed]

Repealed by S.L. 1975, ch. 106, § 673.

23-09-16. License — Application.

Before any food establishment, lodging establishment, pushcart, mobile food unit, or assisted living facility may be operated in this state, it must be licensed by the department. The department shall waive the license requirement for any food establishment, lodging establishment, or assisted living facility licensed by a city or district health unit if the local health unit’s sanitation, safety, and inspection rules are approved by the department. The application must be in writing on forms furnished by the department and must be accompanied by the required fee. The department shall issue a license to an applicant that meets all of the requirements of this chapter and any rules established by the department. The department may adopt rules establishing the amount and the procedures for the collection of annual license fees. The fees must be based on the cost of reviewing construction plans, conducting routine and complaint inspections, reinspection, and necessary enforcement action. License fees collected pursuant to this section must be deposited in the department’s operating fund in the state treasury and any expenditure from the fund is subject to appropriation by the legislative assembly.

23-09-16.1. License renewal.

1. A license issued under this chapter expires on December thirty-first of each year.
2. A license may be renewed by December thirty-first by submitting a renewal application and a renewal fee established by the department by rule, provided the licensee is in compliance with this chapter and any rules established by the department.
3. If the renewal application and renewal fee are not received by December thirty-first, the license expires and the licensee may not operate.
4. Within sixty days after December thirty-first, an expired license may be renewed by submitting the renewal application, renewal fee, and a late fee established by the department by rule. The late fee is equal to fifty-percent of the license fee.
5. If the renewal application, renewal fee, and late fee are not received within sixty days after December thirty-first, the license may not be renewed, and the applicant shall apply and meet the requirements for licensure to be granted a license.
6. The department may extend the renewal deadlines for an application providing proof of hardship rendering the applicant unable to meet the deadline.

23-09-17. License fees. [Repealed]

Repealed by S.L. 2005, ch. 32, § 19.

23-09-18. Failure to comply with chapter — Notice — How served.

The department may deny an application or take disciplinary action against the license of an applicant or a licensee upon the failure of the applicant or licensee to comply with this chapter or with any of the rules adopted by the department. Before the department takes disciplinary action against a license for failure of a license, the department shall notify the licensee in writing of the reason disciplinary action is being considered and shall provide a reasonable amount of time for correction to be made. The notice must be in writing and delivered personally by an inspector of the department or sent by registered or certified mail. Action taken under the authority granted in this section must comply with chapter 28-32.

23-09-19. State’s attorney to prosecute violation.

The state’s attorney of any county of this state, upon complaint on oath of an inspector of the department, shall prosecute in the name of the state of North Dakota a proper proceeding against any person violating any provision of this chapter.

23-09-20. Requirements of fireproof hotel — Penalty for false advertising.

No person may advertise as fireproof a building or hotel unless all foundations, floors, roofs, walls, stairways, stairs, elevator shafts, and dumbwaiter shafts are constructed of concrete, brick, terra cotta blocks, steel, or other fireproof material. Any person violating the provisions of this section is guilty of a class A misdemeanor.

23-09-20.1. Guest record.

A record must be kept in each lodging establishment in which every individual patronizing the lodging establishment shall write that individual’s name and address and the number of members in the party who will occupy a room or rooms therein.

23-09-21. Penalty — General.

Any person operating a food establishment, lodging establishment, or assisted living facility in this state, or letting a building used for such business, without first having complied with this chapter, is guilty of a class B misdemeanor.

23-09-22. License canceled.

Whenever the proprietor of a food establishment, lodging establishment, or assisted living facility has been convicted of a violation of this chapter and for a period of ten days after the conviction fails to comply with any provision of this chapter, the department may cancel the proprietor’s license.

23-09-23. Exemption for bed and breakfast facilities.

This chapter does not apply to bed and breakfast facilities for which rules have been adopted under chapter 23-09.1.

23-09-24. Salvaged food — License required.

It is unlawful for a person to claim to be a salvaged food distributor or to engage in the activity of selling, distributing, or otherwise trafficking in distressed or salvaged food, or both, at wholesale, without a license issued under this chapter authorizing that person to operate as a salvaged food distributor. A salvaged food distributor license may not be issued absent compliance with this section and any rules adopted to implement this section. The department may adopt rules establishing the amount and the procedures for the collection of annual license fees under this section. License fees collected under this section must be deposited in the department’s operating fund in the state treasury and any expenditure from the fund is subject to appropriation by the legislative assembly.

23-09.1-01. Definitions. [Effective through August 31, 2022]

As used in this chapter:

1. “Bed and breakfast facility” means a private home that is used to provide accommodations for a charge to the public, with not more than seven lodging units, in which no more than two family-style meals per day are provided.
2. “Department” means the state department of health.
3. “Family-style meal” means a meal ordered by persons staying at a bed and breakfast facility which is served from common food service containers, as long as any food not consumed by those persons is not reused or fed to other people if the food is unwrapped.

23-09.1-01. Definitions. [Effective September 1, 2022]

As used in this chapter:

1. “Bed and breakfast facility” means a private home that is used to provide accommodations for a charge to the public, with not more than seven lodging units, in which no more than two family-style meals per day are provided.
2. “Department” means the department of health and human services.
3. “Family-style meal” means a meal ordered by persons staying at a bed and breakfast facility which is served from common food service containers, as long as any food not consumed by those persons is not reused or fed to other people if the food is unwrapped.

23-09.1-02. Bed and breakfast facilities — Powers of state department of health. [Effective through August 31, 2022]

The department shall establish by rule the procedures for licensing, qualifying, classifying, inspecting, and regulating persons providing bed and breakfast facilities in private homes, including rules affecting the health and safety of the facility and the persons using the facility. No political subdivision, including a home rule city or county, may impose health and safety, licensure, or inspection requirements that exceed the requirements of this chapter or rules adopted by the department.

23-09.1-02. Bed and breakfast facilities — Powers of department. [Effective September 1, 2022]

The department shall establish by rule the procedures for licensing, qualifying, classifying, inspecting, and regulating persons providing bed and breakfast facilities in private homes, including rules affecting the health and safety of the facility and the persons using the facility. No political subdivision, including a home rule city or county, may impose health and safety, licensure, or inspection requirements that exceed the requirements of this chapter or rules adopted by the department.

23-09.1-02.1. Inspection.

The department shall inspect each bed and breakfast facility at least once every two years. Any duly authorized officer, employee, or agent of the department may enter and inspect any property or place on or at which a bed and breakfast facility is located or is being constructed, installed, or established at any reasonable time for the purpose of ascertaining the state of compliance with this chapter and rules adopted under this chapter.

23-09.1-02.2. License required — Application — Issuance.

Before any bed and breakfast facility may operate in this state, the facility must be licensed by the department. Licenses expire on December thirty-first following the date of issuance unless canceled by failure to comply with this chapter or with any of the rules adopted to implement this chapter. Renewal application for license must be made to the department during December of every year. A license must be issued upon compliance by the applicant with provisions of this chapter and any rules adopted to implement this chapter. The application must be in writing on forms furnished by the department and must be accompanied by the required fee. Licenses issued by the department are not transferable nor applicable to any premises other than those for which the license was issued. The department may adopt rules establishing the amount of and the procedures for the collection of annual license fees. License fees collected pursuant to this section must be deposited in the department’s operating fund in the state treasury and any expenditure from the fund is subject to appropriation by the legislative assembly.

23-09.1-03. License fee. [Repealed]

Repealed by S.L. 2005, ch. 32, § 19.

23-09.1-04. Injunction proceedings.

Whenever in the judgment of the department any person has engaged in or is about to engage in any acts or practices which constitute a violation of this chapter, or any rule or order issued under this chapter, the department may maintain an action in the name of the state enjoining the action or practices or for an order directing compliance and, upon a showing by the department that the person has engaged or is about to engage in any such acts or practices, a permanent or temporary injunction, restraining order, or other order may be granted.

23-09.1-05. Penalty.

Any person who willfully violates this chapter or any rule or order of the department must be punished by a civil penalty of not more than three hundred dollars per day of violation.

23-09.2-01. Definitions. [Effective through August 31, 2022]

As used in this chapter, unless the context otherwise requires:

1. “Department” means the state department of health.
2. “Food preparer” means any person who manufactures, processes, sells, handles, or stores food and who is not required to obtain a license from the department under chapter 19-02.1, 23-09, or 23-09.1.
3. Any term used in this chapter has the same meaning as when used in a comparable context in chapters 19-02.1, 23-09, and 23-09.1.

23-09.2-01. Definitions. [Effective September 1, 2022]

As used in this chapter, unless the context otherwise requires:

1. “Department” means the department of health and human services.
2. “Food preparer” means any person who manufactures, processes, sells, handles, or stores food and who is not required to obtain a license from the department under chapter 19-02.1, 23-09, or 23-09.1.
3. Any term used in this chapter has the same meaning as when used in a comparable context in chapters 19-02.1, 23-09, and 23-09.1.

23-09.2-02. Rules.

The department may adopt rules regarding education of food preparers.

23-09.2-03. Minor violations.

The department, local boards of health, and district health units shall attempt to resolve minor violations of this chapter through education. The department, local boards of health, and district health units are not required to report for prosecution minor violations of this chapter.

23-09.2-04. Exclusions.

This chapter does not apply to private homes where food is prepared or stored for individual family consumption and to the use of home-canned goods, nongrade A dairy products and food prepared using nongrade A dairy products, and to meat not inspected under the Federal Meat Inspection Act [34 Stat. 1260-1265; 21 U.S.C. 603 et seq.].

23-09.3-01. Definitions. [Effective through August 31, 2022]

As used in this chapter:

1. “Basic care facility” means a residence, not licensed under chapter 23-16 by the department, that provides room and board to five or more individuals who are not related by blood or marriage to the owner or manager of the residence and who, because of impaired capacity for independent living, require health, social, or personal care services, but do not require regular twenty-four-hour medical or nursing services and:
   1. Makes response staff available at all times to meet the twenty-four-hour per day scheduled and unscheduled needs of the individual;
   2. Is kept, used, maintained, advertised, or held out to the public as an Alzheimer’s, dementia, or special memory care facility; or
   3. Is attached to a nursing home or assisted living facility and its staff are available to meet the needs of all residents and comply with state and federal regulations.
2. “Department” means the state department of health.
3. “Services” includes responsibility for resident health and safety, assistance with activities of daily living and instrumental activities of daily living, provision of leisure, recreational, and therapeutic activities, supervision of nutritional needs, and medication administration.

23-09.3-01. Definitions. [Effective September 1, 2022]

As used in this chapter:

1. “Basic care facility” means a residence, not licensed under chapter 23-16 by the department, that provides room and board to five or more individuals who are not related by blood or marriage to the owner or manager of the residence and who, because of impaired capacity for independent living, require health, social, or personal care services, but do not require regular twenty-four-hour medical or nursing services and:
   1. Makes response staff available at all times to meet the twenty-four-hour per day scheduled and unscheduled needs of the individual;
   2. Is kept, used, maintained, advertised, or held out to the public as an Alzheimer’s, dementia, or special memory care facility; or
   3. Is attached to a nursing home or assisted living facility and its staff are available to meet the needs of all residents and comply with state and federal regulations.
2. “Department” means the department of health and human services.
3. “Services” includes responsibility for resident health and safety, assistance with activities of daily living and instrumental activities of daily living, provision of leisure, recreational, and therapeutic activities, supervision of nutritional needs, and medication administration.

23-09.3-01.1. Moratorium on expansion of basic care bed capacity. [Effective through August 31, 2022]

1. Basic care beds may not be added to the state’s licensed bed capacity during the period between August 1, 2021, and July 31, 2023, except if:
   1. A nursing facility converts nursing facility beds to basic care;
   2. An entity licenses bed capacity transferred as basic care bed capacity under section 23-16-01.1;
   3. An entity demonstrates to the state department of health and the department of human services that basic care services are not readily available within a designated area of the state or that existing basic care beds within a fifty-mile [80.47-kilometer] radius have been occupied at ninety percent or more for the previous twelve months. In determining whether basic care services will be readily available if an additional license is issued, preference may be given to an entity that agrees to any participation program established by the department of human services for individuals eligible for services under the medical assistance program under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.]; or
   4. The state department of health and the department of human services grant approval of new basic care beds to an entity. The approved entity shall license the beds within forty-eight months from the date of approval.
2. Transfers of basic care beds from one basic care facility to another entity is permitted. Transferred basic care beds must become licensed within seventy-two months of transfer. The entity receiving the transferred beds or any new facility may seek to participate in the basic care assistance program. If the entity can demonstrate that individuals can be cared for at a more independent level and that this service will delay entry into the nursing facility, the entity may be approved for basic care assistance funds.
3. If an Indian tribe acquires basic care beds, the tribal facility must meet state licensing requirements for those beds within seventy-two months of acquisition. A tribal facility may seek to participate in the basic care assistance program. Basic care assistance payments may only be made to a tribal facility that agrees to participate and adhere to all federal and state requirements of the basic care assistance program including participation, screening, ratesetting, and licensing requirements.

23-09.3-01.1. Moratorium on expansion of basic care bed capacity. [Effective September 1, 2022]

1. Basic care beds may not be added to the state’s licensed bed capacity during the period between August 1, 2021, and July 31, 2023, except if:
   1. A nursing facility converts nursing facility beds to basic care;
   2. An entity licenses bed capacity transferred as basic care bed capacity under section 23-16-01.1;
   3. An entity demonstrates to the department that basic care services are not readily available within a designated area of the state or that existing basic care beds within a fifty-mile [80.47-kilometer] radius have been occupied at ninety percent or more for the previous twelve months. In determining whether basic care services will be readily available if an additional license is issued, preference may be given to an entity that agrees to any participation program established by the department for individuals eligible for services under the medical assistance program under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.]; or
   4. The department grant approval of new basic care beds to an entity. The approved entity shall license the beds within forty-eight months from the date of approval.
2. Transfers of basic care beds from one basic care facility to another entity is permitted. Transferred basic care beds must become licensed within seventy-two months of transfer. The entity receiving the transferred beds or any new facility may seek to participate in the basic care assistance program. If the entity can demonstrate that individuals can be cared for at a more independent level and that this service will delay entry into the nursing facility, the entity may be approved for basic care assistance funds.
3. If an Indian tribe acquires basic care beds, the tribal facility must meet state licensing requirements for those beds within seventy-two months of acquisition. A tribal facility may seek to participate in the basic care assistance program. Basic care assistance payments may only be made to a tribal facility that agrees to participate and adhere to all federal and state requirements of the basic care assistance program including participation, screening, ratesetting, and licensing requirements.

23-09.3-02. Residential areas — Nongeriatric persons.

A nursing home, intermediate care facility, basic care facility, or any combination of a nursing home, intermediate care facility, or basic care facility may establish residential areas specifically for inhabitation by nongeriatric persons subject to any reasonable rules adopted by the department.

23-09.3-03. Access to pharmacist. [Repealed]

Repealed by S.L. 2001, ch. 432, § 7.

23-09.3-04. Department to establish standards — Licensing — Inspection — Survey — Prosecute violations.

1. The department shall establish standards for basic care facilities. The department shall inspect all places and grant annual licenses to basic care facilities as conform to the standards established and comply with the rules prescribed, as provided in this chapter. The department may waive all or a portion of a license standard if the department determines the lack of compliance does not adversely affect the health or safety of residents.
2. The department shall implement a survey process for basic care facilities which for purposes of the life safety portions of the survey, all surveys must be announced; which for purposes of the health portions of the survey, half of the surveys must be announced; and which for purposes of complaints related to health and life safety, all surveys must be unannounced. As part of the survey process, the department shall develop, in consultation with basic care facilities, and shall implement a two-tiered system of identifying areas of noncompliance with the health portions of the survey.
3. The department shall prosecute all violations of this chapter.

23-09.3-05. License required — Term — Revocation.

No person, institution, organization, limited liability company, or public or private corporation may keep, operate, conduct, or manage a basic care facility without holding a valid license issued by the department. The license is not valid for more than one year. Any license may be revoked by the department for violation of this chapter or the rules adopted by the department.

23-09.3-05.1. Application for license — License fee. [Effective through August 31, 2022]

Applicants for a license shall file applications under oath with the state department of health upon forms prescribed. An application for a license for facilities not owned by the state or its political subdivisions must be accompanied by a fee of ten dollars per bed. License fees collected pursuant to this section must be deposited in the state department of health services operating fund in the state treasury and any expenditure from the fund is subject to appropriation by the legislative assembly.

23-09.3-05.1. Application for license — License fee. [Effective September 1, 2022]

Applicants for a license shall file applications under oath with the department upon forms prescribed. An application for a license for facilities not owned by the state or its political subdivisions must be accompanied by a fee of ten dollars per bed. License fees collected pursuant to this section must be deposited in the department operating fund in the state treasury and any expenditure from the fund is subject to appropriation by the legislative assembly.

23-09.3-06. Injunction.

The department may apply to the district court of the county in which the basic care facility is located for, and the court has jurisdiction upon hearing and for cause shown to grant, a temporary or permanent injunction restraining any person from establishing, conducting, managing, or operating any basic care facility without obtaining a license under this chapter.

23-09.3-07. Contents of license.

The license must show the name of the owner or manager of the basic care facility, its location, and the maximum number of persons that may be received and kept in the basic care facility at any one time.

23-09.3-08. Records kept by basic care facility.

A record of every individual admitted to any basic care facility must be kept at the place licensed by the owner or manager in the manner and form prescribed by the department.

23-09.3-08.1. Admission of residents to basic care facility — Restrictions — Exception.

1. A basic care facility may not admit and retain an individual unless the:
   1. Facility provides, directly or through contract, appropriate services within the facility to attain or maintain the individual at the individual’s highest practicable level of functioning; and
   2. Condition and abilities of that individual are consistent with the national fire protection association 101 life safety code requirements.
2. Notwithstanding contrary provisions in subsection 1, a basic care facility may retain an individual in need of end-of-life services if the facility wraps around the individual’s family, or the individual’s designee, volunteers, or staff services to support the individual through end of life. The facility, individual, or the individual’s designee may contract with a person or hospice agency to meet the needs of the individual. A basic care facility continues to be responsible for the care and services of every resident.

23-09.3-09. Authority to adopt rules.

The department may adopt rules necessary to carry out its responsibilities under this chapter. Rules adopted by agencies prior to January 1, 1990, which relate to functions or agencies covered by this chapter, remain in effect until they are specifically amended or repealed by the department.

23-09.3-10. Rules on services to nongeriatric persons.

The department shall adopt rules under chapter 23-16 for patient and resident care and quality care review which are not in conflict with any federal laws, and as are necessary to ensure the appropriate medical, social, and psychological services to nongeriatric persons residing in a nursing home, intermediate care facility, basic care facility, or any combination of a nursing home, intermediate care facility, or basic care facility.

23-09.3-11. Department to furnish information when requested.

If called upon by any person, organization, corporation, limited liability company, or community interested in establishing a basic care facility, the department shall furnish information concerning the laws and rules governing operation of a basic care facility.

23-09.3-12. Penalty.

Any person who violates any provision of this chapter is guilty of a class B misdemeanor.

23-09.4-01. Definitions. [Effective through August 31, 2022]

In this chapter unless the context otherwise requires:

1. “Autism spectrum disorder” means a brain disorder that may prevent understanding of what a person sees, hears, or otherwise senses and is conceptualized as a behavioral syndrome with multiple biological manifestations.
2. “Department” means the state department of health.
3. “Residential care facility for children with autism spectrum disorder” means a living facility providing twenty-four-hour assistance for five or more children not related by blood or marriage to the operator through a multidisciplinary approach including a medical diagnosis of autism spectrum disorder.
4. “Residential care giver” means an individual who routinely provides assistance with activities of daily living or direct care services in implementing the treatment plan, behavior management, or education to residents in a residential care facility for children with autism spectrum disorder.

23-09.4-01. Definitions. [Effective September 1, 2022]

In this chapter unless the context otherwise requires:

1. “Autism spectrum disorder” means a brain disorder that may prevent understanding of what a person sees, hears, or otherwise senses and is conceptualized as a behavioral syndrome with multiple biological manifestations.
2. “Department” means the department of health and human services.
3. “Residential care facility for children with autism spectrum disorder” means a living facility providing twenty-four-hour assistance for five or more children not related by blood or marriage to the operator through a multidisciplinary approach including a medical diagnosis of autism spectrum disorder.
4. “Residential care giver” means an individual who routinely provides assistance with activities of daily living or direct care services in implementing the treatment plan, behavior management, or education to residents in a residential care facility for children with autism spectrum disorder.

23-09.4-02. Department to establish standards — Licensing — Inspection.

The department shall establish standards for the licensure of residential care facilities for children with autism spectrum disorder, regularly inspect the facilities, and grant annual licenses to the facilities that meet the established standards. Upon the request of the department, the state fire marshal shall inspect any facility seeking licensure, or any licensed facility, and shall report the inspection results to the department.

23-09.4-03. License required — Term — Revocation.

No person may operate or manage a residential care facility for children with autism spectrum disorder unless the facility has been licensed by the department. The license must state the name of the owner or manager of the facility, its location, and the maximum number of persons who may reside in the facility at any time. The license is not valid for more than one year. Any license may be revoked by the department for violation of this chapter or the rules adopted by the department.

23-09.4-04. Method of providing service.

A residential care facility for children with autism spectrum disorder must be specifically designed, arranged, and staffed to provide twenty-four hour assistance with activities of daily living in a homelike environment in response to the individual needs of the residents. A residential care facility for children with autism spectrum disorder must provide or make arrangements for diagnostic and treatment services, behavioral management, and educational services to enable residents to attain or maintain their highest practicable level of functioning.

23-09.4-05. Records.

The owner or manager of a residential care facility for children with autism spectrum disorder must keep a record of every individual admitted to the facility, in the manner and form prescribed by the department.

23-09.4-06. Violations — Injunction.

The department shall prosecute all violations of this chapter. The department may apply to the district court of the county in which the residential care facility for children with autism spectrum disorder is located, for a temporary or permanent injunction restraining any person from conducting, managing, or operating a facility without a license as required by this chapter.

23-09.4-07. Authority to adopt rules.

The department may adopt rules necessary to carry out its responsibilities under this chapter.

23-09.4-08. Penalty.

1. Any person who operates or manages a residential care facility for children with autism spectrum disorder without first obtaining a license as required by this chapter is guilty of a class B misdemeanor.
2. Any person who violates any provision of this chapter or any rule adopted under this chapter may be assessed a civil penalty not to exceed one thousand dollars for each violation and for each day the violation continues, plus interest and any costs incurred by the department to enforce this penalty. The civil penalty may be imposed by a court in a civil proceeding or by the state health officer through an administrative hearing under chapter 28-32. The assessment of a civil penalty does not preclude the imposition of other sanctions authorized by rules adopted under this chapter.

23-09.5-01. Definitions.

As used in this chapter:

1. “Cottage food operator” means an individual who produces or packages cottage food products in a kitchen designed and intended for use by the residents of a private home.
2. “Cottage food product” means baked goods, jams, jellies, and other food and drink products produced by a cottage food operator.
3. “Delivery” means the transfer of a cottage food product resulting from a transaction between a cottage food operator and an informed end consumer.
4. “Farmers market” means a market or group of booths where farmers and other cottage food operators sell cottage food products directly to consumers.
5. “Home consumption” means food consumed within a private home or food from a private home consumed only by family members, employees, or nonpaying guests.
6. “Informed end consumer” means an individual who is the last individual to purchase a cottage food product and has been informed the cottage food product is not licensed, regulated, or inspected.
7. “Transaction” means the exchange of buying and selling.

23-09.5-02. Direct producer to consumer sales of cottage food products. [Effective through August 31, 2022]

1. Notwithstanding any other provision of law, a state agency or political subdivision may not require licensure, permitting, certification, inspection, packaging, or labeling that pertains to the preparation or sale of cottage food products under this section. This section does not preclude an agency from providing assistance, consultation, or inspection, upon request, of a producer.
2. Transactions under this section must be directly between the cottage food operator and the informed end consumer and be only for home consumption. Transactions may occur at a farm, ranch, farmers market, farm stand, home-based kitchen, or any other venue not otherwise prohibited by law or through delivery.
3. Transactions under this section may not:
   1. Involve interstate commerce;
   2. Be conducted over the internet or phone, through the mail, or by consignment;
   3. Include the sale of uninspected products made from meat, except as provided under subdivision d; or
   4. Include the sale of uninspected products made from poultry, unless:
      1. The cottage food operator slaughters no more than one thousand poultry raised by the cottage food operator during the calendar year;
      2. The cottage food operator does not buy or sell poultry products, except products produced from poultry raised by the cottage food operator; and
      3. The poultry product is not adulterated or misbranded.
4. Except for whole, unprocessed fruits and vegetables, food prepared by a cottage food operator may not be sold or used in any food establishment, food processing plant, or food store.
5. The cottage food operator shall inform the end consumer that any cottage food product or food sold under this section is not certified, labeled, licensed, packaged, regulated, or inspected.
6. This section does not change any requirement for brand inspection or animal health inspections.
7. A cottage food operator shall label all cottage food products that require refrigeration, such as baked goods containing cream, custard, meringue, cheesecake, pumpkin pie, and cream cheese, with safe handling instructions and a product disclosure statement indicating the product was transported and maintained frozen.
8. A cottage food operator shall display a consumer advisory sign at the point of sale or place a label on the cottage food product with the following statement:
9. The state department of health or a local regulating authority may conduct an investigation upon complaint of an illness or environmental health complaint.

“This product is made in a home kitchen that is not inspected by the state or local health department.”

23-09.5-02. Direct producer to consumer sales of cottage food products. [Effective September 1, 2022]

1. Notwithstanding any other provision of law, a state agency or political subdivision may not require licensure, permitting, certification, inspection, packaging, or labeling that pertains to the preparation or sale of cottage food products under this section. This section does not preclude an agency from providing assistance, consultation, or inspection, upon request, of a producer.
2. Transactions under this section must be directly between the cottage food operator and the informed end consumer and be only for home consumption. Transactions may occur at a farm, ranch, farmers market, farm stand, home-based kitchen, or any other venue not otherwise prohibited by law or through delivery.
3. Transactions under this section may not:
   1. Involve interstate commerce;
   2. Be conducted over the internet or phone, through the mail, or by consignment;
   3. Include the sale of uninspected products made from meat, except as provided under subdivision d; or
   4. Include the sale of uninspected products made from poultry, unless:
      1. The cottage food operator slaughters no more than one thousand poultry raised by the cottage food operator during the calendar year;
      2. The cottage food operator does not buy or sell poultry products, except products produced from poultry raised by the cottage food operator; and
      3. The poultry product is not adulterated or misbranded.
4. Except for whole, unprocessed fruits and vegetables, food prepared by a cottage food operator may not be sold or used in any food establishment, food processing plant, or food store.
5. The cottage food operator shall inform the end consumer that any cottage food product or food sold under this section is not certified, labeled, licensed, packaged, regulated, or inspected.
6. This section does not change any requirement for brand inspection or animal health inspections.
7. A cottage food operator shall label all cottage food products that require refrigeration, such as baked goods containing cream, custard, meringue, cheesecake, pumpkin pie, and cream cheese, with safe handling instructions and a product disclosure statement indicating the product was transported and maintained frozen.
8. A cottage food operator shall display a consumer advisory sign at the point of sale or place a label on the cottage food product with the following statement:
9. The department of health and human services or a local regulating authority may conduct an investigation upon complaint of an illness or environmental health complaint.

“This product is made in a home kitchen that is not inspected by the state or local health department.”

23-10-01. Definitions. [Effective through August 31, 2022]

In this chapter, unless the context or subject matter otherwise requires:

1. “Campground” means any parcel of land containing three or more lots intended for occupancy by recreational vehicles or tents.
2. “Department” means the state department of health.
3. “Lot” means any piece of land of required size intended for occupancy by a mobile home, recreational vehicle, or tent.
4. “Mobile home” means any relocatable manufactured, modular, or prefabricated structure or unit that is designed to be used as residential living quarters. The term does not include a recreational vehicle.
5. “Mobile home park” means any parcel of land containing three or more lots intended for occupancy by mobile homes.
6. “Person” means any individual, firm, trust, partnership, public or private association, corporation, or limited liability company.
7. 1. An independent recreational vehicle containing toilet and lavatory facilities.
   2. A dependent recreational vehicle, which contains either toilet or lavatory facilities or having neither facility.
8. “Recreational vehicle park” means a parcel or tract of land under the control of a person, organization, or government entity where three or more lots are offered for use by members of the public or an organization for rent or lease, including park-owned recreational vehicles held out for rent or lease. A recreational vehicle park is primarily designed to accommodate recreational vehicles.

“Recreational vehicle” means a vehicular-type unit primarily designed as temporary living quarters for recreational, camping, or travel use, which either has its own mode of power or is mounted on or towed by another vehicle. The term includes the following:

23-10-01. Definitions. [Effective September 1, 2022]

In this chapter, unless the context or subject matter otherwise requires:

1. “Campground” means any parcel of land containing three or more lots intended for occupancy by recreational vehicles or tents.
2. “Department” means the department of health and human services.
3. “Lot” means any piece of land of required size intended for occupancy by a mobile home, recreational vehicle, or tent.
4. “Mobile home” means any relocatable manufactured, modular, or prefabricated structure or unit that is designed to be used as residential living quarters. The term does not include a recreational vehicle.
5. “Mobile home park” means any parcel of land containing three or more lots intended for occupancy by mobile homes.
6. “Person” means any individual, firm, trust, partnership, public or private association, corporation, or limited liability company.
7. 1. An independent recreational vehicle, containing toilet and lavatory facilities.
   2. A dependent recreational vehicle, which contains either toilet or lavatory facilities or having neither facility.
8. “Recreational vehicle park” means a parcel or tract of land under the control of a person, organization, or government entity where three or more lots are offered for use by members of the public or an organization for rent or lease, including park-owned recreational vehicles held out for rent or lease. A recreational vehicle park is primarily designed to accommodate recreational vehicles.

“Recreational vehicle” means a vehicular-type unit primarily designed as temporary living quarters for recreational, camping, or travel use, which either has its own mode of power or is mounted on or towed by another vehicle. The term includes the following:

23-10-02. Department to make regulations — Compliance.

The department shall have general supervision over the health, safety, sanitary condition, and legal compliance as outlined in this chapter of all mobile home parks, recreational vehicle parks, and campgrounds in this state and may promulgate and enforce appropriate rules and regulations in accordance with chapter 28-32. All mobile home parks, recreational vehicle parks, and campgrounds constructed after July 1, 1977, must be constructed in accordance with the requirements of this chapter and the rules and regulations promulgated at the time of construction. All mobile home parks, recreational vehicle parks, and campgrounds constructed before July 1, 1977, shall meet the requirements of this chapter by July 1, 1985. All mobile home parks, recreational vehicle parks, and campgrounds shall meet rules and regulations duly promulgated after construction of the park or campground within eight years after the effective date of the rule or regulation.

23-10-02.1. Department authorized to accept local enforcement and inspection.

The department shall accept state, federal, city, or county enforcement of local sanitation, safety, zoning, and inspection requirements in lieu of the enforcement of sanitation, safety, and inspection requirements of the department under this chapter if the department determines that the state, federal, city, or county requirements meet or exceed the requirements of this chapter and any rules and regulations promulgated under this chapter. Before accepting state, federal, city, or county enforcement of local requirements, the department shall determine that the state, federal, city, or county requirements meet or exceed the requirements of this chapter and any rules and regulations promulgated under this chapter.

23-10-03. License required — Application.

1. A person may not establish, maintain, change use, mix use, or enlarge a mobile home park, recreational vehicle park, or campground in this state without first obtaining a license from the department.
2. The application for the license must be made in writing to the department and must state the location and type of the mobile home park, recreational vehicle park, or campground, the proposed water supply, the proposed method of sewerage and garbage disposal, and such other information as may be required by the department. Application forms must be prepared by the department and distributed upon request.
3. The department may not issue a license under this section if the proposed mobile home park, recreational vehicle park, or campground would prevent, interfere, or restrict proposed private development that is actively being pursued.
4. The department shall waive the license fee for any mobile home park, recreational vehicle park, or campground owned by the state, a municipality, or a nonprofit organization. The department shall waive all or a portion of the license fee for any mobile home park, recreational vehicle park, or campground that is subject to local sanitation, safety, and inspection requirements accepted by the department under section 23-10-02.1. A prorated annual license fee may be charged for new mobile home parks, recreational vehicle parks, and campgrounds. The health council may adopt rules establishing the amount and the procedures for the collection of annual license fees. The fees must be based on the cost of reviewing construction plans, conducting routine and complaint inspections, reinspection, and necessary enforcement action. License fees collected pursuant to this section must be deposited in the department’s operating fund in the state treasury and any expenditure from the fund is subject to appropriation by the legislative assembly.

23-10-04. Inspection.

The department shall inspect the premises as soon as practical after receiving an application for a mobile home park, recreational vehicle park, or campground license. If the department is satisfied from the application and inspection that the mobile home park, recreational vehicle park, or campground will not be a source of danger to the health and safety of the occupants or the general public, the department shall notify the applicant of approval of the application and of the amount of the license fee. The department must have access to and may inspect mobile home parks, recreational vehicle parks, and campgrounds at reasonable times. The department may inspect each mobile home park, recreational vehicle park, and campground in response to a complaint, violation of state law, or on a routine schedule determined by the department.

23-10-05. License fees. [Repealed]

Repealed by S.L. 2005, ch. 32, § 19.

23-10-06. License issuance — Fee.

An applicant seeking licensure shall apply to the department on forms prescribed by the department. The applicant shall enclose with the application an application fee as determined by rule. The department shall issue a license to an applicant who meets all of the requirements of this chapter and any rules adopted by the health council.

23-10-06.1. License renewal.

1. A license issued under this chapter expires on December thirty-first of each year.
2. A license may be renewed by December thirty-first by submitting a renewal application, a renewal fee established rule, provided the licensee is in compliance with this chapter and any rules established by the health council.
3. If the renewal application and renewal fee are not received by December thirty-first, the license expires and the licensee may not operate.
4. Within sixty days after December thirty-first, an expired license may be renewed by submitting the renewal application, renewal fee, and a late fee. The late fee is equal to fifty percent of the license fee.
5. If the renewal application, renewal fee, and late fee are not received within sixty days after December thirty-first, the department may not renew the license, and the applicant shall apply and meet the requirements for licensure to be granted a license.
6. The department may extend the renewal deadline for applications providing proof of hardship rendering the applicant unable to meet the deadline.
7. The department may not renew a license if the mobile home park, recreational vehicle park, or campground is not actively conducting business at the site, and the applicant shall apply and meet the requirements for licensure to be granted a license.

23-10-06.2. License transferability.

The department shall transfer a license without charge if the proposed new owner applies in writing for a transfer of the license and certifies that the mobile home park, recreational vehicle park, or campground will be operated in accordance with this chapter.

23-10-07. Sanitation and safety.

Every mobile home park, recreational vehicle park, and campground must be operated with strict regard for the health, safety, and comfort of its occupants. The following sanitary and safety regulations must be followed:

1. Location: Every mobile home park must be established and maintained upon dry, well-drained ground. Any natural sinkholes or collection or pool of water must be artificially drained and filled. Recreational vehicle park and campground lots must be established and maintained upon dry, well-drained spaces.
2. Drinking water supply: An adequate supply of potable and safe drinking water must be provided. The operator of a mobile home park, recreational vehicle park, or campground shall supply drinking water at the mobile home park, recreational vehicle park, or campground which is obtained from an approved source that is a public water system or a nonpublic water system that is constructed, maintained, and operated according to law.
3. Towels: The placing of roller cloth towels for public use in any washroom or place within a mobile home park, recreational vehicle park, or campground is prohibited. Individual cloth towels, cloth towels provided in mechanical dispensers, individual paper towels, or roller paper towels must be placed for use.
4. Toilets: Modern sanitary flush toilets must be provided where a sewer connection is available. If a sewer connection is not available, sanitary flyproof privies must be maintained. All toilets and privies must be kept in a clean, sanitary condition. Separate toilets and privies must be provided for each sex. No privy or cesspool may be located less than one hundred feet [30.48 meters] from any well, kitchen, or sleeping quarters.
5. Garbage: All garbage and refuse must be stored in durable, cleanable, insect- and rodent-resistant containers, and the contents removed and disposed of at a frequency that will minimize the development of objectionable odors and other conditions that attract or harbor insects and rodents. All buildings within the mobile home park, recreational vehicle park, or campground must be screened against flies and kept in a clean and sanitary condition.
6. Plumbing installations: All plumbing installations in a mobile home park, recreational vehicle park, or campground must be made in accordance with the state plumbing code and state laws.
7. Electrical installations: All electrical installations in a mobile home park, recreational vehicle park, or campground must be made in accordance with the state electrical code.
8. Streets and roadways: Each mobile home park, recreational vehicle park, and campground must have roadways or streets wide enough to facilitate the movement of traffic within the park or campground.
9. Lighting: Each mobile home park, recreational vehicle park, and campground must have adequate lighting as set forth in rule.
10. Fire protection: Each mobile home park, recreational vehicle park, and campground must have adequate fire protection in accordance with the state fire code.
11. Playgrounds: Each mobile home park containing twenty-five or more lots shall provide playground space equivalent to one lot for every twenty-five lots in the park.
12. Multiple-story parks: A multiple-story mobile home park or trailer park may not be constructed in this state.

23-10-07.1. Service fees.

Service fees that reasonably reflect the cost of the service provided in a mobile home park, recreational vehicle park, or campground may be charged. Fees may not be charged unless a service is actually provided.

23-10-08. Sickness in motor or trailer courts — Penalty for failure to report. [Repealed]

Repealed by S.L. 1975, ch. 106, § 673.

23-10-09. Occupancy record.

The owner or manager of a mobile home park, recreational vehicle park, or campground shall maintain a current record of the names of the occupants of the park or campground.

23-10-10. Posting rules and regulations.

The owner or manager of a licensed mobile home park, recreational vehicle park, or campground conspicuously shall post or distribute a digital or hard copy of the relevant rules and regulations to each tenant in the park. Material required to be distributed or posted under this section must be provided by the department free of charge.

23-10-10.1. Requirement of emergency response procedures.

The owner of a mobile home park, recreational vehicle park, or campground shall establish a procedure for responding to emergencies and complaints. The procedure must include the ability to reach a person who has the authority to perform, or direct the performance of, duties imposed on the owner under this chapter. The procedure must be posted conspicuously in the mobile home park, recreational vehicle park, and campground or a copy must be provided to the tenants in writing.

23-10-11. Ejection from premises.

The owner or manager of a mobile home park, recreational vehicle park, or campground may eject any person from the premises for nonpayment of charges or fees for accommodations, for a violation of law, for disorderly conduct, for a violation of any regulation of the department, or for a violation of any reasonable rule of the mobile home park, recreational vehicle park, or campground which is publicly posted within the park or campground.

23-10-12. Revocation of license — Penalty for operating without license.

The department may deny an application or take disciplinary action, up to and including revocation, against any applicant or licensee upon the failure of the applicant or licensee to comply with this chapter or with any of the rules adopted by the health council and regulations promulgated by the department. Before the department takes disciplinary action against a license, the department shall notify the licensee in writing of the reason disciplinary action is being considered and shall provide a reasonable amount of time for correction to be made. Action taken under the authority granted in this section must comply with chapter 28-32. Any person who maintains or operates a mobile home park, recreational vehicle park, or campground without first obtaining a license, or who operates the same after revocation of the license, is guilty of an infraction.

23-10-13. Change in use or closure of mobile home park.

If the owner of a mobile home park applies for the rezoning of a park, the owner shall post a notice of the proposed rezoning in the park at least five days before the public hearing on the rezoning. In addition, the owner of a mobile home park shall notify all tenants in that park in writing of a change in use at least one hundred eighty days before the change in use. A change in use is a change in the park that would alter any portion of the park which is used to lease to mobile home owners so that the portion will no longer be leased to mobile home owners. The owner or manager may not increase rent within ninety days before giving notice of a change in use for the portion of the park to which the change will apply.

23-10-14. Mobile home security deposit.

The amount of a security deposit may not be modified after the initial lease agreement between a mobile home park owner and a tenant has been executed by both parties.

23-11-01. Definitions.

In this chapter, unless the context or subject matter otherwise requires:

1. “Area of operation” includes:
   1. In the case of a housing authority of a city having a population of less than fifteen thousand inhabitants, the city and the area within five miles [8.05 kilometers] of the territorial boundaries of the city, but does not include any area that is within the territorial boundaries of another city.
   2. In the case of a housing authority of a city having a population of fifteen thousand inhabitants or more, the city and an area within ten miles [16.10 kilometers] of the territorial boundaries of the city, but does not include any area that is within the territorial boundaries of another city.
   3. In the case of a housing authority of a county, all of the county except that portion that is within the territorial boundaries of any city.
2. “Auditor” means the city auditor or the county auditor, as appropriate.
3. “Authority” or “housing authority” means any of the public corporations created by section 23-11-02.
4. “Bonds” means any bonds, notes, certificates, debentures, or other obligations issued by an authority under this chapter.
5. “City” means any city having a population of more than five thousand inhabitants according to the last federal census and “the city” means the particular city for which a particular housing authority is created, except that it does not mean a city that has agreed to or will so elect to participate in a county housing authority pursuant to section 54-40-08, provided that any city with less than five thousand population which has an activated city housing authority prior to July 1, 1971, or a city with less than five thousand population which has determined a shortage of safe or sanitary dwelling accommodations in the city pursuant to section 23-11-03, must be included within this definition.
6. “County” means any county in this state and “the county” means the particular county for which a particular housing authority is created.
7. “Federal government” includes the United States of America and any agency or instrumentality, corporate or otherwise, of the United States of America.
8. “Governing body” means, in the case of a city, the city council or the board of city commissioners, as appropriate, and in the case of a county, the board of county commissioners.
9. “Housing project” may be applied to the planning of the buildings and improvements, the acquisition of property, the demolition of existing structures, the construction, reconstruction, alteration, and repair of the improvements, and all other work in connection with the same and means any work or undertaking:
   1. To demolish, clear, or remove buildings from any slum area, and the work or undertaking may embrace the adaption of the area to public purposes, including parks or other recreational or community purposes;
   2. To provide or assist in providing decent, safe, and sanitary urban or rural housing dwellings, apartments, or other living accommodations and related facilities for persons of low or moderate income in need of housing, including single-family and multifamily residential units designed and financed under this chapter. This work or undertaking may include the planning of buildings and improvements, land, equipment, facilities, and the acquisition of real or personal property that may be needed immediately or in the future for housing purposes, the construction, reconstruction, alteration and repair of new or existing buildings, and the provisions of all equipment, facilities, and other real or personal property for necessary, convenient, or desirable appurtenances, streets, sewers, water service, parks, site preparations, landscaping, gardening, administrative, community, health, recreational, educational, welfare, or other purposes; or
   3. To accomplish a combination of any of the foregoing projects.
10. “Mayor” means the mayor of the city or the president of the board of city commissioners, as appropriate.
11. “Obligee of the authority” or “obligee” includes any bondholder, trustee for any bondholders, or lessor demising to the authority property used in connection with a housing project, or any assignee of a lessor’s interest, or of any part of an interest, and the federal government when it is a party to any contract with the authority.
12. “Persons of low income” means individuals or families who lack the amount of income which is necessary, as determined by the authority undertaking the housing project, to enable them, without financial assistance, to live in decent, safe, and sanitary dwellings without overcrowding.
13. “Persons of moderate income” means individuals or families whose income is not adequate without governmental assistance to cause private enterprise to provide a substantial supply of decent, safe, and sanitary housing at rents or prices within their financial means.
14. “Real property” includes land, including improvements and fixtures on the land and property of any nature appurtenant to the land or used in connection with the land, and every estate, interest, and right, legal or equitable, in the land, including terms for years and liens by way of judgment, mortgage, or otherwise and the indebtedness secured by the liens.
15. “Slum” means any area where dwellings predominate which by reason of dilapidation, overcrowding, faulty arrangement or design, lack of ventilation, light, or sanitary facilities, or by reason of any combination of these factors are detrimental to safety, health, and morals.

23-11-02. Creation of housing authorities.

In each city and in each county of the state, there is created a public body corporate and politic to be known as the “housing authority” of the city or county, as the case may be. Such authority may not transact any business nor exercise any powers granted by this chapter until the governing body of the city or of the county, as the case may be, by proper resolution, declares that there is need for an authority to function in such city or county. The determination as to whether there is such need may be made by the governing body on its own motion and must be made upon filing of a petition signed by twenty-five residents of the city or county, as the case may be, asserting that there is need for such authority to function in such city or county and requesting that the governing body so declare.

23-11-03. When resolution declaring housing authority to be necessary shall be adopted.

1. The governing body of the city or county, as appropriate, shall adopt a resolution declaring that there is need for a housing authority in the city or county if the governing body finds that unsanitary or unsafe inhabited dwelling accommodations exist in the city or county, or that there is a shortage of safe or sanitary dwelling accommodations in the city or county available to persons of low or moderate income at rentals they can afford to pay.
2. In determining whether dwelling accommodations are unsafe or unsanitary, the governing body may take into consideration the degree of overcrowding, the percentage of land coverage, the light, air, space, and access available to the inhabitants of the dwelling accommodations, the size and arrangement of the rooms, the sanitary facilities, and the extent to which conditions which endanger life or property by fire or other causes exist in the buildings.

23-11-04. When authority conclusively deemed established.

In any suit, action, or proceeding involving the validity or enforcement of, or relating to, any contract of the authority, the authority must be conclusively deemed to have become established and authorized to transact business and exercise its powers hereunder upon proof of the adoption of a resolution by the governing body of the city or county declaring the need for the authority. Such resolution must be deemed sufficient if it declares that there is need for an authority and finds that either or both of the conditions enumerated in section 23-11-03 exist in the city or county, as the case may be. A copy of the resolution, duly certified by the auditor of the city or county, is admissible in evidence in any suit, action, or proceeding.

23-11-05. Commissioners of authority — Appointment, qualifications, tenure, compensation.

When the governing body of a city adopts a resolution declaring there is need for a housing authority, the governing body promptly shall notify the mayor of the adoption. Upon receiving the notice, the mayor shall appoint no fewer than five commissioners of the authority. When the governing body of a county adopts a resolution declaring there is need for a housing authority, the governing body shall appoint no fewer than five commissioners of the authority. The commissioners must be appointed for terms of five years, except all vacancies must be filled for the unexpired term. The terms of the commissioners must be staggered to ensure an approximately equal number of appointments expire each year and the term of one or more commissioners may initially be less than five years to accommodate the required staggering of terms. A commissioner shall hold office until a successor has been appointed and has qualified. A certificate of the appointment or reappointment of any commissioner must be filed with the auditor of the city or county, as the case may be, and the certificate is conclusive evidence of the appointment of the commissioner. The governing body of the city or county shall establish the rate of compensation for commissioners and actual expenses incurred by commissioners may be reimbursed at the official reimbursement rates of the appointing authority.

23-11-06. Chairman of commissioners of authority, appointment — Vice chairman, appointment — Quorum — Majority vote necessary.

The mayor in the case of an authority of a city, or the governing body in the case of an authority of a county, shall designate which of the commissioners appointed must be the first chairman. When the office of the chairman of the authority thereafter becomes vacant, the commissioners of the authority shall select one of their number as chairman. The commissioners also shall select one of their number as vice chairman. Three commissioners constitute a quorum for the conduct of the business of the authority. Action may be taken by the authority upon a vote of a majority of the commissioners present unless the bylaws of the authority require a larger number.

23-11-07. Powers of commissioners of authority.

The powers of each authority must be vested in the commissioners of the authority. The authority may delegate to one or more of its agents or employees such powers and duties as it deems proper.

23-11-08. Employees of authority — Duty of city and state’s attorney — Legal assistants.

The commissioners of an authority may employ a secretary who must be its executive director, and such technical experts, and other officers, agents, and employees, permanent and temporary, as it may require. The commissioners shall determine the qualifications of all persons employed and their duties and compensation. For such legal service as may be required, the commissioners may call upon the city attorney or the state’s attorney, or they may employ counsel or a legal staff for the authority.

23-11-09. Commissioner or employee may not have interest in housing project or property to be used.

No commissioner or employee of an authority may acquire any direct or indirect interest in any housing project or in any property included or planned to be included in any project, nor may such a person have any direct or indirect interest in any contract or proposed contract for materials or services to be furnished or used in connection with any housing project. If any commissioner or employee of an authority owns or controls a direct or indirect interest in any property included or planned to be included in any housing project, that person immediately shall disclose the same in writing to the authority, and such disclosure must be entered upon the minutes of the authority. Failure to disclose such interest constitutes misconduct in office.

23-11-10. Removal of commissioners.

A commissioner of an authority may be removed by the mayor, or in the case of an authority for a county, by the governing body of the county, for inefficiency, neglect of duty, or misconduct in office. A commissioner may be removed, however, only after having had an opportunity to be heard upon the charges in person or by counsel. A copy of the charges must be served upon the commissioner at least ten days before the date fixed for the hearing. In the event of the removal of any commissioner, a record of the proceedings, together with the charges and findings thereon, must be filed in the office of the auditor of the city or county, as the case may be.

23-11-11. Powers of authority.

An authority has the following powers and duties:

1. To exercise public and essential governmental functions.
2. To sue and be sued.
3. To have perpetual succession.
4. To make and execute contracts and other instruments necessary or convenient to the exercise of the powers of the authority.
5. To make, amend, and repeal such bylaws, rules, and regulations, not inconsistent with this chapter, as are necessary to carry into effect the powers and purposes of the authority.
6. To prepare, carry out, acquire, lease, and operate housing projects within its area of operation.
7. To provide for the construction, reconstruction, improvement, alteration, or repair of any housing project, or any part of a housing project, within the authority’s area of operation.
8. To arrange or contract for the furnishing by any person or any public or private agency of services, privileges, works, or facilities for, or in connection with, a housing project or the occupants of a housing project.
9. To include, in any contract let in connection with a project, stipulations requiring that the contractor and any subcontractor comply with requirements as to minimum wages and maximum hours of labor and any conditions that the federal government may have attached to the financial aid for the project.
10. To lease or rent any dwellings, houses, accommodations, lands, buildings, structures, or facilities embraced in any housing project and, subject to the limitations contained in this chapter, to establish and revise the rents or charges in the housing project.
11. To own, hold, and improve property.
12. To purchase, lease, obtain options upon, or acquire, by gift, grant, bequest, devise, or otherwise, any property or any interest in property.
13. Subject to chapter 32-15, to acquire real property by the exercise of the power of eminent domain.
14. To sell, lease, exchange, transfer, assign, pledge, or dispose of any property, or any interest in property.
15. To insure, or provide for the insurance of, any property, or any operation of the authority, against any risks or hazards.
16. To procure insurance or guaranties from the federal government of the payment of any debts, or parts of debts, secured by mortgages on any property included in any of the authority’s housing projects, whether the debts were incurred by the authority or not.
17. To invest any funds held by the authority in reserves or sinking funds, or any funds not required for immediate disbursement, in property or securities in which savings banks may legally invest funds subject to a savings bank’s control.
18. To purchase its bonds at a price not more than the principal amount of the bonds and accrued interest, a bond so purchased is canceled.
19. To investigate, in the authority’s area of operation, living, dwelling, and housing conditions and the means and methods of improving the same.
20. To determine, within the authority’s area of operation, where slum areas exist or where there is a shortage of decent, safe, and sanitary dwelling accommodations for persons of low or moderate income.
21. To make studies and recommendations relating to the problem of clearing, replanning, and reconstructing the slum areas within the authority’s area of operation and the problem of providing dwelling accommodations for the persons of low or moderate income, and to cooperate with the city, county, or state, or any political subdivision in any action taken in connection with these problems.
22. To engage in research, studies, and experimentation on the subject of housing within the authority’s area of operation.
23. To conduct examinations and investigations and to hear testimony and take proof under oath at public or private hearings on any matter material for the authority’s information.
24. To administer oaths, issue subpoenas requiring the attendance of witnesses or the production of books and papers, and to issue commissions for the examinations of witnesses who are outside of the state or unable to attend before the authority or who are excused from attendance.
25. To make available to appropriate agencies, including those charged with the duty of abating or requiring the correction of nuisances or like conditions, or of demolishing unsafe or unsanitary structures within the authority’s area of operation, the authority’s findings and recommendations with regard to any building or property where conditions exist which are dangerous to the public health, morals, safety, or welfare.
26. To issue bonds from time to time for any of its corporate purposes.
27. To issue refunding bonds for the purpose of paying or retiring bonds previously issued by the authority.
28. To borrow money or accept grants or other financial assistance from the federal government for, or in aid of, any housing project within the authority’s area of operation.
29. To take over or lease or manage any housing project or undertaking constructed or owned by the federal government.
30. To comply with conditions and to enter into mortgages, trust indentures, leases, or agreements as may be necessary, convenient, or desirable to carry out this section.
31. To do any and all things necessary or desirable to secure the financial aid or cooperation of the federal government in the undertaking, construction, maintenance, or operation of any housing project.
32. To exercise all or any part or combination of powers granted.
33. To exercise within the authority’s area of operation the authority granted to the industrial commission under section 54-17-07.6.
34. To exercise the power to provide operation and maintenance expenses under subdivision a of subsection 23 of section 23-11-24.
35. To exercise the power to pledge the general obligation of the city or county for which the housing authority is created in accordance with subsection 23 of section 23-11-24.
36. To develop a plan identifying the public purposes of the authority’s ownership, conditions that would make the authority’s ownership no longer necessary for accomplishing those public purposes, and a plan to divest the authority’s ownership interest as soon as economically prudent once those conditions occur and to effectuate the plan.
37. To exercise other powers and duties as may be necessary to carry out the purposes and provisions of this chapter.

An authority, in exercising the powers specified in subsections 23, 24, and 25, may act through one or more of the commissioners or through other persons designated by the authority. Provisions of law with respect to the acquisition, operation, or disposition of property by other public bodies are not applicable to an authority unless there is specific provision to that effect by the legislative assembly. The construction of a housing project is a public improvement for which an authority is subject to the requirements of chapter 48-01.2.

23-11-12. Rentals to be at lowest possible rate — Authority not to be operated for profit.

Each housing authority shall manage and operate its housing projects in an efficient manner so as to enable it to fix the rentals for dwelling accommodations at the lowest possible rates consistent with its providing decent, safe, and sanitary dwelling accommodations. No housing authority may construct or operate any project for profit or as a source of revenue to the city or the county.

23-11-13. Rentals — How fixed by authority.

An authority shall fix the rentals for dwelling in its projects at no higher rates than it finds to be necessary in order to produce revenues which, together with all other available moneys, revenues, income, and receipts of the authority from whatever source derived will be sufficient to:

1. Pay, as the same become due, the principal and interest on the bonds of the authority;
2. Meet the cost of, and provide for maintaining and operating, the projects of the authority, including the cost of any insurance thereon, and the administrative expenses of the authority; and
3. Create, during not less than the six years immediately succeeding its issuance of any bonds, a reserve sufficient to meet the largest principal and interest payments which will be due on such bonds in any one year thereafter, and to maintain such reserve.

23-11-14. Rentals and tenant selection.

In the operation or management of housing projects, an authority at all times shall observe the following duties with respect to rentals and tenant selection:

1. The authority may rent or lease the dwelling accommodations in the project solely to persons of low or moderate income.
2. The authority may rent or lease the dwelling accommodations in the project solely at rentals within the financial reach of persons of low or moderate income.
3. The authority may rent or lease to a tenant dwelling accommodations consisting solely of the number of rooms which the authority determines necessary to provide safe and sanitary accommodations to the proposed occupants, without overcrowding.
4. The authority may not accept persons of low income as a tenant in any housing project if the individual or family who would occupy the dwelling accommodations has an aggregate annual income in excess of five times the annual rental of the quarters to be furnished the individual or family. In computing the rental for this purpose, there must be included in the rental the average annual cost to the occupant, as determined by the authority, of heat, water, electricity, gas, cooking, and other necessary services or facilities, whether the charge for the services and facilities is in fact included in the rental.
5. The authority shall prohibit subletting by tenants.

23-11-15. Right of authority to vest certain rights in obligee not restricted.

Sections 23-11-12, 23-11-13, and 23-11-14 may not be construed as limiting or restricting the power of an authority to vest in an obligee the right, in the event of a default by the authority, to take possession of a housing project or to cause the appointment of a receiver thereof or to acquire title thereto through foreclosure proceedings.

23-11-16. Cooperation between authorities.

Any two or more authorities may join or cooperate with one another in the exercise of any or all of the powers conferred upon them for the purpose of financing, planning, undertaking, constructing, or operating a housing project or projects located within the area of operation of any one or more of such authorities.

23-11-16.1. Dissolution of city housing authorities authorized — Procedure — Effect.

The governing body of any city may, by resolution, dissolve the housing authority of such city for the purpose of electing to participate in a county housing authority pursuant to section 54-40-08. Upon the adoption of such a resolution the city authority shall cease to exist, except for the purpose of winding up its affairs and executing a deed to the county housing authority pursuant to the agreement executed between the city and the county under the provisions of section 54-40-08. All the rights, contracts, obligations, and property, real and personal, of the city authority must be transferred to and become vested in the county authority, provided that all bonded indebtedness issued by the city authority remains a lien against the income and revenues of the housing project pledged to the payment of such bonds. All rights and remedies of any person against the city authority may be asserted and enforced against the county authority to the same extent as they might have been against the city authority.

23-11-17. Eminent domain — Exercise of power.

As a prerequisite to the taking of real property by the exercise of the power of eminent domain, an authority shall adopt a resolution declaring that the acquisition of the real property described therein is necessary for its purposes under the provisions of this chapter. Such power may be exercised in the manner provided in sections 32-15-01 to 32-15-34, or by any other applicable provision of this code relating to the exercise of the power of eminent domain.

23-11-18. Planning, zoning, and building laws.

All housing projects of an authority are subject to the planning, zoning, sanitary, and building laws, ordinances, and regulations applicable in the locality in which the housing project is situated. In the planning and location of any housing project, an authority shall take into consideration the relationship of the project to any larger plan or long-range program for the development of the area in which the housing authority functions.

23-11-19. Bonds — Issued pursuant to resolution — General provisions.

Bonds of an authority must be issued pursuant to a resolution of the commissioners thereof. The resolution must specify:

1. Whether the bonds must be issued in one or more series.
2. The date or dates which the bonds must bear.
3. The time or times at which the bonds must mature.
4. The interest rate or rates.
5. The denomination or denominations in which the bonds must be issued.
6. The form, either coupon or registered, in which the bonds must be issued.
7. The conversion or registration privileges, if any, which the bonds must carry.
8. The rank or priority which must exist between various issues of bonds and various kinds of bonds issued.
9. The manner in which the bonds must be executed.
10. The medium in which the bonds must be payable.
11. The place or places at which the bonds must be payable.
12. The terms of redemption, and whether with or without premium, to which the bonds are subject.

The conditions specified in the resolution may be printed in any trust indenture or mortgage given by the authority to secure any bonds issued by it.

23-11-20. Bonds — Types which may be issued.

1. An authority may issue any type of bond as the authority determines necessary for the purpose of financing housing for persons of low or moderate income, including a bond on which the interest and principal are payable:
   1. Exclusively from the income and revenues of the housing project financed with the proceeds of the bond or with the proceeds together with a grant from the federal government in aid of the project;
   2. Exclusively from the income and revenues of certain designated housing projects whether the projects are financed in whole or in part with the proceeds of the bond; or
   3. From the authority’s revenues generally.
2. The bonds and other obligations of the authority are not payable out of any funds or properties other than those of the authority or funds of the city or county which has pledged its general obligation pursuant to subsection 23 of section 23-11-24. These bonds, however, may be secured additionally by a pledge of any loan, grant, or contribution, or part of the same, from the federal government or other source of a pledge of any income or revenues or by a mortgage on any housing project, projects, or other property of the authority.

23-11-21. Bonds — Liability — Tax exempt.

Neither the commissioners of an authority nor any person executing bonds of the authority is liable personally on the bonds by reason of the issuance of the bonds. The bonds and other obligations of an authority are not a debt of the city, county, or state, nor of any political subdivision, unless a city or county pledges its general obligation to the payment of the bonds under subsection 23 of section 23-11-24. The bond obligations are declared to be issued for an essential public and governmental purpose and to be public instrumentalities and the bonds, together with the interest on the bonds and income from the bonds are exempt from taxation. The tax exemption provisions of this chapter are considered part of the contract for the security of the bond obligations authorized by this chapter and do not need to be restated in the bond obligations.

23-11-22. Sale of bonds.

Bonds issued by an authority may be sold at a private sale without notice or at public sale held after a notice has been published at least five days prior to the sale in a newspaper having a general circulation in the city or county, as the case may be. Bond issues sold at private sale must bear interest at a rate or rates and be sold at a price resulting in an average net interest cost not exceeding twelve percent per annum. There is no interest rate ceiling on issues sold at public sale or to the state of North Dakota or any of its agencies or instrumentalities. The bonds may not be sold for less than ninety-eight percent of par.

23-11-23. Bonds — Validity when officer who signs bond is no longer in office — Deemed issued for housing project.

If any of the commissioners or officers of an authority whose signatures appear on any bonds or coupons cease to be a commissioner or officer before the delivery of the bonds, the signatures are valid and sufficient for all purposes the same as if the commissioner or officer had remained in office until the delivery had been completed. Any bonds issued under this chapter must be fully negotiable. In an action, suit, or proceeding involving the validity or enforceability of any bond of an authority or of the security for the bond, the bond must be deemed conclusively to have been issued for a housing project if the bond recites that it has been issued by the authority to aid in financing a housing project to provide dwelling accommodations for persons of low or moderate income. The project is planned, located, and constructed in accordance with this chapter if this statement is contained in the bond.

23-11-24. Provisions of bonds, trust indentures, and mortgages.

In connection with the issuance of bonds or the incurring of obligations under leases and in order to secure the payment of the bonds or obligations, an authority, in addition to the authority’s other powers, has power:

1. To pledge all or any part of the authority’s gross or net rents, fees, or revenues to which the authority’s right then exists or thereafter may come into existence.
2. To mortgage all or any part of the authority’s property then owned or thereafter acquired.
3. To covenant against pledging all or any part of the authority’s rents, fees, and revenues, or against mortgaging all or any part of the authority’s property, to which the authority’s right or title then exists or thereafter may come into existence, or against permitting or suffering any lien on any revenues or property.
4. To covenant with respect to limitations on the authority’s right to sell, lease, or otherwise dispose of any housing projects or any part of a housing project.
5. To covenant as to what other or additional debts or obligations may be incurred by the authority.
6. To covenant as to the bonds to be issued and as to the issuance of bonds in escrow or otherwise and as to the use and disposition of the proceeds of the bonds.
7. To provide for the replacement of lost, destroyed, or mutilated bonds.
8. To covenant against extending the time for the payment of the authority’s bonds or interest on the bonds.
9. To redeem the bonds, to covenant for the bonds’ redemption, and to provide the terms and conditions of redemption.
10. To covenant, subject to the limitations contained in this chapter, as to the rents and fees to be charged in the operation of a housing project or projects, the amount to be raised each year or other period of time by rents, fees, and other revenues, and as to the use and disposition to be made of the same.
11. To create, or to authorize the creation of, special funds for moneys held for construction or operating costs, debt service, reserves, or other purposes, and to covenant as to the use and disposition of the moneys held in these funds.
12. To prescribe the procedure, if any, by which the terms of any contract with bondholders may be amended or abrogated, the amount of bonds the holders of which must consent, and the manner in which consent may be given.
13. To covenant as to the use of any or all of the authority’s property.
14. To covenant as to the maintenance of the authority’s property, the replacement of property, the insurance to be carried on property, and the use and disposition of insurance moneys.
15. To covenant as to the rights, liabilities, powers, and duties arising upon the breach by the authority of any covenant, condition, or obligation.
16. To covenant and prescribe as to events of default and terms and conditions upon which any or all of the authority’s bonds or obligations shall become, or may be declared, due before maturity, and as to the terms and conditions upon which the declaration and the declaration’s consequences may be waived.
17. To vest in a trustee or trustees or in the holders of bonds, or any proportion of trustees or holders, the right to enforce the payment of the bonds or any covenants securing or relating to the bonds.
18. To vest in a trustee or trustees the right, in the event of a default by the authority, to take possession and to use, operate, and manage any housing project or part of the housing project, to collect the rents and revenues arising from the housing project, and to dispose of these moneys in accordance with the agreement of the authority with the trustee.
19. To provide for the powers and duties of a trustee or trustees and to limit the liabilities of the trustee.
20. To provide the terms and conditions upon which the trustee or trustees or the holders of bonds, or any proportion of trustees or holders, may enforce any covenant or rights securing or relating to the bonds.
21. To exercise all or any part or combination of the powers granted in this section.
22. To make covenants in addition to the covenants expressly authorized of like or different character.
23. To make covenants and to do any acts and things as may be necessary, convenient, or desirable in order to secure the authority’s bonds, or, in the absolute discretion of the authority, as will tend to make the bonds more marketable notwithstanding that the covenants, acts, or things are not enumerated, including:
    1. To the payment of the principal of and interest on bond obligations, when due, there may be pledged as a first charge and lien the gross revenues of the housing project financed in whole or in part by the obligations, and the governing city or county may covenant to provide additional funds for the benefit of that housing project to the extent that the gross revenues in excess of those debt service requirements are not also sufficient from time to time to pay the reasonable operating and maintenance expenses of that housing project.
    2. The governing body of an authority may pledge the general obligation of the city or county for which the authority was created as additional security for bonds provided that the authority finds that the pledged revenues will equal or exceed one hundred ten percent of the principal and interest due on the bonds for each year, the maturity of the bonds does not exceed thirty-five years, and the principal amount of the issue and the general obligation pledge are approved by the governing body of the city or county in which the housing project is located and whose general obligation is pledged. A public hearing must be held on issuance of the obligations and the pledge of the general obligation by the city or county in which the housing project is located. The hearing must be held at least fifteen days, but not more than one hundred twenty days, before the sale of the obligations.

23-11-25. Certification of attorney general as to legality of bonds.

An authority may submit to the attorney general of this state any bonds to be issued hereunder after all proceedings for the issuance of such bonds have been taken. Upon the submission of such proceedings to the attorney general, the attorney general shall examine and pass upon the validity thereof and of the regularity of all proceedings in connection therewith. If such proceedings conform to the provisions of this chapter and otherwise are regular in form, and if the bonds, when delivered and paid for, will constitute binding and legal obligations of the authority enforceable according to the terms thereof, the attorney general shall certify in substance upon the back of each of said bonds that it is issued in accordance with the constitution and laws of the state of North Dakota.

23-11-26. Rights and remedies of an obligee of authority.

An obligee of an authority, in addition to all other rights which may be conferred on such obligee, and subject only to any contractual restrictions binding upon such obligee, may:

1. By mandamus, suit, action, or proceeding at law or in equity, compel the authority and the commissioners, officers, agents, or employees thereof, to perform each and every term, provision, and covenant contained in any contract of the authority with or for the benefit of such obligee, and require the carrying out of any or all such covenants and agreements of said authority and the fulfillment of all duties imposed upon said authority by this chapter.
2. By suit, action, or proceeding in equity, enjoin any act or thing which may be unlawful or in violation of any of the rights of such obligee of the authority.

23-11-27. Additional remedies conferrable by authority on obligee.

An authority, by its resolution, trust indenture, mortgage, lease, or other contract, may confer upon any obligee holding or representing a specified amount in bonds, or holding a lease, in addition to all rights that otherwise may be conferred, the right, upon the happening of an event of default as defined in such resolution or instrument, by suit, action, or proceeding, in any court of competent jurisdiction:

1. To cause possession of any housing project, or any part thereof, to be surrendered to such obligee.
2. To obtain the appointment of a receiver of any housing project of said authority, or of any part thereof, and of the rents and profits therefrom. If such receiver is appointed, the receiver may enter into and take possession of such housing project, or of any part thereof, and operate and maintain the same and collect and receive all fees, rents, revenues, or other charges thereafter arising therefrom, and the receiver shall keep such moneys in a separate account or accounts and apply the same in accordance with the obligations of the authority as the court shall direct.
3. To require the authority and the commissioners thereof to account as if it and they were the trustees of an express trust.

23-11-28. Exemption of real property from execution sale.

All real property of an authority, including an authority created under Indian laws recognized by the federal government, is exempt from levy and sale by virtue of an execution, and no execution or other judicial process may issue against the same nor may any judgment against any authority be a charge or lien upon its real property. The provisions of this section, however, do not apply to nor limit the right of obligees to foreclose or otherwise enforce any mortgage of an authority or the right of an obligee to pursue any remedies for the enforcement of any pledge or lien given by an authority on its rents, fees, or revenues.

23-11-29. Tax exemptions and payments in lieu of taxes.

The property of an authority used for low-income housing, authority administration, or other property solely owned by the authority and used to conduct the powers granted to the authority in this chapter, including an authority created under Indian laws recognized by the federal government, is declared to be public property used for essential public and governmental purposes and is exempt from all taxes and special assessments of the state or any political subdivision. In lieu of taxes or special assessments, an authority may agree to make payments to the state or any political subdivision for improvements, services, and facilities furnished by the state or political subdivision for the benefits of a housing project. The payments may not exceed the estimated cost of the improvements, services, or facilities to be so furnished. Notwithstanding any other provision of law, the property of an authority used for moderate income housing is exempt from all taxes of the state or any political subdivision except special assessments unless specifically exempted from the special assessment by the political subdivision.

23-11-30. Reports.

At least once every year, an authority shall file with the city auditor or county auditor, as the case may be, a report of its activities for the preceding year and shall make recommendations with reference to such additional legislation or other action as it deems necessary in order to carry out the purposes of this chapter.

23-11-31. Houses for workers in national defense and veterans.

Any housing authority may undertake the development and administration of projects to assure the availability of safe and sanitary dwellings for persons engaged in national defense activities who, as determined by the housing authority, would not otherwise be able to secure safe and sanitary dwellings within the vicinity thereof. In the ownership, development, or administration of such projects, a housing authority has all the rights, powers, privileges, and immunities that such authority has under any provisions of law relating to the ownership, development, or administration of slum clearance and housing projects for persons of low income. The authority shall exercise such rights, powers, and privileges as though all the provisions of law applicable to slum clearance and housing projects for persons of low income were applicable to projects developed or administered to assure the availability of safe and sanitary dwellings for persons engaged in national defense activities as provided in this section. Housing projects developed or administered hereunder constitute housing projects under the provisions of this chapter. When a housing authority finds that within its area of operation, or any part thereof, there is an acute shortage of safe and sanitary dwellings which impedes the national defense program or the general welfare of veterans and that necessary and safe and sanitary dwellings would not otherwise be provided when needed for such persons, any project developed or administered by such housing authority or by any housing authority cooperating with such authority pursuant to this section, with the financial aid of the federal government or as agent for the federal government as hereinafter provided, is not subject to the limitations provided in sections 23-11-13 and 23-11-14. Any such finding must be conclusive in any suit, action, or other proceeding. A housing authority may make payments in such amounts as it finds necessary or desirable for any services, facilities, works, privileges, or improvements furnished for or in connection with any such projects. After the national defense period any such projects owned and administered by a housing authority must be administered in accordance with the preceding sections of this chapter except veterans are not subject to the limitations in section 23-11-14.

23-11-32. Cooperation with federal government.

A housing authority may exercise any or all of its powers for the purpose of cooperating with, or acting as agent for, the federal government in the development or administration of projects by the federal government to assure the availability of safe and sanitary dwellings for persons engaged in national defense activities or veterans and may undertake the development or administration of any such projects for the federal government. In order to assure the availability of safe and sanitary housing for persons engaged in national defense activities or for veterans, a housing authority may sell, in whole or in part, to the federal government any housing project developed for such persons but not yet occupied by such persons. Such sale must be at a price and upon those terms the housing authority prescribes and must include provision for the satisfaction of all debts and liabilities of the authority relating to the project.

23-11-33. Municipalities may cooperate.

Any city, county, or other public body may cooperate with housing authorities, or with the federal government, with respect to the development or administration of projects, and necessary slum clearance, to assure the availability of safe and sanitary dwellings for persons engaged in national defense activities and for veterans.

23-11-34. Powers of housing authority.

This chapter constitutes an independent authorization for a housing authority to undertake the development or administration of projects to assure the availability of safe and sanitary dwellings for persons engaged in national defense activities and for veterans as provided in this chapter and for a housing authority to cooperate with, or act as agent for, the federal government in the development or administration of similar projects by the federal government. In acting under this authorization, a housing authority is not subject to any limitations, restrictions, or requirements of other laws, except those relating to land acquisition, prescribing the procedure or action to be taken in the development or administration of any public works, including slum clearance and housing projects for such persons or undertakings or projects of municipal or public corporations or political subdivisions or agencies of the state. A housing authority may do any and all things necessary or desirable to cooperate with, or act as agent for, the federal government, or to secure financial aid, in the expeditious development or in the administration of projects to assure the availability of safe and sanitary dwellings for persons engaged in national defense activities and for veterans and to effectuate the purposes of this chapter.

23-11-35. Definitions.

As used in sections 23-11-31 to 23-11-36:

1. “Administration” means any and all undertakings necessary for management, operation, or maintenance, in connection with any project, and includes the leasing of any project, in whole or in part, from the federal government.
2. “Development” means any and all undertakings necessary for the planning, land acquisition, demolition, financing, construction, or equipment in connection with a project, including the negotiation or award of contracts therefor, and includes the acquisition of any project, in whole or in part, from the federal government.
3. “Federal government” means the United States of America or any agency or instrumentality, corporate or otherwise, of the United States of America.
4. “Housing authority” means any housing authority established or hereafter established pursuant to the provisions of this chapter.
5. “Persons engaged in national defense activities” includes enlisted men in the military and naval services of the United States, employees of the war and navy departments assigned to duty at military or naval reservations, posts, or bases, and workers engaged or to be engaged in industries connected with and essential to the national defense program, and includes the families of the aforesaid persons who are living with them.
6. “Persons of low income” means persons or families who lack the amount of income which is necessary, as determined by the housing authority undertaking the housing project, to enable them, without financial assistance, to live in decent, safe, and sanitary dwellings, without overcrowding.
7. “Veteran” means a person, as defined by section 37-01-40, who may be eligible under the terms of sections 23-11-31 through 23-11-34 for aid or assistance.

The development of a project must be deemed to be initiated if a housing authority has issued any bonds, notes, or other obligations with respect to financing the development of such project of the authority, or has contracted with the federal government with respect to the exercise of powers hereunder in the development of such project of the federal government for which an allocation of funds has been made during the existence of this chapter.

23-11-36. Powers not limited.

The powers conferred by sections 23-11-31 to 23-11-35 are in addition and supplemental to the powers conferred by any other law, and nothing contained herein may be construed as limiting any other powers of a housing authority.

23-12-01. Disinfection of secondhand goods. [Repealed]

Repealed by S.L. 1975, ch. 225, § 1.

23-12-02. Penalty for not disinfecting secondhand goods. [Repealed]

Repealed by S.L. 1975, ch. 106, § 673; S.L. 1975, ch. 225, § 1.

23-12-03. Use of public drinking cup prohibited — Penalty.

Any person in charge of any:

1. Public conveyance;
2. Passenger terminal building;
3. Public, parochial, or private school, or other educational institution; or
4. Public building

who furnishes or permits the common use of public drinking cups in such place is guilty of an infraction.

23-12-04. Permission to establish hospital in residence block of city required.

No hospital which treats patients for pay may be established in any residence block of any city in this state unless the person, firm, corporation, or limited liability company proposing to establish the same files with the city auditor the written consent of the resident freeholders of such block.

23-12-05. Advertising certain cures and drugs and specialization prohibited — Penalty. [Repealed]

Repealed by S.L. 1975, ch. 106, § 673.

23-12-06. Injury to public health — Penalty. [Repealed]

Repealed by S.L. 1975, ch. 106, § 673.

23-12-07. Violation of health laws — General penalty.

Any person who willfully violates any provision of this title, if another penalty is not specifically provided for such violation, is guilty of an infraction.

23-12-08. Emergency medical service authorized.

Any county or municipality of the state of North Dakota, by itself, or in combination with any other county or municipality of the state of North Dakota, may, acting through its governing body, establish, maintain, contract for, or otherwise provide emergency medical service for such county or municipality; and for this purpose, out of any funds of such county or municipality not otherwise committed, may buy, rent, lease, or otherwise contract for all such vehicles, equipment, or other facilities or services which may be necessary to effectuate such purpose.

23-12-09. Smoking in public places and places of employment — Definitions. [Effective through August 31, 2022]

In sections 23-12-09 through 23-12-11, unless the context or subject matter otherwise requires:

1. “Bar” means a retail alcoholic beverage establishment licensed under chapter 5-02 that is devoted to the serving of alcoholic beverages for consumption by guests on the premises and in which the serving of food is only incidental to the consumption of those beverages. The term includes a bar located within a hotel, bowling center, restaurant, or other establishment that is not licensed primarily or exclusively to sell alcoholic beverages.
2. “Business” means a sole proprietorship, partnership, association, joint venture, corporation, or other business entity, either for profit or not for profit, including retail establishments where goods or services are sold and professional corporations and other entities where professional services are delivered.
3. “E-cigarette” means any electronic oral device, such as one composed of a heating element and battery or electronic circuit, or both, which provides a vapor of nicotine or any other substances, and the use or inhalation of which simulates smoking. The term shall include any such device, whether manufactured, distributed, marketed, or sold as an e-cigarette, e-cigar, and e-pipe or under any other product, name, or descriptor.
4. “Employee” means an individual who is employed by an employer in consideration for direct or indirect monetary wages or profit, or an individual who volunteers services for an employer.
5. “Employer” means an individual, business, or private club, including a municipal corporation or trust, or the state and its agencies and political subdivisions that employs the services of one or more individuals.
6. “Enclosed area” means all space between a floor and ceiling that has thirty-three percent or more of the surface area of its perimeter bounded by opened or closed walls, windows, or doorways. A wall includes any physical barrier regardless of whether it is opened or closed, temporary or permanent, or contains openings of any kind, and includes retractable dividers and garage doors.
7. “Entrance” means an exterior door that actuates to the left or right which allows access to a public place.
8. “Health care facility” means any office or institution providing health care services or treatment of diseases, whether physical, mental or emotional, or other medical, physiological or psychological conditions. Some examples of health care facilities include hospitals; clinics; ambulatory surgery centers; outpatient care facilities; weight control clinics; nursing homes; homes for the aging or chronically ill; nursing, basic, long-term, or assisted living facilities; laboratories; and offices of any medical professional licensed under title 43, including all specialties and subspecialties in those fields. This definition shall include all waiting rooms, hallways, private rooms, semiprivate rooms, wards within health care facilities, and any mobile or temporary health care facilities.
9. “Health care services” means services provided by any health care facility. Some examples of health care services are medical, surgical, dental, vision, chiropractic, psychological, and pharmaceutical services.
10. “Place of employment” means an area under the control of a public or private employer, including work areas, auditoriums, classrooms, conference rooms, elevators, employee cafeterias, employee lounges, hallways, meeting rooms, private offices, restrooms, temporary offices, vehicles, and stairs. A private residence is not a place of employment unless it is used as a licensed child care, adult day care, or health care facility.
11. “Public place” means an area which the public enters. Some examples of public places are publicly owned buildings, vehicles, or offices; bars; bingo facilities; gambling and gaming facilities as defined in section 12.1-28-01; child care and adult day care facilities subject to licensure by the department of human services, including those operated in private homes; convention facilities; educational facilities, both public and private; facilities primarily used for exhibiting a motion picture, stage, drama, lecture, musical recital, or other similar performance; financial institutions; health care facilities; hotels and motels, including all rooms that are rented to guests; laundromats; any common areas in apartment buildings, condominiums, mobile home parks, retirement facilities, nursing homes, and other multiple-unit residential facilities; private and semi-private nursing home rooms; museums, libraries, galleries, and aquariums; polling places; professional offices; public transportation facilities, including buses, trains, airplanes and similar aircraft, taxicabs and similar vehicles such as towncars and limousines when used for public transportation, and ticket, boarding, and waiting areas of public transit facilities, including bus and train stations and airports; reception areas; restaurants; retail food production and marketing establishments; retail service establishments; retail stores, including tobacco and hookah establishments; rooms, chambers, places of meeting or public assembly, including school buildings; shopping malls; sports arenas; theaters; and waiting rooms.
12. “Publicly owned building, vehicle, or office” means a place or vehicle owned, leased, or rented by any state or political subdivision, or by any agency supported by appropriation of, or by contracts or grants from, funds derived from the collection of taxes.
13. “Restaurant” includes every building or other structure, or any part thereof, and all buildings in connection therewith that are kept, used, maintained, advertised, or held out to the public as a place where food is served. Some examples of restaurants include coffee shops, cafeterias, sandwich stands, private and public school cafeterias, kitchens, and catering facilities in which food is prepared on the premises for serving elsewhere, and a bar area within a restaurant.
14. “Shopping mall” means an enclosed public walkway or hall area that serves to connect retail or professional businesses.
15. “Smoking” means inhaling, exhaling, burning, or carrying any lighted or heated cigar, cigarette, or pipe, or any other lighted or heated tobacco or plant product intended for inhalation, in any manner or in any form. Smoking also includes the use of an e-cigarette which creates a vapor, in any manner or any form, or the use of any oral smoking device for the purpose of circumventing the prohibition of smoking in this Act.
16. “Sports arena” means an indoor or outdoor place where members of the public assemble to engage in physical exercise, participate in athletic competition, or witness sports or other events. Some examples of sports arenas include sports pavilions, stadiums, gymnasiums, health spas, boxing arenas, swimming pools, roller and ice rinks, and bowling centers.

23-12-09. Smoking in public places and places of employment — Definitions. [Effective September 1, 2022]

In sections 23-12-09 through 23-12-11, unless the context or subject matter otherwise requires:

1. “Bar” means a retail alcoholic beverage establishment licensed under chapter 5-02 that is devoted to the serving of alcoholic beverages for consumption by guests on the premises and in which the serving of food is only incidental to the consumption of those beverages. The term includes a bar located within a hotel, bowling center, restaurant, or other establishment that is not licensed primarily or exclusively to sell alcoholic beverages.
2. “Business” means a sole proprietorship, partnership, association, joint venture, corporation, or other business entity, either for profit or not for profit, including retail establishments where goods or services are sold and professional corporations and other entities where professional services are delivered.
3. “E-cigarette” means any electronic oral device, such as one composed of a heating element and battery or electronic circuit, or both, which provides a vapor of nicotine or any other substances, and the use or inhalation of which simulates smoking. The term shall include any such device, whether manufactured, distributed, marketed, or sold as an e-cigarette, e-cigar, and e-pipe or under any other product, name, or descriptor.
4. “Employee” means an individual who is employed by an employer in consideration for direct or indirect monetary wages or profit, or an individual who volunteers services for an employer.
5. “Employer” means an individual, business, or private club, including a municipal corporation or trust, or the state and its agencies and political subdivisions that employs the services of one or more individuals.
6. “Enclosed area” means all space between a floor and ceiling that has thirty-three percent or more of the surface area of its perimeter bounded by opened or closed walls, windows, or doorways. A wall includes any physical barrier regardless of whether it is opened or closed, temporary or permanent, or contains openings of any kind, and includes retractable dividers and garage doors.
7. “Entrance” means an exterior door that actuates to the left or right which allows access to a public place.
8. “Health care facility” means any office or institution providing health care services or treatment of diseases, whether physical, mental or emotional, or other medical, physiological or psychological conditions. Some examples of health care facilities include hospitals; clinics; ambulatory surgery centers; outpatient care facilities; weight control clinics; nursing homes; homes for the aging or chronically ill; nursing, basic, long-term, or assisted living facilities; laboratories; and offices of any medical professional licensed under title 43, including all specialties and subspecialties in those fields. This definition shall include all waiting rooms, hallways, private rooms, semiprivate rooms, wards within health care facilities, and any mobile or temporary health care facilities.
9. “Health care services” means services provided by any health care facility. Some examples of health care services are medical, surgical, dental, vision, chiropractic, psychological, and pharmaceutical services.
10. “Place of employment” means an area under the control of a public or private employer, including work areas, auditoriums, classrooms, conference rooms, elevators, employee cafeterias, employee lounges, hallways, meeting rooms, private offices, restrooms, temporary offices, vehicles, and stairs. A private residence is not a place of employment unless it is used as a licensed child care, adult day care, or health care facility.
11. “Public place” means an area which the public enters. Some examples of public places are publicly owned buildings, vehicles, or offices; bars; bingo facilities; gambling and gaming facilities as defined in section 12.1-28-01; child care and adult day care facilities subject to licensure by the department of health and human services, including those operated in private homes; convention facilities; educational facilities, both public and private; facilities primarily used for exhibiting a motion picture, stage, drama, lecture, musical recital, or other similar performance; financial institutions; health care facilities; hotels and motels, including all rooms that are rented to guests; laundromats; any common areas in apartment buildings, condominiums, mobile home parks, retirement facilities, nursing homes, and other multiple-unit residential facilities; private and semi-private nursing home rooms; museums, libraries, galleries, and aquariums; polling places; professional offices; public transportation facilities, including buses, trains, airplanes and similar aircraft, taxicabs and similar vehicles such as towncars and limousines when used for public transportation, and ticket, boarding, and waiting areas of public transit facilities, including bus and train stations and airports; reception areas; restaurants; retail food production and marketing establishments; retail service establishments; retail stores, including tobacco and hookah establishments; rooms, chambers, places of meeting or public assembly, including school buildings; shopping malls; sports arenas; theaters; and waiting rooms.
12. “Publicly owned building, vehicle, or office” means a place or vehicle owned, leased, or rented by any state or political subdivision, or by any agency supported by appropriation of, or by contracts or grants from, funds derived from the collection of taxes.
13. “Restaurant” includes every building or other structure, or any part thereof, and all buildings in connection therewith that are kept, used, maintained, advertised, or held out to the public as a place where food is served. Some examples of restaurants include coffee shops, cafeterias, sandwich stands, private and public school cafeterias, kitchens, and catering facilities in which food is prepared on the premises for serving elsewhere, and a bar area within a restaurant.
14. “Shopping mall” means an enclosed public walkway or hall area that serves to connect retail or professional businesses.
15. “Smoking” means inhaling, exhaling, burning, or carrying any lighted or heated cigar, cigarette, or pipe, or any other lighted or heated tobacco or plant product intended for inhalation, in any manner or in any form. Smoking also includes the use of an e-cigarette which creates a vapor, in any manner or any form, or the use of any oral smoking device for the purpose of circumventing the prohibition of smoking in this Act.
16. “Sports arena” means an indoor or outdoor place where members of the public assemble to engage in physical exercise, participate in athletic competition, or witness sports or other events. Some examples of sports arenas include sports pavilions, stadiums, gymnasiums, health spas, boxing arenas, swimming pools, roller and ice rinks, and bowling centers.

23-12-10. Smoking restrictions — Exceptions — Retaliation — Application. [Effective through August 31, 2022]

1. In order to protect the public health and welfare and to recognize the need for individuals to breathe smoke-free air, smoking is prohibited in all enclosed areas of:
   1. Public places; and
   2. Places of employment.
2. Smoking is prohibited within twenty feet [6.10 meters] of entrances, exits, operable windows, air intakes, and ventilation systems of enclosed areas in which smoking is prohibited. Owners, operators, managers, employers, or other persons who own or control a public place or place of employment may seek to rebut the presumption that twenty feet [6.10 meters] is a reasonable minimum distance by making application to the director of the local health department or district in which the public place or place of employment is located.  The presumption will be rebutted if the applicant can show by clear and convincing evidence that, given the unique circumstances presented by the location of entrances, exits, windows that open, ventilation intakes, or other factors, smoke will not infiltrate or reach the entrances, exits, open windows, or ventilation intakes or enter into such public place or place of employment and, therefore, the public health and safety will be adequately protected by a lesser distance.
3. The following areas are exempt from subsections 1 and 2:
   1. Private residences, except those residences used as a child care, adult day care, or health care facility subject to licensure by the department of human services.
   2. Outdoor areas of places of employment, except those listed in subsection 2.
   3. Any area that is not commonly accessible to the public and which is part of an owner-operated business having no employee other than the owner-operator.
4. Smoking as part of a traditional American Indian spiritual or cultural ceremony is not prohibited.
5. No person or employer shall discharge, refuse to hire, or in any manner retaliate against an employee, applicant for employment, or other person because that person asserts or exercises any rights afforded by this section or reports or attempts to prosecute a violation of this section. An employee who works in a setting where an employer allows smoking does not waive or surrender any legal rights the employee may have against the employer or any other party.  Violations of this subsection shall be a class B misdemeanor.
6. This section may not be interpreted or construed to permit smoking where it is otherwise restricted by other applicable laws.
7. Notwithstanding any other provision of this chapter, an owner, operator, manager or other person in control of an establishment, facility, or outdoor area may declare that entire establishment, facility, or outdoor area as a nonsmoking place.

23-12-10. Smoking restrictions — Exceptions — Retaliation — Application. [Effective September 1, 2022]

1. In order to protect the public health and welfare and to recognize the need for individuals to breathe smoke-free air, smoking is prohibited in all enclosed areas of:
   1. Public places; and
   2. Places of employment.
2. Smoking is prohibited within twenty feet [6.10 meters] of entrances, exits, operable windows, air intakes, and ventilation systems of enclosed areas in which smoking is prohibited. Owners, operators, managers, employers, or other persons who own or control a public place or place of employment may seek to rebut the presumption that twenty feet [6.10 meters] is a reasonable minimum distance by making application to the director of the local health department or district in which the public place or place of employment is located.  The presumption will be rebutted if the applicant can show by clear and convincing evidence that, given the unique circumstances presented by the location of entrances, exits, windows that open, ventilation intakes, or other factors, smoke will not infiltrate or reach the entrances, exits, open windows, or ventilation intakes or enter into such public place or place of employment and, therefore, the public health and safety will be adequately protected by a lesser distance.
3. The following areas are exempt from subsections 1 and 2:
   1. Private residences, except those residences used as a child care, adult day care, or health care facility subject to licensure by the department of health and human services.
   2. Outdoor areas of places of employment, except those listed in subsection 2.
   3. Any area that is not commonly accessible to the public and which is part of an owner-operated business having no employee other than the owner-operator.
4. Smoking as part of a traditional American Indian spiritual or cultural ceremony is not prohibited.
5. No person or employer shall discharge, refuse to hire, or in any manner retaliate against an employee, applicant for employment, or other person because that person asserts or exercises any rights afforded by this section or reports or attempts to prosecute a violation of this section. An employee who works in a setting where an employer allows smoking does not waive or surrender any legal rights the employee may have against the employer or any other party.  Violations of this subsection shall be a class B misdemeanor.
6. This section may not be interpreted or construed to permit smoking where it is otherwise restricted by other applicable laws.
7. Notwithstanding any other provision of this chapter, an owner, operator, manager or other person in control of an establishment, facility, or outdoor area may declare that entire establishment, facility, or outdoor area as a nonsmoking place.

23-12-10.1. Responsibility of proprietors. [Repealed]

Repealed by S.L. 2005, ch. 239, § 7.

23-12-10.2. Complaints and enforcement — City and county ordinances and home rule charters. [Effective through August 31, 2022]

1. State agencies with statutory jurisdiction over a state-owned building or office shall enforce section 23-12-10. These agencies include the fire marshal department, state department of health, department of human services, legislative council, and office of management and budget.
2. A city or county ordinance, a city or county home rule charter, or an ordinance adopted under a home rule charter may not provide for less stringent provisions than those provided under sections 23-12-09 through 23-12-11. Nothing in this Act shall preempt or otherwise affect any other state or local tobacco control law that provides more stringent protection from the hazards of secondhand smoke. This subsection does not preclude any city or county from enacting any ordinance containing penal language when otherwise authorized to do so by law.
3. The provisions of this Act shall be enforced by state’s attorneys who may ask the North Dakota attorney general to adopt administrative rules to ensure compliance with this Act.  State and local law enforcement agencies may apply for injunctive relief to enforce provisions of this Act.

23-12-10.2. Complaints and enforcement — City and county ordinances and home rule charters. [Effective September 1, 2022]

1. State agencies with statutory jurisdiction over a state-owned building or office shall enforce section 23-12-10. These agencies include the fire marshal department, department of health and human services, legislative council, and office of management and budget.
2. A city or county ordinance, a city or county home rule charter, or an ordinance adopted under a home rule charter may not provide for less stringent provisions than those provided under sections 23-12-09 through 23-12-11. Nothing in this Act shall preempt or otherwise affect any other state or local tobacco control law that provides more stringent protection from the hazards of secondhand smoke. This subsection does not preclude any city or county from enacting any ordinance containing penal language when otherwise authorized to do so by law.
3. The provisions of this Act shall be enforced by state’s attorneys who may ask the North Dakota attorney general to adopt administrative rules to ensure compliance with this Act.  State and local law enforcement agencies may apply for injunctive relief to enforce provisions of this Act.

23-12-10.3. Exceptions — Medical necessity. [Repealed]

Repealed by I.M. approved November 6, 2012, S.L. 2013, ch. 510, § 7.

23-12-10.4. Responsibility of proprietors — Reimbursement of costs of compliance. [Effective through August 31, 2022]

1. The owner, operator, manager, or other person in control of a public place or place of employment where smoking is prohibited by this Act shall:
   1. Clearly and conspicuously post no smoking signs or the international no smoking symbol in that place.
   2. Clearly and conspicuously post at every entrance to that place a sign stating that smoking is prohibited.
   3. Remove all ashtrays from any area where smoking is prohibited, except for ashtrays displayed for sale and not for use on the premises and ashtrays that are factory-installed in vehicles.
   4. By December 6, 2012, communicate to all existing employees and to all prospective employees upon their application for employment that smoking is prohibited in that place.
   5. For places under his or her control, direct a person who is smoking in violation of this Act to extinguish the product being smoked. If the person does not stop smoking, the owner, operator, manager, or employee shall refuse service and shall immediately ask the person to leave the premises. If the person in violation refuses to leave the premises, the owner, operator, manager, or employee shall immediately report the violation to an enforcement agency identified in this Act. The refusal of the person to stop smoking or leave the premises in response to requests made under this section by an owner, operator, manager, or employee shall not constitute a violation of the Act by the owner, operator, manager, or employee.
2. The owner, operator, manager, or other person in control of a public place or place of employment where smoking is prohibited by this chapter may request from the state department of health the signs necessary to comply with the signage requirements of subsection 1.

23-12-10.4. Responsibility of proprietors — Reimbursement of costs of compliance. [Effective September 1, 2022]

1. The owner, operator, manager, or other person in control of a public place or place of employment where smoking is prohibited by this Act shall:
   1. Clearly and conspicuously post no smoking signs or the international no smoking symbol in that place.
   2. Clearly and conspicuously post at every entrance to that place a sign stating that smoking is prohibited.
   3. Remove all ashtrays from any area where smoking is prohibited, except for ashtrays displayed for sale and not for use on the premises and ashtrays that are factory-installed in vehicles.
   4. By December 6, 2012, communicate to all existing employees and to all prospective employees upon their application for employment that smoking is prohibited in that place.
   5. For places under his or her control, direct a person who is smoking in violation of this Act to extinguish the product being smoked. If the person does not stop smoking, the owner, operator, manager, or employee shall refuse service and shall immediately ask the person to leave the premises. If the person in violation refuses to leave the premises, the owner, operator, manager, or employee shall immediately report the violation to an enforcement agency identified in this Act. The refusal of the person to stop smoking or leave the premises in response to requests made under this section by an owner, operator, manager, or employee shall not constitute a violation of the Act by the owner, operator, manager, or employee.
2. The owner, operator, manager, or other person in control of a public place or place of employment where smoking is prohibited by this chapter may request from the department of health and human services the signs necessary to comply with the signage requirements of subsection 1.

23-12-10.5. Construction and severability.

This Act shall be construed liberally so as to further its purposes. The provisions of this Act are declared to be severable. If any provision, clause, sentence, or paragraph of this Act, or its application to any person or circumstances, shall be held invalid, that invalidity shall not affect the other provisions of this Act that can be given without the invalid provision or applications.

23-12-11. Penalty.

1. An individual who smokes in an area in which smoking is prohibited under section 23-12-10 is guilty of an infraction punishable by a fine not exceeding fifty dollars.
2. Except as otherwise provided in subsection 5 of section 23-12-10, an owner or other person with general supervisory responsibility over a public place or place of employment who willfully fails to comply with section 23-12-10 is guilty of an infraction, subject to a fine not to exceed one hundred dollars for the first violation, to a fine not to exceed two hundred dollars for a second violation within one year, and a fine not to exceed five hundred dollars for each additional violation within one year of the preceding violation.
3. In addition to the fines established by this section, violation of this Act by a person who owns, manages, operates, or otherwise controls a public place or place of employment may result in the suspension or revocation of any permit or license issued to the person for the premises on which the violation occurred.
4. Violations of this Act are declared to be a public nuisance that may be abated by restraining order, preliminary or permanent injunction, or other means provided by law.
5. Each day on which a violation of this Act occurs shall be considered a separate and distinct violation.

23-12-12. Federal Health Care Quality Improvement Act of 1986 applicable in North Dakota.

Pursuant to the Health Care Quality Improvement Act of 1986 [Pub. L. 99-660, Title IV; 100 Stat. 3784; 42 U.S.C. 11101 et seq.], providing for a limitation on damages for professional review actions, the provisions of that Act are effective in this state.

23-12-13. Persons authorized to provide informed consent to health care for incapacitated persons — Priority.

1. Informed consent for health care for a minor patient or a patient who is determined by a physician to be an incapacitated person, as defined in subsection 2 of section 30.1-26-01, and unable to consent may be obtained from a person authorized to consent on behalf of the patient. Persons in the following classes and in the following order of priority may provide informed consent to health care on behalf of the patient:
   1. The individual, if any, to whom the patient has given a durable power of attorney that encompasses the authority to make health care decisions, unless a court of competent jurisdiction specifically authorizes a guardian to make medical decisions for the incapacitated person;
   2. The appointed guardian or custodian of the patient, if any;
   3. The patient’s spouse who has maintained significant contacts with the incapacitated person;
   4. Children of the patient who are at least eighteen years of age and who have maintained significant contacts with the incapacitated person;
   5. Parents of the patient, including a stepparent who has maintained significant contacts with the incapacitated person;
   6. Adult brothers and sisters of the patient who have maintained significant contacts with the incapacitated person;
   7. Grandparents of the patient who have maintained significant contacts with the incapacitated person;
   8. Grandchildren of the patient who are at least eighteen years of age and who have maintained significant contacts with the incapacitated person; or
   9. A close relative or friend of the patient who is at least eighteen years of age and who has maintained significant contacts with the incapacitated person.
2. A physician seeking informed consent for proposed health care for a minor patient or a patient who is an incapacitated person and is unable to consent must make reasonable efforts to locate and secure authorization for the health care from a competent person in the first or succeeding class identified in subsection 1. If the physician is unable to locate such person, authorization may be given by any person in the next class in the order of descending priority. A person identified in subsection 1 may not provide informed consent to health care if a person of higher priority has refused to give such authorization.
3. Before any person authorized to provide informed consent pursuant to this section exercises that authority, the person must first determine in good faith that the patient, if not incapacitated, would consent to the proposed health care. If such a determination cannot be made, the decision to consent to the proposed health care may be made only after determining that the proposed health care is in the patient’s best interests.
4. No person authorized to provide informed consent pursuant to this section may provide consent for sterilization, abortion, or psychosurgery or for admission to a state mental health facility for a period of more than forty-five days without a mental health proceeding or other court order.
5. If a patient who is determined by a physician to be an incapacitated person, or a person interested in the patient’s welfare, objects to a determination of incapacity made pursuant to this section, a court hearing pursuant to chapter 30.1-28 must be held to determine the issue of incapacity.

23-12-14. Copies of medical records and medical bills.

1. As used in this section, “health care provider” means a licensed individual or licensed facility providing health care services. Upon the request of a health care provider’s patient or any person authorized by a patient, the provider shall provide a free copy of a patient’s health care records to a health care provider designated by the patient or the person authorized by the patient if the records are requested for the purpose of transferring that patient’s health care to another health care provider for the continuation of treatment.
2. Except as provided in subsection 1, upon the request for medical records or medical bills with the signed authorization of the patient, the health care provider shall provide medical records and any associated medical bills either in paper or facsimile format at a charge of no more than twenty dollars for the first twenty-five pages and seventy-five cents per page after twenty-five pages or in an electronic, digital, or other computerized format at a charge of thirty dollars for the first twenty-five pages and twenty-five cents per page after twenty-five pages. This charge includes any administration fee, retrieval fee, and postage expense.

23-12-15. State agency provision of medical equipment — Policy for reuse, recycling, or resale.

If a state agency uses state funds to provide free medical equipment to an individual, that state agency shall establish a policy addressing the possible reuse, recycling, or resale value of the medical equipment upon replacement of the medical equipment by that state agency or upon disuse of the medical equipment by the individual.

23-12-16. Right to breastfeed.

A woman may breastfeed her child in any location, public or private, where the woman and child are otherwise authorized to be.

23-12-17. Workplace breastfeeding policies — Infant friendly designation. [Effective through August 31, 2022]

1. An employer may use the designation “infant friendly” on its promotional materials if the employer adopts a workplace breastfeeding policy that includes the following:
   1. Flexible work scheduling, including scheduling breaks and permitting work patterns that provide time for expression of breast milk;
   2. A convenient, sanitary, safe, and private location, other than a restroom, allowing privacy for breastfeeding or expressing breast milk;
   3. A convenient clean and safe water source with facilities for washing hands and rinsing breast-pumping equipment located in the private location specified in subdivision b; and
   4. A convenient hygienic refrigerator in the workplace for the temporary storage of the mother’s breast milk.
2. The state department of health shall establish guidelines for employers concerning workplace breastfeeding and infant friendly designations.

23-12-17. Workplace breastfeeding policies — Infant friendly designation. [Effective September 1, 2022]

1. An employer may use the designation “infant friendly” on its promotional materials if the employer adopts a workplace breastfeeding policy that includes the following:
   1. Flexible work scheduling, including scheduling breaks and permitting work patterns that provide time for expression of breast milk;
   2. A convenient, sanitary, safe, and private location, other than a restroom, allowing privacy for breastfeeding or expressing breast milk;
   3. A convenient clean and safe water source with facilities for washing hands and rinsing breast-pumping equipment located in the private location specified in subdivision b; and
   4. A convenient hygienic refrigerator in the workplace for the temporary storage of the mother’s breast milk.
2. The department of health and human services shall establish guidelines for employers concerning workplace breastfeeding and infant friendly designations.

23-12-18. Medical facility and provider performance reviews and ratings — Notice.

1. If a medical facility or provider in this state has a performance review that results in the receipt of a rating, and at any time pays a fee to the person completing the rating, the medical facility or provider shall include a public notice in any promotional or marketing activities referring to the rating information stating that the medical facility or provider made a payment and stating the amount of that payment made to the person performing the rating.
2. Subsection 1 does not apply to a performance review required to maintain licensure or accreditation by governmental or third-party payers or to maintain accreditation by a quality assurance organization.

23-12-19. Voluntary participation in the health information organization — Prohibition on withholding care or benefits.

1. As used in this section:
   1. “Health information organization” means the health information exchange created under chapter 54-59.
   2. “Individually identifiable health information” has the meaning set forth in title 45, Code of Federal Regulations, section 160.103.
2. An individual may opt-out of participating in the health information organization by providing notice to the organization. If an individual chooses to opt-out of participating in the health information organization, the individual’s individually identifiable health information may not be accessed by search by a health insurer, government health plan, or health care provider other than the provider who originally created or ordered the creation of the individually identifiable health information.
3. In opting out of participating in the health information organization under this section, the individual must have the option of:
   1. Opting out of participating; or
   2. Conditionally opting out, in which case the accessibility of the individual’s individually identifiable health information is limited to access by a health care provider who determines access is required by a medical emergency.
4. An individual’s decision to opt-out of participating in the health information organization:
   1. May be changed at any time by the individual by providing written notice to the health information organization.
   2. Does not prohibit use or disclosure of individually identifiable health information which is required by law.
5. A health care provider, health insurer, or government health plan may not withhold coverage or care from an individual nor may a health insurer deny an individual a health insurance benefit plan based solely on that individual’s choice to participate or to opt-out of the health information organization.

23-12-20. COVID-19 vaccination and infection information. [Repealed effective August 1, 2023]

1. Neither a state government entity nor any of its political subdivisions, agents, or assigns may:
   1. Require documentation, whether physical or electronic, for the purpose of certifying or otherwise communicating the following before providing access to property, funds, or services:
      1. An individual’s COVID-19 vaccination status;
      2. The presence of COVID-19 pathogens, antigens, or antibodies; or
      3. An individual’s COVID-19 post-transmission recovery status;
   2. Otherwise publish or share an individual’s COVID-19 vaccination record or similar health information, except as specifically authorized by the individual or otherwise authorized by statute; or
   3. Require a private business to obtain documentation, whether physical or electronic, for purposes of certifying or otherwise communicating the following before employment or providing access to property, funds, or services based on:
      1. An individual’s COVID-19 vaccination status;
      2. The presence of COVID-19 pathogens, antigens, or antibodies; or
      3. An individual’s COVID-19 post-transmission recovery status.
2. Subsection 1 does not apply to the department of corrections and rehabilitation, a correctional facility as defined under section 12-44.1-01, the state hospital, or a public health unit.
3. A private business located in this state or doing business in this state may not require a patron, client, or customer in this state to provide any documentation certifying COVID-19 vaccination, the presence of COVID-19 pathogens, antigens, or antibodies, or COVID-19 post-transmission recovery to gain access to, entry upon, or services from the business.This subsection does not apply to a developmental disability residential facility or a health care provider, including a long-term care provider, basic care provider, and assisted living provider. As used in this subsection, a private business does not include a nonprofit entity that does not sell a product or a service.
4. This section may not be construed to interfere with an individual’s rights to access that individual’s own personal health information or with a person’s right to access personal health information of others which the person otherwise has a right to access.
5. Subsection 1 is not applicable to the state board of higher education, the university system, or institutions under the control of the state board of higher education to the extent the entity has adopted policies and procedures governing the type of documentation required, the circumstances under which such documentation may be shared, and exemptions from providing such documentation.
6. This section is not applicable during a public health disaster or emergency declared in accordance with chapter 37-17.1.
7. As used in this section, the term “COVID-19” means severe acute respiratory syndrome coronavirus 2 identified as SARS-CoV-2 and any mutation or viral fragments of SARS-CoV-2.

23-13-01. Definitions.

In this chapter, unless the context and subject matter otherwise require:

1. “Filling station” means all places of whatever character or description where gasoline, other inflammable liquids, or compressed natural gas are sold at retail for use in motor vehicles.
2. “Motor vehicle” means all vehicles, engines, machines, or mechanical contrivances which are propelled by internal combustion motors or engines.
3. “Person” means natural persons, partnerships, firms, associations, corporations, and limited liability companies.

23-13-02. Sale of motor fuels — Regulations for handling and dispensing.

No person other than the owner or operator of a filling station or a regular bona fide employee or authorized attendant of such owner or operator may fill, wholly or partly, with gasoline or other inflammable liquid at a filling station, any fuel tank of a motor vehicle or any barrel, drum, or other vessel or container, nor may any such person use, handle, or manipulate any hose, pump, pipe, or other contrivance for conveying, measuring, or handling of such liquid. Provided, however, this section does not apply to the operation of self-service motor fuel dispensing devices, provided such operation is in accordance with sections 23-13-02.1 through 23-13-02.7.

23-13-02.1. Definitions.

As used in sections 23-13-02.1 through 23-13-02.7, unless the context requires otherwise:

1. “Fire marshal” means the fire marshal of the state of North Dakota.
2. “Person” means any individual, corporation, limited liability company, company, firm, association, trust, or beneficiary thereof, but does not include any private or fraternal club or association.
3. “Self-service motor fuel dispensing facility” means any business establishment which offers for sale at retail prices motor fuels or compressed natural gas which are dispensed from self-service motor fuel or compressed natural gas dispensing units.
4. “Self-service motor fuel dispensing unit” means any system, device, or pump for dispensing motor fuels or compressed natural gas into the fuel tanks of motor vehicles which is intended to be operated by the purchaser of such motor fuel or compressed natural gas, except that such term does not include any system, device, or pump which is coin operated or currency operated.

23-13-02.2. Operation of self-service motor fuel dispensing unit.

It is lawful for any person to own, operate, or engage in the business of operating self-service motor fuel dispensing units or self-service motor fuel dispensing facilities in this state, provided such operation is in accordance with the provisions of sections 23-13-02.1 through 23-13-02.7.

23-13-02.3. Requirements for the operation of self-service motor fuel dispensing facilities.

All self-service motor fuel dispensing facilities shall be maintained and operated in accordance with the following:

1. All laws, ordinances, rules, or regulations now applicable for sale and dispensing of motor fuels shall, to the extent applicable, apply to the operation of self-service motor fuel dispensing facilities.
2. At all times during the operation of a self-service motor fuel dispensing facility, the owner, operator, employee, or authorized attendant shall be on the premises and shall supervise the operation thereof. The person attending the operation shall refuse service to anyone who appears for any reason to be unable to dispense motor fuel safely. If, however, the filling station provides pump island service to its customers, the attendant must provide refueling services to any mobility-impaired person stopped at a self-service motor fuel dispensing unit who requests assistance and whose vehicle displays a certificate issued under section 39-01-15. No additional cost may be charged to a mobility-impaired person because of the service. This subsection does not apply to any self-service motor fuel dispensing unit equipped with a card-operated, credit card-operated, or key-operated dispensing device. Self-service motor fuel dispensing units equipped with a card-operated, credit card-operated, or key-operated dispensing device are subject to and must conform with the emergency controls, emergency contact, and fire control standards as specified by the national fire protection association. In addition, the operating instructions, warning signs, and emergency instructions specified in the standards of the national fire protection association must be conspicuously posted in the dispensing area.
3. Persons dispensing motor fuel from self-service motor fuel dispensing units shall be a qualified operator of a motor vehicle under North Dakota law. Permanent signs shall be posted on all self-service motor fuel dispensing units prohibiting their operation except by a qualified operator of a motor vehicle under North Dakota law.
4. Operating instructions for the use of self-service motor fuel dispensing units shall be conspicuously posted in the dispensing area.

23-13-02.4. Self-service units to be equipped with emergency power cutoff.

All self-service motor fuel dispensing units must be so constructed that their electrical pumping systems have an accessible switch or circuit breaker provided at a location remote from the dispensing device, including remote pumping systems, and accessible to the supervising attendant, unless an attendant is not required to be on the premises by subsection 2 of section 23-13-02.3, to shut off electrical power to the dispensing devices in the event of an emergency.

23-13-02.5. Self-service motor fuel dispensing units to be in view of attendant — Exception.

Unless an attendant is not required to be on the premises by subsection 2 of section 23-13-02.3, all self-service motor fuel dispensing facilities must, at all times, be in clear view of the attendant who must be able to communicate, by voice, with persons in the dispensing area.

23-13-02.6. Prohibited activities.

With respect to any self-service dispensing facility it is unlawful to:

1. Use, operate, or install any coin-operated or currency-operated dispensing device in any self-service motor fuel dispensing facility.
2. Provide for or use living or residential facilities or accommodations for the benefit of any owner, operator, or employee of the self-service motor fuel dispensing facilities on the premises of such facility.
3. Permit smoking of any nature, so as to constitute a hazard within the vicinity of any self-service motor fuel dispensing unit.
4. Permit the dispensing of any gasoline through self-service gasoline dispensing units to motor vehicles while the motor vehicle’s engine is in operation.

23-13-02.7. Plans and specifications.

Plans and specifications for any new self-service dispensing facility must be submitted to the fire marshal for approval. This does not include conversion of existing facilities for dispensing of motor fuel to self-service dispensing facilities.

23-13-03. Penalty.

Any person who violates any provision of sections 23-13-02 through 23-13-02.7, or any rule or regulation of the fire marshal made pursuant thereto, or who, if an owner or operator of a filling station, permits such violation, is guilty of a class B misdemeanor.

23-13-03.1. Definitions.

As used in sections 23-13-03.1 through 23-13-03.5, unless the context clearly requires otherwise:

1. “Liquefied petroleum gas” means any material which is composed predominately of any of the following hydrocarbons or mixtures of the same: Propane, propylene, butanes (normal butane and isobutane), and the butylenes.
2. “Liquefied petroleum gas containers” means any pressurized containers which are designed to hold more than one hundred fifty gallons [567.81 liters] of liquefied petroleum gas.
3. “Owner” means any person who holds a written bill of sale under which title to a container was transferred or any manufacturer of a container who has not sold or transferred ownership of the container by a written bill of sale.

23-13-03.2. Liquefied petroleum gas containers — Unauthorized use — Prohibited covering of identification marks.

It is unlawful for any person except the owner or the owner’s authorized agent to fill, drain, or refill a liquefied petroleum gas container; or buy, sell, offer for sale, give, take, loan, deliver, or permit to be delivered, or otherwise use a liquefied petroleum gas container if the container bears upon its surface, in plainly legible characters, the name, initials, mark, or other identifying device of the owner; nor may any person other than the owner of a liquefied petroleum container or a person so authorized by the owner, deface, erase, obliterate, cover up, or otherwise remove or conceal any name, mark, initial, or identifying device on the container.

23-13-03.3. Unauthorized possession — Presumptive evidence.

The use of a container by any person other than an authorized agent of the person whose name, mark, initial, or identifying device is or was on the container without written consent or purchase of the marked and distinguished container for the sale of liquefied petroleum gas or filling or refilling with liquefied petroleum gas, or the possession of a container by any person other than an authorized agent of the person whose name, mark, initial, or other identifying device is stamped on the container without the written consent of the owner, is presumptive evidence of the unlawful use or filling of the container.

23-13-03.4. Exemption.

Contractors engaged in construction projects for the building, replacement, or repair of roads, streets, alleys, or parking lots are exempt from the provisions of sections 23-13-03.1 through 23-13-03.5.

23-13-03.5. Penalty.

Any person who violates any provision of sections 23-13-03.1 through 23-13-03.5 is guilty of a class B misdemeanor for each separate offense.

23-13-04. Doors of public buildings — Construction.

All doors of ingress and egress in all schoolhouses and churches within the limits of any city and in all other buildings used for public assemblages of any character in this state, including theaters, public halls, city halls, courthouses, factories, hotels, and all other public buildings wherein numbers of persons are employed or are in the habit of meeting together for any purpose, must be so constructed as to conform with the requirements of the state building code as provided in chapter 54-21.3 and the Americans with Disabilities Act Accessibility Guidelines for Buildings and Facilities as contained in the appendix to title 28, Code of Federal Regulations, part 36 [28 CFR 36].

23-13-05. Penalty for failure to construct doors of public buildings as required.

All persons owning or having charge of any building described in section 23-13-04, including trustees and members of boards of directors and boards of education, shall see that the provisions of such section are complied with. Any person who fails to comply with the provisions of that section, or who builds, maintains, or permits to be used any building contrary to the provisions thereof, is guilty of a class B misdemeanor.

23-13-06. Owner of land to fill abandoned or disused wells, shafts, and other excavations.

Any person owning or occupying lands in this state upon which is located any abandoned or disused well or shaft shall cause such well or shaft to be filled with earth or stones so as to obviate any possible menace to the safety of persons or property. Any person violating the provisions of this section is guilty of a class B misdemeanor.

23-13-07. Overseer of highways to fill wells on state and school lands — Compensation.

The overseer of highways shall cause to be filled or covered, as provided in section 23-13-06, any and all wells situated on any United States lands, state lands, or common school lands within the overseer’s district. The overseer shall receive such compensation, payable out of the road and bridge fund of the township as the board of township supervisors, on presentation of the overseer’s account therefor verified by oath, shall deem reasonable.

23-13-08. Failure of owner to protect mine or well — Duty of overseer.

If any individual, firm, corporation, or limited liability company owning or occupying lands neglects or refuses to comply with the provisions of section 23-13-06, the overseer of highways of the district in which the land is located shall serve a written notice on such owner or occupant, and if the owner or occupant neglects or refuses to comply with the provisions of such section, the overseer, within thirty days after having given such notice, shall cause such wells or mines to be filled or covered. The owner of such land is liable to the township for the cost of such work and the material furnished and the necessary expense incurred in collecting the same. If the owner refuses to pay such cost and expense, the board of township supervisors shall take proper proceedings to obtain judgment against the owner or occupant for the amount expended in filling or covering the same and all costs which may have accrued in obtaining judgment therefor.

23-13-09. North Dakota state safety committee — Members. [Repealed]

Repealed by S.L. 1971, ch. 261, § 1.

23-13-10. State safety committee — Meetings — Purpose. [Repealed]

Repealed by S.L. 1971, ch. 261, § 1.

23-13-11. County safety council or director.

The board of county commissioners is hereby authorized to designate a county safety council or director whose duty it is to give assistance and to cooperate with other agencies and organizations engaged in the promotion of general safety in the respective counties.

23-13-12. Handrail in toilet stalls. [Repealed]

Repealed by S.L. 1993, ch. 261, § 6.

23-13-13. Buildings and facilities constructed or remodeled after effective date to comply with standards. [Repealed]

Repealed by S.L. 1993, ch. 261, § 6.

23-13-14. Sale of metal beverage containers having detachable parts prohibited — Penalty.

No person may sell or offer for sale in this state a carbonated or noncarbonated soft drink, beer, other malt beverage, tea, or fruit or vegetable drink in liquid form and intended for human consumption contained in an individual sealed metal container designed and constructed so that a metal pull tab is detached in the process of opening the container. This section does not prohibit the use of adhesively attached aluminized polyester film pull top seals. Violation of this section is a class B misdemeanor and each day of violation is a separate offense.

23-13-15. Smoke detection systems for residential rental property — Penalty.

1. All residential rental property with the exception of property covered by section 23-09-02.1 must be equipped with smoke detection systems or other approved alarm systems for the protection of occupants of the property. Systems must be installed and maintained in compliance with applicable national fire protection standards as defined by rules adopted by the state fire marshal. The state fire marshal and local fire departments shall provide information concerning the installation of smoke detection systems to owners of residential rental properties. A system installed in a single-family rental dwelling must be maintained and inspected by the tenant occupying the single-family rental dwelling. In other dwellings, the landlord is responsible for installation and ensuring the proper operation of the system upon the occupancy of each new tenant. The tenant is responsible for maintaining the system during the tenant’s occupancy.
2. The landlord of a residential dwelling unit shall provide an approved visual smoke detection system or other visual alarm system for fire if requested in writing by a tenant who is deaf. A landlord is not subject to this subsection if the rental property of that landlord does not exceed one building and that building does not exceed four residential dwelling units.
3. Nothing in this section may be construed to alter the provisions of chapter 54-21.3 regarding smoke detection systems or alarm systems for newly constructed residences.
4. Any property owner who willfully fails to install a system as required by this section is guilty of a class B misdemeanor.

23-13-16. Aboveground storage tanks permitted — Limitations.

Subject to local zoning ordinances, a business selling petroleum products for dispensing into motor vehicles may utilize aboveground tanks with a maximum capacity not exceeding nineteen thousand gallons [71922.6 liters] for the storage of petroleum products. No business selling petroleum products for dispensing into motor vehicles may use aboveground storage tanks with an aggregate capacity of more than ninety-five thousand gallons [359613 liters] for the storage of petroleum products at one location.

23-15-01. Fireworks defined — Sale of fireworks.

1. The term fireworks means any combustible or explosive composition, or any substance or combination of substances or article prepared for the purpose of producing a visible or an audible effect by combustion, explosion, deflagration, or detonation. The term includes any blank cartridge, toy pistol, toy cannon, toy cane, or toy gun in which an explosive other than a toy paper cap is used; balloon that requires fire underneath to propel the balloon; firecracker, torpedo, skyrocket, Roman candle, daygo bomb, sparkler, or other item of like construction; item containing any explosive or flammable compound; or any tablet or other device containing any explosive substance. This section does not apply to any toy paper cap containing not more than twenty-five hundredths of a grain [16.20 milligrams] of explosive composition per cap.
2. Any person operating a retail business and who has a retail license as provided in section 23-15-04 may offer for sale and sell at retail that year, to any individual who is at least twelve years of age, only during the periods of June twenty-seventh through July fifth and December twenty-sixth through January first, the following items:
   1. A star light, with wood spike cemented in one end, total pyrotechnic composition not to exceed twenty grams each in weight (10 ball). However, a person may not offer to sell or offer to distribute a skyrocket, customarily known as a bottle rocket, if the outside diameter of the casing is less than five-eighths inch [15.875 millimeters] and the length of the casing is less than three and one-half inches [88.9 millimeters].
   2. A helicopter type flyer, total pyrotechnic composition not to exceed twenty grams each in weight.
   3. A cylindrical fountain, total pyrotechnic composition not to exceed seventy-five grams each in weight. The inside tube diameter may not exceed three-fourths inch [19.05 millimeters].
   4. A cone fountain, total pyrotechnic composition not to exceed fifty grams each in weight.
   5. A wheel, total pyrotechnic composition not to exceed sixty grams in weight, for each driver unit, but there may be any number of drivers on any one wheel. The inside bore of a driver tube may not be over one-half inch [12.7 millimeters].
   6. An illuminating torch or a colored fire in any form, total pyrotechnic composition not to exceed one hundred grams each in weight.
   7. A sparkler or a dipped stick, total pyrotechnic composition not to exceed one hundred grams each in weight. Pyrotechnic composition containing any chlorate may not exceed five grams.
   8. A comet or shell, of which the mortar is an integral part, except a comet or shell designed to produce an audible effect, total pyrotechnic composition not to exceed forty grams each in weight.
   9. A soft shell firecracker not to exceed one and one-half inches [38.1 millimeters] in length and one-fourth inch [6.35 millimeters] in diameter, total pyrotechnic composition not to exceed fifty milligrams each in weight.
   10. A whistle without report, total pyrotechnic composition not to exceed forty grams each in weight.

23-15-02. Sale of fireworks prohibited.

Except as otherwise provided in this chapter, no person may offer for sale, expose for sale, sell at retail, bring into this state or cause to be brought into this state, or use or explode any fireworks.

23-15-03. Public display of fireworks permitted by municipality or fair association within its limits — Supervised display allowed — Permit required — Duty of fire marshal to establish regulations.

This chapter does not prohibit supervised public displays of fireworks by cities, fair associations, amusement parks, and other organizations. Except when such display is given by a municipality or fair association within its own limits, no display may be given unless a permit therefor has first been secured. Every application for such a permit must be made in writing to the city auditor at least fifteen days in advance of the date of the display. The application promptly must be referred to the governing body of the city which shall make an investigation to determine whether the operator of the display is competent and whether the display is of such character and is to be so located, discharged, or fired that it will not be hazardous to property or endanger any person. Such governing body shall report the results of this investigation to the city auditor and if it reports that in its opinion the operator is competent and that the display as planned will conform to safety requirements, including the rules and regulations of the state fire marshal hereinafter provided for, such auditor shall issue a permit for the display when the applicant pays a permit fee of two dollars. When the supervised public display for which a permit is sought is to be held outside the limits of an incorporated municipality, the application must be made to the county auditor and the duties imposed by this chapter upon the city auditor must be performed in such case by the county auditor. The duties imposed on the governing body of the city by this chapter must be performed in such case by the board of county commissioners. After such permit has been granted, sales, possession, use, and distribution of fireworks for such display are lawful for that purpose only. No permit granted hereunder is transferable. The state fire marshal shall adopt reasonable rules and regulations not inconsistent with the provisions of this chapter to ensure that fireworks displays are given safely.

23-15-04. Exceptions.

1. This chapter does not prohibit:
   1. A licensed wholesaler, dealer, or jobber from selling at wholesale fireworks that are not prohibited.
   2. The sale of any kind of fireworks for shipment directly out of the state.
   3. The use of fireworks by transportation agencies for signal purposes or illumination.
   4. The sale or use of blank cartridges for a show or theater, for signal or ceremonial purposes in athletics or sports, or for use by military organizations.
2. An application for a license as distributor must be made to the state fire marshal on forms prescribed by the state fire marshal. An application for a license as a retailer must be made to the county sheriff on forms prescribed by the state fire marshal. Each application must be accompanied by the required fee, which must be two hundred fifty dollars for a distributor’s license and twenty dollars for a retailer’s license. Fees for distributors’ licenses must be deposited in the general fund in the state treasury and fees for retailers’ licenses must be deposited in the county general fund. The license is valid only for the calendar year in which issued and must at all times be displayed at the place of business of the licensee. The licenses are in addition to any other license required by law or municipal ordinance. The licensing provisions of this section do not apply to a retailer who is required to become licensed by any municipality. Any license fee levied by a municipality must be deposited in the municipality’s general fund.

A person not licensed as a wholesaler or retailer may not bring any fireworks into this state, and a retailer may not sell any fireworks that have not been purchased from a wholesaler licensed under this chapter. A person licensed under this chapter shall keep available for inspection by the state fire marshal or any sheriff, police officer, or local fire marshal a copy of each invoice for fireworks purchased as long as any fireworks included on the invoice are held in the licensee’s possession, which invoice must show the license number of the wholesaler from whom the purchase was made.

23-15-05. State fire marshal or sheriff to seize all fireworks or combustibles.

The state fire marshal or any sheriff, police officer, or local fire marshal shall seize, take, remove, or cause to be removed at the expense of the owner all fireworks or combustibles offered or exposed for sale, stored, or held for use in violation of this chapter.

23-15-06. General penalty.

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

23-15.1-01. Purpose.

It is hereby declared to be the purpose of the legislative assembly to establish standards for model rockets and model rocket launch sites for the protection of individuals involved in and exposed to the launching of model rockets.

23-15.1-02. Definitions.

As used in this chapter, unless the context or subject matter otherwise requires:

1. “Model rocket engine” means a commercially manufactured, nonreusable rocket propulsion device constructed of a nonmetallic casing and solid propellant wherein all of the ingredients are self-contained so as not to require mixing or handling by the user. The propellant charge may not exceed two and two-tenths ounces [62.37 grams] per engine. Such engine may not be considered fireworks as defined by section 23-15-01.
2. “Model rockets” means nonprofessional rockets which are propelled by approved commercially manufactured solid propellant engines and not considered fireworks as defined by section 23-15-01.
3. “One newton” equals three and six-tenths ounces [102.06 grams] or .225 pound [102.06 grams].
4. “User” includes an individual, partnership, firm, company, association, corporation, or limited liability company.

23-15.1-03. Model rocket standards.

Model rocket design and construction standards must comply with the following:

1. The model rocket engine must be a commercially manufactured propellant device and may not contain more than two and two-tenths ounces [62.37 grams] of propelling charge and must produce less than eighty newton-seconds of total impulse with a thrust duration of not less than one-half second.
2. When more than one rocket engine is used, the total propelling charge may not exceed four and five-tenths ounces [127.57 grams].
3. The model rocket engine used must display on the casing:
   1. Total propulsive power category.
   2. Time delay.
   3. Average thrust in newtons.
4. The rocket must be constructed of paper, plastic, rubber, or wood, except that minor components such as screw eyes and motor mounts may be of light gauge metal material.
5. The rocket must include within its construction an effective means for returning the rocket safely to the ground without causing injury to persons or property.
6. The entire weight of the finished rocket with any payload may not exceed one and one-tenths pounds [498.95 grams].
7. The model rocket may not contain any type of explosive or pyrotechnic warhead.

23-15.1-04. Launch site standards.

Sites used as model rocket launch sites must comply with the following:

1. No person other than the user and individuals assisting the user may be permitted within fifteen feet [4.57 meters] of the launching device when engines of an “A”, “B”, or “C” category are used or within thirty feet [9.14 meters] of the launching device when engines of “D”, “E”, or “F” category are used.
2. When required by the fire authority, lines or barriers must be provided to restrain spectators from encroaching upon the clearance requirements of this section.
3. No model rocket user may fire any model rocket engine from any site without first securing authorization, either verbal or written, to conduct this activity from the fire official having the responsibility of the prevention and suppression of fire in the areas where the model rocket is to be used nor without securing authorization, either written or verbal, of the owner of the land intended to be used for the launch of the model rocket.
4. The launch site should consist of a firing area and a recovery area. The firing area should be considered that area surrounding the launching devices contained within a radius of ten feet [3.05 meters] outward from the location of the launching devices. The recovery area should include the firing area and must be determined to be the minimum area necessary to retrieve the launched rocket based on the estimated height achieved by the model rocket having a total weight fired with a specific type of engine. The following table may be used to determine the size of the recovery area necessary:
5. The launching site and recovery area should be located in areas that are not susceptible to fire, such as grain fields, forest lands, heavy brush, or other areas deemed dangerous by the fire authority. The site should be located at least two hundred feet [60.96 meters] from any buildings or structures unless approved by the property owner. The site may not contain any high voltage lines or be within five hundred feet [152.4 meters] of the nearest road or highway.
6. The launch rod may not be tilted more than thirty degrees from a vertical angle.
7. No launching site or recovery area may be located within five miles [8.05 kilometers] of any airport, unless written permission is first obtained from the appropriate airport authority or other agency responsible for operation of the airport.

MODEL ROCKET LAUNCH SITE STANDARDS Engine types all time delays Minimum dimension in feet Maximum total weight in ounces of rocket with engine and any payload Longest time delay in seconds permitted for maximum total weight 1/4A-1/2A 50 3 2 A 100 4 3 B 200 6 2 C 400 6 3 D 500 13 3 E 1,000 17.66 4 F 1,000 17.66 4

Click to view

If the recovery area is circular, the minimum dimension in feet referred to in the table relates to diameter of the area. If the recovery area is rectangular or square, the minimum dimension in feet referred to in the table refers to the length of the shortest side.

23-15.1-05. Storage and sale.

1. No model rocket engines may be stored, sold, or offered for sale at retail unless such model rocket engine has been classified into one of the standardized engine codes listed in the chart in this section and unless such code is marked upon the model rocket engine.
2. No model rocket engine will be sold, given, or delivered to any person under ten years of age. Model rocket engines bearing the standardized engine coding 1/4A, 1/2A, A, B, C, or D may be purchased by any persons who are ten years of age or older. Model rocket engines bearing the standardized engine coding E or F may be purchased only by persons who are fourteen years of age or over.

23-15.1-06. Accident reporting.

In the event of an accident involving damage to either persons or property by a model rocket or by a model rocket engine, it is the responsibility of the investigating authority to immediately notify the state fire marshal or local fire control authorities that such accident has occurred. If local fire control authorities are notified, they shall notify the fire marshal as soon as practicable.

23-15.1-07. Penalty.

Any person who violates any provision of this chapter is guilty of an infraction.

23-16-01. Licensure of medical hospitals and state hospitals. [Effective through August 31, 2022]

After July 1, 1947, no person, partnership, association, corporation, limited liability company, county or municipal corporation, or agency thereof, which maintains and operates organized facilities for the diagnosis, treatment, or care of two or more nonrelated persons suffering from illness, injury, or deformity or where obstetrical or other care is rendered over a period exceeding twenty-four hours, may be established, conducted, or maintained in the state of North Dakota without obtaining annually a license therefor in the manner hereinafter provided in sections 23-16-02 and 23-16-03. Chiropractic hospitals, sanatoriums, and hospitals such as those for unmarried mothers maintained and operated by the department of human services are not required to obtain a license under this chapter.

In the case of emergency or transfer beds attached to and forming a part of a licensed medical doctor’s office, the state department of health has the right of inspection, but no license may be required under the provisions of this chapter when the number of such beds does not exceed four.

23-16-01. Licensure of medical hospitals and state hospitals. [Effective September 1, 2022]

After July 1, 1947, no person, partnership, association, corporation, limited liability company, county or municipal corporation, or agency thereof, which maintains and operates organized facilities for the diagnosis, treatment, or care of two or more nonrelated persons suffering from illness, injury, or deformity or where obstetrical or other care is rendered over a period exceeding twenty-four hours, may be established, conducted, or maintained in the state of North Dakota without obtaining annually a license therefor in the manner hereinafter provided in sections 23-16-02 and 23-16-03. Chiropractic hospitals, sanatoriums, and hospitals such as those for unmarried mothers maintained and operated by the department of health and human services are not required to obtain a license under this chapter.

In the case of emergency or transfer beds attached to and forming a part of a licensed medical doctor’s office, the department of health and human services has the right of inspection, but no license may be required under the provisions of this chapter when the number of such beds does not exceed four.

23-16-01.1. Moratorium on expansion of long-term care bed capacity. [Effective through August 31, 2022]

1. Notwithstanding sections 23-16-06 and 23-16-10, except when a facility reverts basic care beds to nursing facility beds or relicenses nursing facility beds delicensed after July 31, 2011, nursing facility beds may not be added to the state’s licensed bed capacity during the period between August 1, 2021, and July 31, 2023. A nursing facility may not delicense nursing facility bed capacity, relicense nursing facility bed capacity, convert licensed nursing bed capacity to basic care bed capacity, revert licensed basic care bed capacity back to nursing facility bed capacity, or otherwise reconfigure licensed nursing facility bed capacity more than two times in a twelve-month period.
2. Transfer of licensed nursing facility bed capacity from a nursing facility to another entity is permitted. The nursing facility may transfer the bed capacity either as nursing facility bed capacity or basic care bed capacity. Transferred bed capacity must become licensed by an entity within seventy-two months of transfer. Bed capacity transferred as basic care bed capacity may not be reverted to nursing facility bed capacity at any time. A receiving entity may transfer the received bed capacity to another entity within the seventy-two-month period originally established at the time the nursing facility first transferred the licensed nursing facility bed capacity. The subsequent receiving entity must license the received bed capacity within the seventy-two-month period originally established at the time of the first transfer.
3. A nursing facility may convert licensed nursing facility bed capacity to basic care. If the converted beds remain in the same facility and are not transferred, the beds may revert to nursing facility status after one year of licensure as basic care beds.
4. Nursing facility beds that are converted to basic care may be transferred as basic care beds. However, upon the transfer, the basic care beds may not be relicensed as nursing facility beds.
5. If a federally recognized tribal nation acquires nursing facility beds, the tribal facility must meet state licensing requirements for those beds within seventy-two months of acquisition. A tribal facility may seek to participate in the medical assistance programs. Medical assistance payments may only be made to a Medicaid certified tribal facility that agrees to participate and adhere to all federal and state requirements of the medical assistance program, including participation, screening, ratesetting, and licensing requirements.
6. A nursing facility, upon prior written notice to the state department of health, may delicense a maximum of thirty percent of its licensed nursing facility bed capacity and have the delicensed nursing facility held for a period of forty-eight months. The total delicensed nursing facility bed capacity that may be held for a nursing facility at no time may be greater than fifty percent of the number of currently licensed beds in the nursing facility. Delicensed nursing facility bed capacity in excess of fifty percent of the nursing facility’s licensed capacity may not be held and is not eligible for the provisions of subsection 7. Delicensed bed capacity not sold or relicensed at the conclusion of the forty-eight-month holding period ceases to exist.
7. During the forty-eight-month holding period established at the time of delicensure, delicensed nursing facility bed capacity that is being held for the nursing facility may be:
   1. Relicensed by the nursing facility. Relicensing of nursing facility bed capacity may not occur for six months from the time of delicensure.
   2. Transferred to another entity as nursing facility bed capacity or basic care bed capacity. The receiving entity must license the transferred bed capacity as the type of bed capacity transferred within a seventy-two-month period established at the time of transfer. Bed capacity transferred as basic care bed capacity may not be reverted to nursing facility bed capacity at any time. A receiving entity may transfer the received bed capacity to another entity within the seventy-two-month period established at the time of transfer. The subsequent receiving entity must license the received bed capacity within the seventy-two-month period established at the time of transfer.
   3. Licensed as basic care beds by the same facility. If the licensed basic care beds remain in the same facility and are not transferred, the beds may be reverted to licensed nursing facility bed capacity after twelve months.
8. Notwithstanding any other provision of this section, a nursing facility bed transferred before July 1, 2019, must be relicensed by the receiving entity within a seventy-two-month period established at the time of transfer.
9. Notwithstanding any other provision of this section, a nursing facility bed in the layaway program before July 1, 2019, may remain in the program for forty-eight months from the time the bed was first laid away.

23-16-01.1. Moratorium on expansion of long-term care bed capacity. [Effective September 1, 2022]

1. Notwithstanding sections 23-16-06 and 23-16-10, except when a facility reverts basic care beds to nursing facility beds or relicenses nursing facility beds delicensed after July 31, 2011, nursing facility beds may not be added to the state’s licensed bed capacity during the period between August 1, 2021, and July 31, 2023. A nursing facility may not delicense nursing facility bed capacity, relicense nursing facility bed capacity, convert licensed nursing bed capacity to basic care bed capacity, revert licensed basic care bed capacity back to nursing facility bed capacity, or otherwise reconfigure licensed nursing facility bed capacity more than two times in a twelve-month period.
2. Transfer of licensed nursing facility bed capacity from a nursing facility to another entity is permitted. The nursing facility may transfer the bed capacity either as nursing facility bed capacity or basic care bed capacity. Transferred bed capacity must become licensed by an entity within seventy-two months of transfer. Bed capacity transferred as basic care bed capacity may not be reverted to nursing facility bed capacity at any time. A receiving entity may transfer the received bed capacity to another entity within the seventy-two-month period originally established at the time the nursing facility first transferred the licensed nursing facility bed capacity. The subsequent receiving entity must license the received bed capacity within the seventy-two-month period originally established at the time of the first transfer.
3. A nursing facility may convert licensed nursing facility bed capacity to basic care. If the converted beds remain in the same facility and are not transferred, the beds may revert to nursing facility status after one year of licensure as basic care beds.
4. Nursing facility beds that are converted to basic care may be transferred as basic care beds. However, upon the transfer, the basic care beds may not be relicensed as nursing facility beds.
5. If a federally recognized tribal nation acquires nursing facility beds, the tribal facility must meet state licensing requirements for those beds within seventy-two months of acquisition. A tribal facility may seek to participate in the medical assistance programs. Medical assistance payments may only be made to a Medicaid certified tribal facility that agrees to participate and adhere to all federal and state requirements of the medical assistance program, including participation, screening, ratesetting, and licensing requirements.
6. A nursing facility, upon prior written notice to the department of health and human services, may delicense a maximum of thirty percent of its licensed nursing facility bed capacity and have the delicensed nursing facility held for a period of forty-eight months. The total delicensed nursing facility bed capacity that may be held for a nursing facility at no time may be greater than fifty percent of the number of currently licensed beds in the nursing facility. Delicensed nursing facility bed capacity in excess of fifty percent of the nursing facility’s licensed capacity may not be held and is not eligible for the provisions of subsection 7. Delicensed bed capacity not sold or relicensed at the conclusion of the forty-eight-month holding period ceases to exist.
7. During the forty-eight-month holding period established at the time of delicensure, delicensed nursing facility bed capacity that is being held for the nursing facility may be:
   1. Relicensed by the nursing facility. Relicensing of nursing facility bed capacity may not occur for six months from the time of delicensure.
   2. Transferred to another entity as nursing facility bed capacity or basic care bed capacity. The receiving entity must license the transferred bed capacity as the type of bed capacity transferred within a seventy-two-month period established at the time of transfer. Bed capacity transferred as basic care bed capacity may not be reverted to nursing facility bed capacity at any time. A receiving entity may transfer the received bed capacity to another entity within the seventy-two-month period established at the time of transfer. The subsequent receiving entity must license the received bed capacity within the seventy-two-month period established at the time of transfer.
   3. Licensed as basic care beds by the same facility. If the licensed basic care beds remain in the same facility and are not transferred, the beds may be reverted to licensed nursing facility bed capacity after twelve months.
8. Notwithstanding any other provision of this section, a nursing facility bed transferred before July 1, 2019, must be relicensed by the receiving entity within a seventy-two-month period established at the time of transfer.
9. Notwithstanding any other provision of this section, a nursing facility bed in the layaway program before July 1, 2019, may remain in the program for forty-eight months from the time the bed was first laid away.

23-16-02. Existing medical hospitals.

Institutions subject to this chapter which are already in operation at the time of enactment of this chapter must be given a reasonable time, not to exceed one year from the date of the enactment of this chapter, within which to comply with the rules, regulations, and minimum standards provided for herein.

23-16-03. Application for license — License fee. [Effective through August 31, 2022]

Applicants for license shall file applications under oath with the state department of health upon forms prescribed. Applications must be signed by the owner, or in the case of a corporation by two of its officers, or in the case of a county or municipal unit by the head of the governmental department having jurisdiction over it. Applications must set forth the full name and address of the owner of the institution for which license is sought, the names of the persons in control thereof, and such additional information as the state department of health may require, including affirmative evidence of ability to comply with such minimum standards, rules, and regulations as may be lawfully prescribed pursuant to this section. An application for a license for facilities not owned by the state or its political subdivisions must be accompanied by the following fees:

1. For each licensed acute care bed, ten dollars.
2. For each licensed skill care bed, ten dollars.

License fees collected pursuant to this section must be deposited in the state department of health services operating fund in the state treasury and any expenditure from the fund is subject to appropriation by the legislative assembly.

23-16-03. Application for license — License fee. [Effective September 1, 2022]

Applicants for license shall file applications under oath with the department of health and human services upon forms prescribed. Applications must be signed by the owner, or in the case of a corporation by two of its officers, or in the case of a county or municipal unit by the head of the governmental department having jurisdiction over it. Applications must set forth the full name and address of the owner of the institution for which license is sought, the names of the persons in control thereof, and such additional information as the department of health and human services may require, including affirmative evidence of ability to comply with such minimum standards, rules, and regulations as may be lawfully prescribed pursuant to this section. An application for a license for facilities not owned by the state or its political subdivisions must be accompanied by the following fees:

1. For each licensed acute care bed, ten dollars.
2. For each licensed skill care bed, ten dollars.

License fees collected pursuant to this section must be deposited in the department of health and human services operating fund in the state treasury and any expenditure from the fund is subject to appropriation by the legislative assembly.

23-16-04. Licenses. [Effective through August 31, 2022]

Licenses issued hereunder expire one year after date of issuance or upon such uniform dates annually, as the health council may prescribe by rule. Licenses must be issued only for the premises and persons named in the application and are not transferable or assignable. Licenses must be posted in a conspicuous place on the licensed premises.

23-16-04. Licenses. [Effective September 1, 2022]

Licenses issued hereunder expire one year after date of issuance or upon such uniform dates annually, as the department of health and human services may prescribe by rule. Licenses must be issued only for the premises and persons named in the application and are not transferable or assignable. Licenses must be posted in a conspicuous place on the licensed premises.

23-16-05. Inspections, consultations, and approval of plans. [Effective through August 31, 2022]

The state department of health shall make or cause to be made such inspections as may be prescribed by regulation. The health council may prescribe by regulations that any licensee or prospective applicant desiring to make a substantial alteration or addition to its facilities or to construct new facilities shall, before commencing such alteration, addition, or new construction, submit plans and specifications therefor to the state department of health for preliminary inspection, recommendation, and approval.

23-16-05. Inspections, consultations, and approval of plans. [Effective September 1, 2022]

The department of health and human services shall make or cause to be made such inspections as may be prescribed by regulation. The health council may prescribe by regulations that any licensee or prospective applicant desiring to make a substantial alteration or addition to its facilities or to construct new facilities shall, before commencing such alteration, addition, or new construction, submit plans and specifications therefor to the department of health and human services for preliminary inspection, recommendation, and approval.

23-16-06. Authority to issue, deny, suspend, or revoke licenses. [Effective through August 31, 2022]

The state department of health shall issue licenses for the operation of institutions subject to this chapter which are found to comply with the provisions of this chapter and such regulations as are lawfully promulgated by the health council. The state health officer with the approval of the health council may, after a hearing, suspend or revoke licenses issued hereunder on any of the following grounds:

1. Violation of any of the provisions of this chapter or the rules and regulations promulgated pursuant thereto.
2. Permitting, aiding, or abetting the commission of any unlawful act.
3. Conduct or practices detrimental to the health or safety of patients and employees of said institutions; provided that this provision may not be construed to have any reference to practices authorized by law; and provided further that no license may be suspended or revoked for any trivial violation.

No application for a license may be denied, or any licenses suspended or revoked, except after a hearing before the health council held pursuant to written notice to the applicant or licensee, served by registered or certified mail, which notice must concisely state the grounds for such denial or for such proposed suspension or revocation and must fix the time and place of hearing which may not be less than thirty days after the date of the mailing of such notice. After such hearing, the council shall make an order, either denying the application for license or granting the same, or suspending or revoking such license, or dismissing the proceedings to suspend or revoke as the merits of the case warrant. The council shall send a copy of its order to the applicant or licensee by registered or certified mail, which must contain its findings and conclusions, and such order, except an order of dismissal, becomes final thirty days after the date of mailing unless the applicant or licensee appeals therefrom in the manner provided by section 23-16-10.

23-16-06. Authority to issue, deny, suspend, or revoke licenses. [Effective September 1, 2022]

The department of health and human services shall issue licenses for the operation of institutions subject to this chapter which are found to comply with the provisions of this chapter and rules adopted by the department. The state health officer with the approval of the health council may, after a hearing, suspend or revoke licenses issued hereunder on any of the following grounds:

1. Violation of any of the provisions of this chapter or the rules and regulations promulgated pursuant thereto.
2. Permitting, aiding, or abetting the commission of any unlawful act.
3. Conduct or practices detrimental to the health or safety of patients and employees of said institutions; provided that this provision may not be construed to have any reference to practices authorized by law; and provided further that no license may be suspended or revoked for any trivial violation.

No application for a license may be denied, or any licenses suspended or revoked, except after a hearing before the health council held pursuant to written notice to the applicant or licensee, served by registered or certified mail, which notice must concisely state the grounds for such denial or for such proposed suspension or revocation and must fix the time and place of hearing which may not be less than thirty days after the date of the mailing of such notice. After such hearing, the council shall make an order, either denying the application for license or granting the same, or suspending or revoking such license, or dismissing the proceedings to suspend or revoke as the merits of the case warrant. The council shall send a copy of its order to the applicant or licensee by registered or certified mail, which must contain its findings and conclusions, and such order, except an order of dismissal, becomes final thirty days after the date of mailing unless the applicant or licensee appeals therefrom in the manner provided by section 23-16-10.

23-16-07. Not applicable to certain laws.

This chapter may not be construed in any way to restrict or modify any law pertaining to the placement and adoption of children or the care of unmarried mothers.

23-16-08. Offering or advertising to dispose of infants prohibited. [Effective through August 31, 2022]

No hospital providing maternity care may in any way offer to dispose of any child or advertise that it will give children for adoption or hold itself out, directly or indirectly, as being able to dispose of children, however, such hospitals may inform an unmarried mother of child-placing agencies licensed by the department of human services.

23-16-08. Offering or advertising to dispose of infants prohibited. [Effective September 1, 2022]

No hospital providing maternity care may in any way offer to dispose of any child or advertise that it will give children for adoption or hold itself out, directly or indirectly, as being able to dispose of children, however, such hospitals may inform an unmarried mother of child-placing agencies licensed by the department of health and human services.

23-16-08.1. Access to pharmacist.

Irrespective of the type of distribution system used, no person may refuse to allow a resident of a nursing home, as defined in subsection 3 of section 43-34-01, to choose a pharmacist of the resident’s choice for the compounding and dispensing of drugs pursuant to chapter 43-15.

23-16-09. Information confidential. [Effective through August 31, 2022]

Information other than reports relating to vital statistics received by the state department of health through inspection or otherwise, authorized under this chapter are confidential and may not be disclosed publicly except in a proceeding involving the question of license. No agent of the state department of health or of any board of health, may disclose individually identifiable health information of such an institution obtained in the course of a survey or inspection except in a judicial or administrative proceeding in response to an order of a court or administrative tribunal.

23-16-09. Information confidential. [Effective September 1, 2022]

Information other than reports relating to vital statistics received by the department of health and human services through inspection or otherwise, authorized under this chapter are confidential and may not be disclosed publicly except in a proceeding involving the question of license. No agent of the department of health and human services or of any board of health, may disclose individually identifiable health information of such an institution obtained in the course of a survey or inspection except in a judicial or administrative proceeding in response to an order of a court or administrative tribunal.