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<section article="ghg" article_name="Health - General" number="18-109" title_number="18" title_name="Disease Prevention" subtitle_number="1" subtitle_name="General Responsibilities of Secretary">
  <level label="a">
    <level label="1">
      <text>In this section the following words have the meanings indicated.</text>
    </level>
    <level label="2">
      <text>“Authorized user” means:</text>
      <level label="i">
        <text>A child care facility;</text>
      </level>
      <level label="ii">
        <text>A health care provider;</text>
      </level>
      <level label="iii">
        <text>A health insurer;</text>
      </level>
      <level label="iv">
        <text>A health maintenance organization;</text>
      </level>
      <level label="v">
        <text>An institution of higher learning;</text>
      </level>
      <level label="vi">
        <text>A local health department;</text>
      </level>
      <level label="vii">
        <text>A long–term care facility;</text>
      </level>
      <level label="viii">
        <text>A managed care organization;</text>
      </level>
      <level label="ix">
        <text>A nonprofit health service plan;</text>
      </level>
      <level label="x">
        <text>A patient;</text>
      </level>
      <level label="xi">
        <text>A school;</text>
      </level>
      <level label="xii">
        <text>A school–based health center;</text>
      </level>
      <level label="xiii">
        <text>In the case of a minor child, a parent or guardian; and</text>
      </level>
      <level label="xiv">
        <text>Any other user designated by the Secretary.</text>
      </level>
    </level>
    <level label="3">
      <text>“Health care provider” means a licensed health care practitioner authorized under the Health Occupations Article to administer vaccines in the State.</text>
    </level>
    <level label="4">
      <text>“ImmuNet” means a computerized information and reminder system to:</text>
      <level label="i">
        <text>Improve the timely and appropriate delivery of immunizations;</text>
      </level>
      <level label="ii">
        <text>Provide a coordinated network for reminder notices when immunizations are due;</text>
      </level>
      <level label="iii">
        <text>Provide and collect information to be shared by authorized users; and</text>
      </level>
      <level label="iv">
        <text>Provide a quality indicator for the insurers’ health care provider practices and public health purposes.</text>
      </level>
    </level>
    <level label="5">
      <text>“Immunization” means the process by which an individual becomes protected against a disease including, as the result of having a disease, receiving a vaccination, or receiving preformed antibodies.</text>
    </level>
    <level label="6">
      <text>“Refusal to permit” means the right of an individual or the parent or guardian of a minor to prevent disclosure to authorized users of individual identifiable information that was reported to ImmuNet.</text>
    </level>
    <level label="7">
      <text>“Vaccination” means the administration of a killed or weakened infectious organism to prevent disease caused by that organism.</text>
    </level>
    <level label="8">
      <text>“Vaccine” means a substance that:</text>
      <level label="i">
        <text>May be administered by injection, mouth, or aerosol; and</text>
      </level>
      <level label="ii">
        <text>Produces immunity that protects the body from a disease.</text>
      </level>
    </level>
  </level>
  <level label="b">
    <text>There is an ImmuNet program in the Department.</text>
  </level>
  <level label="c">
    <text>Subject to subsection (d) of this section, an authorized user may use the information in ImmuNet for the following purposes:</text>
    <level label="1">
      <text>To provide coordinated immunization services, including sending reminder notices to individuals who need immunizations;</text>
    </level>
    <level label="2">
      <text>To obtain an individual immunization history;</text>
    </level>
    <level label="3">
      <text>To identify geographic areas or population groups that are underimmunized;</text>
    </level>
    <level label="4">
      <text>To compile aggregate data and distribute statistical reports on the status of immunizations in geographic areas and population groups;</text>
    </level>
    <level label="5">
      <text>To assist in the management of State and local immunization programs;</text>
    </level>
    <level label="6">
      <text>To monitor the safety of vaccines;</text>
    </level>
    <level label="7">
      <text>To assess compliance with immunization requirements by monitoring admissions to schools, institutions of higher learning, and child care facilities; and</text>
    </level>
    <level label="8">
      <text>For any other purpose that the Secretary deems necessary to prevent the spread of communicable diseases.</text>
    </level>
  </level>
  <level label="d">
    <level label="1">
      <text>An individual, or the parent or guardian of a minor child who has received a vaccination, may refuse to permit disclosure of confidential information collected by ImmuNet, to an authorized user.</text>
    </level>
    <level label="2">
      <text>If the individual or the parent or guardian of a minor child does not want the release of the individual’s or child’s confidential information, the individual or the parent or guardian of a minor child shall complete a “refusal to permit” form, provided by the Department, to be returned to the Department.</text>
    </level>
    <level label="3">
      <text>The Secretary shall make available “refusal to permit” forms to each health care provider who gives vaccinations.</text>
    </level>
    <level label="4">
      <text>The Department shall:</text>
      <level label="i">
        <text>Develop brochures about ImmuNet that:</text>
        <level label="1">
          <text>Describe the benefits of ImmuNet for authorized users;</text>
        </level>
        <level label="2">
          <text>Describe privacy protections in ImmuNet;</text>
        </level>
        <level label="3">
          <text>Notify an individual of the right to refuse to permit disclosure to an authorized user;</text>
        </level>
        <level label="4">
          <text>Notify an individual that the individual may correct any inaccurate information;</text>
        </level>
        <level label="5">
          <text>Provide a list of addresses where an individual may obtain a form to request the correction or removal of inaccurate information from ImmuNet;</text>
        </level>
        <level label="6">
          <text>Explain the right of an individual who has received a vaccination to have the individual’s personal information kept confidential;</text>
        </level>
        <level label="7">
          <text>Describe the kind of information collected and retained by ImmuNet about an individual who receives a vaccination;</text>
        </level>
        <level label="8">
          <text>Describe who has access to the information in ImmuNet; and</text>
        </level>
        <level label="9">
          <text>Describe how the information is used by ImmuNet; and</text>
        </level>
      </level>
      <level label="ii">
        <text>Make the brochure available to each health care provider who administers vaccines.</text>
      </level>
    </level>
    <level label="5">
      <text>Prior to administering vaccines to a newborn child, each birth hospital or birthing center shall distribute the form and the brochure described in paragraphs (2) and (4) of this subsection to the parent of a newborn child.</text>
    </level>
    <level label="6">
      <text>A health care provider who administers a vaccine, or the agent of the health care provider, shall:</text>
      <level label="i">
        <text>Provide the individual with a copy of the form and the brochure described in paragraphs (2) and (4) of this subsection;</text>
      </level>
      <level label="ii">
        <text>Notify the individual or the parent or guardian of a minor of the right to refuse to disclose to ImmuNet; and</text>
      </level>
      <level label="iii">
        <text>Report to ImmuNet all vaccines administered.</text>
      </level>
    </level>
  </level>
  <level label="e">
    <text>Subject to the provisions of subsection (d) of this section, information for ImmuNet may be obtained from:</text>
    <level label="1">
      <text>Any records owned or controlled by the Department, including Medicaid records, clinic records, and vital records;</text>
    </level>
    <level label="2">
      <text>Any authorized user; and</text>
    </level>
    <level label="3">
      <text>Any other source of information authorized by the Secretary for use.</text>
    </level>
  </level>
  <level label="f">
    <text>Authorized users may not use the information in ImmuNet:</text>
    <level label="1">
      <text>To release or disclose information in ImmuNet that an individual has refused to disclose;</text>
    </level>
    <level label="2">
      <text>To solicit new patients or clients; or</text>
    </level>
    <level label="3">
      <text>For any other purpose unless authorized by the Secretary.</text>
    </level>
  </level>
  <level label="g">
    <level label="1">
      <text>A local health department may operate a local immunization system.</text>
    </level>
    <level label="2">
      <text>A local health department operating a local immunization system shall be subject to the provisions of subsections (c) through (f) of this section.</text>
    </level>
    <level label="3">
      <text>A local health department is required to submit information maintained in a local immunization system to ImmuNet in accordance with regulations adopted by the Secretary.</text>
    </level>
  </level>
  <level label="h">
    <text>An authorized user who in good faith discloses or does not disclose information to ImmuNet is not liable in any cause of action arising from the disclosure or nondisclosure of that information.</text>
  </level>
  <level label="i">
    <text>An authorized user, including an officer or employee of a governmental unit, who knowingly and willfully violates subsection (f) of this section is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000 for the first offense and not exceeding $5,000 for each subsequent offense.</text>
  </level>
  <level label="j">
    <text>If the confidentiality of records of Maryland citizens is protected, the Secretary may enter into collaborative agreements with other states for the purpose of sharing information about immunizations.</text>
  </level>
  <level label="k">
    <text>The Secretary shall adopt regulations to implement this section, including regulations specifying:</text>
    <level label="1">
      <text>The type and kind of information to be collected;</text>
    </level>
    <level label="2">
      <text>Procedures for protecting the confidentiality of information in ImmuNet;</text>
    </level>
    <level label="3">
      <text>The permissible use of information compiled by ImmuNet; and</text>
    </level>
    <level label="4">
      <text>Standards for maintaining security and reliability of collected information in the system.</text>
    </level>
  </level>
</section>
