Health - General (GHG) — Title 4. Statistics and Records

The Drug Abuse Administration;

The Prevention and Health Promotion Administration; or

The Secretary; and

Each confidential record shall remain in the custody and control of:

The confidential record may be used only for the research and study for which it was assembled or obtained.

A person may not disclose any confidential record to any person who is not engaged in the research or study project.

“Dead body” means:

“Dead body” does not include an amputated part.

To which individuals are committed by law; or

That provides to 2 or more unrelated individuals:

An individual who is:

An individual who:

The Secretary shall:

The forms shall provide for the information that the Secretary needs for proper registration and use of these vital records.

Investigate to determine the facts of record; and

Send a certified statement of the facts to the Secretary.

If the Secretary corrects a death or fetal death record, the Secretary shall send a notice of the correction to the county registrar for the county where the event occurred. The county registrar shall enter the correction on the county registrar’s record by photographic, electronic, or other means prescribed by the Secretary.

If a discrepancy exists between the record of the Secretary and the record of a county registrar, the record of the Secretary shall be considered correct.

The Secretary may change a marriage, divorce, or annulment record in the file of the Department only if a clerk of court sends, as provided by law, a certified report of the change.

If a discrepancy exists between the record of a clerk of court and the record of the Secretary as to a marriage, divorce, or annulment, the record of the clerk of court shall be considered correct.

A clerk of court may provide a certified copy of a record of any marriage, divorce, or annulment in accordance with usual custom and as provided by law.

The Secretary may not provide a certified copy of any record of divorce or annulment.

Each certificate of birth, death, or fetal death shall be typed or printed legibly in unfading black ink, or stored on electronic media approved by the Secretary.

The person who is required to complete the record shall attest to its accuracy either by signature or by approved electronic process.

Except as provided in subsection (g) of this section, within 5 calendar days after a birth occurs in an institution, or en route to the institution, or outside an institution with an attending clinician, the administrative head of the institution or a designee of the administrative head, or the attending clinician or a designee of the attending clinician, shall:

Except as provided in subsection (g) of this section, the attending physician, physician assistant, nurse practitioner, nurse midwife, or attending clinician shall provide the date of birth and medical information that are required on the certificate within 5 calendar days after the birth.

The results of the universal hearing screening of newborns shall be incorporated into the supplemental information required by the Department to be submitted as a part of the birth event.

When an individual who is not married gives birth to a child in an institution or outside an institution with an attending clinician, the administrative head of the institution or the designee of the administrative head, or the attending clinician or the designee of the attending clinician, shall:

An institution, the administrative head of the institution, the designee of the administrative head of an institution, an employee of an institution, the attending clinician, and the designee of the attending clinician may not be held liable in any cause of action arising out of the establishment of parentage.

If the child’s mother was not married at the time of either conception or birth or between conception and birth, the name of the child’s other parent may not be entered on the certificate without an affidavit of parentage as authorized by § 5–1028 of the Family Law Article signed by the mother and the person to be named on the certificate as the other parent.

If the child’s mother was married at the time of either the conception or birth or between conception and birth, the name of the mother’s spouse shall be entered on the certificate as the child’s other parent.

If the parent who did not give birth to the child is not named on the certificate of birth, no other information about that parent shall be entered on the certificate.

Except as provided in subsection (g) of this section, within 5 calendar days after a birth occurs outside an institution without an attending clinician, the birth shall be verified by the Secretary and a certificate of birth shall be prepared, on the form that the Secretary provides, and filed by one of the following, in the indicated order of priority:

In any case that involves a gestational carrier in which parentage is determined by a court of competent jurisdiction:

When a birth occurs on a common carrier within the United States and the child is first removed from the carrier in this State, the birth shall be registered in this State, and the place where the child is first removed shall be considered the place of birth.

When a birth occurs on a common carrier while in international waters, air space, or in a foreign country and the child is first removed from the carrier in this State, the birth shall be registered in this State but the certificate shall show the actual place of birth insofar as can be determined.

Except as provided in subsection (g) of this section, the certificate shall be filed within 5 calendar days after the child is removed from the carrier.

Each parent shall provide his or her own Social Security number on the form provided by the Secretary under this section.

The Social Security number as provided by each parent shall be recorded on the portion of the form provided by the Secretary which remains in the official birth record.

The Social Security numbers of the parents may not appear on the portion of the birth certificate issued as proof of birth.

Upon adjudication of parentage, the court shall order the parent to provide the parent’s Social Security number to the clerk of court; and

The clerk of court shall send the parent’s Social Security number to the Secretary, as provided under § 4–211(f) of this subtitle.

Within 72 hours after a person takes custody of a child of unknown parentage, the person shall prepare and file a report, on the form that the Secretary provides.

The report shall state:

Shall be sealed; and

May be reopened only:

If the Secretary rejects a delayed certificate of birth under this section, a person may petition a court of competent jurisdiction to order the establishment of a record of birth.

If the court finds, from the evidence, that the individual for whom a delayed certificate of birth is sought was born in this State, the court shall make findings as to parentage and place and date of birth and any other findings that the case requires and shall order the Secretary to establish a record of birth. The order shall include the findings to be entered in the record of birth and the date of the court action.

On or before the tenth day of each month, each clerk of court shall send to the Secretary each court order for a delayed certificate of birth that was entered during the preceding month.

The individual was born in this State; and

Regardless of the location, one of the following has occurred:

The individual was born in this State; and

Regardless of the location, one of the following has occurred:

The previously unwed parents of the individual have married each other after the birth of the individual;

A court of competent jurisdiction in this State has entered an order as to parentage or legitimation; or

The parent who did not give birth to the individual acknowledged himself or herself by affidavit to be a parent of the individual and the mother of the individual has consented by affidavit to the acknowledgment.

The court that decrees the adoption;

The adoptive parents; or

The adopted individual, if an adult.

The individual shall be treated as having at birth the status that later is acquired or established and of which proof is submitted.

If the individual is adopted, the name of the individual shall be that set by the decree of adoption, and the adoptive parents shall be recorded as the parents of the individual.

The new certificate of birth shall contain wording that requires each parent shown on the new certificate to indicate his or her own Social Security number.

When a new certificate of birth is made under subsection (b) of this section:

A new certificate of birth made under subsection (b) of this section may not:

If a new certificate of birth is made, the Secretary shall:

The seal may be broken only:

A certified copy of the certificate of birth that later is issued shall be a copy of the new certificate of birth, unless:

Each decree of adoption;

Each adjudication of parentage, including the parent’s Social Security number; and

Each revocation or amendment of any decree of adoption or adjudication of paternity that the court enters.

A delayed certificate of birth shall be filed with the Secretary as provided in § 4–210 of this subtitle before a new certificate of birth is established; and

The new birth certificate shall be prepared on the delayed birth certificate form.

The Secretary shall, on request, prepare and register a certificate in this State for an individual born in a foreign country and who was adopted:

Except as provided in paragraph (3) of this subsection, the certificate shall be established on receipt of:

If the child was adopted under the laws of a jurisdiction or country other than the United States and has been granted an IR–3 or IH–3 visa by the U.S. Citizenship and Immigration Services under the Immigration and Nationality Act, the certificate shall be established on receipt of:

The certificate shall be labeled “Certificate of Foreign Birth” and shall show the actual country of birth.

A statement shall also be included on the certificate indicating that it is not evidence of United States citizenship for the child for whom it is issued.

A certificate of death regardless of age of decedent shall be filled out and signed by:

The medical examiner, physician, physician assistant, or nurse practitioner shall fill in only the following information on the certificate of death:

Any other information that is required on the certificate of death regardless of age of decedent shall be filled in:

The medical certification shall be completed within 24 hours after receipt of the death certificate 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 medical examiner.

In the absence or inability of the attending physician, physician assistant, or nurse practitioner or with the attending physician’s, physician assistant’s, or nurse practitioner’s approval, the certificate may be completed by:

The person completing the cause of death and medical certification shall attest to the accuracy by signature or by an approved electronic process.

The funeral director or person acting as the funeral director shall in all cases obtain the medical certification from the person responsible for its completion or obtain assurance that the medical certification has been provided to the Secretary by an approved electronic process.

The deceased was not under treatment by a physician, physician assistant, or nurse practitioner during the terminal illness;

The cause of death is unknown; or

The individual considers any of the following conditions to be the cause of death or to have contributed to the death:

A physician, physician assistant, or nurse practitioner who fills out a certificate of death shall give it or transmit it by approved electronic media, including facsimile, to the mortician within 24 hours after the death occurred.

A medical examiner who fills out a certificate of death shall give it or transmit it by approved electronic media, including facsimile, to the mortician within 24 hours after the medical examiner took charge of the body.

If a death occurs on a common carrier in the United States and the body is removed from the carrier in this State, the death shall be registered in this State, and the place where it is first removed shall be considered the place of death. When a death occurs on a common carrier while in international waters or air space or in a foreign country or its air space and the body is first removed from the carrier in this State, the death shall be registered in this State, but the certificate shall show the actual place of death insofar as can be determined.

The individual in charge or the owner of the common carrier or a designee shall file a certificate of death within 24 hours after the body is removed from the carrier.

If the death occurred under any of the conditions or circumstances set forth in subsection (c) of this section, the medical examiner shall be notified.

Except as authorized under this subtitle, an individual who has a duty to fill out and sign a certificate of death may not execute more than one certificate for a death.

The attending physician, the physician assistant, the nurse practitioner, or a medical examiner who takes charge of a body may file a replacement death certificate if a correction that the physician, the physician assistant, the nurse practitioner, or medical examiner authorizes cannot be entered legibly on the original certificate.

The mortician who first takes custody of a fetus;

The person in charge of the institution or the person’s designated representative when a fetus is delivered in an institution;

The physician in attendance at or immediately after delivery when a fetus is delivered outside an institution; or

The medical examiner when a fetal death occurs without medical attendance at or immediately after the delivery when a medical examiner’s inquiry is required.

The personal information from the next of kin or the best qualified individual or source available; and

The medical certification of cause of death:

If any certificate of birth, death, or fetal death is amended, the facts shall be certified to the Secretary and entered on the original certificate with the date of the amendment, over the signature or initials of a designee of the Secretary and with a line drawn through the original data.

All amendments may be stored on electronic media approved by the Secretary.

All copies of certificates that are amended shall contain a notation that an amendment has been made.

A record shall be maintained which identifies the evidence upon which the amendment was based, the date of the amendment, and the identity of the person making the amendment.

When an informant does not submit the minimum documentation required in the regulations for amending a vital record or when the Secretary has cause to question the validity or adequacy of the applicant’s sworn statements or the documentary evidence, and if the deficiencies are not corrected, the Secretary shall not amend the vital record and shall advise the applicant of the reason for this action and shall further advise the applicant of the right of appeal to the Office of Administrative Hearings.

Except as provided in § 4–211(f) of this subtitle, on receipt of a court order that changes the name of an individual who was born in this State and on request of the individual or a parent, guardian, or legal representative of the individual, the Secretary shall amend the certificate of birth to reflect the new name.

Within 72 hours after death or after delivery in a fetal death and before final disposition or removal of the body or fetus from this State, the mortician who first takes custody of the body or fetus shall obtain a burial–transit permit.

If the death or fetal death certificate is on a multicopy form, one copy of which is designated specifically as a “burial–transit permit” and is signed by the attending physician or medical examiner, that copy shall provide for the later entry of final disposition information and serves as a burial–transit permit.

A person in charge of a cemetery may not permit the final disposition of a body or fetus unless it is accompanied by a burial–transit permit.

The person in charge of a cemetery shall:

If there is no person in charge of the cemetery, the mortician shall fill out the burial–transit permit.

A permit for disinterment and reinterment is required before the disinterment of human remains if reinterment is not to be made in the same cemetery. The Secretary or a health officer shall issue the permit after receipt of an application on the form that the Secretary requires.

If all human remains in a cemetery are to be disinterred for purposes of relocation or abandonment of the cemetery, one application is sufficient for that purpose.

The Department shall keep a record of each permit issued for the disinterment and reinterment of human remains.

Except as provided in paragraph (5) of this subsection, the Department may not disclose or allow public inspection of information in a permit record about the location of the site of a disinterment or reinterment if a local burial sites advisory board or the Director of the Maryland Historical Trust determines that:

The Department may not deny inspection of a permit record to:

Except as provided in subsection (b) of this section, the Secretary shall provide, on request, any person authorized by regulations adopted under this subtitle with a certified or abridged copy of a birth, death, or fetal death certificate registered under this subtitle or of the certificate of a marriage performed after June 1, 1951.

Except as provided in subsection (b) of this section and subject to subsection (h) of this section, a local health department or the Motor Vehicle Administration may:

A certified or abridged copy of a birth certificate may be issued only:

A certified or abridged copy of a birth certificate may contain only the personal information that appears on the birth certificate and may not include any confidential medical information that appears on the birth certificate.

Birth certificate information may not be given if it is to be used for commercial solicitation or private gain.

A noncertified copy of a birth certificate including confidential medical information may be provided to a unit of the Department to carry out its legal mandate or to conduct Institutional Review Board (IRB) approved research or study. Any report resulting from this research or study may not contain personal identifiers unless authorized by the subject of the record or the subject’s parent or authorized representative.

A copy of a birth certificate may be given to the Maryland Immunization Program to improve childhood immunization rates.

Except as otherwise provided by law:

From the fee the Department collects under paragraph (1) of this subsection, the Department shall transfer the entire fee to the General Fund.

The Department, a local health department, or the Motor Vehicle Administration may collect a fee for a certificate requested by an agency of the State or any of its political subdivisions.

The Secretary may waive all or part of a fee if chargeable to an agency of the United States.

The fee set by the local health department or the Motor Vehicle Administration for processing and issuing a death certificate under this subsection may not exceed the actual costs to the local health department or the Motor Vehicle Administration for processing and issuing a death certificate.

The Department shall develop and implement security protocols and other protections to:

The security protocols and other protections developed under paragraph (1) of this subsection shall include an auditable record of the following information:

Publish a report of vital statistics, including population estimates; and

Print and distribute the report to any official, agency, library, or other person whom the Secretary considers entitled to the report.

An individual with a developmental disability, as defined in § 7–101(g) of this article, who resided in or was receiving services from any program or facility licensed or operated by the Developmental Disabilities Administration; or

An individual with a mental illness who resided in or was receiving services from any program or facility approved, licensed, or operated by the Behavioral Health Administration.

Except as provided in paragraph (2) of this subsection, any information in the certificate that relates to a parent who did not give birth to a child is prima facie evidence.

If the parentage of the child is contested, and the parent who did not give birth to the child is a putative father as defined in § 5–1001 of the Family Law Article, the information that relates to the putative father is not evidence in any proceeding adverse to the interests of the putative father or the putative father’s heirs, next of kin, devisees, legatees, or other successors in interest.

The Secretary may investigate any irregularity or violation of this subtitle.

On request of the Secretary, each registrar shall help the Secretary in the investigation.

A person may not willfully provide false information for entry or willfully enter false information on a certificate of birth, death, or fetal death.

A person may not fail to provide a Social Security number or willfully provide a false Social Security number to the clerk of court under § 4–208(f) of this subtitle.

A person may not willfully use or attempt to use, with the intention to deceive, any certificate of birth or certified copy of a record of birth knowing that the certificate or certified copy:

A person may not willfully and knowingly provide a certificate of birth or a certified copy of a record of birth to another person with the intention that it be used by that person to deceive.

Violate any provision of this subtitle;

Neglect to perform any duty imposed by this subtitle; or

Violate any rule or regulation adopted under this subtitle.

By two or more health care providers;

By two or more health care providers employed by a mutual employer for a wage, salary, fee, or payment to perform work for the employer;

By health care organizations operating as an organized health care arrangement, as defined in 45 C.F.R. § 160.103;

By a health care entity or health care entities that possess an ownership or equity interest of 5% or more in another health care entity; or

By affiliated providers operating under the same trade name.

To diagnose, evaluate, rehabilitate, manage, treat, or maintain the physical or mental condition of a patient or recipient; or

That affects the structure or any function of the human body.

“Health care provider” means:

“Health care provider” includes the agents, employees, officers, and directors of a facility and the agents and employees of a health care provider.

“Health information exchange” means:

“Health information exchange” does not include:

The provision of abortion care; and

Reproductive health and other sensitive health services as determined by the Secretary based on the recommendations of the Protected Health Care Commission established under § 4–310 of this subtitle.

“Medical record” means any oral, written, or other transmission in any form or medium of information that:

“Medical record” includes any:

“Mental health services” means health care rendered to a recipient primarily in connection with the diagnosis, evaluation, treatment, case management, or rehabilitation of any mental disorder.

For acute general hospital services, mental health services are considered to be the primarily rendered service only if service is provided pursuant to Title 10, Subtitle 6 of this article or Title 3 of the Criminal Procedure Article.

An adult on whom a health care provider maintains a medical record;

A person authorized to consent to health care for an adult consistent with the authority granted;

A duly appointed personal representative of a deceased person;

If item (4) of this subsection does not apply to a minor:

An attorney appointed in writing by a person listed in item (1), (2), (3), (4), or (5) of this subsection.

Has primary responsibility for the development of the mental health treatment plan for the recipient; and

Is actively involved in providing that treatment.

Reproductive health services other than abortion care; and

Gender–affirming care.

Keep the medical record of a patient or recipient confidential; and

Disclose the medical record only:

Not kept in the medical record of a patient or recipient that is related to the administration of a health care facility, including:

Governed by the federal confidentiality of alcohol and drug abuse patient records regulations, 42 C.F.R. Part 2 and the provisions of § 8–601(c) of this article; or

Governed by the developmental disability confidentiality provisions in §§ 7–1008 through 7–1011 of this article.

Unless the patient has restricted or prohibited the disclosure of directory information, a health care provider may disclose directory information about a patient to an individual who has asked for the patient by name.

A health care provider shall:

If providing an opportunity under paragraph (2)(ii) of this subsection to restrict or prohibit the disclosure of directory information is not practicable because of the patient’s incapacity or need for emergency care or treatment, a health care provider may disclose the patient’s directory information if the disclosure is:

The redisclosure is:

Except as provided in paragraph (2) of this subsection, a person may not disclose by sale, rental, or barter any medical record.

This subsection shall not prohibit the transfers of medical records relating to the transfer of ownership of a health care practice or facility if the transfer is in accord with the ethical guidelines of the applicable health care profession or professions.

Accredited by the Electronic Healthcare Network Accreditation Commission; or

Certified by the Maryland Health Care Commission.

The regulations adopted under subsection (a) of this section shall:

The regulations adopted under subsection (a) of this section may not prohibit:

This section does not prohibit the Commission from adopting regulations that are more stringent than federal law in accordance with 45 C.F.R. § 160.203.

May not be sold for financial remuneration until the regulations required under subsections (a) and (b) of this section are adopted; and

May be sold for financial remuneration only in accordance with the regulations adopted under subsections (a) and (b) of this section.

In this section the following words have the meanings indicated.

“Electronic health care transactions” means health care transactions that have been approved by a nationally recognized health care standards development organization to support health care informatics, information exchange, systems integration, and other health care applications.

“Electronic health network” means an entity:

“Nursing home” has the meaning stated in § 19–1401 of this article.

“Standard request” means a request for clinical information from a health information exchange that conforms to the major standards version specified by the Office of the National Coordinator for Health Information Technology.

Except for the State–designated health information exchange, a health information exchange operating in the State; and

A payor that:

Respond to the request to the extent authorized under federal and State privacy laws; and

Transmit the response to the State–designated health information exchange in the manner specified in the regulations adopted under subsection (g) of this section.

On request of the Department, a nursing home shall submit electronically clinical information to the State–designated health information exchange to facilitate the objectives stated in paragraph (3) of this subsection.

In accordance with State and federal law and to facilitate the objectives stated in paragraph (3) of this subsection, the State–designated health information exchange may provide the information submitted under paragraph (1) of this subsection to:

The State–designated health information exchange shall:

If approved by the Maryland Commission on Health Equity, the State–designated health information exchange may use the data set maintained under paragraph (1) of this subsection to improve health outcomes for patients.

An electronic health network shall provide electronic health care transactions to the State–designated health information exchange for the following public health and clinical purposes:

An electronic health network may not charge a fee to a health care provider, health care payor, or to the State–designated health information exchange for providing the information as required under paragraph (1) of this subsection.

The State–designated health information exchange shall develop and implement policies and procedures to implement paragraph (1) of this subsection that are consistent with regulations adopted by the Maryland Health Care Commission.

Shall adopt regulations for implementing the connectivity to the State–designated health information exchange required under this section; and

Shall seek, through any regulations adopted under item (1) of this subsection, to promote technology standards and formats that conform to those specified by the Office of the National Coordinator for Health Information Technology.

The Maryland Health Care Commission shall adopt regulations that:

Any regulations adopted under paragraph (1) of this subsection shall limit the scope of the clinical information to purposes that:

Regulations adopted under paragraph (1) of this subsection:

Require an entity to which this section applies to collect clinical information or obtain any authorizations, not otherwise required by federal or State law, relating to information to be sent or received through the State–designated health information exchange;

Prohibit an entity to which this section applies from directly receiving or sending information to providers or subscribers outside of the State–designated health information exchange; or

Prohibit an entity to which this section applies from connecting and interoperating with the State–designated health information exchange in a manner and scope beyond that required under this section.

For the adjudication of claims; or

To a specific treating provider at the written request of and with the consent of:

Beginning June 1, 2024, a person who knowingly violates this section is guilty of a misdemeanor and on conviction is subject to a fine not to exceed $10,000 per day.

In determining the fine to be imposed under paragraph (1) of this subsection, the following factors shall be considered:

The Secretary shall determine for abortion care and sensitive health services the procedure, diagnosis, medication, and other related codes that are subject to the restrictions on disclosure established under subsection (b) of this section due to a substantial risk to patients or health care providers that would result from disclosure.

A determination made under paragraph (1) of this subsection shall:

In this section the following words have the meanings indicated.

“Business associate” has the meaning stated in 45 C.F.R. § 160.103.

“Electronic health care transactions” has the meaning stated in § 4–302.3 of this subtitle.

“Electronic health network” has the meaning stated in § 4–302.3 of this subtitle.

“Nursing home” has the meaning stated in § 19–1401 of this article.

If a nursing home contracts with or uses an electronic health network or electronic medical record vendor, the nursing home may direct the electronic health network or electronic medical record vendor to release patient medical records or electronic health care transactions held by the electronic health network or electronic medical record vendor to a business associate of the nursing home.

An electronic health network or electronic medical record vendor releasing patient medical records or electronic health care transactions under paragraph (1) of this subsection:

Be in writing, dated, and signed by the person in interest;

State the name of the health care provider;

Identify to whom the information is to be disclosed;

State the period of time that the authorization is valid, which may not exceed 1 year, except:

Apply only to a medical record developed by the health care provider unless in writing:

Except in cases of criminal justice referrals, a person in interest may revoke an authorization in writing.

A revocation of an authorization becomes effective on the date of receipt by the health care provider.

A disclosure made before the effective date of a revocation is not affected by the revocation.

A written authorization;

Any action taken in response to an authorization; and

Any revocation of an authorization.

Except as otherwise provided in this subtitle, a health care provider shall comply within a reasonable time after a person in interest requests in writing:

If a medical record relates to a psychiatric or psychological problem and the attending health care provider, with any available and feasible input from a primary provider of mental health services, believes disclosure of any portion of the medical record to be injurious to the health of a patient or recipient, the health care provider may refuse to disclose that portion of the medical record to the patient, recipient, or person in interest but, on written request, shall:

A health care provider shall establish procedures for a person in interest to request an addition to or correction of a medical record.

A person in interest may not have any information deleted from a medical record.

Within a reasonable time after a person in interest requests a change in a medical record, the health care provider shall:

A notice of refusal shall contain:

If the final determination of the health care provider is a refusal to change the medical record, the provider:

A health care provider shall give a notice of a change in a medical record or a copy of a statement of disagreement:

If a health care provider discloses a medical record after an addition, correction, or statement of disagreement has been made, the provider shall include with the medical record a copy of each addition, correction, or statement of disagreement.

A health care provider may require a person in interest or any other authorized person who requests a copy of a medical record to pay for the cost of copying:

A health care provider or a representative of the health care provider may not charge a fee for providing copies of a medical record:

Notwithstanding any other provision of law, a health care provider may not charge a person in interest, except for an attorney appointed in writing by a person in interest, who requests a copy of a medical record of an individual enrolled in the Maryland Medical Assistance Program a fee that exceeds $20, adjusted annually for inflation in accordance with the Consumer Price Index, for each 100 pages or portion of 100 pages copied.

Notwithstanding any other provision of law, any person or entity who is not subject to the provisions of this subsection and who obtains a medical record from a health care provider or the provider’s agent may not charge a fee for any subsequent copies of that medical record that exceeds the fee authorized under paragraph (3)(i) of this subsection.

If the person given access to the medical record signs an acknowledgment of the duty under this Act not to redisclose any patient identifying information, to a person for:

Subject to the additional limitations for a medical record developed primarily in connection with the provision of mental health services in § 4–307 of this subtitle, to a government agency performing its lawful duties as authorized by an act of the Maryland General Assembly or the United States Congress;

Subject to the additional limitations for a medical record developed primarily in connection with the provision of mental health services in § 4–307 of this subtitle, to another health care provider for the sole purpose of treating the patient or recipient on whom the medical record is kept;

If a claim has been or may be filed by, or with the authorization of a patient or recipient on behalf of the patient or recipient, for covered insureds, covered beneficiaries, or enrolled recipients only, to third party payors and their agents, if the payors or agents have met the applicable provisions of §§ 15–10B–01 to 15–10B–18 of the Insurance Article, including nonprofit health service plans, health maintenance organizations, fiscal intermediaries and carriers, the Department and its agents, the United States Department of Health and Human Services and its agents, or any other person obligated by contract or law to pay for the health care rendered for the sole purposes of:

If a health care provider makes a professional determination that an immediate disclosure is necessary, to provide for the emergency health care needs of a patient or recipient;

To immediate family members of the patient or any other individual with whom the patient is known to have a close personal relationship, provided that:

To an appropriate organ, tissue, or eye recovery agency under the restrictions of § 5–408 of this article for a patient whose organs and tissues may be donated for the purpose of evaluating the patient for possible organ and tissue donation;

To the Department or an organ, tissue, or eye recovery agency designated by the Department for the purpose of conducting death record reviews under § 19–310 of this article;

Subject to subsection (c) of this section, if the purpose of the medical record disclosure is for the coordination of services and record retention within the Montgomery County Department of Health and Human Services; or

To a carrier, as defined in § 15–1301 of the Insurance Article, or an accountable care organization, as defined in § 3022 of the Patient Protection and Affordable Care Act, for the sole purposes of enhancing or coordinating patient care, provided that:

The disclosure of medical records under subsection (b)(10) of this section to a person that is not employed by or under contract with the Montgomery County Department of Health and Human Services shall be conducted in accordance with this subtitle.

Under provisions of State law regarding confidentiality, the Montgomery County Department of Health and Human Services shall be considered to be one agency.

To a unit of State or local government, or to a member of a multidisciplinary team assisting the unit, for purposes of investigation or treatment in a case of suspected abuse or neglect of a child or an adult, subject to the following conditions:

Subject to the additional limitations for a medical record developed primarily in connection with the provision of mental health services in § 4–307 of this subtitle, to health professional licensing and disciplinary boards, in accordance with a subpoena for medical records for the sole purpose of an investigation regarding:

To a health care provider or the provider’s insurer or legal counsel, all information in a medical record relating to a patient or recipient’s health, health care, or treatment which forms the basis for the issues of a claim in a civil action initiated by the patient, recipient, or person in interest;

Notwithstanding any privilege in law, as needed, to a medical review committee as defined in § 1–401 of the Health Occupations Article or a dental review committee as defined in § 4–501 of the Health Occupations Article;

To another health care provider as provided in § 10–807 or § 19–308.2 of this article;

Subject to the additional limitations for a medical record developed primarily in connection with the provision of mental health services in § 4–307 of this subtitle and except as otherwise provided in items (2), (7), and (8) of this subsection, in accordance with compulsory process, if the health care provider receives:

Subject to the additional limitations for a medical record developed primarily in connection with the provision of mental health services in § 4–307 of this subtitle, and the limitations on patient overdose information under § 13–3602(e) of this article, to grand juries, prosecution agencies, law enforcement agencies or their agents or employees to further an investigation or prosecution, pursuant to a subpoena, warrant, or court order for the sole purposes of investigating and prosecuting criminal activity, provided that the prosecution agencies and law enforcement agencies have written procedures to protect the confidentiality of the records;

To the Maryland Insurance Administration when conducting an investigation or examination pursuant to Title 2, Subtitle 2 of the Insurance Article, provided that the Insurance Administration has written procedures to maintain the confidentiality of the records;

To a State or local child fatality review team established under Title 5, Subtitle 7 of this article as necessary to carry out its official functions;

To a local domestic violence fatality review team established under Title 4, Subtitle 7 of the Family Law Article as necessary to carry out its official functions;

To a local drug overdose fatality review team established under Title 5, Subtitle 9 of this article as necessary to carry out its official functions, subject to:

To a guardian ad litem appointed by a court to protect the best interests of a minor or a disabled or elderly individual who is a victim of a crime or a delinquent act, for the sole purpose and use of the guardian ad litem in carrying out the guardian ad litem’s official function to protect the best interests of the minor or the disabled or elderly individual in a criminal or juvenile delinquency court proceeding as permitted under 42 C.F.R. § 164.512(e).

Subject to paragraphs (2) through (4) of this subsection, a health care provider shall disclose medical and legal records without the authorization of an individual to a public defender who states in writing that the Office of the Public Defender represents the individual in:

Legal records required to be disclosed under paragraph (1) of this subsection include:

The records disclosed under paragraph (1) of this subsection shall be limited to those records needed by the public defender to represent the individual in the proceedings listed in paragraph (1) of this subsection.

Records provided under paragraph (1)(i) of this subsection shall be provided:

A written request for disclosure or written confirmation by the health care provider of an oral request that justifies the need for disclosure shall be inserted in the medical record of the patient or recipient; and

Documentation of the disclosure shall be inserted in the medical record of the patient or recipient.

Subject to paragraph (2) of this subsection, a health care provider shall disclose a medical record in accordance with compulsory process not later than 30 days after receiving:

On a showing of good cause, a health care provider may request up to 30 additional days beyond the date by which disclosure is required under paragraph (1) of this subsection to disclose a medical record.

In this section the following words have the meanings indicated.

“Case management” means an individualized recipient centered service designed to assist a recipient in obtaining effective mental health services through the assessing, planning, coordinating, and monitoring of services on behalf of the recipient.

“Core service agency” has the meaning stated in § 7.5–101 of this article.

“Director” means the Director of the Behavioral Health Administration or the designee of the Director.

“Mental health director” means the health care professional who performs the functions of a clinical director or the designee of that person in a health care, detention, or correctional facility.

To the extent a mental health care provider determines it necessary and appropriate, the mental health care provider may maintain a personal note regarding a recipient.

A personal note shall be considered part of a recipient’s medical records if, at any time, a mental health care provider discloses a personal note to a person other than:

The provisions of this subsection do not prohibit the disclosure, discovery, or admissibility of a personal note regarding a recipient who has initiated an action for malpractice, an intentional tort, or professional negligence against the health care provider.

Except as otherwise provided in paragraphs (3), (4), and (5) of this subsection, if the disclosure of a portion of a medical record relating to a psychological test would compromise the objectivity or fairness of the test or the testing process, a mental health care provider may not disclose that portion of the medical record to any person, including a subject of the test.

The raw test data relating to a psychological test is only discoverable or admissible as evidence in a criminal, civil, or administrative action on the determination by the court or administrative hearing officer that the expert witness for the party seeking the raw test data is qualified by the appropriate training, education, or experience to interpret the results of that portion of the raw test data relating to the psychological test.

A health care provider may disclose a medical record relating to a psychological test as provided under § 4–305(b)(2)(i) of this subtitle.

The provisions of this subsection may not restrict access to or affect the disclosure of a medical record which is also an education record under the federal Individuals with Disabilities Education Act, the federal Family Educational Rights and Privacy Act, or any federal and State regulations that have been adopted to implement those laws.