<section article="ghg" article_name="Health - General" number="4-101" title_number="4" title_name="Statistics and Records" subtitle_number="1" subtitle_name="Confidential Research Records"> <text>In this subtitle, “confidential record” means any record, report, statement, note, or other information that:</text> <level label="1"> <text>Is assembled or obtained for research or study by:</text> <level label="i"> <text>The Drug Abuse Administration;</text> </level> <level label="ii"> <text>The Prevention and Health Promotion Administration; or</text> </level> <level label="iii"> <text>The Secretary; and</text> </level> </level> <level label="2"> <text>Names or otherwise identifies any person.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-102" title_number="4" title_name="Statistics and Records" subtitle_number="1" subtitle_name="Confidential Research Records"> <level label="a"> <level label="1"> <text>Each confidential record shall remain in the custody and control of:</text> <level label="i"> <text>The Drug Abuse Administration, if that Administration assembled or obtained the confidential record;</text> </level> <level label="ii"> <text>The Prevention and Health Promotion Administration, if that Administration assembled or obtained the confidential record; or</text> </level> <level label="iii"> <text>The Secretary or an agent or employee of the Secretary, if the Secretary assembled or obtained the confidential record.</text> </level> </level> <level label="2"> <text>The confidential record may be used only for the research and study for which it was assembled or obtained.</text> </level> <level label="3"> <text>A person may not disclose any confidential record to any person who is not engaged in the research or study project.</text> </level> </level> <level label="b"> <text>This section does not apply to or restrict the use or publication of any statistics, information, or other material that summarizes or refers to confidential records in the aggregate, without disclosing the identity of any person who is the subject of the confidential record.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-103" title_number="4" title_name="Statistics and Records" subtitle_number="1" subtitle_name="Confidential Research Records"> <text>A person who violates any provision of this subtitle is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000.</text> </section> <section article="ghg" article_name="Health - General" number="4-201" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Attending clinician” means the physician, nurse midwife, or direct–entry midwife in charge of a birth outside an institution.</text> </level> <level label="c"> <text>“Attending physician” means the physician in charge of the patient’s care for the illness or condition which resulted in death.</text> </level> <level label="d"> <text>“County registrar” means the registrar of vital records for a county.</text> </level> <level label="e"> <level label="1"> <text>“Dead body” means:</text> <level label="i"> <text>A dead human body; or</text> </level> <level label="ii"> <text>Parts or bones of a human body if, from their condition, an individual reasonably may conclude that death has occurred.</text> </level> </level> <level label="2"> <text>“Dead body” does not include an amputated part.</text> </level> </level> <level label="f"> <text>“Direct–entry midwife” means an individual licensed to practice direct–entry midwifery under Title 8, Subtitle 6C of the Health Occupations Article.</text> </level> <level label="g"> <text>“Father” has the meaning stated in § 5–1001 of the Family Law Article.</text> </level> <level label="h"> <text>“Fetal death” means death of a product of human conception, before its complete expulsion or extraction from the mother, regardless of the duration of the pregnancy, as indicated by the fact that, after the expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as heart beat, pulsation of the umbilical cord, or definite movement of voluntary muscle.</text> </level> <level label="i"> <text>“File” means to present for registration any certificate, report, or other record including records transmitted by approved electronic media, including facsimile, of birth, death, fetal death, adoption, marriage, or divorce for which this subtitle provides and to have the Secretary accept the record.</text> </level> <level label="j"> <text>“Filing date” means the date a vital record is accepted for registration by the Secretary.</text> </level> <level label="k"> <text>“Final disposition” means the burial, cremation, or other final disposition of a body or fetus.</text> </level> <level label="l"> <text>“Institution” means any public or private establishment:</text> <level label="1"> <text>To which individuals are committed by law; or</text> </level> <level label="2"> <text>That provides to 2 or more unrelated individuals:</text> <level label="i"> <text>Any inpatient or outpatient medical, surgical, or diagnostic care or treatment; or</text> </level> <level label="ii"> <text>Any nursing, custodial, or domiciliary care.</text> </level> </level> </level> <level label="m"> <text>“Licensed health care practitioner” means:</text> <level label="1"> <text>An individual who is:</text> <level label="i"> <text>A physician licensed under Title 14 of the Health Occupations Article;</text> </level> <level label="ii"> <text>A psychologist licensed under Title 18 of the Health Occupations Article;</text> </level> <level label="iii"> <text>A registered nurse licensed and certified to practice as a nurse practitioner, nurse psychotherapist, or clinical nurse specialist under Title 8 of the Health Occupations Article; or</text> </level> <level label="iv"> <text>A licensed certified social worker–clinical licensed under Title 19 of the Health Occupations Article; or</text> </level> </level> <level label="2"> <text>An individual who:</text> <level label="i"> <text>Is licensed to practice a profession listed in item (1) of this subsection in another state; and</text> </level> <level label="ii"> <text>Meets the requirements under the Health Occupations Article to qualify for a license to practice the profession in this State.</text> </level> </level> </level> <level label="n"> <text>“Live birth” means the complete expulsion or extraction of a product of human conception from the mother, regardless of the period of gestation, if, after the expulsion or extraction, it breathes or shows any other evidence of life, such as heart beat, pulsation of the umbilical cord, or definite movement of voluntary muscle, whether or not the umbilical cord is cut or the placenta is attached.</text> </level> <level label="o"> <text>“Mortician” means a funeral director, mortician, or other person who is authorized to make final disposition of a body.</text> </level> <level label="p"> <text>“Mother” has the meaning stated in § 5–1001 of the Family Law Article.</text> </level> <level label="q"> <text>“Nurse midwife” means an individual certified to practice as a nurse midwife under Title 8 of the Health Occupations Article.</text> </level> <level label="r"> <text>“Physician” means a person authorized or licensed to practice medicine or osteopathy pursuant to the laws of this State.</text> </level> <level label="s"> <text>“Physician assistant” means an individual who is licensed under Title 15 of the Health Occupations Article to practice as a physician assistant.</text> </level> <level label="t"> <text>“Registration” means acceptance by the Secretary and incorporation in the records of the Department of any certificate, report, or other record of birth, death, fetal death, adoption, marriage, divorce, or dissolution or annulment of marriage for which this subtitle provides.</text> </level> <level label="u"> <text>“Vital record” means a certificate or report of birth, death, fetal death, marriage, divorce, dissolution or annulment of marriage, adoption, or adjudication of paternity that is required by law to be filed with the Secretary.</text> </level> <level label="v"> <text>“Vital statistics” means the data derived from certificates and reports of birth, death, fetal death, marriage, divorce, dissolution or annulment of marriage, and reports related to any of these certificates and reports.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-202" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>The Secretary shall appoint a State registrar of vital records, who shall be in the skilled service of the State Personnel Management System.</text> </level> <level label="b"> <text>The health officer for a county is the registrar of vital records for the county.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-203" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>The Secretary is charged with administering efficiently and uniformly this subtitle throughout this State.</text> </level> <level label="b"> <level label="1"> <text>The Secretary shall:</text> <level label="i"> <text>Establish appropriate methods and the necessary forms for accurate registration of vital records;</text> </level> <level label="ii"> <text>On or before January 1, 2015, establish a process by which death certificates can be filed electronically; and</text> </level> <level label="iii"> <text>Educate physicians, physician assistants, and nurse practitioners regarding the process by which death certificates can be filed electronically.</text> </level> </level> <level label="2"> <text>The forms shall provide for the information that the Secretary needs for proper registration and use of these vital records.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-204" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>The Secretary shall collect, index, and safeguard from fire, loss, or damage each certificate of birth, death, and fetal death.</text> </level> <level label="b"> <text>After registration of a completed birth, death, or fetal death certificate, the Secretary shall provide a copy of the original certificate to the county registrar for the county where the event occurred and the county registrar where the subject of the certificate resides or resided if the county of residence is different from the county where the event occurred.</text> </level> <level label="c"> <text>A copy of a certificate provided to a county registrar under this section may be used by the county health department to carry out public health functions.</text> </level> <level label="d"> <text>A copy of a certificate provided under this section may be photographic or electronic or produced by other means as prescribed by the Secretary.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-205" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>A county registrar shall preserve for 3 years each copy of a death or fetal death record that the Secretary sends to the county registrar.</text> </level> <level label="b"> <text>The county death and fetal death records shall be open to inspection by the Secretary, a designee of the Secretary, or an official of a municipal corporation or county, if the inspection is made for a proper purpose and in a manner that does not subject the contents of these records to risk of damage or alteration.</text> </level> <level label="c"> <text>If any omission or discrepancy in the personal or medical facts in a county death or fetal death record is called to the attention of a county registrar, the county registrar promptly shall:</text> <level label="1"> <text>Investigate to determine the facts of record; and</text> </level> <level label="2"> <text>Send a certified statement of the facts to the Secretary.</text> </level> </level> <level label="d"> <text>A county registrar shall investigate and inform the Secretary in full of any violation or suspected violation of this subtitle.</text> </level> <level label="e"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>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.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-206" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>The Secretary shall collect, index, and safeguard the marriage, divorce, and annulment records that clerks of court file as provided by law.</text> </level> <level label="b"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>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.</text> </level> </level> <level label="c"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>The Secretary may not provide a certified copy of any record of divorce or annulment.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-207" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>The person who is required to complete the record shall attest to its accuracy either by signature or by approved electronic process.</text> </level> </level> <level label="b"> <text>A certificate is not complete or correct if it does not give each item of required information to the extent the information is obtainable.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-208" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>In this section, “gestational carrier” means a woman other than an intended parent or gamete donor who agrees to become pregnant for an intended parent with the intention of gestating and delivering the child of the intended parent.</text> </level> <level label="b"> <level label="1"> <text>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:</text> <level label="i"> <text>Prepare, on the form that the Secretary provides, a certificate of birth;</text> </level> <level label="ii"> <text>Secure each signature that is required on the certificate;</text> </level> <level label="iii"> <text>File the certificate; and</text> </level> <level label="iv"> <text>If applicable, attach a copy of the order of the court establishing parentage.</text> </level> </level> <level label="2"> <text>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.</text> </level> <level label="3"> <text>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.</text> </level> <level label="4"> <text>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:</text> <level label="i"> <text>Provide an opportunity for the child’s parents to complete a standardized affidavit of parentage recognizing parentage of the child on the standardized form provided by the Department of Human Services under § 5–1028 of the Family Law Article;</text> </level> <level label="ii"> <text>Furnish to the mother written information prepared by the Child Support Administration concerning the benefits of having the parentage of the child established, including the availability of child support enforcement services; and</text> </level> <level label="iii"> <text>Forward the completed affidavit to the Maryland Department of Health, Division of Vital Records. The Maryland Department of Health, Division of Vital Records shall make the affidavits available to the parents, guardian of the child, or a child support enforcement agency upon request.</text> </level> </level> <level label="5"> <text>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.</text> </level> <level label="6"> <text>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.</text> </level> <level label="7"> <text>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.</text> </level> <level label="8"> <level label="i"> <text>In any case that does not involve a gestational carrier in which parentage of a child is determined by a court of competent jurisdiction, the name of the parent who did not give birth to the child and surname of the child shall be entered on the certificate of birth in accordance with the finding and order of the court.</text> </level> <level label="ii"> <text>In any case that involves a gestational carrier in which parentage is determined by a court of competent jurisdiction:</text> <level label="1"> <text>The following shall be recorded on the forms provided by the Secretary:</text> </level> <level label="A"> <text>An indication that the delivery of birth was by a gestational carrier;</text> </level> <level label="B"> <text>The identity of the gestational carrier;</text> </level> <level label="C"> <text>All relevant medical information regarding the gestational carrier and the delivery; and</text> </level> <level label="D"> <text>Information regarding the intended parents;</text> </level> <level label="2"> <text>An order of the court establishing parentage shall be attached to the forms provided by the Secretary; and</text> </level> <level label="3"> <text>On receipt of the forms provided by the Secretary and the order of the court establishing parentage, the Division of Vital Records shall immediately:</text> </level> <level label="A"> <text>Seal the forms provided by the court; and</text> </level> <level label="B"> <text>Register the certificate of birth in accordance with the order of the court.</text> </level> </level> </level> <level label="9"> <text>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.</text> </level> </level> <level label="c"> <level label="1"> <text>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:</text> <level label="i"> <text>The attending individual.</text> </level> <level label="ii"> <text>In the absence of an attending individual, either parent of the child.</text> </level> <level label="iii"> <text>In the absence or inability of either parent, the individual in charge of the premises where the birth occurred.</text> </level> </level> <level label="2"> <text>In any case that involves a gestational carrier in which parentage is determined by a court of competent jurisdiction:</text> <level label="i"> <text>The person specified in regulations adopted by the Department shall record the following on the forms provided by the Secretary:</text> <level label="1"> <text>An indication that the delivery of birth was by a gestational carrier;</text> </level> <level label="2"> <text>The identity of the gestational carrier;</text> </level> <level label="3"> <text>All relevant medical information regarding the gestational carrier and the delivery; and</text> </level> <level label="4"> <text>Information regarding the intended parents;</text> </level> </level> <level label="ii"> <text>The person specified in regulations adopted by the Department shall attach an order of the court establishing parentage to the forms provided by the Secretary; and</text> </level> <level label="iii"> <text>On receipt of the forms provided by the Secretary and order of the court establishing parentage, the Division of Vital Records shall immediately:</text> <level label="1"> <text>Seal the forms provided by the Secretary; and</text> </level> <level label="2"> <text>Register the certificate of birth in accordance with the order of the court.</text> </level> </level> </level> </level> <level label="d"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>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.</text> </level> <level label="3"> <text>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.</text> </level> </level> <level label="e"> <level label="1"> <text>Each parent shall provide his or her own Social Security number on the form provided by the Secretary under this section.</text> </level> <level label="2"> <level label="i"> <text>If the parent who did not give birth to the child is not available to provide the parent’s Social Security number on the form provided under paragraph (1) of this subsection, the parent shall provide the parent’s Social Security number on a form provided by the Secretary for this purpose.</text> </level> <level label="ii"> <text>The form provided under this paragraph shall:</text> <level label="1"> <text>State that the form is for the purpose of providing the Social Security numbers of parents, to be included on the portion of the form that remains in the official birth record;</text> </level> <level label="2"> <text>Contain a specific reference to this subtitle; and</text> </level> <level label="3"> <text>State that the parent’s Social Security number shall be provided under penalty of perjury.</text> </level> </level> </level> <level label="3"> <text>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.</text> </level> <level label="4"> <text>The Social Security numbers of the parents may not appear on the portion of the birth certificate issued as proof of birth.</text> </level> <level label="5"> <level label="i"> <text>The Secretary shall permit disclosure of the Social Security numbers of the parents only to the Child Support Administration of the Department of Human Services.</text> </level> <level label="ii"> <text>The Child Support Administration may use the Social Security numbers of the parents to:</text> <level label="1"> <text>Locate a parent;</text> </level> <level label="2"> <text>Establish parentage; and</text> </level> <level label="3"> <text>Establish and enforce a child support order under Title 10, Subtitle 1 of the Family Law Article.</text> </level> </level> </level> </level> <level label="f"> <text>If, under subsection (e)(1) of this section, the Social Security number of the parent who did not give birth to the child is not entered on the form provided by the Secretary:</text> <level label="1"> <text>Upon adjudication of parentage, the court shall order the parent to provide the parent’s Social Security number to the clerk of court; and</text> </level> <level label="2"> <text>The clerk of court shall send the parent’s Social Security number to the Secretary, as provided under § 4–211(f) of this subtitle.</text> </level> </level> <level label="g"> <text>A certificate of birth may be filed within 10 days after the birth occurred if a parent of the child notifies the person required to file the certificate of birth on a form provided by the Secretary as soon as practicable after birth, but not later than 5 days after the birth occurs.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-209" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>The report shall state:</text> <level label="i"> <text>The date and place of finding of the child;</text> </level> <level label="ii"> <text>The sex, color or race, and approximate date of birth of the child, as determined by a physician;</text> </level> <level label="iii"> <text>The name and address of the person with whom the child is placed for care;</text> </level> <level label="iv"> <text>The name that the custodian gives the child; and</text> </level> <level label="v"> <text>Any other information that the Secretary requires.</text> </level> </level> </level> <level label="b"> <text>The person shall enter the place where the child was found as the place of birth.</text> </level> <level label="c"> <text>A report under this section is the certificate of birth for the child.</text> </level> <level label="d"> <text>If the child is identified and a certificate of birth is found or obtained, the report under this section:</text> <level label="1"> <text>Shall be sealed; and</text> </level> <level label="2"> <text>May be reopened only:</text> <level label="i"> <text>On order of a court of competent jurisdiction;</text> </level> <level label="ii"> <text>On written order of a designee of the Secretary; or</text> </level> <level label="iii"> <text>As the rules and regulations of the Secretary provide.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-210" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>The Secretary may adopt rules and regulations to govern the filing of a record of birth if a certificate of birth is not filed within the time required by § 4-208 or § 4-209 of this subtitle.</text> </level> <level label="b"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>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.</text> </level> <level label="3"> <text>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.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-211" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>Except as provided in subsection (d) of this section, the Secretary shall make a new certificate of birth for an individual if the Department receives satisfactory proof that:</text> <level label="1"> <text>The individual was born in this State; and</text> </level> <level label="2"> <text>Regardless of the location, one of the following has occurred:</text> <level label="i"> <text>The previously unwed parents of the individual have married each other after the birth of the individual;</text> </level> <level label="ii"> <text>A court of competent jurisdiction has entered an order as to the parentage, legitimation, or adoption of the individual; or</text> </level> <level label="iii"> <text>If a parent who did not give birth to the individual is not named on an earlier certificate of birth:</text> <level label="1"> <text>The parent who did not give birth to the individual has acknowledged himself or herself by affidavit to be a parent of the individual; and</text> </level> <level label="2"> <text>The mother of the individual has consented by affidavit to the acknowledgment.</text> </level> </level> </level> </level> <level label="b"> <text>Except as provided in subsection (d) of this section, the Secretary shall make a new certificate of birth for an individual if the Department receives satisfactory proof that:</text> <level label="1"> <text>The individual was born in this State; and</text> </level> <level label="2"> <text>Regardless of the location, one of the following has occurred:</text> <level label="i"> <level label="1"> <text>A licensed health care practitioner who has treated or evaluated the individual has determined that the individual’s sex designation should be changed because the individual has undergone treatment appropriate for the purpose of sex transition or has been diagnosed with an intersex condition;</text> </level> <level label="2"> <text>The individual, or if the individual is a minor or disabled person under guardianship, the individual’s parent, guardian, or legal representative, has made a written request for a new certificate of birth with a sex designation that differs from the sex designated on the original certificate of birth; and</text> </level> <level label="3"> <text>The licensed health care practitioner has signed a statement, under penalty of perjury, that:</text> </level> <level label="A"> <text>The individual has undergone surgical, hormonal, or other treatment appropriate for the individual, based on generally accepted medical standards; or</text> </level> <level label="B"> <text>The individual has an intersex condition and, in the professional opinion of the licensed health care practitioner, based on generally accepted medical standards, the individual’s sex designation should be changed accordingly;</text> </level> </level> <level label="ii"> <text>A court of competent jurisdiction has issued an order indicating that the sex of an individual born in this State has been changed; or</text> </level> <level label="iii"> <text>Before October 1, 2015, the Secretary, as provided under regulations adopted by the Department, amended an original certificate of birth on receipt of a certified copy of an order of a court of competent jurisdiction indicating the sex of the individual had been changed.</text> </level> </level> </level> <level label="c"> <text>Except as provided in subsection (d) of this section, the Secretary may make a new certificate of birth for an individual who was born outside the United States if one of the following occurred in this State:</text> <level label="1"> <text>The previously unwed parents of the individual have married each other after the birth of the individual;</text> </level> <level label="2"> <text>A court of competent jurisdiction in this State has entered an order as to parentage or legitimation; or</text> </level> <level label="3"> <text>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.</text> </level> </level> <level label="d"> <text>The Secretary may not make a new certificate of birth in connection with an order of a court of competent jurisdiction relating to the adoption of an individual, if one of the following so directs the Secretary:</text> <level label="1"> <text>The court that decrees the adoption;</text> </level> <level label="2"> <text>The adoptive parents; or</text> </level> <level label="3"> <text>The adopted individual, if an adult.</text> </level> </level> <level label="e"> <text>A new certificate of birth shall be prepared on the following basis:</text> <level label="1"> <text>The individual shall be treated as having at birth the status that later is acquired or established and of which proof is submitted.</text> </level> <level label="2"> <level label="i"> <text>If the parents of the individual were not married and parentage is established by legal proceedings, the name of the parent who did not give birth to the individual shall be inserted.</text> </level> <level label="ii"> <text>The legal proceeding should request and report to the Secretary that the surname of the subject of the record be changed from that shown on the original certificate, if a change is desired.</text> </level> </level> <level label="3"> <text>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.</text> </level> <level label="4"> <text>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.</text> </level> </level> <level label="f"> <level label="1"> <text>When a new certificate of birth is made under subsection (b) of this section:</text> <level label="i"> <text>The sex designation of the individual on the new certificate of birth shall be the sex designation for which satisfactory proof has been submitted in accordance with subsection (b) of this section; and</text> </level> <level label="ii"> <text>If the name of the individual has been changed at any time, the name of the individual on the new certificate of birth shall be the name that was last established and for which appropriate documentation has been submitted to the Department.</text> </level> </level> <level label="2"> <text>A new certificate of birth made under subsection (b) of this section may not:</text> <level label="i"> <text>Be marked “amended”; or</text> </level> <level label="ii"> <text>Show on its face that a change has been made to:</text> <level label="1"> <text>A sex designation; or</text> </level> <level label="2"> <text>If applicable, a change of name.</text> </level> </level> </level> </level> <level label="g"> <level label="1"> <text>If a new certificate of birth is made, the Secretary shall:</text> <level label="i"> <text>Substitute the new certificate of birth for any certificate then on file; and</text> </level> <level label="ii"> <text>Place the original certificate of birth and all records that relate to the new certificate of birth under seal.</text> </level> </level> <level label="2"> <text>The seal may be broken only:</text> <level label="i"> <text>On order of a court of competent jurisdiction;</text> </level> <level label="ii"> <text>If it does not violate the confidentiality of the record, on written order of a designee of the Secretary; or</text> </level> <level label="iii"> <text>In accordance with Title 5, Subtitle 3A or Subtitle 4B of the Family Law Article.</text> </level> </level> <level label="3"> <text>A certified copy of the certificate of birth that later is issued shall be a copy of the new certificate of birth, unless:</text> <level label="i"> <text>A court of competent jurisdiction orders the issuance of a copy of the original certificate of birth; or</text> </level> <level label="ii"> <text>Title 5, Subtitle 3A or Subtitle 4B of the Family Law Article provides for the issuance of a copy of the original certificate of birth.</text> </level> </level> </level> <level label="h"> <text>Each clerk of court shall send to the Secretary, on the form that the Secretary provides, a report of:</text> <level label="1"> <text>Each decree of adoption;</text> </level> <level label="2"> <text>Each adjudication of parentage, including the parent’s Social Security number; and</text> </level> <level label="3"> <text>Each revocation or amendment of any decree of adoption or adjudication of paternity that the court enters.</text> </level> </level> <level label="i"> <text>Upon receipt of a report or decree of annulment of adoption, the original certificate of birth shall be restored to its place in the files, and the adoption certificate and any accompanying documents are not subject to inspection except upon order of a court of competent jurisdiction or as provided by regulation.</text> </level> <level label="j"> <text>If no certificate of birth is on file for the person for whom a new birth certificate is to be established under this section, and the date and place of birth have not been determined in the adoption or paternity proceedings:</text> <level label="1"> <text>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</text> </level> <level label="2"> <text>The new birth certificate shall be prepared on the delayed birth certificate form.</text> </level> </level> <level label="k"> <level label="1"> <text>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:</text> <level label="i"> <text>Through a court of competent jurisdiction in this State; or</text> </level> <level label="ii"> <level label="1"> <text>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; and</text> </level> <level label="2"> <text>By an adopting parent who is a resident of this State.</text> </level> </level> </level> <level label="2"> <text>Except as provided in paragraph (3) of this subsection, the certificate shall be established on receipt of:</text> <level label="i"> <text>A certificate of adoption from the court decreeing the adoption;</text> </level> <level label="ii"> <text>Proof of the date and place of the child’s birth; and</text> </level> <level label="iii"> <text>A request from the court, the adopting parents, or the adopted person if 18 years of age or over that the certificate be prepared.</text> </level> </level> <level label="3"> <text>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:</text> <level label="i"> <text>An official copy of the decree from the jurisdiction or country in which the child was adopted;</text> </level> <level label="ii"> <text>A certified translation of the foreign adoption decree;</text> </level> <level label="iii"> <text>Proof of the date and place of the child’s birth;</text> </level> <level label="iv"> <text>Proof of IR–3 or IH–3 visa status;</text> </level> <level label="v"> <text>A request from the court, the adopting parents, or the adopted person if 18 years of age or over that the certificate be prepared; and</text> </level> <level label="vi"> <text>Proof that the adopting parent is a resident of this State.</text> </level> </level> <level label="4"> <text>The certificate shall be labeled “Certificate of Foreign Birth” and shall show the actual country of birth.</text> </level> <level label="5"> <text>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.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-212" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>This section does not apply to a fetal death.</text> </level> <level label="b"> <level label="1"> <text>A certificate of death regardless of age of decedent shall be filled out and signed by:</text> <level label="i"> <text>The medical examiner, if the medical examiner takes charge of the body; or</text> </level> <level label="ii"> <text>If the medical examiner does not take charge of the body, the physician, physician assistant, or nurse practitioner who last attended the deceased.</text> </level> </level> <level label="2"> <text>The medical examiner, physician, physician assistant, or nurse practitioner shall fill in only the following information on the certificate of death:</text> <level label="i"> <text>The name of the deceased;</text> </level> <level label="ii"> <text>The cause of death and medical certification;</text> </level> <level label="iii"> <text>The date and hour of death; and</text> </level> <level label="iv"> <text>The place where death occurred.</text> </level> </level> <level label="3"> <text>Any other information that is required on the certificate of death regardless of age of decedent shall be filled in:</text> <level label="i"> <text>By the person who has charge of the body; or</text> </level> <level label="ii"> <text>If the State Anatomy Board has charge of the body, by the person who last had charge of the body before it was sent to the State Anatomy Board.</text> </level> </level> <level label="4"> <text>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.</text> </level> <level label="5"> <text>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:</text> <level label="i"> <text>The attending physician’s associate;</text> </level> <level label="ii"> <text>The chief medical officer or designee of the institution in which death occurred;</text> </level> <level label="iii"> <text>The physician who performed an autopsy upon the decedent, provided the individual has access to the medical history of the case and death is due to natural causes; or</text> </level> <level label="iv"> <text>A physician designated by the State Anatomy Board, only if within 72 hours after the State Anatomy Board takes charge of the body, the State Anatomy Board has failed after a good faith effort to make contact with any of the individuals described in items (i), (ii), or (iii) of this paragraph or paragraph (4) of this subsection.</text> </level> </level> <level label="6"> <text>The person completing the cause of death and medical certification shall attest to the accuracy by signature or by an approved electronic process.</text> </level> <level label="7"> <text>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.</text> </level> </level> <level label="c"> <text>Each individual concerned with carrying out this subtitle promptly shall notify the medical examiner if:</text> <level label="1"> <text>The deceased was not under treatment by a physician, physician assistant, or nurse practitioner during the terminal illness;</text> </level> <level label="2"> <text>The cause of death is unknown; or</text> </level> <level label="3"> <text>The individual considers any of the following conditions to be the cause of death or to have contributed to the death:</text> <level label="i"> <text>An accident, including a fall with a fracture or other injury;</text> </level> <level label="ii"> <text>Homicide;</text> </level> <level label="iii"> <text>Suicide;</text> </level> <level label="iv"> <text>Other external manner of death;</text> </level> <level label="v"> <text>Alcoholism; or</text> </level> <level label="vi"> <text>Criminal or suspected criminal abortion.</text> </level> </level> </level> <level label="d"> <level label="1"> <level label="i"> <text>If, within 24 hours after taking charge of a body, the medical examiner has not determined the cause of death, the medical examiner shall enter “investigation pending” in the cause of death section of the death certificate.</text> </level> <level label="ii"> <text>As soon as the medical examiner determines the cause of death, the medical examiner shall send to the Secretary a report of the cause of death, for entry on the certificate.</text> </level> </level> <level label="2"> <level label="i"> <text>A physician who completes a death certificate under subsection (b)(5)(iv) of this section shall enter “unspecified natural causes” in the cause of death section of the death certificate.</text> </level> <level label="ii"> <text>The State Anatomy Board shall send to the Secretary a report of the cause of death for entry on a death certificate completed under subsection (b)(5)(iv) of this section if the State Anatomy Board receives information about the cause of death from an individual described in subsection (b)(4) or (5)(i), (ii), or (iii) of this section.</text> </level> </level> </level> <level label="e"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>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.</text> </level> </level> <level label="f"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>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.</text> </level> <level label="3"> <text>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.</text> </level> </level> <level label="g"> <text>A mortician who obtains a certificate of death under this section shall file the certificate within 72 hours after the death.</text> </level> <level label="h"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>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.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-213" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>If a fetal death occurs after a gestation period of 20 weeks or more, then within 72 hours after delivery, a certificate of fetal death shall be filed by:</text> <level label="1"> <text>The mortician who first takes custody of a fetus;</text> </level> <level label="2"> <text>The person in charge of the institution or the person’s designated representative when a fetus is delivered in an institution;</text> </level> <level label="3"> <text>The physician in attendance at or immediately after delivery when a fetus is delivered outside an institution; or</text> </level> <level label="4"> <text>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.</text> </level> </level> <level label="b"> <text>The person who files the fetal death certificate shall obtain:</text> <level label="1"> <text>The personal information from the next of kin or the best qualified individual or source available; and</text> </level> <level label="2"> <text>The medical certification of cause of death:</text> <level label="i"> <text>From the medical examiner, within 24 hours after the medical examiner takes charge of the fetus; or</text> </level> <level label="ii"> <text>If the medical examiner does not take charge of the fetus, from the attending physician within 24 hours after delivery.</text> </level> </level> </level> <level label="c"> <text>When a fetal death occurs on a common carrier and the fetus is first removed from the carrier in this State or when a fetus is found in this State and the place of fetal death is unknown, the fetal death shall be reported in this State.</text> </level> <level label="d"> <text>The place where the fetus was first removed from the carrier or the fetus was found shall be considered the place of fetal death.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-213.1" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>The Secretary shall establish procedures for the issuance of a certificate of birth resulting in stillbirth.</text> </level> <level label="b"> <text>The Department shall make available a certificate of birth resulting in stillbirth to the parent or parents of a stillborn child for whom a fetal death was registered.</text> </level> <level label="c"> <text>The individual preparing the certificate of birth resulting in stillbirth shall not include any references to the stillborn child’s first name if the stillborn child’s parent or parents do not wish to provide a first name for the stillborn child.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-214" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>A certificate or record registered under this subtitle may be amended only in accordance with this subtitle and any rules and regulations that the Secretary adopts to protect the integrity and accuracy of vital records.</text> </level> <level label="b"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>All amendments may be stored on electronic media approved by the Secretary.</text> </level> <level label="3"> <text>All copies of certificates that are amended shall contain a notation that an amendment has been made.</text> </level> <level label="4"> <text>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.</text> </level> <level label="5"> <text>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.</text> </level> <level label="6"> <level label="i"> <text>Except as provided in subparagraph (ii) of this paragraph, any amendments to death certificates requested beyond 3 years or more after the death shall require a court order.</text> </level> <level label="ii"> <text>The Office of the Chief Medical Examiner may amend the cause of death on a certificate of death at any time after registration without a court order.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>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.</text> </level> <level label="2"> <level label="i"> <text>The Department may change the name on a birth certificate once without a court order if, within 12 months after the birth, the Department receives from both parents named on the birth certificate of the child or, if only one parent is named, the parent named on the birth certificate of the child:</text> <level label="1"> <text>A written request for the change of name; and</text> </level> <level label="2"> <text>An affidavit that has been sworn before a notary public of the State and states that the individual is the parent of the child and is making the request of the individual’s own free will.</text> </level> </level> <level label="ii"> <text>If the Department receives an affidavit in accordance with subparagraph (i)2 of this paragraph from both parents named on the birth certificate of the child, only one affidavit signed by both parents is required.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-215" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>In this section, “cemetery” includes a crematory or other place for final disposition.</text> </level> <level label="b"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>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.</text> </level> </level> <level label="c"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>The person in charge of a cemetery shall:</text> <level label="i"> <text>Write on the permit:</text> <level label="1"> <text>The date of final disposition;</text> </level> <level label="2"> <text>The name and physical address of the cemetery; and</text> </level> <level label="3"> <level label="A"> <text>The burial, inurnment, or scattering section and the lot and space number; or</text> </level> </level> <level label="B"> <text>If the body or fetus was cremated and an authorizing agent, as defined in § 5–508 of this article, takes control of the cremains, the name and address of the authorizing agent and the authorizing agent’s relationship to the deceased or fetus;</text> </level> </level> <level label="ii"> <text>Sign the permit; and</text> </level> <level label="iii"> <text>Within 10 days after final disposition, return the permit to the Secretary.</text> </level> </level> <level label="3"> <text>If there is no person in charge of the cemetery, the mortician shall fill out the burial–transit permit.</text> </level> </level> <level label="d"> <text>A burial–transit permit issued by any state or a foreign country is sufficient authority for transit through this State or final disposition in any cemetery in this State.</text> </level> <level label="e"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>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.</text> </level> <level label="3"> <text>The Department shall keep a record of each permit issued for the disinterment and reinterment of human remains.</text> </level> <level label="4"> <text>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:</text> <level label="i"> <text>The site is historic property, as defined in § 5A–301 of the State Finance and Procurement Article; and</text> </level> <level label="ii"> <text>Disclosure would create a substantial risk of harm, theft, or destruction to the site.</text> </level> </level> <level label="5"> <text>The Department may not deny inspection of a permit record to:</text> <level label="i"> <text>The owner of the site of the disinterment or reinterment;</text> </level> <level label="ii"> <text>A governmental entity that has the power of eminent domain; or</text> </level> <level label="iii"> <text>The spouse, domestic partner, next of kin, or appointed personal representative of the deceased whose human remains have been disinterred or reinterred.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-216" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <text>The administrative head of an institution shall record and report each birth, death, and fetal death and all statistical information required by this subtitle, about the incarcerated individuals or patients of the institution. The information shall be obtained from the best possible source and presented to the individual responsible for execution of a certificate under this subtitle.</text> </section> <section article="ghg" article_name="Health - General" number="4-217" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>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:</text> <level label="i"> <text>Access electronically from the Department a certified or abridged copy of a birth certificate or death certificate registered under this subtitle; and</text> </level> <level label="ii"> <text>On request, provide any person authorized by regulations adopted under this subtitle with a certified or abridged copy of a birth certificate or death certificate registered under this subtitle.</text> </level> </level> <level label="3"> <level label="i"> <text>The Secretary shall provide on request, to any person authorized by regulation adopted under this subtitle, a commemorative birth certificate.</text> </level> <level label="ii"> <text>The Department shall set a fee for the commemorative birth certificate.</text> </level> <level label="iii"> <text>The commemorative birth certificate shall:</text> <level label="1"> <text>Be in a form consistent with the need to protect the integrity of vital records but suitable for display; and</text> </level> <level label="2"> <text>Have the same status as evidence as the original birth certificate.</text> </level> </level> <level label="iv"> <text>A portion of the funds collected under this paragraph shall go to the Department for the production costs of issuing the commemorative birth certificates. The remainder of the funds collected shall be paid into the Children’s Trust Fund established under § 13–2207 of this article to provide funding for the Child Abuse Medical Providers (Maryland CHAMP) Initiative.</text> </level> <level label="v"> <text>The Secretary shall adopt regulations to implement the provisions of this paragraph.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>A certified or abridged copy of a birth certificate may be issued only:</text> <level label="i"> <text>On order of a court of competent jurisdiction;</text> </level> <level label="ii"> <text>On request of the individual to whom the record relates;</text> </level> <level label="iii"> <text>On request of a parent, guardian, surviving spouse, or other authorized representative of the individual; or</text> </level> <level label="iv"> <text>In accordance with Title 5, Subtitle 3A or Subtitle 4B of the Family Law Article.</text> </level> </level> <level label="2"> <text>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.</text> </level> <level label="3"> <text>Birth certificate information may not be given if it is to be used for commercial solicitation or private gain.</text> </level> <level label="4"> <text>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.</text> </level> <level label="5"> <text>A copy of a birth certificate may be given to the Maryland Immunization Program to improve childhood immunization rates.</text> </level> </level> <level label="c"> <level label="1"> <text>Except as otherwise provided by law:</text> <level label="i"> <text>The Department shall collect a $12 fee:</text> <level label="1"> <text>For each certified or abridged copy of a fetal death, marriage, or divorce verification certificate;</text> </level> <level label="2"> <text>For a report that a search of the fetal death, marriage, or divorce verification certificate files was made and the requested record is not on file;</text> </level> <level label="3"> <text>For each change to a fetal death, marriage, or divorce verification certificate made later than 1 year after the certificate has been registered with the Department; or</text> </level> <level label="4"> <text>To process an adoption, foreign adoption, or legitimation;</text> </level> </level> <level label="ii"> <text>The Department shall collect a $10 fee:</text> <level label="1"> <text>Except as provided in paragraph (6)(ii) of this subsection, for each certified or abridged copy of a birth certificate;</text> </level> <level label="2"> <text>For the first copy of a certified or abridged death certificate issued in a single transaction;</text> </level> <level label="3"> <text>For a report that a search of the birth or death certificate files was made and the requested record is not on file; or</text> </level> <level label="4"> <text>For each change to a birth or death certificate made later than 1 year after the certificate has been registered with the Department; and</text> </level> </level> <level label="iii"> <text>The Department shall collect a $12 fee for each additional certified or abridged copy of a death certificate provided concurrently with an initial requested death certificate.</text> </level> </level> <level label="2"> <text>From the fee the Department collects under paragraph (1) of this subsection, the Department shall transfer the entire fee to the General Fund.</text> </level> <level label="3"> <level label="i"> <text>Any local health department or the Motor Vehicle Administration may set and collect a fee for processing and issuing a birth certificate or death certificate, or for a report that a search of the files was made and the requested record is not on file, that covers:</text> <level label="1"> <text>The administrative costs of providing this service; and</text> </level> <level label="2"> <text>The requirements of subparagraph (iii) of this paragraph.</text> </level> </level> <level label="ii"> <text>The fee set by the local health department or the Motor Vehicle Administration for processing and issuing a birth certificate or for a report under subparagraph (i) of this paragraph may not exceed the actual costs to the local health department or the Motor Vehicle Administration for processing and issuing a birth certificate or death certificate or a report.</text> </level> <level label="iii"> <text>From the fee the local health department or the Motor Vehicle Administration collects under subparagraph (i) of this paragraph, $10 shall be transferred to the General Fund.</text> </level> <level label="iv"> <text>Prior to setting and collecting a fee for processing and issuing a birth certificate or death certificate or for a report under subparagraph (i) of this paragraph, the local health department or the Motor Vehicle Administration shall enter into a memorandum of understanding with the Maryland Department of Health that outlines the local health department’s or the Motor Vehicle Administration’s fee structure.</text> </level> </level> <level label="4"> <text>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.</text> </level> <level label="5"> <text>The Secretary may waive all or part of a fee if chargeable to an agency of the United States.</text> </level> <level label="6"> <level label="i"> <text>The Department may not collect a fee for a copy of a vital record issued to:</text> <level label="1"> <text>A current or former member of the uniformed services; or</text> </level> <level label="2"> <text>The surviving spouse or child of the member, if the copy will be used in connection with a claim for a dependent or beneficiary of the member.</text> </level> </level> <level label="ii"> <level label="1"> <text>In this subparagraph, “homeless individual” has the meaning stated in the federal McKinney–Vento Homeless Education Assistance Improvements Act of 2001.</text> </level> <level label="2"> <text>Subject to subsubparagraph 4 of this subparagraph, the Department may not collect a fee for a certified or an abridged copy of a birth certificate issued to a homeless individual.</text> </level> <level label="3"> <text>The Department shall accept as proof of homelessness a signed written statement from a homeless services provider located in the State that:</text> </level> <level label="A"> <text>Affirms that the individual is homeless; and</text> </level> <level label="B"> <text>Includes the address to which the copy of the birth certificate requested under this section may be sent.</text> </level> <level label="4"> <text>A homeless individual may receive one copy of a birth certificate without a fee in a single transaction.</text> </level> <level label="5"> <text>The Department shall adopt regulations to implement this subparagraph.</text> </level> </level> <level label="iii"> <text>The Department may not collect a fee for a certified or abridged copy of a death certificate of a first responder, as defined in § 18–213.2 of this article, killed in the line of duty, if the copy is issued to a surviving spouse or child of the first responder and will be used in connection with a claim for a dependent or beneficiary of the first responder.</text> </level> </level> </level> <level label="d"> <level label="1"> <level label="i"> <text>Except as provided in subparagraph (ii) of this paragraph, any local health department or the Motor Vehicle Administration may set and collect a fee for processing and issuing a death certificate that covers the administrative costs of providing this service.</text> </level> <level label="ii"> <text>A local health department or the Motor Vehicle Administration may not collect a fee for processing and issuing a certified or abridged copy of a death certificate of a first responder, as defined in § 18–213.2 of this article, killed in the line of duty, if the copy is issued to a surviving spouse or child of the first responder and will be used in connection with a claim for a dependent or beneficiary of the first responder.</text> </level> </level> <level label="2"> <text>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.</text> </level> </level> <level label="e"> <text>The Secretary shall include with every copy of a death certificate, in a form prescribed and provided by the Insurance Commissioner, a notice which advises that certain individuals may be entitled to continuation of group health insurance benefits under § 15–407 of the Insurance Article.</text> </level> <level label="f"> <text>The Secretary shall include with every copy of a death certificate that is completed by the Chief Medical Examiner a notice that advises a person in interest, as defined in § 4–101(g) of the General Provisions Article, of the right to appeal a denial by the Chief Medical Examiner of a request to correct findings and conclusions as to the cause and manner of death recorded on a death certificate as provided under § 5–310(d) of this article.</text> </level> <level label="g"> <text>A person may use a photocopy of a birth, death, fetal death, or marriage certificate for any nonfraudulent and nondeceptive purpose.</text> </level> <level label="h"> <level label="1"> <text>The Department shall develop and implement security protocols and other protections to:</text> <level label="i"> <text>Ensure a person without authorization is prohibited from accessing any vital records; and</text> </level> <level label="ii"> <text>Minimize the disclosure of and the access to medically sensitive information from the vital records database by employees not employed by the Department.</text> </level> </level> <level label="2"> <text>The security protocols and other protections developed under paragraph (1) of this subsection shall include an auditable record of the following information:</text> <level label="i"> <text>The date and time a certified or abridged copy of a birth certificate was printed; and</text> </level> <level label="ii"> <text>The identification of the employee who printed the certified or abridged copy of the birth certificate.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-218" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>In consultation with the State Health Planning and Development Agency, the Department shall prepare annually population estimates for this State and each county.</text> </level> <level label="b"> <text>The population estimates shall include categories of age, sex, and race.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-219" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>At least annually, the Secretary shall:</text> <level label="1"> <text>Publish a report of vital statistics, including population estimates; and</text> </level> <level label="2"> <text>Print and distribute the report to any official, agency, library, or other person whom the Secretary considers entitled to the report.</text> </level> </level> <level label="b"> <text>In addition to the requirements of subsection (a) of this section, by June 30 of each year the Secretary shall report to the Morbidity, Mortality, and Quality Review Committee established under § 18–107 of this article on the number and cause of death of Maryland children under the age of 1 year who died during the prior calendar year ending December 31st.</text> </level> <level label="c"> <text>In addition to the requirements of subsections (a) and (b) of this section, within 24 hours of notification of a death, the Secretary shall report to the Mortality and Quality Review Committee any death of an individual who at the time of death was:</text> <level label="1"> <text>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</text> </level> <level label="2"> <text>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.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-220" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>The Secretary may provide the United States Department of Health and Human Services with copies of vital records or other information that is required for national statistics, on the condition that the information may not be used for other than statistical purposes unless authorized by the Secretary.</text> </level> <level label="b"> <text>On request, the Secretary may provide federal, State, local, and other public or private agencies with copies of vital records or other information for statistical purposes on terms or conditions that the Secretary sets.</text> </level> <level label="c"> <text>On request, the Secretary may provide the State designated health information exchange with select information from death certificates to allow linkage of the data to the State designated health information exchange master patient index in order that a date of death may be associated and stored with the records of those patients who have died for statistical and clinician notification purposes in accordance with regulations or a data sharing agreement.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-221" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <text>The Secretary may approve specific projects for typewritten, photographic, or other reproductions of originals, carbon copies, and indexes of vital records. These projects shall state the method of reproduction, the disposition or location of the depository of any record reproduced, and the type of records and the period covered.</text> </section> <section article="ghg" article_name="Health - General" number="4-222" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <text>The Secretary shall provide to the Executive Director of the Social Services Administration in the Department of Human Services birth record information for a child born to an individual whose identifying information has been provided to the Secretary within the previous 10 years by the Executive Director or a court under § 5–715 of the Family Law Article.</text> </section> <section article="ghg" article_name="Health - General" number="4-223" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>Except as otherwise provided in this section, if a certificate of birth, death, or fetal death is filed within 1 year after the event, the original or a certified copy of the certificate is prima facie evidence of the facts stated in it.</text> </level> <level label="b"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>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.</text> </level> </level> <level label="c"> <text>If a certificate or record is filed more than 1 year after the event or is amended, the court or official before whom the certificate or record is offered as evidence shall determine its evidentiary value.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-224" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <text>To protect the integrity of vital records, to ensure their proper use, and to ensure the efficient and proper administration of the vital records system, a person may not, except as authorized in § 4–217, § 4–220, § 4–221, or § 4–222 of this subtitle or § 9–1015 of the State Government Article or by the rules and regulations of the Department:</text> <level label="1"> <text>Permit inspection of or disclose any information contained in a vital record; or</text> </level> <level label="2"> <text>Copy or issue a copy of all or part of any vital record.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-225" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <level label="1"> <text>The Secretary may investigate any irregularity or violation of this subtitle.</text> </level> <level label="2"> <text>On request of the Secretary, each registrar shall help the Secretary in the investigation.</text> </level> </level> <level label="b"> <text>If the Secretary considers it necessary, the Secretary shall report a violation of this subtitle to the State’s Attorney for the appropriate county, with a statement of the relevant facts and circumstances, for appropriate action.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-226" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <level label="a"> <text>A person may not fail or refuse to execute and deliver a certificate of birth, death, or fetal death required by this subtitle.</text> </level> <level label="b"> <level label="1"> <text>A person may not willfully provide false information for entry or willfully enter false information on a certificate of birth, death, or fetal death.</text> </level> <level label="2"> <text>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.</text> </level> </level> <level label="c"> <text>Except as authorized by this subtitle, a person may not willfully alter any certificate, certified copy of a certificate, or other certified statement that relates to a birth, death, fetal death, or marriage registered under this subtitle.</text> </level> <level label="d"> <level label="1"> <text>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:</text> <level label="i"> <text>Was issued on a record that is wholly or partly false; or</text> </level> <level label="ii"> <text>Relates to the birth of another individual.</text> </level> </level> <level label="2"> <text>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.</text> </level> </level> <level label="e"> <text>Without authorization, a person may not produce, reproduce, or distribute a blank certificate or other form that the Secretary uses to register or certify facts that relate to a birth, death, fetal death, or marriage.</text> </level> <level label="f"> <text>A person may not willfully use or attempt to use a photocopy of a birth, death, fetal death, or marriage certificate for any fraudulent or deceptive purpose.</text> </level> <level label="g"> <text>A person who has access to the birth, death, or fetal death records in the custody of the Secretary or an agent of the Secretary may not willfully communicate to anyone known to the person to be unauthorized any fact recorded on any birth, death, or fetal death certificate.</text> </level> <level label="h"> <text>A person may not willfully transport or accept for transportation, dissection, or other disposition a body without a burial–transit permit, as provided in this subtitle.</text> </level> <level label="i"> <text>A person may not willfully:</text> <level label="1"> <text>Violate any provision of this subtitle;</text> </level> <level label="2"> <text>Neglect to perform any duty imposed by this subtitle; or</text> </level> <level label="3"> <text>Violate any rule or regulation adopted under this subtitle.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-227" title_number="4" title_name="Statistics and Records" subtitle_number="2" subtitle_name="Vital Statistics and Records"> <text>A person who violates § 4-226 of this subtitle is guilty of a misdemeanor and on conviction is subject to the following penalties:</text> <level label="1"> <text>For violating § 4-226(a) or (b), a fine not exceeding $100.</text> </level> <level label="2"> <text>For violating § 4-226(g) or (h), a fine not exceeding $200.</text> </level> <level label="3"> <text>For violating § 4-226(d), a fine not exceeding $500.</text> </level> <level label="4"> <text>For violating § 4-226(c), a fine not exceeding $500 or imprisonment not exceeding 6 months or both.</text> </level> <level label="5"> <text>For violating § 4-226(e), a fine not exceeding $500 or imprisonment not exceeding 1 year or both.</text> </level> <level label="6"> <text>For violating § 4-226(i), except where a different penalty is provided in this section, a fine not exceeding $100.</text> </level> <level label="7"> <text>For violating § 4-226(f), a fine not exceeding $1,000 or imprisonment not exceeding 30 days or both.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-301" title_number="4" title_name="Statistics and Records" subtitle_number="3" subtitle_name="Confidentiality of Medical Records"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Common ownership” means ownership of a health care entity:</text> <level label="1"> <text>By two or more health care providers;</text> </level> <level label="2"> <text>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;</text> </level> <level label="3"> <text>By health care organizations operating as an organized health care arrangement, as defined in 45 C.F.R. § 160.103;</text> </level> <level label="4"> <text>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</text> </level> <level label="5"> <text>By affiliated providers operating under the same trade name.</text> </level> </level> <level label="c"> <text>“Directory information” means information concerning the presence and general health condition of a patient who has been admitted to a health care facility or who is currently receiving emergency health care in a health care facility.</text> </level> <level label="d"> <text>“Disclose” or “disclosure” means the transmission or communication of information in a medical record, including an acknowledgment that a medical record on a particular patient or recipient exists.</text> </level> <level label="e"> <text>“Emergency” means a situation when, in the professional opinion of the health care provider, a clear and significant risk of death or imminent serious injury or harm to a patient or recipient exists.</text> </level> <level label="f"> <text>“General health condition” means the health status of a patient described in terms of “critical”, “poor”, “fair”, “good”, “excellent”, or terms denoting similar conditions.</text> </level> <level label="g"> <text>“Health care” means any care, treatment, or procedure by a health care provider:</text> <level label="1"> <text>To diagnose, evaluate, rehabilitate, manage, treat, or maintain the physical or mental condition of a patient or recipient; or</text> </level> <level label="2"> <text>That affects the structure or any function of the human body.</text> </level> </level> <level label="h"> <level label="1"> <text>“Health care provider” means:</text> <level label="i"> <text>A person who is licensed, certified, or otherwise authorized under the Health Occupations Article or § 13–516 of the Education Article to provide health care in the ordinary course of business or practice of a profession or in an approved education or training program; or</text> </level> <level label="ii"> <text>A facility where health care is provided to patients or recipients, including a facility as defined in § 10–101(g) of this article, a hospital as defined in § 19–301 of this article, a related institution as defined in § 19–301 of this article, a health maintenance organization as defined in § 19–701(g) of this article, an outpatient clinic, a medical laboratory, a comprehensive crisis response center, a crisis stabilization center, and a crisis treatment center established under § 7.5–207 of this article.</text> </level> </level> <level label="2"> <text>“Health care provider” includes the agents, employees, officers, and directors of a facility and the agents and employees of a health care provider.</text> </level> </level> <level label="i"> <level label="1"> <text>“Health information exchange” means:</text> <level label="i"> <text>An individual or entity that determines, controls, or has the discretion to administer any requirement, policy, or agreement that allows, enables, or requires the use of any technology or services for access, exchange, or use of electronic protected health care information:</text> <level label="1"> <text>Among more than two unaffiliated individuals or entities that are enabled to exchange electronic protected health information with each other; and</text> </level> <level label="2"> <text>That is for a treatment, payment, or health care operations purpose, as those terms are defined in 45 C.F.R. § 164.501, regardless of whether the individuals or entities are subject to the requirements of 45 C.F.R. parts 160 and 164; or</text> </level> </level> <level label="ii"> <text>A health information technology developer of certified health information technology that develops or offers health information technology, as that term is defined in 42 U.S.C. 300jj(5), and has one or more Health Information Technology Modules certified under a program for the voluntary certification of health information technology that is kept or recognized by the National Coordinator in accordance with 42 U.S.C. 300jj–11(c)(5).</text> </level> </level> <level label="2"> <text>“Health information exchange” does not include:</text> <level label="i"> <text>An entity composed of health care providers under common ownership if the organizational and technical processes the entity provides or governs are for health care treatment, payment, or health care operations purposes, as those terms are defined in 45 C.F.R. § 164.501;</text> </level> <level label="ii"> <text>A carrier, as defined in § 15–1301 of the Insurance Article if the organizational and technical processes the carrier provides or governs are for health care treatment, payment, or health care operations purposes, as those terms are defined in 45 C.F.R. § 164.501;</text> </level> <level label="iii"> <text>An administrator, as defined in § 8–301 of the Insurance Article, if the organizational and technical processes the administrator provides or governs are for health care treatment, payment, or health care operations purposes, as those terms are defined in 45 C.F.R. § 164.501;</text> </level> <level label="iv"> <text>A health care provider, as defined in subsection (h) of this section, if the organizational and technical processes the health care provider provides or governs are for health care treatment, payment, or health care operations purposes, as those terms are defined in 45 C.F.R. § 164.501;</text> </level> <level label="v"> <text>A carrier’s business associate, as defined in 45 C.F.R. § 160.103, if the organizational and technical processes provided or governed by the business associate are transactions, as defined in 45 C.F.R. § 160.103; or</text> </level> <level label="vi"> <text>A carrier exchanging information as required by 45 C.F.R. § 156.221.</text> </level> </level> </level> <level label="j"> <text>“Legally protected health care” means all sensitive health services, medications, and supplies related to:</text> <level label="1"> <text>The provision of abortion care; and</text> </level> <level label="2"> <text>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.</text> </level> </level> <level label="k"> <level label="1"> <text>“Medical record” means any oral, written, or other transmission in any form or medium of information that:</text> <level label="i"> <text>Is entered in the record of a patient or recipient;</text> </level> <level label="ii"> <text>Identifies or can readily be associated with the identity of a patient or recipient; and</text> </level> <level label="iii"> <text>Relates to the health care of the patient or recipient.</text> </level> </level> <level label="2"> <text>“Medical record” includes any:</text> <level label="i"> <text>Documentation of disclosures of a medical record to any person who is not an employee, agent, or consultant of the health care provider;</text> </level> <level label="ii"> <text>File or record maintained under § 12–403(c)(13) of the Health Occupations Article by a pharmacy of a prescription order for drugs, medicines, or devices that identifies or may be readily associated with the identity of a patient;</text> </level> <level label="iii"> <text>Documentation of an examination of a patient regardless of who:</text> <level label="1"> <text>Requested the examination; or</text> </level> <level label="2"> <text>Is making payment for the examination; and</text> </level> </level> <level label="iv"> <text>File or record received from another health care provider that:</text> <level label="1"> <text>Relates to the health care of a patient or recipient received from that health care provider; and</text> </level> <level label="2"> <text>Identifies or can readily be associated with the identity of the patient or recipient.</text> </level> </level> </level> </level> <level label="l"> <level label="1"> <text>“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.</text> </level> <level label="2"> <text>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.</text> </level> </level> <level label="m"> <text>“Patient” means a person who receives health care and on whom a medical record is maintained.</text> </level> <level label="n"> <text>“Person in interest” means:</text> <level label="1"> <text>An adult on whom a health care provider maintains a medical record;</text> </level> <level label="2"> <text>A person authorized to consent to health care for an adult consistent with the authority granted;</text> </level> <level label="3"> <text>A duly appointed personal representative of a deceased person;</text> </level> <level label="4"> <level label="i"> <text>A minor, if the medical record concerns treatment to which the minor has the right to consent and has consented under Title 20, Subtitle 1 of this article; or</text> </level> <level label="ii"> <text>A parent, guardian, custodian, or a representative of the minor designated by a court, in the discretion of the attending physician who provided the treatment to the minor, as provided in § 20–102 or § 20–104 of this article;</text> </level> </level> <level label="5"> <text>If item (4) of this subsection does not apply to a minor:</text> <level label="i"> <text>A parent of the minor, except if the parent’s authority to consent to health care for the minor has been specifically limited by a court order or a valid separation agreement entered into by the parents of the minor; or</text> </level> <level label="ii"> <text>A person authorized to consent to health care for the minor consistent with the authority granted; or</text> </level> </level> <level label="6"> <text>An attorney appointed in writing by a person listed in item (1), (2), (3), (4), or (5) of this subsection.</text> </level> </level> <level label="o"> <text>“Primary provider of mental health services” means the designated mental health services provider who:</text> <level label="1"> <text>Has primary responsibility for the development of the mental health treatment plan for the recipient; and</text> </level> <level label="2"> <text>Is actively involved in providing that treatment.</text> </level> </level> <level label="p"> <text>“Protected health information” means all individually identifiable health information held or transmitted by a covered entity or its business associate protected under the U.S. Department of Health and Human Services Privacy Rule.</text> </level> <level label="q"> <text>“Recipient” means a person who has applied for, for whom an application has been submitted, or who has received mental health services.</text> </level> <level label="r"> <text>“Sensitive health services” includes:</text> <level label="1"> <text>Reproductive health services other than abortion care; and</text> </level> <level label="2"> <text>Gender–affirming care.</text> </level> </level> <level label="s"> <text>“State–designated health information exchange” means the health information exchange designated by the Maryland Health Care Commission and the Health Services Cost Review Commission under § 19–143 of this article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-302" title_number="4" title_name="Statistics and Records" subtitle_number="3" subtitle_name="Confidentiality of Medical Records"> <level label="a"> <text>A health care provider shall:</text> <level label="1"> <text>Keep the medical record of a patient or recipient confidential; and</text> </level> <level label="2"> <text>Disclose the medical record only:</text> <level label="i"> <text>As provided by this subtitle; or</text> </level> <level label="ii"> <text>As otherwise provided by law.</text> </level> </level> </level> <level label="b"> <text>The provisions of this subtitle do not apply to information:</text> <level label="1"> <text>Not kept in the medical record of a patient or recipient that is related to the administration of a health care facility, including:</text> <level label="i"> <text>Risk management;</text> </level> <level label="ii"> <text>Quality assurance; and</text> </level> <level label="iii"> <text>Any activities of a medical or dental review committee that are confidential under the provisions of § 1–401 and Title 4, Subtitle 5 of the Health Occupations Article and any activities of a pharmacy review committee;</text> </level> </level> <level label="2"> <text>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</text> </level> <level label="3"> <text>Governed by the developmental disability confidentiality provisions in §§ 7–1008 through 7–1011 of this article.</text> </level> </level> <level label="c"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>A health care provider shall:</text> <level label="i"> <text>Inform a patient of the health care information that the health care provider may include in a directory and the persons to whom the health care provider may disclose the information; and</text> </level> <level label="ii"> <text>As soon as practicable, provide the patient with the opportunity to restrict or prohibit disclosure of directory information.</text> </level> </level> <level label="3"> <text>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:</text> <level label="i"> <text>Consistent with a prior expressed preference of the patient that is known to the health care provider; and</text> </level> <level label="ii"> <text>Determined to be, based on the health care provider’s professional judgment, in the patient’s best interest.</text> </level> </level> </level> <level label="d"> <text>A person to whom a medical record is disclosed may not redisclose the medical record to any other person unless:</text> <level label="1"> <text>The redisclosure is:</text> <level label="i"> <text>Authorized by the person in interest;</text> </level> <level label="ii"> <text>Otherwise permitted by this subtitle;</text> </level> <level label="iii"> <text>Permitted under § 1–202(b) or (c) of the Human Services Article; or</text> </level> <level label="iv"> <text>Directory information; or</text> </level> </level> <level label="2"> <level label="i"> <text>The person to whom the medical record was disclosed is a guardian ad litem who received the medical record in accordance with § 4–306(b)(12) of this subtitle;</text> </level> <level label="ii"> <text>A reasonable effort to secure a qualified protective order has been made in accordance with 42 C.F.R. § 164.512(e)(1)(v); and</text> </level> <level label="iii"> <text>The guardian ad litem determines that it is necessary to redisclose the medical record to carry out the guardian ad litem’s official function to protect the best interests of a minor or a disabled or elderly individual in a criminal or juvenile delinquency court proceeding.</text> </level> </level> </level> <level label="e"> <level label="1"> <text>Except as provided in paragraph (2) of this subsection, a person may not disclose by sale, rental, or barter any medical record.</text> </level> <level label="2"> <text>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.</text> </level> </level> <level label="f"> <text>The provisions of this subtitle may not be construed to constitute an exception to the reporting requirements of Title 5, Subtitle 7 and Title 14, Subtitle 3 of the Family Law Article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-302.1" title_number="4" title_name="Statistics and Records" subtitle_number="3" subtitle_name="Confidentiality of Medical Records"> <level label="a"> <text>Payors that accept claims originating in this State from medical care electronic claims clearinghouses shall accept claims only from medical care electronic claims clearinghouses that are:</text> <level label="1"> <text>Accredited by the Electronic Healthcare Network Accreditation Commission; or</text> </level> <level label="2"> <text>Certified by the Maryland Health Care Commission.</text> </level> </level> <level label="b"> <text>The Maryland Health Care Commission shall adopt regulations to carry out this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-302.2" title_number="4" title_name="Statistics and Records" subtitle_number="3" subtitle_name="Confidentiality of Medical Records"> <level label="a"> <text>The Maryland Health Care Commission shall adopt regulations for the privacy and security of protected health information obtained or released through a health information exchange.</text> </level> <level label="b"> <level label="1"> <text>The regulations adopted under subsection (a) of this section shall:</text> <level label="i"> <text>Govern the access, use, maintenance, disclosure, and redisclosure of protected health information as required by State or federal law, including the federal Health Insurance Portability and Accountability Act, the federal Health Information Technology for Economic and Clinical Health Act, the federal 21st Century Cures Act, and Title 21, Subtitle 2A of this article;</text> </level> <level label="ii"> <text>Include protections for the secondary use of protected health information obtained or released through a health information exchange;</text> </level> <level label="iii"> <text>Require the State–designated health information exchange to develop and maintain a consent management application, subject to State and federal law, that:</text> <level label="1"> <text>Allows a person in interest to opt out of having electronic health information shared or disclosed by a health information exchange;</text> </level> <level label="2"> <text>Informs the person in interest of the electronic health information that may be shared or disclosed notwithstanding the choice to opt out;</text> </level> <level label="3"> <text>Requires that the State–designated health information exchange provide a health information exchange with the opt–out status of a person in interest, on receipt of an electronic request from the health information exchange for the opt–out status of the person in interest;</text> </level> <level label="4"> <text>Requires a health information exchange to obtain the opt–out status of a person in interest from the State–designated health information exchange before sharing or disclosing the electronic health information of the person in interest; and</text> </level> <level label="5"> <text>Except as provided in paragraph (2) of this subsection, prohibits a health information exchange from sharing or disclosing the electronic health information of a person in interest if the person in interest has opted out of having electronic health information shared or disclosed by a health information exchange; and</text> </level> </level> <level label="iv"> <text>Provide appropriate penalties for noncompliance with the regulations, including fines that do not exceed $10,000 per day and that are determined based on:</text> <level label="1"> <text>The extent of actual or potential public harm caused by the violation;</text> </level> <level label="2"> <text>The cost of investigating the violation; and</text> </level> <level label="3"> <text>Whether the person committed previous violations.</text> </level> </level> </level> <level label="2"> <text>The regulations adopted under subsection (a) of this section may not prohibit:</text> <level label="i"> <text>The Department, the Maryland Health Care Commission, or the Health Services Cost Review Commission from using electronic health information, subject to federal and State law, for health regulatory and public health functions;</text> </level> <level label="ii"> <text>The sharing or disclosing of information that is required to be exchanged under Title 21, Subtitle 2A of this article; or</text> </level> <level label="iii"> <text>The sharing or disclosing of information that is required to be exchanged under federal law, including for the purposes of payment, as defined in 45 C.F.R. § 164.501.</text> </level> </level> <level label="3"> <text>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.</text> </level> </level> <level label="c"> <text>Data obtained or released through a health information exchange:</text> <level label="1"> <text>May not be sold for financial remuneration until the regulations required under subsections (a) and (b) of this section are adopted; and</text> </level> <level label="2"> <text>May be sold for financial remuneration only in accordance with the regulations adopted under subsections (a) and (b) of this section.</text> </level> </level> <level label="d"> <text>The Maryland Health Care Commission shall consult with health care providers, payors, State health agencies, consumer advocates, and employers before adopting regulations under subsections (a) and (b) of this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-302.3" future_version_removed="true" title_number="4" title_name="Statistics and Records" subtitle_number="3" subtitle_name="Confidentiality of Medical Records"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“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.</text> </level> <level label="3"> <text>“Electronic health network” means an entity:</text> <level label="i"> <text>Involved in the exchange of electronic health care transactions between a payor, health care provider, vendor, and any other entity; and</text> </level> <level label="ii"> <text>Certified by the Maryland Health Care Commission.</text> </level> </level> <level label="4"> <text>“Nursing home” has the meaning stated in § 19–1401 of this article.</text> </level> <level label="5"> <text>“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.</text> </level> </level> <level label="b"> <text>This section applies to:</text> <level label="1"> <text>Except for the State–designated health information exchange, a health information exchange operating in the State; and</text> </level> <level label="2"> <text>A payor that:</text> <level label="i"> <text>Holds a valid certificate of authority issued by the Maryland Insurance Commissioner; and</text> </level> <level label="ii"> <text>Acts as, operates, or owns a health information exchange.</text> </level> </level> </level> <level label="c"> <text>An entity to which this section applies shall connect to the State–designated health information exchange in a manner consistent with applicable federal and State privacy laws.</text> </level> <level label="d"> <text>When a standard request for clinical information is received through the State–designated health information exchange, an entity to which this section applies shall:</text> <level label="1"> <text>Respond to the request to the extent authorized under federal and State privacy laws; and</text> </level> <level label="2"> <text>Transmit the response to the State–designated health information exchange in the manner specified in the regulations adopted under subsection (g) of this section.</text> </level> </level> <level label="e"> <text>A consent from a patient to release clinical information to a provider obtained by an entity to which this section applies shall apply to information transmitted through the State–designated health information exchange or by other means.</text> </level> <level label="f"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>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:</text> <level label="i"> <text>A health care provider;</text> </level> <level label="ii"> <text>An authorized health information exchange user;</text> </level> <level label="iii"> <text>A health information exchange authorized by the Maryland Health Care Commission;</text> </level> <level label="iv"> <text>A federal official; and</text> </level> <level label="v"> <text>A State official.</text> </level> </level> <level label="3"> <level label="i"> <text>If approved by the Maryland Health Care Commission, the information submitted under paragraph (1) of this subsection may be combined with other data maintained by the State–designated health information exchange to facilitate:</text> <level label="1"> <text>A State health improvement program;</text> </level> <level label="2"> <text>Mitigation of a public health emergency;</text> </level> <level label="3"> <text>Improvement of patient safety; and</text> </level> <level label="4"> <text>The participation of the State in the Center for Medicare and Medicaid Innovation’s States Advancing All–Payer Health Equity Approaches and Development (AHEAD) Model and any successor models.</text> </level> </level> <level label="ii"> <text>The information submitted by a nursing home under paragraph (1) of this subsection may be used only to facilitate the objectives stated in subparagraph (i) of this paragraph and may not be used for any other purpose, including licensing and certification.</text> </level> </level> </level> <level label="g"> <level label="1"> <text>The State–designated health information exchange shall:</text> <level label="i"> <text>Participate in the advisory committee established under § 13–4306(a)(1) of this article; and</text> </level> <level label="ii"> <text>Maintain a data set for the Maryland Commission on Health Equity and provide data from the data set consistent with the parameters defined by the advisory committee.</text> </level> </level> <level label="2"> <text>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.</text> </level> </level> <level label="h"> <level label="1"> <text>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:</text> <level label="i"> <text>A State health improvement program;</text> </level> <level label="ii"> <text>Mitigation of a public health emergency;</text> </level> <level label="iii"> <text>Improvement of patient safety; and</text> </level> <level label="iv"> <text>The participation of the State in the Center for Medicare and Medicaid Innovation’s States Advancing All–Payer Health Equity Approaches and Development (AHEAD) Model and any successor models.</text> </level> </level> <level label="2"> <text>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.</text> </level> <level label="3"> <text>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.</text> </level> </level> <level label="i"> <text>The Maryland Health Care Commission:</text> <level label="1"> <text>Shall adopt regulations for implementing the connectivity to the State–designated health information exchange required under this section; and</text> </level> <level label="2"> <text>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.</text> </level> </level> <level label="j"> <level label="1"> <text>The Maryland Health Care Commission shall adopt regulations that:</text> <level label="i"> <text>Specify the scope of clinical information to be exchanged or sent under this section; and</text> </level> <level label="ii"> <text>Provide for a uniform, gradual implementation of the exchange of clinical information under this section.</text> </level> </level> <level label="2"> <text>Any regulations adopted under paragraph (1) of this subsection shall limit the scope of the clinical information to purposes that:</text> <level label="i"> <text>Improve treatment, including improved access to clinical records by treating clinicians;</text> </level> <level label="ii"> <text>Promote uses of the State–designated health information exchange important to public health; or</text> </level> <level label="iii"> <text>The protection of the electronic health information of a person in interest who has opted out of having electronic health information shared or disclosed by a health information exchange.</text> </level> </level> <level label="3"> <text>Regulations adopted under paragraph (1) of this subsection:</text> <level label="i"> <text>Shall limit redisclosure of financial information, including billed or paid amounts available in electronic claims transactions;</text> </level> <level label="ii"> <text>May not restrict the State’s use of financial information, including billed or paid amounts available in electronic claims transactions, for public health purposes related to the participation of the State in the Center for Medicare and Medicaid Innovation’s States Advancing All–Payer Health Equity Approaches and Development (AHEAD) Model and any successor models;</text> </level> <level label="iii"> <text>Shall restrict data of patients who have opted out of records sharing through the State–designated health information exchange or a health information exchange authorized by the Maryland Health Care Commission;</text> </level> <level label="iv"> <text>Shall restrict data from health care providers that possess sensitive health care information; and</text> </level> <level label="v"> <text>Shall restrict data of patients who have obtained legally protected health care.</text> </level> </level> </level> <level label="k"> <text>This section does not:</text> <level label="1"> <text>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;</text> </level> <level label="2"> <text>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</text> </level> <level label="3"> <text>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.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-302.4" title_number="4" title_name="Statistics and Records" subtitle_number="3" subtitle_name="Confidentiality of Medical Records"> <text>The existence of a health information exchange does not, in itself, create a new cause of action against a health information exchange or a health care provider.</text> </section> <section article="ghg" article_name="Health - General" number="4-302.5" title_number="4" title_name="Statistics and Records" subtitle_number="3" subtitle_name="Confidentiality of Medical Records"> <level label="a"> <text>Subject to subsection (d)(3)(ii) of this section, this section applies to disclosures of health information to recipients located in the State and outside the State.</text> </level> <level label="b"> <text>Subject to subsection (d)(3)(ii) of this section, beginning December 1, 2023, a health information exchange or electronic health network may not disclose Mifepristone data or the diagnosis, procedure, medication, or related codes for abortion care and other sensitive health services as determined by the Secretary under subsection (d) of this section to a treating provider, a business entity, another health information exchange, or another electronic health network unless the disclosure is:</text> <level label="1"> <text>For the adjudication of claims; or</text> </level> <level label="2"> <text>To a specific treating provider at the written request of and with the consent of:</text> <level label="i"> <text>A patient, for services for which the patient can provide consent under State law; or</text> </level> <level label="ii"> <text>A parent or guardian of a patient, for services for which the parent or guardian can provide consent under State law.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>In determining the fine to be imposed under paragraph (1) of this subsection, the following factors shall be considered:</text> <level label="i"> <text>The extent of actual or potential public harm caused by the violation;</text> </level> <level label="ii"> <text>The cost of investigating the violation; and</text> </level> <level label="iii"> <text>Whether the person previously violated this section.</text> </level> </level> </level> <level label="d"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>A determination made under paragraph (1) of this subsection shall:</text> <level label="i"> <text>Follow applicable guidelines of the American College of Obstetricians and Gynecologists, the World Health Organization, and the Society of Family Planning; and</text> </level> <level label="ii"> <text>For sensitive health services, be based on the recommendations of the Protected Health Care Commission established under § 4–310 of this subtitle.</text> </level> </level> <level label="3"> <level label="i"> <text>The Secretary shall adopt regulations to restrict the disclosure of abortion care and other sensitive health services information by diagnosis, procedure, medication, or related codes under subsection (b) of this section.</text> </level> <level label="ii"> <text>Except as provided in subparagraph (iii) of this paragraph, the Secretary may adopt restrictions on the disclosure of abortion care or other sensitive health services under subparagraph (i) of this paragraph that are applicable only to disclosures by health information exchanges or electronic health networks to out–of–state treating providers, out–of–state business entities, other health information exchanges, or other electronic health networks.</text> </level> <level label="iii"> <text>Any regulations adopted by the Secretary to implement restrictions on the disclosure of Mifepristone data under subsection (b) of this section shall apply to disclosures of data to recipients located in the State and outside the State.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-302.6" title_number="4" title_name="Statistics and Records" subtitle_number="3" subtitle_name="Confidentiality of Medical Records"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Business associate” has the meaning stated in 45 C.F.R. § 160.103.</text> </level> <level label="3"> <text>“Electronic health care transactions” has the meaning stated in § 4–302.3 of this subtitle.</text> </level> <level label="4"> <text>“Electronic health network” has the meaning stated in § 4–302.3 of this subtitle.</text> </level> <level label="5"> <text>“Nursing home” has the meaning stated in § 19–1401 of this article.</text> </level> </level> <level label="b"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>An electronic health network or electronic medical record vendor releasing patient medical records or electronic health care transactions under paragraph (1) of this subsection:</text> <level label="i"> <text>Shall release the patient medical records or electronic health care transactions in an electronic format that conforms to the specifications of the Office of the National Coordinator for Health Information Technology or another form required by the State–designated health information exchange;</text> </level> <level label="ii"> <text>Shall make the patient medical records or electronic health care transactions available on a regular basis and release the information in a timely manner to support patient care and monitoring; and</text> </level> <level label="iii"> <text>May not restrict, limit, or charge a fee for the release of the patient medical records or electronic health care transactions.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-303" title_number="4" title_name="Statistics and Records" subtitle_number="3" subtitle_name="Confidentiality of Medical Records"> <level label="a"> <text>A health care provider shall disclose a medical record on the authorization of a person in interest in accordance with this section.</text> </level> <level label="b"> <text>Except as otherwise provided in subsections (c) and (d) of this section, an authorization shall:</text> <level label="1"> <text>Be in writing, dated, and signed by the person in interest;</text> </level> <level label="2"> <text>State the name of the health care provider;</text> </level> <level label="3"> <text>Identify to whom the information is to be disclosed;</text> </level> <level label="4"> <text>State the period of time that the authorization is valid, which may not exceed 1 year, except:</text> <level label="i"> <text>In cases of criminal justice referrals, in which case the authorization shall be valid until 30 days following final disposition; or</text> </level> <level label="ii"> <text>In cases where the patient on whom the medical record is kept is a resident of a nursing home, in which case the authorization shall be valid until revoked, or for any time period specified in the authorization; and</text> </level> </level> <level label="5"> <text>Apply only to a medical record developed by the health care provider unless in writing:</text> <level label="i"> <text>The authorization specifies disclosure of a medical record that the health care provider has received from another provider; and</text> </level> <level label="ii"> <text>The other provider has not prohibited redisclosure.</text> </level> </level> </level> <level label="c"> <text>A health care provider shall disclose a medical record on receipt of a preauthorized form that is part of an application for insurance.</text> </level> <level label="d"> <text>A health care provider shall disclose a medical record on receipt of an authorization for the release of relevant medical information that is included with the claim application form filed with the Workers’ Compensation Commission in accordance with § 9–709(a), § 9–710(b), or § 9–711(a) of the Labor and Employment Article.</text> </level> <level label="e"> <level label="1"> <text>Except in cases of criminal justice referrals, a person in interest may revoke an authorization in writing.</text> </level> <level label="2"> <text>A revocation of an authorization becomes effective on the date of receipt by the health care provider.</text> </level> <level label="3"> <text>A disclosure made before the effective date of a revocation is not affected by the revocation.</text> </level> </level> <level label="f"> <text>A copy of the following shall be entered in the medical record of a patient or recipient:</text> <level label="1"> <text>A written authorization;</text> </level> <level label="2"> <text>Any action taken in response to an authorization; and</text> </level> <level label="3"> <text>Any revocation of an authorization.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-304" title_number="4" title_name="Statistics and Records" subtitle_number="3" subtitle_name="Confidentiality of Medical Records"> <level label="a"> <level label="1"> <text>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:</text> <level label="i"> <text>To receive a copy of a medical record; or</text> </level> <level label="ii"> <text>To see and copy the medical record.</text> </level> </level> <level label="2"> <text>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:</text> <level label="i"> <text>Make a summary of the undisclosed portion of the medical record available to the patient, recipient, or person in interest;</text> </level> <level label="ii"> <text>Insert a copy of the summary in the medical record of the patient or recipient;</text> </level> <level label="iii"> <text>Permit examination and copying of the medical record by another health care provider who is authorized to treat the patient or recipient for the same condition as the health care provider denying the request; and</text> </level> <level label="iv"> <text>Inform the patient or recipient of the patient’s or recipient’s right to select another health care provider under this subsection.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>A health care provider shall establish procedures for a person in interest to request an addition to or correction of a medical record.</text> </level> <level label="2"> <text>A person in interest may not have any information deleted from a medical record.</text> </level> <level label="3"> <text>Within a reasonable time after a person in interest requests a change in a medical record, the health care provider shall:</text> <level label="i"> <text>Make the requested change; or</text> </level> <level label="ii"> <text>Provide written notice of a refusal to make the change to the person in interest.</text> </level> </level> <level label="4"> <text>A notice of refusal shall contain:</text> <level label="i"> <text>Each reason for the refusal; and</text> </level> <level label="ii"> <text>The procedures, if any, that the health care provider has established for review of the refusal.</text> </level> </level> <level label="5"> <text>If the final determination of the health care provider is a refusal to change the medical record, the provider:</text> <level label="i"> <text>Shall permit a person in interest to insert in the medical record a concise statement of the reason that the person in interest disagrees with the record; and</text> </level> <level label="ii"> <text>May insert in the medical record a statement of the reasons for the refusal.</text> </level> </level> <level label="6"> <text>A health care provider shall give a notice of a change in a medical record or a copy of a statement of disagreement:</text> <level label="i"> <text>To any individual the person in interest has designated to receive the notice or statement; and</text> </level> <level label="ii"> <text>To whom the health care provider has disclosed an inaccurate, an incomplete, or a disputed medical record within the previous 6 months.</text> </level> </level> <level label="7"> <text>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.</text> </level> </level> <level label="c"> <level label="1"> <level label="i"> <text>In this subsection, “medical record” includes a copy of a medical bill that has been requested by an individual.</text> </level> <level label="ii"> <text>The provisions of this subsection do not apply to x–rays.</text> </level> </level> <level label="2"> <text>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:</text> <level label="i"> <text>For State facilities regulated by the Maryland Department of Health, as provided in § 4–206 of the General Provisions Article; or</text> </level> <level label="ii"> <text>For all other health care providers, a reasonable cost–based fee for providing the information requested.</text> </level> </level> <level label="3"> <level label="i"> <text>Except as provided in subparagraph (iii) of this paragraph, for a copy of a medical record requested by a person in interest or any other authorized person under paragraph (2)(ii) of this subsection, a health care provider may charge a fee for copying and mailing not exceeding 76 cents for each page of the medical record.</text> </level> <level label="ii"> <text>In addition to the fee charged under subparagraph (i) of this paragraph, a hospital or a health care provider may charge:</text> <level label="1"> <text>Subject to the fee limitations that apply to persons in interest under 45 C.F.R. 164.524 and any guidance on those limitations issued by the U.S. Department of Health and Human Services, a preparation fee not to exceed $22.88 for medical record retrieval and preparation; and</text> </level> <level label="2"> <text>The actual cost for postage and handling of the medical record.</text> </level> </level> <level label="iii"> <text>Subject to the fee limitations that apply to persons in interest under 45 C.F.R. 164.524 and any guidance on those limitations issued by the U.S. Department of Health and Human Services, a hospital or a health care provider that uses or maintains the requested medical records in an electronic format may charge for an electronic copy of a medical record in an electronic format requested by a person in interest or any other authorized person:</text> <level label="1"> <text>A preparation fee not to exceed $22.88 for electronic format medical records retrieval and preparation;</text> </level> <level label="2"> <text>A per–page fee of 75% of the per–page fee charged by a health care provider under subparagraph (i) of this paragraph that may not exceed $80; and</text> </level> <level label="3"> <text>The actual cost for postage and handling of the electronic format medical records.</text> </level> </level> </level> <level label="4"> <level label="i"> <text>Except as provided in subparagraph (ii) of this paragraph, the fees charged under paragraph (3) of this subsection may be adjusted annually for inflation in accordance with the Consumer Price Index.</text> </level> <level label="ii"> <text>The preparation fee charged for medical record retrieval and preparation under paragraph (3)(ii)1 of this subsection and for retrieval and preparation of a medical record in an electronic format under paragraph (3)(iii)1 of this subsection may not be adjusted annually for inflation in accordance with the Consumer Price Index.</text> </level> </level> <level label="5"> <text>A health care provider or a representative of the health care provider may not charge a fee for providing copies of a medical record:</text> <level label="i"> <text>Requested by:</text> <level label="1"> <text>The patient;</text> </level> <level label="2"> <text>The patient’s personal representative;</text> </level> <level label="3"> <text>An employee or other representative of a nonprofit legal services entity or other volunteer or nonprofit program representing the patient; or</text> </level> <level label="4"> <text>An attorney representing the patient; and</text> </level> </level> <level label="ii"> <text>That will be used for the purpose of filing a claim regarding or appealing a denial of Social Security disability income or Social Security benefits under Title II or Title XVI of the Social Security Act.</text> </level> </level> <level label="6"> <level label="i"> <text>Except as provided in subparagraph (ii) of this paragraph, a health care provider may charge a fee, as authorized under paragraphs (3) and (4) of this subsection, for the retrieval, copying, preparation, mailing, and actual cost of postage and handling of a medical record disclosed under § 4–306 of this subtitle.</text> </level> <level label="ii"> <text>If a government unit or agency or court–appointed guardian ad litem in a criminal or juvenile delinquency court proceeding makes a request for the disclosure of a medical record under § 4–306 of this subtitle, a health care provider may not charge the government unit or agency or court–appointed guardian ad litem a fee for the retrieval, copying, preparation, mailing, and actual cost of postage and handling of the medical record.</text> </level> </level> <level label="7"> <text>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.</text> </level> <level label="8"> <text>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.</text> </level> </level> <level label="d"> <text>Except for an emergency request from a unit of State or local government concerning a child protective services case or adult protective services case, a health care provider may withhold copying until the fee for copying is paid.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-305" title_number="4" title_name="Statistics and Records" subtitle_number="3" subtitle_name="Confidentiality of Medical Records"> <level label="a"> <text>This section may not be construed to impose an obligation on a health care provider to disclose a medical record.</text> </level> <level label="b"> <text>A health care provider may disclose a medical record without the authorization of a person in interest:</text> <level label="1"> <level label="i"> <text>To the provider’s authorized employees, agents, medical staff, medical students, or consultants for the sole purpose of offering, providing, evaluating, or seeking payment for health care to patients or recipients by the provider;</text> </level> <level label="ii"> <text>To the provider’s legal counsel regarding only the information in the medical record that relates to the subject matter of the representation; or</text> </level> <level label="iii"> <text>To any provider’s insurer or legal counsel, or the authorized employees or agents of a provider’s insurer or legal counsel, for the sole purpose of handling a potential or actual claim against any provider if the medical record is maintained on the claimant and relates to the subject matter of the claim;</text> </level> </level> <level label="2"> <text>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:</text> <level label="i"> <text>Educational or research purposes, subject to the applicable requirements of an institutional review board;</text> </level> <level label="ii"> <text>Evaluation and management of health care delivery systems; or</text> </level> <level label="iii"> <text>Accreditation of a facility by professional standard setting entities;</text> </level> </level> <level label="3"> <text>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;</text> </level> <level label="4"> <text>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;</text> </level> <level label="5"> <text>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:</text> <level label="i"> <text>Submitting a bill to the third party payor;</text> </level> <level label="ii"> <text>Reasonable prospective, concurrent, or retrospective utilization review or predetermination of benefit coverage;</text> </level> <level label="iii"> <text>Review, audit, and investigation of a specific claim for payment of benefits; or</text> </level> <level label="iv"> <text>Coordinating benefit payments in accordance with the provisions of the Insurance Article under more than one sickness and accident, dental, or hospital and medical insurance policy;</text> </level> </level> <level label="6"> <text>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;</text> </level> <level label="7"> <text>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:</text> <level label="i"> <text>The disclosure is limited to information that is directly relevant to the individual’s involvement in the patient’s health care; and</text> </level> <level label="ii"> <level label="1"> <text>If the patient is present or otherwise available before the disclosure and has the capacity to make health care decisions:</text> </level> <level label="A"> <text>The patient has been provided with an opportunity to object to the disclosure and the patient has not objected; or</text> </level> <level label="B"> <text>The health care provider reasonably infers from the circumstances that, based on the health care provider’s professional judgment, the patient does not object to the disclosure; or</text> </level> <level label="2"> <text>If the patient is not present or otherwise available before the disclosure is made, or providing the patient with an opportunity to object to the disclosure is not practicable because of the patient’s incapacity or need for emergency care or treatment, the health care provider determines, based on the health care provider’s professional judgment, that the disclosure is in the best interests of the patient;</text> </level> </level> </level> <level label="8"> <text>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;</text> </level> <level label="9"> <text>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;</text> </level> <level label="10"> <text>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</text> </level> <level label="11"> <text>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:</text> <level label="i"> <text>A disclosure under this item is subject to the additional limitations in § 4–307 of this subtitle on disclosure of a medical record developed primarily in connection with the provision of mental health services;</text> </level> <level label="ii"> <text>A medical record may be disclosed only in accordance with the federal Health Insurance Portability and Accountability Act of 1996, any regulations adopted under the Act, and any other applicable federal privacy laws, and disclosures under this item may not be made in violation of the prohibited uses or disclosures under the federal Health Insurance Portability and Accountability Act of 1996;</text> </level> <level label="iii"> <text>A disclosure under this item may not be used for underwriting or utilization review purposes;</text> </level> <level label="iv"> <text>A health care provider that discloses a medical record in accordance with this item shall provide a notice consistent with the requirements of 45 C.F.R. § 164.520 specifying the information to be shared, with whom it will be shared, and the specific types of uses and disclosures that the health care provider may make in accordance with this item;</text> </level> <level label="v"> <text>The notice required by item (iv) of this item shall include an opportunity for the individual to opt out of the sharing of the individual’s medical record with a carrier or an accountable care organization for the purposes identified in this item;</text> </level> <level label="vi"> <text>If a health care provider discloses medical information or medical data to a carrier or accountable care organization through an infrastructure that provides organizational and technical capabilities for the exchange of protected health information among entities not under common ownership, the health care providers are subject to the requirements of §§ 4–302.2 and 4–302.3 of this subtitle; and</text> </level> <level label="vii"> <text>If the disclosure is of abortion care or other sensitive health services information as determined by the Secretary under § 4–302.5(d) of this subtitle, the disclosure is subject to the requirements under § 4–302.5 of this subtitle.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>Under provisions of State law regarding confidentiality, the Montgomery County Department of Health and Human Services shall be considered to be one agency.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-306" title_number="4" title_name="Statistics and Records" subtitle_number="3" subtitle_name="Confidentiality of Medical Records"> <level label="a"> <text>In this section, “compulsory process” includes a subpoena, summons, warrant, or court order that appears on its face to have been issued on lawful authority.</text> </level> <level label="b"> <text>A health care provider shall disclose a medical record without the authorization of a person in interest:</text> <level label="1"> <text>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:</text> <level label="i"> <text>The health care provider shall disclose only the medical record of a person who is being assessed in an investigation or to whom services are being provided in accordance with Title 5, Subtitle 7 or Title 14, Subtitle 3 of the Family Law Article;</text> </level> <level label="ii"> <text>The health care provider shall disclose only the information in the medical record that will, in the professional judgment of the provider, contribute to the:</text> <level label="1"> <text>Assessment of risk;</text> </level> <level label="2"> <text>Development of a service plan;</text> </level> <level label="3"> <text>Implementation of a safety plan; or</text> </level> <level label="4"> <text>Investigation of the suspected case of abuse or neglect; and</text> </level> </level> <level label="iii"> <text>The medical record may be redisclosed as provided in §§ 1–201, 1–202, 1–204, and 1–205 of the Human Services Article;</text> </level> </level> <level label="2"> <text>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:</text> <level label="i"> <text>Licensure, certification, or discipline of a health professional; or</text> </level> <level label="ii"> <text>The improper practice of a health profession;</text> </level> </level> <level label="3"> <text>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;</text> </level> <level label="4"> <text>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;</text> </level> <level label="5"> <text>To another health care provider as provided in § 10–807 or § 19–308.2 of this article;</text> </level> <level label="6"> <text>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:</text> <level label="i"> <level label="1"> <text>A written assurance from the party or the attorney representing the party seeking the medical records that:</text> </level> <level label="A"> <text>In a Child in Need of Assistance proceeding pursuant to Title 3, Subtitle 8 of the Courts and Judicial Proceedings Article, a person in interest has not objected to the disclosure of the designated medical records and 15 days have elapsed since the notice was sent;</text> </level> <level label="B"> <text>In all other proceedings, a person in interest has not objected to the disclosure of the designated medical records within 30 days after the notice was sent; or</text> </level> <level label="C"> <text>The objections of a person in interest have been resolved and the request for disclosure is in accordance with the resolution;</text> </level> <level label="2"> <text>Proof that service of the subpoena, summons, warrant, or court order has been waived by the court for good cause; or</text> </level> <level label="3"> <text>A copy of an order entered by a court expressly authorizing disclosure of the designated medical records;</text> </level> </level> <level label="ii"> <text>For disclosures made under item (i)1A of this item, copies of the following items that were mailed by certified mail to the person in interest by the person requesting the disclosure at least 15 days before the records are to be disclosed:</text> <level label="1"> <text>The subpoena, summons, warrant, or court order seeking the disclosure or production of the records;</text> </level> <level label="2"> <text>This section; and</text> </level> <level label="3"> <text>A notice in the following form or a substantially similar form:</text> <text>__________________ In the</text> <text>Plaintiffs ______________________________</text> <text>v. For</text> <text>______________________________</text> <text>_____________________________________</text> <text>Defendants</text> <text>Case No.:_____________________</text> <text>NOTICE TO (Patient Name)</text> <text>IN COMPLIANCE WITH § 4–306 OF THE HEALTH – GENERAL ARTICLE,</text> <text>ANNOTATED CODE OF MARYLAND</text> <text>TAKE NOTE that medical records regarding (Patient Name), have been subpoenaed from the (Name and address of Health Care Provider) pursuant to the attached subpoena and § 4–306 of the Health – General Article, Annotated Code of Maryland. This subpoena _____ does _____ does not (mark one) seek production of mental health records.</text> <text>Please examine these papers carefully. IF YOU HAVE ANY OBJECTION TO THE PRODUCTION OF THESE DOCUMENTS, YOU MUST FILE A MOTION FOR A PROTECTIVE ORDER OR A MOTION TO QUASH THE SUBPOENA ISSUED FOR THESE DOCUMENTS UNDER MARYLAND RULES 2–403 AND 2–510 NO LATER THAN FIFTEEN (15) DAYS FROM THE DATE THIS NOTICE IS MAILED. For example, a protective order may be granted if the records are not relevant to the issues in this case, the request unduly invades your privacy, or causes you specific harm.</text> <text>Also attached to this form is a copy of the subpoena duces tecum issued for these records.</text> <text>If you believe you need further legal advice about this matter, you should consult your attorney.</text> <text>______________________________</text> <text>Attorney</text> <text>(Firm Name</text> <text>Attorney address</text> <text>Attorney phone number)</text> <text>Attorneys for (Name of Party Represented)</text> <text>Certificate of Service</text> <text>I hereby certify that a copy of the foregoing notice was mailed, first–class</text> <text>postage prepaid, this ___ day of _________, 20__ to</text> <text>___________________________________</text> <text>Patient</text> <text>___________________________________</text> <text>Each Counsel in Case</text> <text>___________________________________</text> <text>Attorney</text> </level> </level> <level label="iii"> <text>For disclosures made under item (i)1B of this item, copies of the following items that were mailed by certified mail and by mail sent first–class postage prepaid to the person in interest and, if applicable, by mail sent first–class postage prepaid to the court and parties in a criminal or juvenile delinquency case by the person requesting the disclosure at least 30 days before the records are to be disclosed:</text> <level label="1"> <text>The subpoena, summons, warrant, or court order seeking the disclosure or production of the records;</text> </level> <level label="2"> <text>This section; and</text> </level> <level label="3"> <text>A notice in the following form or a substantially similar form:</text> <text>___________________________________ In the</text> <text>Plaintiffs ______________________________</text> <text>v. For</text> <text>______________________________</text> <text>___________________________________</text> <text>Defendants</text> <text>Case No.:_____________________</text> <text>NOTICE TO (Patient Name)</text> <text>IN COMPLIANCE WITH § 4–306 OF THE HEALTH – GENERAL ARTICLE,</text> <text>ANNOTATED CODE OF MARYLAND</text> <text>TAKE NOTE that medical records regarding (Patient Name), have been subpoenaed from the (Name and address of Health Care Provider) pursuant to the attached subpoena and § 4–306 of the Health – General Article, Annotated Code of Maryland. This subpoena ____ does ____ does not (mark one) seek production of mental health records.</text> <text>Please examine these papers carefully. IF YOU HAVE ANY OBJECTION TO THE PRODUCTION OF THESE DOCUMENTS, YOU MUST FILE A MOTION FOR A PROTECTIVE ORDER OR A MOTION TO QUASH THE SUBPOENA ISSUED FOR THESE DOCUMENTS UNDER MARYLAND RULES 2–403, 2–510, OR 4–266 NO LATER THAN THIRTY (30) DAYS FROM THE DATE THIS NOTICE IS MAILED. For example, a protective order may be granted if the records are not relevant to the issues in this case, the request unduly invades your privacy, or causes you specific harm.</text> <text>Also attached to this form is a copy of the subpoena duces tecum issued for these records.</text> <text>If you believe you need further legal advice about this matter, you should consult your attorney.</text> <text>______________________________</text> <text>Attorney</text> <text>(Firm Name</text> <text>Attorney address</text> <text>Attorney phone number)</text> <text>Attorneys for (Name of Party Represented)</text> <text>Certificate of Service</text> <text>I hereby certify that a copy of the foregoing notice was mailed, first–class postage prepaid, this ___ day of _________, 20__ to</text> <text>___________________________________</text> <text>Patient</text> <text>___________________________________</text> <text>Each Counsel in Case</text> <text>___________________________________</text> <text>Attorney</text> </level> </level> </level> <level label="7"> <text>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;</text> </level> <level label="8"> <text>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;</text> </level> <level label="9"> <text>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;</text> </level> <level label="10"> <text>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;</text> </level> <level label="11"> <text>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:</text> <level label="i"> <text>The additional limitations under § 4–307 of this subtitle for disclosure of a medical record developed primarily in connection with the provision of mental health services; and</text> </level> <level label="ii"> <text>Any additional limitations for disclosure or redisclosure of a medical record developed in connection with the provision of substance abuse treatment services under State law or 42 U.S.C. § 290dd–2 and 42 C.F.R. Part 2; or</text> </level> </level> <level label="12"> <text>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).</text> </level> </level> <level label="c"> <level label="1"> <text>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:</text> <level label="i"> <text>An involuntary admission proceeding under Title 10, Subtitle 6 of this article;</text> </level> <level label="ii"> <text>A release proceeding under Title 10, Subtitle 8 of this article; or</text> </level> <level label="iii"> <text>A commitment or release proceeding under Title 3 of the Criminal Procedure Article.</text> </level> </level> <level label="2"> <text>Legal records required to be disclosed under paragraph (1) of this subsection include:</text> <level label="i"> <text>An emergency petition;</text> </level> <level label="ii"> <text>An application for involuntary admission; and</text> </level> <level label="iii"> <text>A certification for involuntary admission.</text> </level> </level> <level label="3"> <text>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.</text> </level> <level label="4"> <text>Records provided under paragraph (1)(i) of this subsection shall be provided:</text> <level label="i"> <text>Within 24 hours after the health care provider receives a written request for the records from the public defender; and</text> </level> <level label="ii"> <text>Only if the individual has not yet retained private counsel.</text> </level> </level> </level> <level label="d"> <text>When a disclosure is sought under this section:</text> <level label="1"> <text>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</text> </level> <level label="2"> <text>Documentation of the disclosure shall be inserted in the medical record of the patient or recipient.</text> </level> </level> <level label="e"> <level label="1"> <text>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:</text> <level label="i"> <text>The documentation required under subsection (b)(6) of this section; and</text> </level> <level label="ii"> <text>Any fees owed to the health care provider by the party or the attorney representing the party seeking the medical record for the retrieval, copying, preparation, mailing, and actual cost of postage and handling of the medical record under § 4–304(c) of this subtitle.</text> </level> </level> <level label="2"> <text>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.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-307" title_number="4" title_name="Statistics and Records" subtitle_number="3" subtitle_name="Confidentiality of Medical Records"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“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.</text> </level> <level label="3"> <text>“Core service agency” has the meaning stated in § 7.5–101 of this article.</text> </level> <level label="4"> <text>“Director” means the Director of the Behavioral Health Administration or the designee of the Director.</text> </level> <level label="5"> <text>“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.</text> </level> <level label="6"> <level label="i"> <text>“Personal note” means information that is:</text> <level label="1"> <text>The work product and personal property of a mental health provider; and</text> </level> <level label="2"> <text>Except as provided in subsection (d)(3) of this section, not discoverable or admissible as evidence in any criminal, civil, or administrative action.</text> </level> </level> <level label="ii"> <text>Except as provided in subsection (d)(2) of this section, a medical record does not include a personal note of a mental health care provider, if the mental health care provider:</text> <level label="1"> <text>Keeps the personal note in the mental health care provider’s sole possession for the provider’s own personal use;</text> </level> <level label="2"> <text>Maintains the personal note separate from the recipient’s medical records; and</text> </level> <level label="3"> <text>Does not disclose the personal note to any other person except:</text> </level> <level label="A"> <text>The mental health provider’s supervising health care provider that maintains the confidentiality of the personal note;</text> </level> <level label="B"> <text>A consulting health care provider that maintains the confidentiality of the personal note; or</text> </level> <level label="C"> <text>An attorney of the health care provider that maintains the confidentiality of the personal note.</text> </level> </level> <level label="iii"> <text>“Personal note” does not include information concerning the patient’s diagnosis, treatment plan, symptoms, prognosis, or progress notes.</text> </level> </level> </level> <level label="b"> <text>The disclosure of a medical record developed in connection with the provision of mental health services shall be governed by the provisions of this section in addition to the other provisions of this subtitle.</text> </level> <level label="c"> <text>When a medical record developed in connection with the provision of mental health services is disclosed without the authorization of a person in interest, only the information in the record relevant to the purpose for which disclosure is sought may be released.</text> </level> <level label="d"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>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:</text> <level label="i"> <text>The provider’s supervising health care provider;</text> </level> <level label="ii"> <text>A consulting health care provider;</text> </level> <level label="iii"> <text>An attorney of the health care provider; or</text> </level> <level label="iv"> <text>A recipient under paragraph (3) of this subsection.</text> </level> </level> <level label="3"> <text>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.</text> </level> </level> <level label="e"> <level label="1"> <text>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.</text> </level> <level label="2"> <text>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.</text> </level> <level label="3"> <level label="i"> <text>A recipient who has been the subject of a psychological test may designate a psychologist licensed under Title 18 of the Health Occupations Article or a psychiatrist licensed under Title 14 of the Health Occupations Article to whom a health care provider may disclose the medical record.</text> </level> <level label="ii"> <text>The recipient shall:</text> <level label="1"> <text>Request the disclosure authorized under this paragraph in writing; and</text> </level> <level label="2"> <text>Comply with the provisions of § 4–304 of this subtitle.</text> </level> </level> </level> <level label="4"> <text>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.</text> </level> <level label="5"> <text>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.</text> </level> </level> <level label="f"> <text>Notwithstanding any other provision of this subtitle, a person in interest shall have the right to obtain a medical record of a recipient that is developed in conjunction with a mental health evaluation relating to obtaining or continuing employment, if the evaluation has been performed at the request of or on behalf of an employer or prospective employer:</text> <level label="1"> <text>In connection with a civil action or U.S. Equal Employment Opportunity Commission complaint initiated by the person in interest; or</text> </level> <level label="2"> <text>On a written authorization of the employer or prospective employer.</text> </level> </level> <level label="g"> <text>A health care provider may disclose a medical record that relates to and identifies more than one recipient in group or family therapy only:</text> <level label="1"> <text>On the authorization of a person in interest for each recipient;</text> </level> <level label="2"> <text>As provided in this subtitle; or</text> </level> <level label="3"> <text>As otherwise provided by law.</text> </level> </level> <level label="h"> <text>This section may not be construed to prevent the disclosure of a medical record that relates to the provision of mental health services between or among the health care providers that participate in the approved plan of a core service agency or local behavioral health authority for the delivery of mental health services, if a recipient:</text> <level label="1"> <text>Has received a current list of the participating providers; and</text> </level> <level label="2"> <text>Has signed a written agreement with the core service agency or local behavioral health authority to participate in the client information system developed by the agency.</text> </level> </level> <level label="i"> <text>If an individual given access to a medical record that relates to the provision of mental health services signs an acknowledgment of the duty under this Act not to redisclose personal identifying information about a recipient, this section may not be construed to prevent the disclosure of the medical record for rate review, auditing, health planning, licensure, approval, or accreditation of a facility by governmental or professional standard setting entities.</text> </level> <level label="j"> <level label="1"> <text>A health care provider may disclose a medical record without the authorization of a person in interest:</text> <level label="i"> <text>To the medical or mental health director of a juvenile or adult detention or correctional facility if:</text> <level label="1"> <text>The recipient has been involuntarily committed under State law or a court order to the detention or correctional facility requesting the medical record; and</text> </level> <level label="2"> <text>After a review of the medical record, the health care provider who is the custodian of the record is satisfied that disclosure is necessary for the proper care and treatment of the recipient;</text> </level> </level> <level label="ii"> <text>As provided in § 5–609 of the Courts Article;</text> </level> <level label="iii"> <level label="1"> <text>If a health care provider is a facility as defined in § 10–101 of this article, to a law enforcement agency concerning a recipient who:</text> </level> <level label="A"> <text>Has been admitted involuntarily or by court order to the facility; and</text> </level> <level label="B"> <text>Is on an unauthorized absence or has otherwise left the facility without being discharged or released;</text> </level> <level label="2"> <text>The facility director may disclose to the law enforcement agency identifying information and only such further information that the director believes is necessary to aid the law enforcement agency in locating and apprehending the recipient for the purpose of:</text> </level> <level label="A"> <text>Safely returning the recipient to custody; or</text> </level> <level label="B"> <text>Fulfilling the provisions of subparagraph (ii) of this paragraph;</text> </level> </level> <level label="iv"> <text>If a health care provider is a facility as defined in § 10–101 of this article, the facility director may confirm or deny the presence in the facility of a recipient to a parent, guardian, next of kin, or any individual who has a significant interest in the status of the recipient if that individual has filed a missing persons report regarding the recipient; and</text> </level> <level label="v"> <text>To allow for the service of process or a court order in a facility when appropriate arrangements have been made with the facility director so as to minimize loss of confidentiality.</text> </level> </level> <level label="2"> <text>When a disclosure is made under this subsection, documentation of the disclosure shall be inserted in the medical record of the recipient.</text> </level> </level> <level label="k"> <level label="1"> <text>A health care provider shall disclose a medical record without the authorization of a person in interest:</text> <level label="i"> <text>To the medical or mental health director of a juvenile or adult detention or correctional facility or to another inpatient provider of mental health services in connection with the transfer of a recipient from an inpatient provider, if:</text> <level label="1"> <text>The health care provider with the records has determined that disclosure is necessary for the continuing provision of mental health services; and</text> </level> <level label="2"> <text>The recipient is transferred:</text> </level> <level label="A"> <text>As an involuntary commitment or by court order to the provider;</text> </level> <level label="B"> <text>Under State law to a juvenile or adult detention or correctional facility; or</text> </level> <level label="C"> <text>To a provider that is required by law or regulation to admit the recipient;</text> </level> </level> <level label="ii"> <text>To the State designated protection and advocacy system for mentally ill individuals under the federal Protection and Advocacy for Mentally Ill Individuals Act of 1986, as amended, if:</text> <level label="1"> <text>The State designated protection and advocacy system has received a complaint regarding the recipient or the director of the system has certified in writing to the chief administrative officer of the health care provider that there is probable cause to believe that the recipient has been subject to abuse or neglect;</text> </level> <level label="2"> <text>The recipient by reason of mental or physical condition is unable to authorize disclosure; and</text> </level> <level label="3"> <level label="A"> <text>The recipient does not have a legal guardian or other legal representative who has the authority to consent to the release of health care information; or</text> </level> </level> <level label="B"> <text>The legal guardian of the recipient is a representative of a State agency;</text> </level> </level> <level label="iii"> <text>To another health care provider or legal counsel to the other health care provider prior to and in connection with or for use in a commitment proceeding in accordance with Title 10, Subtitle 6 or Title 12 of this article;</text> </level> <level label="iv"> <text>In accordance with a court order, other than compulsory process compelling disclosure, as permitted under § 9–109(d), § 9–109.1(d), or § 9–121(d) of the Courts Article, or as otherwise provided by law, to:</text> <level label="1"> <text>A court;</text> </level> <level label="2"> <text>An administrative law judge;</text> </level> <level label="3"> <text>A health claims arbitrator; or</text> </level> <level label="4"> <text>A party to a court, administrative, or arbitration proceeding;</text> </level> </level> <level label="v"> <text>In accordance with a subpoena for medical records on specific recipients:</text> <level label="1"> <text>To health professional licensing and disciplinary boards for the sole purpose of an investigation regarding licensure, certification, or discipline of a health professional or the improper practice of a health profession; and</text> </level> <level label="2"> <text>To grand juries, prosecution agencies, and law enforcement agencies under the supervision of prosecution agencies for the sole purposes of investigation and prosecution of a provider for theft and fraud, related offenses, obstruction of justice, perjury, unlawful distribution of controlled substances, and of any criminal assault, neglect, patient abuse or sexual offense committed by the provider against a recipient, provided that the prosecution or law enforcement agency shall:</text> </level> <level label="A"> <text>Have written procedures which shall be developed in consultation with the Director to maintain the medical records in a secure manner so as to protect the confidentiality of the records; and</text> </level> <level label="B"> <text>In a criminal proceeding against a provider, to the maximum extent possible, remove and protect recipient identifying information from the medical records used in the proceeding; or</text> </level> </level> <level label="vi"> <text>In the event of the death of a recipient, to the office of the medical examiner as authorized under § 5–309 or § 10–713 of this article.</text> </level> </level> <level label="2"> <text>If a recipient believes that a medical record has been inappropriately obtained, maintained, or disclosed under paragraph (1)(vi) of this subsection, the recipient may petition the State prosecutor for an investigation of the allegation.</text> </level> <level label="3"> <text>Except in a proceeding relating to payment for the health care of a recipient, the medical record of a recipient and any information obtained as a result of disclosure under paragraph (1)(vi) of this subsection is disclosable, notwithstanding any privilege in law, but may not be used in any proceeding against the recipient.</text> </level> <level label="4"> <text>A written request for disclosure or written confirmation of an oral request in an emergency that justifies the need for disclosure shall be inserted in the medical record of the recipient.</text> </level> <level label="5"> <text>Documentation of the disclosure shall be inserted in the medical record of the recipient.</text> </level> <level label="6"> <text>This subsection may not preclude a health care provider, a recipient, or person in interest from asserting in a motion to quash or a motion for a protective order any constitutional right or other legal authority in opposition to disclosure.</text> </level> </level> <level label="l"> <level label="1"> <text>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:</text> <level label="i"> <text>An involuntary admission proceeding under Title 10, Subtitle 6 of this article;</text> </level> <level label="ii"> <text>A release proceeding under Title 10, Subtitle 8 of this article; or</text> </level> <level label="iii"> <text>A commitment or release proceeding under Title 3 of the Criminal Procedure Article.</text> </level> </level> <level label="2"> <text>Legal records required to be disclosed under paragraph (1) of this subsection include:</text> <level label="i"> <text>An emergency petition;</text> </level> <level label="ii"> <text>An application for involuntary admission; and</text> </level> <level label="iii"> <text>A certification for involuntary admission.</text> </level> </level> <level label="3"> <text>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.</text> </level> <level label="4"> <text>Records provided under paragraph (1)(i) of this subsection shall be provided:</text> <level label="i"> <text>Within 24 hours after the health care provider receives a written request for the records from the public defender; and</text> </level> <level label="ii"> <text>Only if the individual has not yet retained private counsel.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-308" title_number="4" title_name="Statistics and Records" subtitle_number="3" subtitle_name="Confidentiality of Medical Records"> <text>A health care provider, who in good faith discloses or does not disclose a medical record, is not liable in any cause of action arising from the disclosure or nondisclosure of the medical record.</text> </section> <section article="ghg" article_name="Health - General" number="4-309" title_number="4" title_name="Statistics and Records" subtitle_number="3" subtitle_name="Confidentiality of Medical Records"> <level label="a"> <text>If a health care provider knowingly refuses to disclose a medical record within a reasonable time but no more than 21 working days after the date a person in interest requests the disclosure, the health care provider is liable for actual damages.</text> </level> <level label="b"> <text>A health care provider may not refuse to disclose a medical record on the request of a person in interest because of the failure of the person in interest to pay for health care rendered by the health care provider.</text> </level> <level label="c"> <text>A health care provider or any other person is in violation of this subtitle if the health care provider or any other person:</text> <level label="1"> <text>Requests or obtains a medical record under false pretenses or through deception; or</text> </level> <level label="2"> <text>Discloses a medical record in violation of this subtitle.</text> </level> </level> <level label="d"> <text>Except as otherwise provided in subsection (e) of this section, a health care provider or any other person, including an officer or employee of a governmental unit, who knowingly and willfully violates any provision of this subtitle 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 conviction for a violation of any provision of this subtitle.</text> </level> <level label="e"> <level label="1"> <text>A health care provider or any other person, including an officer or employee of a governmental unit, who knowingly and willfully requests or obtains a medical record under false pretenses or through deception or knowingly and willfully discloses a medical record in violation of this subtitle is guilty of a misdemeanor and on conviction is subject to the following penalties:</text> <level label="i"> <text>A fine not exceeding $50,000, imprisonment for not more than 1 year, or both;</text> </level> <level label="ii"> <text>If the offense is committed under false pretenses, a fine not exceeding $100,000, imprisonment for not more than 5 years, or both; and</text> </level> <level label="iii"> <text>If the offense is committed with intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain, or malicious harm, a fine not exceeding $250,000, imprisonment for not more than 10 years, or both.</text> </level> </level> <level label="2"> <text>This subsection does not apply to an officer or employee of a governmental unit that is conducting a criminal investigation.</text> </level> </level> <level label="f"> <text>A health care provider or any other person who knowingly violates any provision of this subtitle is liable for actual damages.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-310" title_number="4" title_name="Statistics and Records" subtitle_number="3" subtitle_name="Confidentiality of Medical Records"> <level label="a"> <text>There is a Protected Health Care Commission.</text> </level> <level label="b"> <text>The purpose of the Commission is to make recommendations to the Secretary regarding sensitive health services that should be determined by the Secretary to be legally protected health care under this subtitle.</text> </level> <level label="c"> <text>The Commission consists of the following members:</text> <level label="1"> <text>The Attorney General or the Attorney General’s designee;</text> </level> <level label="2"> <text>The Executive Director of the Maryland Health Care Commission or the Executive Director’s designee; and</text> </level> <level label="3"> <text>The following members appointed by the Secretary:</text> <level label="i"> <text>A resident of the State who is a licensed physician and nominated by the American College of Obstetricians and Gynecologists;</text> </level> <level label="ii"> <text>A resident of the State who is a licensed clinician who provides reproductive health care and nominated by the Reproductive Health Access Project;</text> </level> <level label="iii"> <text>A resident of the State who is a certified nurse–midwife nominated by the Maryland affiliate of the American College of Nurse Midwives;</text> </level> <level label="iv"> <text>A resident of the State who is a representative of Physicians for Reproductive Health;</text> </level> <level label="vi"> <text>Two residents of the State who are consumer representatives with expertise in consumer data privacy; and</text> </level> <level label="vii"> <text>A resident of the State with expertise in health information.</text> </level> </level> </level> <level label="d"> <text>The Commission shall:</text> <level label="1"> <text>Select a chair of the Commission each year; and</text> </level> <level label="2"> <text>Meet at least four times a year.</text> </level> </level> <level label="e"> <text>The Department shall provide staff for the Commission.</text> </level> <level label="f"> <level label="1"> <text>The Commission shall identify sensitive health services information by diagnosis, procedural, medication, or related codes for which disclosure by a health information exchange or electronic health network to a treating provider, business entity, another health information exchange, or another electronic health network would create a substantial risk to patients or health care providers.</text> </level> <level label="2"> <text>In carrying out its work, the Commission may consult with:</text> <level label="i"> <text>Organizations with expertise in legal issues impacting providers of legally protected health care;</text> </level> <level label="ii"> <text>Organizations with expertise in consumer health privacy;</text> </level> <level label="iii"> <text>Organizations with expertise in health information technology; and</text> </level> <level label="iv"> <text>Other organizations with clinical, policy, or legal expertise related to the work of the Commission.</text> </level> </level> </level> <level label="g"> <level label="1"> <text>The Commission shall issue semiannual reports to the Secretary on recommendations regarding sensitive health services that should be determined by the Secretary to be legally protected health care under this subtitle or for which the Secretary should rescind a previous determination.</text> </level> <level label="2"> <text>The reports shall include an assessment of the potential risk to patients and health care providers that would result from the disclosure of the sensitive health services that are addressed in the reports.</text> </level> <level label="3"> <text>Within 60 days after receiving a semiannual report under paragraph (1) of this subsection, the Secretary shall submit a written response to the report that includes the findings and determinations of the Secretary to:</text> <level label="i"> <text>The Commission; and</text> </level> <level label="ii"> <text>In accordance with § 2–1257 of the State Government Article, the Senate Finance Committee and the House Health and Government Operations Committee.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="4-401" title_number="4" title_name="Statistics and Records" subtitle_number="4" subtitle_name="Personal Medical Records"> <level label="a"> <text>In this section, “provider” means:</text> <level label="1"> <text>An acupuncturist;</text> </level> <level label="2"> <text>A chiropractor;</text> </level> <level label="3"> <text>A dentist;</text> </level> <level label="4"> <text>A nurse;</text> </level> <level label="5"> <text>An optometrist;</text> </level> <level label="6"> <text>A physician;</text> </level> <level label="7"> <text>A podiatrist; or</text> </level> <level label="8"> <text>A person who is employed by or under contract with a hospital, nursing institution, or other health care provider.</text> </level> </level> <level label="b"> <text>A provider may not knowingly or willfully destroy, damage, alter, obliterate, or otherwise obscure a medical record, hospital report, laboratory report, X-ray report, or other information about a patient in an effort to conceal the information from use as evidence in an administrative, civil, or criminal proceeding.</text> </level> <level label="c"> <text>A provider who violates any provision of this section is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $5,000 or imprisonment not exceeding 1 year or both.</text> </level> </section> <section article="ghg" article_name="Health - General" number="4-402" title_number="4" title_name="Statistics and Records" subtitle_number="4" subtitle_name="Personal Medical Records"> <text>On admission of a patient, a hospital, related institution, or mental health outpatient clinic shall record on the medical record whether the patient is a veteran of the uniformed services.</text> </section> <section article="ghg" article_name="Health - General" number="4-403" title_number="4" title_name="Statistics and Records" subtitle_number="4" subtitle_name="Personal Medical Records"> <level label="a"> <level label="1"> <text>In this section, a “health care provider” means:</text> <level label="i"> <text>An acupuncturist;</text> </level> <level label="ii"> <text>An audiologist;</text> </level> <level label="iii"> <text>A chiropractor;</text> </level> <level label="iv"> <text>A dietitian;</text> </level> <level label="v"> <text>A dentist;</text> </level> <level label="vi"> <text>An electrologist;</text> </level> <level label="vii"> <text>A health care facility that is:</text> <level label="1"> <text>A freestanding ambulatory care facility as defined under § 19–3B–01 of this article;</text> </level> <level label="2"> <text>A freestanding medical facility as defined under § 19–3A–01 of this article;</text> </level> <level label="3"> <text>A health care facility as defined under § 10–101 of this article;</text> </level> <level label="4"> <text>A health maintenance organization as defined under § 19–701 of this article;</text> </level> <level label="5"> <text>A hospital as defined under § 19–301 of this article;</text> </level> <level label="6"> <text>A limited service hospital as defined under § 19–301 of this article;</text> </level> <level label="7"> <text>A related institution as defined in § 19–301 of this article; and</text> </level> <level label="8"> <text>A residential treatment center as defined under § 19–301 of this article;</text> </level> </level> <level label="viii"> <text>A massage therapist;</text> </level> <level label="ix"> <text>A mortician;</text> </level> <level label="x"> <text>A nurse;</text> </level> <level label="xi"> <text>A nutritionist;</text> </level> <level label="xii"> <text>An occupational therapist;</text> </level> <level label="xiii"> <text>An optometrist;</text> </level> <level label="xiv"> <text>A physical therapist;</text> </level> <level label="xv"> <text>A physician;</text> </level> <level label="xvi"> <text>A podiatrist;</text> </level> <level label="xvii"> <text>A professional counselor;</text> </level> <level label="xviii"> <text>A psychologist;</text> </level> <level label="xix"> <text>A social worker;</text> </level> <level label="xx"> <text>A speech–language pathologist; and</text> </level> <level label="xxi"> <text>A pharmacist.</text> </level> </level> <level label="2"> <text>“Health care provider” includes an agent, employee, officer, or director of any entity listed under paragraph (1) of this subsection.</text> </level> </level> <level label="b"> <text>Except for a minor patient, unless a patient is notified, a health care provider may not destroy a medical record or laboratory or X–ray report about a patient for 7 years after the record or report is made.</text> </level> <level label="c"> <text>In the case of a minor patient, a medical record or laboratory or X–ray report about a minor patient may not be destroyed until the patient attains the age of majority plus 7 years, unless:</text> <level label="1"> <text>The parent or guardian of the minor patient is notified; or</text> </level> <level label="2"> <text>If the medical care documented in the record was provided under § 20–102(c) or § 20–103(c) of this article, the minor patient is notified.</text> </level> </level> <level label="d"> <level label="1"> <text>The notice under subsection (b) or (c) of this section shall:</text> <level label="i"> <text>Be made by:</text> <level label="1"> <text>First–class mail to the last known address of the patient; or</text> </level> <level label="2"> <text>Subject to paragraph (2) of this subsection, e–mail to the last known e–mail address of:</text> </level> <level label="A"> <text>The patient; or</text> </level> <level label="B"> <text>If the patient is a minor and the medical care documented in the record was not provided under § 20–102(c) or § 20–103(c) of this article, the parent or guardian of the patient;</text> </level> </level> <level label="ii"> <text>Include the date on which the record of the patient shall be destroyed; and</text> </level> <level label="iii"> <text>Include a statement that the record or synopsis of the record, if wanted, must be retrieved at a designated location.</text> </level> </level> <level label="2"> <text>If notice is provided under paragraph (1)(i)2 of this subsection and no response or delivery receipt is obtained from the e–mail address to which notice was provided, the health care provider shall provide notice under paragraph (1)(i)1 of this subsection at least 10 days before the date on which the record is to be destroyed.</text> </level> </level> <level label="e"> <text>The health care provider shall make the record or report available for retrieval:</text> <level label="1"> <text>By the patient or the parent or guardian of the minor patient within 60 days before the date of destruction; and</text> </level> <level label="2"> <text>At the location designated in the notice of destruction of the record or report.</text> </level> </level> <level label="f"> <text>After the death, retirement, surrender of the license, or discontinuance of the practice or business of a health care provider, the health care provider, the administrator of the estate, or a designee who agrees to provide for the maintenance of the medical records of the practice or business and who states, in writing to the appropriate health occupation board within a reasonable time, that the records will be maintained in compliance with this section, shall forward the notice required in this section before the destruction or transfer of medical records to:</text> <level label="1"> <text>The patient; or</text> </level> <level label="2"> <text>For a minor patient, the parent or guardian of the minor patient unless the medical care documented in the record was provided under § 20–102(c) or § 20–103(c) of this article.</text> </level> </level> <level label="g"> <level label="1"> <text>After consulting with the Maryland Hospital Association, the Maryland State Medical Society, and other interested parties, including consumers and payors, the Secretary shall adopt regulations governing the destruction of medical records.</text> </level> <level label="2"> <text>The regulations adopted under this subsection shall:</text> <level label="i"> <text>Specify the manner in which a health care provider shall maintain and store medical records to:</text> <level label="1"> <text>Ensure confidentiality; and</text> </level> <level label="2"> <text>Provide limited access to the medical records until the records are destroyed; and</text> </level> </level> <level label="ii"> <text>Ensure that the method of destruction renders the medical records unreadable.</text> </level> </level> <level label="3"> <text>The regulations adopted under this subsection may not:</text> <level label="i"> <text>Require or encourage the destruction of medical records; or</text> </level> <level label="ii"> <text>Be inconsistent with any provision of law applicable to the maintenance or destruction of medical records.</text> </level> </level> </level> <level label="h"> <level label="1"> <text>A health care provider or any other person who knowingly violates any provision of this subtitle is liable for actual damages.</text> </level> <level label="2"> <level label="i"> <text>In addition to any other penalties provided under this article, a health care facility that knowingly violates this section is subject to an administrative fine not exceeding $10,000 for all violations cited in a single day.</text> </level> <level label="ii"> <level label="1"> <text>In addition to any other penalties provided under this article, an individual who knowingly violates this section is subject to the fines provided in subsubparagraph 2 of this subparagraph if the individual is:</text> </level> <level label="A"> <text>A health care provider, as defined under subsection (a)(1)(i) through (vi) or (viii) through (xx) of this section; or</text> </level> <level label="B"> <text>An agent, employee, officer, or director of a health care provider.</text> </level> <level label="2"> <text>The administrative fines applicable to an individual covered under subsubparagraph 1 of this subparagraph shall be assessed as follows:</text> </level> <level label="A"> <text>The first fine assessed or first set of fines assessed concurrently for all violations cited in a single day may not exceed $1,000;</text> </level> <level label="B"> <text>The second fine assessed or second set of fines assessed concurrently for all violations cited in a single day may not exceed $2,500; and</text> </level> <level label="C"> <text>The third or subsequent fine assessed or third or subsequent set of fines assessed concurrently for all violations cited in a single day may not exceed $5,000.</text> </level> </level> </level> </level> </section>