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<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>
