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<section article="gho" article_name="Health Occupations" number="1-303" title_number="1" title_name="Definitions; General Provisions" subtitle_number="3" subtitle_name="Patient Referrals">
  <level label="a">
    <text>Except as provided in subsection (c) of this section and Title 12 of this article, a health care practitioner making a lawful referral shall disclose the existence of the beneficial interest in accordance with provisions of this section.</text>
  </level>
  <level label="b">
    <text>Prior to referring a patient to a health care entity in which the practitioner, the practitioner's immediate family, or the practitioner in combination with the practitioner's immediate family owns a beneficial interest, the health care practitioner shall:</text>
    <level label="1">
      <text>Except if an oral referral is made by telephone, provide the patient with a written statement that:</text>
      <level label="i">
        <text>Discloses the existence of the ownership of the beneficial interest or compensation arrangement;</text>
      </level>
      <level label="ii">
        <text>States that the patient may choose to obtain the health care service from another health care entity; and</text>
      </level>
      <level label="iii">
        <text>Requires the patient to acknowledge in writing receipt of the statement;</text>
      </level>
    </level>
    <level label="2">
      <text>Except if an oral referral is made by telephone, insert in the medical record of the patient a copy of the written acknowledgement;</text>
    </level>
    <level label="3">
      <text>Place on permanent display a written notice that is in a typeface that is large enough to be easily legible to the average person from a distance of 8 feet and that is in a location that is plainly visible to the patients of the health care practitioner disclosing all of the health care entities:</text>
      <level label="i">
        <text>In which the practitioner, the practitioner's immediate family, or the practitioner in combination with the practitioner's immediate family owns a beneficial interest; and</text>
      </level>
      <level label="ii">
        <text>To which the practitioner refers patients; and</text>
      </level>
    </level>
    <level label="4">
      <text>Documents in the medical record of the patient that:</text>
      <level label="i">
        <text>A valid medical need exists for the referral; and</text>
      </level>
      <level label="ii">
        <text>The practitioner has disclosed the existence of the beneficial interest to the patient.</text>
      </level>
    </level>
  </level>
  <level label="c">
    <text>The provisions of this section do not apply to:</text>
    <level label="1">
      <text>A health care practitioner when treating a member of a health maintenance organization as defined in § 19-701 of the Health - General Article and the health care practitioner does not have a beneficial interest in the health care entity; or</text>
    </level>
    <level label="2">
      <text>A health care practitioner who refers a patient:</text>
      <level label="i">
        <text>To another health care practitioner in the same group practice as the referring health care practitioner;</text>
      </level>
      <level label="ii">
        <text>For in-office ancillary services; or</text>
      </level>
      <level label="iii">
        <text>For health care services provided through or by a health care entity owned or controlled by a hospital.</text>
      </level>
    </level>
  </level>
  <level label="d">
    <text>A health care practitioner who fails to comply with any provision of this section is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $5,000.</text>
  </level>
</section>
