<?xml version='1.0' encoding='utf-8'?>
<subtitle article="gho" title_number="14" subtitle_number="3" title_name="Physicians">
  <section article="gho" article_name="Health Occupations" number="14-301" title_number="14" title_name="Physicians" subtitle_number="3">
    <text>Except as otherwise provided in this title, § 13–516 of the Education Article, or §§ 10–14A–03 and 10–14B–03 of the State Government Article, an individual shall be licensed by the Board before the individual may practice medicine in this State.</text>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-302" title_number="14" title_name="Physicians" subtitle_number="3">
    <text>Subject to the rules, regulations, and orders of the Board, the following individuals may practice medicine without a license:</text>
    <level label="1">
      <text>A medical student or an individual in a postgraduate medical training program that is accredited by an accrediting organization recognized by the Board in regulations, while the individual is practicing medicine in the program and doing the assigned duties at any office of a licensed physician, hospital, clinic, or similar facility;</text>
    </level>
    <level label="2">
      <text>A physician licensed by and residing in another jurisdiction, if the physician:</text>
      <level label="i">
        <text>Is engaged in consultation with a physician licensed in the State about a particular patient and does not direct patient care;</text>
      </level>
      <level label="ii">
        <level label="1">
          <text>Has an active, unrestricted license to practice medicine in the jurisdiction where the physician regularly engages in the practice of medicine;</text>
        </level>
        <level label="2">
          <text>Is employed by or has a written agreement with an athletic team or a sports team based outside the State;</text>
        </level>
        <level label="3">
          <text>Is designated as the team physician by the athletic or sports team to provide medical care to the team’s members, band members, cheerleading squad, mascot, coaches, and other staff who travel to a specified sporting event taking place in the State;</text>
        </level>
        <level label="4">
          <text>While in the State, provides medical care only to individuals listed in item 3 of this item;</text>
        </level>
        <level label="5">
          <text>Does not provide medical care in the State for more than 45 days in a calendar year; and</text>
        </level>
        <level label="6">
          <text>Does not engage in the practice of medicine at a hospital, related institution, or other health care facility, including an acute care facility, located within the State; or</text>
        </level>
      </level>
      <level label="iii">
        <text>Is engaged in clinical training or participates in training or teaching of a skill or procedure in a hospital if:</text>
        <level label="1">
          <text>The skill or procedure:</text>
        </level>
        <level label="A">
          <text>Is advanced beyond those skills or procedures normally taught or exercised in the hospital and in standard medical education or training;</text>
        </level>
        <level label="B">
          <text>Could not be otherwise conveniently taught or demonstrated in standard medical education or training in that hospital; and</text>
        </level>
        <level label="C">
          <text>Is likely to benefit Maryland patients in this instance;</text>
        </level>
        <level label="2">
          <text>The demonstration of all skills or procedures by the physician does not exceed 14 days total in the calendar year;</text>
        </level>
        <level label="3">
          <text>A licensed physician who practices at a hospital in the State will be responsible for the medical care provided by that visiting physician to patients in the State;</text>
        </level>
        <level label="4">
          <text>The visiting physician has no history of any medical disciplinary action in any other state, territory, nation, or any branch of the uniformed services or the U.S. Department of Veterans Affairs, and has no significant detrimental malpractice history;</text>
        </level>
        <level label="5">
          <text>The physician is covered by malpractice insurance in the jurisdiction in which the physician practices; and</text>
        </level>
        <level label="6">
          <text>The hospital ensures that the patients will be protected by adequate malpractice insurance;</text>
        </level>
      </level>
    </level>
    <level label="3">
      <text>A physician employed in the service of the federal government while practicing within the scope of the employment;</text>
    </level>
    <level label="4">
      <text>A physician who resides in and is authorized to practice medicine by any state adjoining this State for the purpose of prescribing home health services to a patient who resides in this State, if the physician:</text>
      <level label="i">
        <text>Does not have an office or other regularly appointed place in this State to meet patients; and</text>
      </level>
      <level label="ii">
        <text>Has performed an in–person physical examination of the patient within the jurisdictional boundaries of the adjoining state in which the prescribing physician is authorized to practice medicine; and</text>
      </level>
    </level>
    <level label="5">
      <text>An individual while under the supervision of a licensed physician who has specialty training in psychiatry, and whose specialty training in psychiatry has been approved by the Board, if the individual submits an application to the Board on or before October 1, 1993, and either:</text>
      <level label="i">
        <level label="1">
          <text>Has a master’s degree from an accredited college or university; and</text>
        </level>
        <level label="2">
          <text>Has completed a graduate program accepted by the Board in a behavioral science that includes 1,000 hours of supervised clinical psychotherapy experience; or</text>
        </level>
      </level>
      <level label="ii">
        <level label="1">
          <text>Has a baccalaureate degree from an accredited college or university; and</text>
        </level>
        <level label="2">
          <text>Has 4,000 hours of supervised clinical experience that is approved by the Board.</text>
        </level>
      </level>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-306" title_number="14" title_name="Physicians" subtitle_number="3">
    <level label="a">
      <text>To the extent authorized by the rules, regulations, and orders of the Board, an individual to whom duties are delegated by a licensed physician or physician assistant may perform those duties without a license as provided in this section.</text>
    </level>
    <level label="b">
      <text>The individuals to whom duties may be delegated under this section include any individual authorized to practice any other health occupation regulated under this article or § 13–516 of the Education Article.</text>
    </level>
    <level label="c">
      <level label="1">
        <text>The Board shall adopt rules and regulations to delineate the scope of this section.</text>
      </level>
      <level label="2">
        <text>Before the Board adopts any rule or regulation under this section, the Board shall invite and consider proposals from any individual or health group that could be affected by the rule or regulation.</text>
      </level>
    </level>
    <level label="d">
      <level label="1">
        <text>If a duty that is to be delegated under this section is a part of the practice of a health occupation that is regulated under this article by another board, any rule or regulation concerning that duty shall be adopted jointly by the Board of Physicians and the board that regulates the other health occupation.</text>
      </level>
      <level label="2">
        <text>If the two boards cannot agree on a proposed rule or regulation, the proposal shall be submitted to the Secretary for a final decision.</text>
      </level>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-306.1" title_number="14" title_name="Physicians" subtitle_number="3">
    <level label="a">
      <text>In accordance with regulations adopted by the Board, a licensed physician may delegate duties to a registered cardiovascular invasive specialist assisting in the physician’s performance of fluoroscopy if:</text>
      <level label="1">
        <text>The delegated duties are limited to a cardiac catheterization procedure performed in a hospital cardiac catheterization laboratory;</text>
      </level>
      <level label="2">
        <text>The physician is physically present and personally directs each act performed by the registered cardiovascular invasive specialist;</text>
      </level>
      <level label="3">
        <text>The registered cardiovascular invasive specialist has completed the training and education and has the experience required by regulations adopted by the Board; and</text>
      </level>
      <level label="4">
        <text>The hospital in which the cardiac catheterization laboratory is located has verified and documented that the registered cardiovascular invasive specialist has completed the training and education and has the experience required by regulations adopted by the Board.</text>
      </level>
    </level>
    <level label="b">
      <text>The hospital in which the cardiac catheterization laboratory is located and the physician delegating duties to a registered cardiovascular invasive specialist under this section are responsible for ensuring that all requirements of this section are met for each procedure.</text>
    </level>
    <level label="c">
      <text>A disciplinary panel may impose a civil penalty of up to $5,000 for each instance of a hospital’s failure to comply with the requirements of this section.</text>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-306.2" title_number="14" title_name="Physicians" subtitle_number="3">
    <level label="a">
      <level label="1">
        <text>In this section the following words have the meanings indicated.</text>
      </level>
      <level label="2">
        <text>“On–site supervision” means oversight exercised by a delegating physician who is:</text>
        <level label="i">
          <text>Personally treating the patient;</text>
        </level>
        <level label="ii">
          <text>In the same medical office as the patient and the supervised medical graduate; and</text>
        </level>
        <level label="iii">
          <text>Immediately available to provide assistance and guidance to the supervised medical graduate for the duration of the completion of a delegated duty.</text>
        </level>
      </level>
      <level label="3">
        <text>“Supervised medical graduate” means an individual who:</text>
        <level label="i">
          <text>Has a degree of:</text>
          <level label="1">
            <text>Doctor of medicine from a medical school that is accredited by an accrediting organization that the Board recognizes in its regulations; or</text>
          </level>
          <level label="2">
            <text>Doctor of osteopathy from a school of osteopathy in the United States, its territories or possessions, Puerto Rico, or Canada that has standards for graduation equivalent to those established by the American Osteopathic Association; and</text>
          </level>
        </level>
        <level label="ii">
          <text>Has passed parts 1 and 2 of:</text>
          <level label="1">
            <text>The United States Medical Licensing Examination; or</text>
          </level>
          <level label="2">
            <text>The Comprehensive Osteopathic Medical Licensing Examination of the United States.</text>
          </level>
        </level>
      </level>
    </level>
    <level label="b">
      <text>Subject to subsection (c) of this section and in accordance with regulations adopted by the Board, a supervised medical graduate may perform delegated duties under on–site supervision.</text>
    </level>
    <level label="c">
      <text>An individual may not practice as a supervised medical graduate for a period of more than 2 years.</text>
    </level>
    <level label="d">
      <text>For the purposes of this section, a delegating physician is not required to be in the presence of a patient and a supervised medical graduate during the completion of a delegated duty.</text>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-306.3" title_number="14" title_name="Physicians" subtitle_number="3">
    <level label="a">
      <text>In accordance with regulations adopted by the Board, an individual may perform X–ray duties as a limited X–ray machine operator registered with the Board under this section without a license if the X–ray procedures:</text>
      <level label="1">
        <text>Do not include:</text>
        <level label="i">
          <text>Computerized or noncomputerized tomography;</text>
        </level>
        <level label="ii">
          <text>Fluoroscopy;</text>
        </level>
        <level label="iii">
          <text>Invasive radiology;</text>
        </level>
        <level label="iv">
          <text>Mammography;</text>
        </level>
        <level label="v">
          <text>Nuclear medicine;</text>
        </level>
        <level label="vi">
          <text>Radiation therapy; or</text>
        </level>
        <level label="vii">
          <text>Xerography;</text>
        </level>
      </level>
      <level label="2">
        <text>Are limited to X–ray procedures of:</text>
        <level label="i">
          <text>The chest;</text>
        </level>
        <level label="ii">
          <text>The spine, including:</text>
          <level label="1">
            <text>The cervical spine;</text>
          </level>
          <level label="2">
            <text>The lumbar spine;</text>
          </level>
          <level label="3">
            <text>The sacroiliac joints;</text>
          </level>
          <level label="4">
            <text>The sacrum and coccyx; and</text>
          </level>
          <level label="5">
            <text>The thoracic spine;</text>
          </level>
        </level>
        <level label="iii">
          <text>Lower extremities, including:</text>
          <level label="1">
            <text>Toes;</text>
          </level>
          <level label="2">
            <text>The foot;</text>
          </level>
          <level label="3">
            <text>The ankle;</text>
          </level>
          <level label="4">
            <text>The calcaneus;</text>
          </level>
          <level label="5">
            <text>The tibia and fibula;</text>
          </level>
          <level label="6">
            <text>The knee and patella; and</text>
          </level>
          <level label="7">
            <text>The femur; and</text>
          </level>
        </level>
        <level label="iv">
          <text>Upper extremities, including:</text>
          <level label="1">
            <text>Fingers;</text>
          </level>
          <level label="2">
            <text>The hand;</text>
          </level>
          <level label="3">
            <text>The wrist;</text>
          </level>
          <level label="4">
            <text>The forearm;</text>
          </level>
          <level label="5">
            <text>The elbow;</text>
          </level>
          <level label="6">
            <text>The humerus;</text>
          </level>
          <level label="7">
            <text>The shoulder;</text>
          </level>
          <level label="8">
            <text>The clavicle;</text>
          </level>
          <level label="9">
            <text>Acromioclavicular joints; and</text>
          </level>
          <level label="10">
            <text>The scapula;</text>
          </level>
        </level>
      </level>
      <level label="3">
        <text>Are performed under the supervision of a licensed physician or radiographer who is on–site or able to provide immediately available direction; and</text>
      </level>
      <level label="4">
        <text>Are performed by an individual who has registered with the Board and attests:</text>
        <level label="i">
          <text>To the successful completion of at least 6 months of clinical care experience;</text>
        </level>
        <level label="ii">
          <text>To the successful completion of:</text>
          <level label="1">
            <text>A limited X–ray educational program; or</text>
          </level>
          <level label="2">
            <text>The first year of an accredited radiologic technologist program in good standing with the Board;</text>
          </level>
        </level>
        <level label="iii">
          <text>To the successful completion of at least 115 hours of didactic training delivered by a radiologic technologist certified by the American Registry of Radiologic Technologists providing instruction in radiographic anatomy, procedures, and pathology, digital image acquisition and display, fundamentals, ethics, and laws of health care, human anatomy and physiology, image production and analysis, imaging equipment and radiation production, medical terminology, and patient care;</text>
        </level>
        <level label="iv">
          <text>To the successful completion of at least 480 hours of clinical training;</text>
        </level>
        <level label="v">
          <text>To the successful completion of a minimum of five competencies in each body part listed under subsection (a)(2) of this section under the direct supervision of a radiologic technologist certified by the American Registry of Radiologic Technologists; and</text>
        </level>
        <level label="vi">
          <text>To the successful achievement of a passing score, as determined by the Board, on the American Registry of Radiologic Technologists examination for limited scope of practice in radiography or an alternative examination approved by the Board.</text>
        </level>
      </level>
    </level>
    <level label="b">
      <text>If the applicant completed the first year of an accredited radiologic technologist educational program, the program director of the educational program shall provide an attestation directly to the Board stating that the applicant meets or exceeds the requirements of subsection (a)(4)(i), (ii)2, (iii), (iv), (v), and (vi) of this section.</text>
    </level>
    <level label="c">
      <text>An individual seeking registration under this section shall:</text>
      <level label="1">
        <text>Apply for registration on a form supplied by the Board;</text>
      </level>
      <level label="2">
        <text>Pay the registration fee established by the Board; and</text>
      </level>
      <level label="3">
        <text>Complete any other requirements established by the Board.</text>
      </level>
    </level>
    <level label="d">
      <text>If an individual was denied a license by the Board, the individual is not eligible for registration under this section.</text>
    </level>
    <level label="e">
      <text>An individual registered under this section shall complete at least 24 hours of approved continuing education credits earned during the 2–year period immediately preceding the expiration of a registration.</text>
    </level>
    <level label="f">
      <level label="1">
        <text>The term of a registration may not exceed 3 years.</text>
      </level>
      <level label="2">
        <text>A registration shall expire on a date established by the Board.</text>
      </level>
      <level label="3">
        <text>To renew a registration, the registrant must:</text>
        <level label="i">
          <text>Apply for renewal on a form supplied by the Board;</text>
        </level>
        <level label="ii">
          <text>Pay the renewal fee established by the Board; and</text>
        </level>
        <level label="iii">
          <text>Complete any other requirements established by the Board.</text>
        </level>
      </level>
    </level>
    <level label="g">
      <text>An applicant for registration shall complete a criminal history records check in accordance with § 14–308.1 of this subtitle.</text>
    </level>
    <level label="h">
      <level label="1">
        <text>The Board shall set reasonable fees for the issuance and renewal of registrations and other services provided.</text>
      </level>
      <level label="2">
        <text>The fees charged shall be set so as to produce funds to approximate the cost of maintaining the registration program and other services provided to registrants under this section.</text>
      </level>
    </level>
    <level label="i">
      <text>In accordance with regulations adopted by the Board, a physician’s office that employs an individual authorized to perform X–ray duties without a license under this section is responsible for ensuring that all requirements of this section are met for each X–ray examination performed.</text>
    </level>
    <level label="j">
      <text>If an unregistered individual performs X–ray duties without meeting the requirements of this section, the Board may impose a civil penalty of up to:</text>
      <level label="1">
        <text>$5,000 for each violation on the physician’s office where the violation occurred; and</text>
      </level>
      <level label="2">
        <text>$1,000 for each violation on the individual who committed the violation.</text>
      </level>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-306.4" title_number="14" title_name="Physicians" subtitle_number="3">
    <level label="a">
      <text>Subject to the hearing provisions of § 14–405 of this title, a disciplinary panel, on the affirmative vote of a majority of the quorum of the disciplinary panel, may deny a registration to practice as a limited X–ray machine operator to any applicant, reprimand any limited X–ray machine operator registrant, place any registrant on probation, or suspend or revoke a registration, if the applicant or registrant:</text>
      <level label="1">
        <text>Fraudulently or deceptively obtains or attempts to obtain a registration for the applicant, registrant, or for another;</text>
      </level>
      <level label="2">
        <text>Fraudulently or deceptively uses a registration;</text>
      </level>
      <level label="3">
        <text>Is guilty of:</text>
        <level label="i">
          <text>Immoral conduct in the practice of limited X–ray machine operation; or</text>
        </level>
        <level label="ii">
          <text>Unprofessional conduct in the practice of limited X–ray machine operation;</text>
        </level>
      </level>
      <level label="4">
        <text>Is:</text>
        <level label="i">
          <text>Professionally incompetent;</text>
        </level>
        <level label="ii">
          <text>Physically incompetent; or</text>
        </level>
        <level label="iii">
          <text>Mentally incompetent;</text>
        </level>
      </level>
      <level label="5">
        <text>Abandons a patient;</text>
      </level>
      <level label="6">
        <text>Is habitually intoxicated;</text>
      </level>
      <level label="7">
        <text>Is addicted to or habitually abuses any narcotic or controlled dangerous substance as defined in § 5–101 of the Criminal Law Article;</text>
      </level>
      <level label="8">
        <text>Provides professional services while:</text>
        <level label="i">
          <text>Under the influence of alcohol; or</text>
        </level>
        <level label="ii">
          <text>Using any narcotic or controlled dangerous substance as defined in § 5–101 of the Criminal Law Article or any other drug that is in excess of therapeutic amounts or without valid medical indication;</text>
        </level>
      </level>
      <level label="9">
        <text>Promotes the sale of services, drugs, devices, appliances, or goods to a patient so as to exploit the patient for financial gain;</text>
      </level>
      <level label="10">
        <text>Willfully makes or files a false report or record in the practice of limited X–ray machine operation;</text>
      </level>
      <level label="11">
        <text>Willfully fails to file or record any report as required under law, willfully impedes or obstructs the filing or recording of a report, or induces another to fail to file or record a report;</text>
      </level>
      <level label="12">
        <text>Breaches patient confidentiality;</text>
      </level>
      <level label="13">
        <text>Pays or agrees to pay any sum or provide any form of remuneration or material benefit to any person for bringing or referring a patient or accepts or agrees to accept any sum or any form of remuneration or material benefit from an individual for bringing or referring a patient;</text>
      </level>
      <level label="14">
        <text>Willfully makes a misrepresentation while practicing limited X–ray machine operation;</text>
      </level>
      <level label="15">
        <text>Willfully practices limited X–ray machine operation with an unauthorized individual or aids an unauthorized individual in the practice of limited X–ray machine operation;</text>
      </level>
      <level label="16">
        <text>Offers, undertakes, or agrees to cure or treat disease by a secret method, treatment, or medicine;</text>
      </level>
      <level label="17">
        <text>Is disciplined by a licensing or disciplinary authority or is convicted or disciplined by a court of any state or country or is disciplined by any branch of the uniformed services or the U.S. Department of Veterans Affairs for an act that would be grounds for disciplinary action under the Board’s disciplinary statutes;</text>
      </level>
      <level label="18">
        <text>Fails to meet appropriate standards for the delivery of quality limited X–ray machine operation care performed in any outpatient surgical facility, office, hospital or related institution, or any other location in this State;</text>
      </level>
      <level label="19">
        <text>Willfully submits false statements to collect fees for which services are not provided;</text>
      </level>
      <level label="20">
        <level label="i">
          <text>Has been subject to investigation or disciplinary action by a disciplinary authority or by a court of any state or country for an act that would be grounds for disciplinary action under the Board’s disciplinary statutes; and</text>
        </level>
        <level label="ii">
          <text>Has:</text>
          <level label="1">
            <text>Surrendered the license, registration, certification, or permit issued by the State or country; or</text>
          </level>
          <level label="2">
            <text>Allowed the license, registration, certification, or permit issued by the State or country to expire or lapse;</text>
          </level>
        </level>
      </level>
      <level label="21">
        <text>Willfully fails to report suspected child abuse in violation of § 5–704 of the Family Law Article;</text>
      </level>
      <level label="22">
        <text>Sells, prescribes, gives away, or administers drugs for illegal or illegitimate medical purposes;</text>
      </level>
      <level label="23">
        <text>Practices or attempts to practice beyond the authorized scope of practice;</text>
      </level>
      <level label="24">
        <text>Refuses, withholds from, denies, or discriminates against an individual with regard to the provision of professional services for which the licensee is licensed and qualified to render because the individual is HIV positive;</text>
      </level>
      <level label="25">
        <text>Practices or attempts to practice a limited X–ray machine operation procedure or uses limited X–ray machine operation equipment if the applicant or registrant has not received an education, an internship, training, or experience in the performance of the procedure or the use of the equipment;</text>
      </level>
      <level label="26">
        <text>Fails to cooperate with a lawful investigation conducted by the Board or a disciplinary panel;</text>
      </level>
      <level label="27">
        <text>Fails to practice under the supervision of a licensed physician or licensed radiographer or violates a supervisory order of a supervising physician or supervising radiographer; or</text>
      </level>
      <level label="28">
        <text>Fails to complete a criminal history records check under § 14–308.1 of this subtitle.</text>
      </level>
    </level>
    <level label="b">
      <text>Except as otherwise provided in the Administrative Procedure Act, before the Board or a disciplinary panel takes any action under subsection (a) of this section, the Board or a disciplinary panel shall give the individual against whom the action is contemplated an opportunity for a hearing before the Board or the disciplinary panel in accordance with the hearing requirements of § 14–405 of this title.</text>
    </level>
    <level label="c">
      <level label="1">
        <text>On the filing of certified docket entries with the Board by the Office of the Attorney General, a disciplinary panel shall order the suspension of a registration if the registrant is convicted of or pleads guilty or nolo contendere with respect to a crime involving moral turpitude, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside.</text>
      </level>
      <level label="2">
        <text>After completion of the appellate process, if the conviction has not been reversed or the plea has not been set aside with respect to a crime involving moral turpitude, a disciplinary panel shall order the revocation of a registration on the certification by the Office of the Attorney General.</text>
      </level>
    </level>
    <level label="d">
      <text>If, after a hearing under § 14–405 of this title, a disciplinary panel finds that there are grounds under subsection (a) of this section to suspend or revoke a registration, to reprimand a registrant, or to place a registrant on probation, the disciplinary panel may impose a fine subject to the Board’s regulations in addition to suspending or revoking the license, reprimanding the registrant, or placing the registrant on probation.</text>
    </level>
    <level label="e">
      <text>In addition to any sanction authorized under this section, a disciplinary panel may require a registrant to comply with specified terms and conditions determined by the disciplinary panel.</text>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-307" title_number="14" title_name="Physicians" subtitle_number="3">
    <level label="a">
      <text>To qualify for a license, an applicant shall be an individual who meets the requirements of this section.</text>
    </level>
    <level label="b">
      <text>The applicant shall be of good moral character.</text>
    </level>
    <level label="c">
      <text>The applicant shall be at least 18 years old.</text>
    </level>
    <level label="d">
      <text>Except as provided in § 14–308 of this subtitle, the applicant shall:</text>
      <level label="1">
        <level label="i">
          <text>Have a degree of doctor of medicine from a medical school that is accredited by an accrediting organization that the Board recognizes in its regulations; and</text>
        </level>
        <level label="ii">
          <text>Submit evidence acceptable to the Board of successful completion of 1 year of training in a postgraduate medical training program that is accredited by an accrediting organization that the Board recognizes in its regulations; or</text>
        </level>
      </level>
      <level label="2">
        <level label="i">
          <text>Have a degree of doctor of osteopathy from a school of osteopathy in the United States, its territories or possessions, Puerto Rico, or Canada that has standards for graduation equivalent to those established by the American Osteopathic Association; and</text>
        </level>
        <level label="ii">
          <text>Submit evidence acceptable to the Board of successful completion of 1 year of training in a postgraduate medical training program accredited by an accrediting organization that the Board recognizes in its regulations.</text>
        </level>
      </level>
    </level>
    <level label="e">
      <text>Except as otherwise provided in this subtitle, the applicant shall meet any education, certification, training, or examination requirements established by the Board.</text>
    </level>
    <level label="f">
      <text>The applicant shall meet any other qualifications that the Board establishes in its regulations for license applicants.</text>
    </level>
    <level label="g">
      <text>An otherwise qualified applicant who passes the examination after having failed the examination or any part of the examination 3 or more times may qualify for a license only if the applicant:</text>
      <level label="1">
        <text>Has successfully completed 2 or more years of a residency or fellowship accredited by the Accreditation Council on Graduate Medical Education or the American Osteopathic Association;</text>
      </level>
      <level label="2">
        <level label="i">
          <text>Has a minimum of 5 years of clinical practice of medicine:</text>
          <level label="1">
            <text>In the United States or in Canada;</text>
          </level>
          <level label="2">
            <text>With at least 3 of the 5 years having occurred within 5 years of the date of the application; and</text>
          </level>
          <level label="3">
            <text>That occurred under a full unrestricted license to practice medicine; and</text>
          </level>
        </level>
        <level label="ii">
          <text>Has no disciplinary action pending and has had no disciplinary action taken against the applicant that would be grounds for discipline under § 14–404 of this title; or</text>
        </level>
      </level>
      <level label="3">
        <text>Is board certified.</text>
      </level>
    </level>
    <level label="h">
      <level label="1">
        <text>The Board shall require as part of its examination or licensing procedures that an applicant for a license to practice medicine demonstrate an oral and written competency in the English language.</text>
      </level>
      <level label="2">
        <text>Graduation from a recognized English–speaking undergraduate school or high school, including General Education Development (GED), after at least 3 years of enrollment, or from a recognized English–speaking professional school is acceptable as proof of proficiency in the oral and written communication of the English language under this section.</text>
      </level>
      <level label="3">
        <text>By regulation, the Board shall develop a procedure for testing individuals who because of their speech impairment are unable to complete satisfactorily a Board approved standardized test of oral competency.</text>
      </level>
      <level label="4">
        <text>If any disciplinary charges or action that involves a problem with the oral and written communication of the English language are brought against a licensee under this title, the Board shall require the licensee to take and pass a Board approved standardized test of oral and written competency.</text>
      </level>
    </level>
    <level label="i">
      <text>The applicant shall complete a criminal history records check in accordance with § 14–308.1 of this subtitle.</text>
    </level>
    <level label="j">
      <level label="1">
        <text>The Board shall license an applicant to practice medicine if:</text>
        <level label="i">
          <text>The applicant:</text>
          <level label="1">
            <text>Became licensed or certified as a physician in another jurisdiction under requirements that the Board determines are substantially equivalent to the licensing requirements of this title;</text>
          </level>
          <level label="2">
            <text>Is in good standing under the laws of the other jurisdiction;</text>
          </level>
          <level label="3">
            <text>Submits an application to the Board on a form that the Board requires; and</text>
          </level>
          <level label="4">
            <text>Pays to the Board an application fee set by the Board; and</text>
          </level>
        </level>
        <level label="ii">
          <text>The jurisdiction in which the applicant is licensed or certified offers a similar reciprocal licensing process for individuals licensed to practice medicine by the Board.</text>
        </level>
      </level>
      <level label="2">
        <text>The Board shall adopt regulations to implement this subsection.</text>
      </level>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-308" title_number="14" title_name="Physicians" subtitle_number="3">
    <level label="a">
      <level label="1">
        <text>In this section the following terms have the meanings indicated.</text>
      </level>
      <level label="2">
        <text>“Fifth pathway program” means a program that the Board approves in its regulations for a student who:</text>
        <level label="i">
          <text>Has studied medicine at an international medical school;</text>
        </level>
        <level label="ii">
          <text>Was a United States citizen when the student enrolled in the international medical school; and</text>
        </level>
        <level label="iii">
          <text>Has completed all of the formal requirements for graduation from the international medical school, except for any social service or postgraduate requirements.</text>
        </level>
      </level>
      <level label="3">
        <text>“International medical school” means a medical school located outside of the United States, its territories or possessions, Puerto Rico, or Canada.</text>
      </level>
    </level>
    <level label="b">
      <text>An applicant for a license is exempt from the educational requirements of § 14–307 of this subtitle, if the applicant:</text>
      <level label="1">
        <text>Has studied medicine at an international medical school;</text>
      </level>
      <level label="2">
        <text>Is certified by the Educational Commission for Foreign Medical Graduates or by its successor as approved by the Board;</text>
      </level>
      <level label="3">
        <text>Passes a qualifying examination for international medical school graduates required by the Board;</text>
      </level>
      <level label="4">
        <text>Meets any other qualifications for international medical school graduates that the Board establishes in its regulation for licensing of applicants;</text>
      </level>
      <level label="5">
        <text>Submits acceptable evidence to the Board of the requirements set in the Board’s regulations; and</text>
      </level>
      <level label="6">
        <text>Meets one of the following requirements:</text>
        <level label="i">
          <text>The applicant graduated from any international medical school and submits evidence acceptable to the Board of successful completion of 2 years of training in a postgraduate medical education program accredited by an accrediting organization recognized by the Board; or</text>
        </level>
        <level label="ii">
          <text>The applicant successfully completed a fifth pathway program and submits evidence acceptable to the Board that the applicant:</text>
          <level label="1">
            <text>Has a document issued by the international medical school certifying that the applicant completed all of the formal requirements of that school for the study of medicine, except for the postgraduate or social service components as required by the international country or its medical school;</text>
          </level>
          <level label="2">
            <text>Has successfully completed a fifth pathway program; and</text>
          </level>
          <level label="3">
            <text>Has successfully completed 2 years of training in a postgraduate medical education program following completion of a Board approved fifth pathway program.</text>
          </level>
        </level>
      </level>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-308.1" title_number="14" title_name="Physicians" subtitle_number="3">
    <level label="a">
      <text>In this section, “Central Repository” means the Criminal Justice Information System Central Repository of the Department of Public Safety and Correctional Services.</text>
    </level>
    <level label="b">
      <text>An applicant, a licensee, or a certificate holder shall apply to the Central Repository for a State and national criminal history records check.</text>
    </level>
    <level label="c">
      <text>As part of the application required under subsection (b) of this section, an individual shall submit to the Central Repository:</text>
      <level label="1">
        <text>Two complete sets of legible fingerprints taken on forms approved by the Director of the Central Repository and the Director of the Federal Bureau of Investigation;</text>
      </level>
      <level label="2">
        <text>The fee authorized under § 10–221(b)(7) of the Criminal Procedure Article for access to State criminal history records; and</text>
      </level>
      <level label="3">
        <text>The mandatory processing fee required by the Federal Bureau of Investigation for a national criminal history records check.</text>
      </level>
    </level>
    <level label="d">
      <text>In accordance with §§ 10–201 through 10–229 of the Criminal Procedure Article, the Central Repository shall forward to the Board and to the individual the criminal history record information of the individual.</text>
    </level>
    <level label="e">
      <text>If criminal history record information is reported to the Central Repository after the date of the initial criminal history records check, the Central Repository shall provide to the Board and the individual a revised printed statement of the individual’s State criminal history record.</text>
    </level>
    <level label="f">
      <text>Information obtained from the Central Repository under this section:</text>
      <level label="1">
        <text>Is confidential;</text>
      </level>
      <level label="2">
        <text>May not be redisseminated; and</text>
      </level>
      <level label="3">
        <text>May be used only for the licensing purpose authorized by this title.</text>
      </level>
    </level>
    <level label="g">
      <text>The subject of a criminal history records check under this section may contest the contents of the printed statement issued by the Central Repository as provided in § 10–223 of the Criminal Procedure Article.</text>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-309" title_number="14" title_name="Physicians" subtitle_number="3">
    <text>To apply for a license, an applicant shall:</text>
    <level label="1">
      <text>Complete a criminal history records check in accordance with § 14–308.1 of this subtitle;</text>
    </level>
    <level label="2">
      <text>Submit an application to the Board on the form that the Board requires; and</text>
    </level>
    <level label="3">
      <text>Pay to the Board the application fee set by the Board.</text>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-311" title_number="14" title_name="Physicians" subtitle_number="3">
    <level label="a">
      <text>An applicant who otherwise qualifies for a license under this title is entitled to sit for an examination as provided under this section or any regulations adopted to carry out this section.</text>
    </level>
    <level label="b">
      <text>An applicant shall:</text>
      <level label="1">
        <text>Attain on the federation licensing examination or the United States Medical Licensing Examination a passing score as set by the Board under its rules and regulations; or</text>
      </level>
      <level label="2">
        <text>Hold a certificate of proficiency and professional standing of:</text>
        <level label="i">
          <text>The National Board of Medical Examiners;</text>
        </level>
        <level label="ii">
          <text>The board of medical examiners of this State or any other state that was issued before January 1, 1985;</text>
        </level>
        <level label="iii">
          <text>The National Board of Examiners for Osteopathic Physicians and Surgeons, if the certificate is issued after January 1, 1971; or</text>
        </level>
        <level label="iv">
          <text>The Licentiate of the Medical Council of Canada.</text>
        </level>
      </level>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-312" title_number="14" title_name="Physicians" subtitle_number="3">
    <text>On request of the Board, a physician who reports to the Board that the physician maintains medical professional liability insurance for purposes of the public individual profile maintained by the Board under § 14–411.1(b) of this title shall provide the Board with verification or other documentation that the physician maintains the insurance within 25 business days after the physician receives a request from the Board.</text>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-313" title_number="14" title_name="Physicians" subtitle_number="3">
    <level label="a">
      <text>Subject to subsection (b) of this section, the Board shall issue a license to any applicant who meets the requirements of this title.</text>
    </level>
    <level label="b">
      <level label="1">
        <text>On receipt of the criminal history record information of an applicant for licensure forwarded to the Board in accordance with § 14–308.1 of this subtitle, in determining whether to issue a license, the Board shall consider:</text>
        <level label="i">
          <text>The age at which the crime was committed;</text>
        </level>
        <level label="ii">
          <text>The nature of the crime;</text>
        </level>
        <level label="iii">
          <text>The circumstances surrounding the crime;</text>
        </level>
        <level label="iv">
          <text>The length of time that has passed since the crime;</text>
        </level>
        <level label="v">
          <text>Subsequent work history;</text>
        </level>
        <level label="vi">
          <text>Employment and character references; and</text>
        </level>
        <level label="vii">
          <text>Other evidence that demonstrates whether the applicant poses a threat to the public health or safety.</text>
        </level>
      </level>
      <level label="2">
        <text>The Board may not issue a license if the criminal history record information required under § 14–308.1 of this subtitle has not been received.</text>
      </level>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-313.1" effective_note="EFFECTIVE UNTIL JUNE 30, 2030 PER CHAPTER 313 OF 2022" title_number="14" title_name="Physicians" subtitle_number="3">
    <level label="a">
      <text>Within 30 days after receiving a request from the Board, a compact physician shall provide to the Board verification, on a form provided by the Board, that the compact physician satisfies the requirements for licensure under this subtitle.</text>
    </level>
    <level label="b">
      <text>Refusal by a compact physician to provide the verification requested under subsection (a) of this section may not be considered a basis for denial of a license under the Interstate Medical Licensure Compact established under § 14–3A–01 of this title.</text>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-314" title_number="14" title_name="Physicians" subtitle_number="3">
    <level label="a">
      <text>Except as otherwise provided in this title, a license authorizes the licensee to practice medicine while the license is effective.</text>
    </level>
    <level label="b">
      <text>A licensee may practice medicine using only the name in which the license is issued.</text>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-315" title_number="14" title_name="Physicians" subtitle_number="3">
    <level label="a">
      <text>The Board shall issue a license free of charge to any physician who:</text>
      <level label="1">
        <text>Provides medical services to patients for which the physician receives no personal remuneration;</text>
      </level>
      <level label="2">
        <text>Is not engaged in the private practice of medicine; and</text>
      </level>
      <level label="3">
        <text>Otherwise qualifies for a license under this title.</text>
      </level>
    </level>
    <level label="b">
      <text>Except as provided in subsection (c) of this section, each license issued under this section expires on a date set by the Board and may be renewed for a term set by the Board.</text>
    </level>
    <level label="c">
      <level label="1">
        <text>If, at any time, a physician licensed under this section ceases to meet the requirements of subsection (a)(1) or (2) of this section, the licensee shall notify the Board of the status change.</text>
      </level>
      <level label="2">
        <text>On receipt of this notice, the Board shall charge the physician the license fee otherwise required under this subtitle.</text>
      </level>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-316" future_version_removed="true" title_number="14" title_name="Physicians" subtitle_number="3">
    <level label="a">
      <level label="1">
        <text>This subsection does not apply to a physician who is on inactive status under § 14–320 of this subtitle or emeritus status under § 14–320.1 of this subtitle.</text>
      </level>
      <level label="2">
        <text>The term of a license issued by the Board may not exceed 3 years.</text>
      </level>
      <level label="3">
        <text>A license expires on a date set by the Board, unless the license is renewed for an additional term as provided in this section.</text>
      </level>
    </level>
    <level label="b">
      <level label="1">
        <text>Subject to paragraph (2) of this subsection, at least 1 month before the license expires, the Board shall send to the licensee, by electronic or first–class mail to the last known electronic or physical address of the licensee a renewal notice that states:</text>
        <level label="i">
          <text>The date on which the current license expires;</text>
        </level>
        <level label="ii">
          <text>The date by which the renewal application must be received by the Board for the renewal to be issued and mailed before the license expires; and</text>
        </level>
        <level label="iii">
          <text>The amount of the renewal fee.</text>
        </level>
      </level>
      <level label="2">
        <text>If the Board chooses to send renewal notices exclusively by electronic mail under paragraph (1) of this subsection, the Board shall send a renewal notice by first–class mail to a licensee on request of the licensee.</text>
      </level>
    </level>
    <level label="c">
      <level label="1">
        <text>Before the license expires, the licensee periodically may renew it for an additional term, if the licensee:</text>
        <level label="i">
          <text>Otherwise is entitled to be licensed;</text>
        </level>
        <level label="ii">
          <text>Is of good moral character;</text>
        </level>
        <level label="iii">
          <text>Pays to the Board a renewal fee set by the Board;</text>
        </level>
        <level label="iv">
          <text>Submits to the Board:</text>
          <level label="1">
            <text>A renewal application on the form that the Board requires; and</text>
          </level>
          <level label="2">
            <text>Satisfactory evidence of compliance with any continuing education or competency requirements set under this section for license renewal; and</text>
          </level>
        </level>
        <level label="v">
          <text>Meets any additional license renewal requirements established by the Board.</text>
        </level>
      </level>
      <level label="2">
        <text>Within 30 days after a license renewal under Section 7 of the Interstate Medical Licensure Compact established under § 14–3A–01 of this title, a compact physician shall submit to the Board the information required under paragraph (1)(iv) of this subsection.</text>
      </level>
    </level>
    <level label="d">
      <level label="1">
        <text>In addition to any other qualifications and requirements established by the Board, the Board may establish continuing education or competency requirements as a condition to the renewal of licenses under this section.</text>
      </level>
      <level label="2">
        <text>In establishing these requirements, the Board shall evaluate existing methods, devices, and programs in use among the various medical specialties and other recognized medical groups.</text>
      </level>
      <level label="3">
        <text>The Board shall adopt regulations that allow a licensee seeking renewal to receive up to 5 continuing education credits per renewal period for providing uncompensated, voluntary medical services during each renewal period.</text>
      </level>
      <level label="4">
        <text>The Board may not establish or enforce these requirements if they would so reduce the number of physicians in a community as to jeopardize the availability of adequate medical care in that community.</text>
      </level>
      <level label="5">
        <text>The Board may not establish a continuing education requirement that every licensee complete a specific course or program as a condition to the renewal of a license under this section.</text>
      </level>
      <level label="6">
        <text>A disciplinary panel may impose a civil penalty of up to $100 per continuing medical education credit in lieu of a sanction under § 14–404 of this title, for a first offense, for the failure of a licensee to obtain the continuing medical education credits required by the Board.</text>
      </level>
    </level>
    <level label="e">
      <text>The Board shall renew the license of each licensee who meets the requirements of this section.</text>
    </level>
    <level label="f">
      <level label="1">
        <text>A licensee shall notify the Board in writing of a change in name or address within 30 days after the change.</text>
      </level>
      <level label="2">
        <text>A licensee who fails to comply with paragraph (1) of this subsection is subject to an administrative penalty of $100.</text>
      </level>
    </level>
    <level label="g">
      <level label="1">
        <text>Beginning October 1, 2016, the Board shall require a criminal history records check in accordance with § 14–308.1 of this subtitle for:</text>
        <level label="i">
          <text>Renewal applicants as determined by regulations adopted by the Board; and</text>
        </level>
        <level label="ii">
          <text>Each former licensee who files for reinstatement under § 14–317 of this subtitle.</text>
        </level>
      </level>
      <level label="2">
        <text>On receipt of the criminal history record information of a licensee forwarded to the Board in accordance with § 14–308.1 of this subtitle, in determining whether disciplinary action should be taken, based on the criminal record information, against a licensee who renewed or reinstated a license, the Board shall consider:</text>
        <level label="i">
          <text>The age at which the crime was committed;</text>
        </level>
        <level label="ii">
          <text>The nature of the crime;</text>
        </level>
        <level label="iii">
          <text>The circumstances surrounding the crime;</text>
        </level>
        <level label="iv">
          <text>The length of time that has passed since the crime;</text>
        </level>
        <level label="v">
          <text>Subsequent work history;</text>
        </level>
        <level label="vi">
          <text>Employment and character references; and</text>
        </level>
        <level label="vii">
          <text>Other evidence that demonstrates whether the licensee poses a threat to the public health or safety.</text>
        </level>
      </level>
      <level label="3">
        <text>The Board may renew or reinstate a license only if the licensee or applicant attests that the licensee or applicant has submitted to a criminal history records check under § 14–308.1 of this subtitle.</text>
      </level>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-317" title_number="14" title_name="Physicians" subtitle_number="3">
    <text>The Board shall reinstate the license of a physician who has failed to renew the license for any reason, is on inactive status under § 14–320 of this subtitle, or is on emeritus status under § 14–320.1 of this subtitle if the physician:</text>
    <level label="1">
      <text>Meets the renewal requirements of § 14–316 of this subtitle;</text>
    </level>
    <level label="2">
      <text>Submits a reinstatement application on the form that the Board requires;</text>
    </level>
    <level label="3">
      <text>Pays to the Board a reinstatement fee set by the Board;</text>
    </level>
    <level label="4">
      <text>Submits to the Board satisfactory evidence of compliance with the qualifications and requirements established under this title for license reinstatements; and</text>
    </level>
    <level label="5">
      <text>Meets any additional license reinstatement requirements established by the Board.</text>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-318" title_number="14" title_name="Physicians" subtitle_number="3">
    <level label="a">
      <text>If an applicant is qualified as a postgraduate teacher, the Board may:</text>
      <level label="1">
        <text>Waive the examination requirements of this subtitle for the applicant; and</text>
      </level>
      <level label="2">
        <text>Issue to the applicant a limited license to practice medicine for postgraduate teaching.</text>
      </level>
    </level>
    <level label="b">
      <text>Each limited license issued under this section expires on the first anniversary of its effective date.</text>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-319" title_number="14" title_name="Physicians" subtitle_number="3">
    <level label="a">
      <text>The Board may:</text>
      <level label="1">
        <text>License an applicant by virtue of the conceded eminence and authority of the applicant in the profession if the applicant:</text>
        <level label="i">
          <text>Is recommended to the Board by:</text>
          <level label="1">
            <text>The dean of a school of medicine in the State; or</text>
          </level>
          <level label="2">
            <text>The Director of the National Institutes of Health;</text>
          </level>
        </level>
        <level label="ii">
          <text>Is to receive an appointment at the institution making the recommendation under item (i) of this paragraph; and</text>
        </level>
        <level label="iii">
          <text>Meets any other requirement the Board may adopt by regulation under this section;</text>
        </level>
      </level>
      <level label="2">
        <text>Define by regulation the term “conceded eminence and authority in the profession” and, for this purpose, shall consider such criteria as:</text>
        <level label="i">
          <text>Academic appointments;</text>
        </level>
        <level label="ii">
          <text>Length of time in the profession;</text>
        </level>
        <level label="iii">
          <text>Scholarly publications; and</text>
        </level>
        <level label="iv">
          <text>Professional accomplishments;</text>
        </level>
      </level>
      <level label="3">
        <text>Adopt regulations concerning the further qualifications of an applicant for licensure, including conditions of employment, application procedures, and fees under this section;</text>
      </level>
      <level label="4">
        <text>Allow an exception to the general education and examination requirements of § 14–307(d) and (e) of this subtitle, but may not permit waiver of the requirements of § 14–307(a) through (c) of this subtitle;</text>
      </level>
      <level label="5">
        <text>Qualify, restrict, or otherwise limit a license granted under this section; and</text>
      </level>
      <level label="6">
        <text>Require a 6–month probationary period during which the medical services performed by the applicant granted a license under this section are supervised by another licensed physician.</text>
      </level>
    </level>
    <level label="b">
      <text>Upon judicial review, a determination by the Board under this section shall be accorded the maximum deference permitted by law.</text>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-320" title_number="14" title_name="Physicians" subtitle_number="3">
    <level label="a">
      <text>The Board may place a licensee on inactive status, if the licensee submits to the Board:</text>
      <level label="1">
        <text>An application for inactive status on the form required by the Board; and</text>
      </level>
      <level label="2">
        <text>The inactive status fee set by the Board.</text>
      </level>
    </level>
    <level label="b">
      <text>A licensee on inactive status is exempt from the continuing education requirements under § 14–316(d) of this subtitle.</text>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-320.1" title_number="14" title_name="Physicians" subtitle_number="3">
    <level label="a">
      <text>The Board may place a licensee on emeritus status, if the licensee submits to the Board:</text>
      <level label="1">
        <text>An application for emeritus status on the form required by the Board; and</text>
      </level>
      <level label="2">
        <text>The emeritus status fee set by the Board.</text>
      </level>
    </level>
    <level label="b">
      <text>The Board shall place a licensee on emeritus status if the individual:</text>
      <level label="1">
        <text>Has an active, unrestricted license to practice medicine under this subtitle;</text>
      </level>
      <level label="2">
        <text>Is not under investigation by the Board for a violation of this title;</text>
      </level>
      <level label="3">
        <text>Has practiced medicine in this State for at least 10 years;</text>
      </level>
      <level label="4">
        <text>Has not been the subject of disciplinary action in a jurisdiction where the individual is licensed that resulted in the revocation or suspension of the individual’s license; and</text>
      </level>
      <level label="5">
        <text>Attests that the individual is retired and is no longer actively practicing medicine in this State.</text>
      </level>
    </level>
    <level label="c">
      <text>A licensee on emeritus status is exempt from the continuing education requirements under § 14–316(d) of this subtitle.</text>
    </level>
  </section>
  <section article="gho" article_name="Health Occupations" number="14-322" title_number="14" title_name="Physicians" subtitle_number="3">
    <text>Notwithstanding any other law, the Board may not require as a qualification to obtain a license or as a condition to renew a license:</text>
    <level label="1">
      <text>Certification by a nationally recognized accrediting organization that specializes in a specific area of medicine; or</text>
    </level>
    <level label="2">
      <text>Maintenance of certification by a nationally recognized accrediting organization that specializes in a specific area of medicine that includes continuous reexamination to measure core competencies in the practice of medicine as a requirement for maintaining certification.</text>
    </level>
  </section>
</subtitle>