# COMAR Title 10 — Maryland Department of Health

## Subtitle 03 — Health Statistics

### Chapter 01 — Vital Records

**Authority:** Family Law Article, §§5-359, 5-3A-42, and 5-3B-29, and Title 5, Subtitle 4B;Health-General Article, §§4-201—4-227 and 13-2207; Annotated Code of MarylandCh.316, Acts of 2016; Public Law 108-458; Public Law 109-13

**Administrative History:** Effective date: October 7, 1963

**Administrative History:** Amended effective January 1, 1965; May 16, 1966; January 1, 1970

**Administrative History:** Regulations .01—.09 repealed effective November 30, 1987 (14:24 Md. R. 2555)

**Administrative History:** Annotation: COMAR 10.03.01.07 cited in Attorney General Opinion No. 85-035 (December 31, 1985)

**Administrative History:** Regulations .01—.10 adopted effective November 30, 1987 (14:24 Md. R. 2555)

**Administrative History:** Regulation .01B amended effective August 17, 1992 (19:16 Md. R. 1474); January 2, 1994 (20:26 Md. R. 2027); January 24, 2000 (27:1 Md. R. 75); February 19, 2001 (28:3 Md. R. 205)

**Administrative History:** Regulation .01B amended as an emergency provision effective September 8, 2003 (30:19 Md. R. 1327); amended permanently effective December 11, 2003 (30:24 Md. R. 1740)

**Administrative History:** Regulation .01B amended effective October 8, 2007 (34:20 Md. R. 1736); June 15, 2009 (36:12 Md. R. 837)

**Administrative History:** Regulation .02 amended effective August 25, 1997 (24:17 Md. R. 1214)

**Administrative History:** Regulation .02 amended as an emergency provision effective December 18, 2002 (30:1 Md. R. 21)

**Administrative History:** Regulation .02 amended effective March 31, 2003 (30:6 Md. R. 420)

**Administrative History:** Regulation .02A, E amended effective June 15, 2009 (36:12 Md. R. 837)

**Administrative History:** Regulation .02C amended effective September 13, 1993 (20:18 Md. R. 1430)

**Administrative History:** Regulation .02D amended effective January 2, 1994 (20:26 Md. R. 2027)

**Administrative History:** Regulation .03B amended effective January 2, 1994 (20:26 Md. R. 2027)

**Administrative History:** Regulation .05 amended effective February 19, 2001 (28:3 Md. R. 205)

**Administrative History:** Regulation .06 amended effective February 19, 2001 (28:3 Md. R. 205)

**Administrative History:** Regulation .07 amended effective January 24, 2000 (27:1 Md. R. 75)

**Administrative History:** Regulation .07 amended as an emergency provision effective December 18, 2002 (30:1 Md. R. 21)

**Administrative History:** Regulation .07 amended as an emergency provision effective September 8, 2003 (30:19 Md. R. 1327); amended permanently effective December 11, 2003 (30:24 Md. R. 1740)

**Administrative History:** Regulation .07 amended effective October 8, 2007 (34:20 Md. R. 1736)

**Administrative History:** Regulation .07A amended effective January 2, 1994 (20:26 Md. R. 2027); August 25, 1997 (24:17 Md. R. 1214)

**Administrative History:** Regulation .07B amended effective August 17, 1992 (19:16 Md. R. 1474); January 2, 1994 (20:26 Md. R. 2027); June 15, 2009 (36:12 Md. R. 837); October 19, 2009 (36:21 Md. R. 1591)

**Administrative History:** Regulation .07C amended effective August 17, 1992 (19:16 Md. R. 1474)

**Administrative History:** Regulation .07D amended effective February 19, 2001 (28:3 Md. R. 205)

**Administrative History:** Regulation .07E amended effective July 9, 1990 (17:13 Md. R. 1610)

**Administrative History:** Regulation .07G amended effective January 17, 2005 (32:1 Md. R. 27)

**Administrative History:** Regulation .07H amended effective July 9, 1990 (17:13 Md. R. 1610); June 15, 2009 (36:12 Md. R. 837)

**Administrative History:** Regulation .07-1 adopted effective March 31, 2003 (30:6 Md. R. 420)

**Administrative History:** Regulation .09 amended as an emergency provision effective December 18, 2002 (30:1 Md. R. 21)

**Administrative History:** Regulation .09 amended effective March 31, 2003 (30:6 Md. R. 420); June 15, 2009 (36:12 Md. R. 837)

**Administrative History:** Regulation .11 adopted as an emergency provision effective January 20, 1989 (16:3 Md. R. 336); adopted permanently effective July 10, 1989 (16:13 Md. R. 1421)

**Administrative History:** Regulation .11 repealed effective June 15, 2009 (36:12 Md. R. 837)

**Administrative History:** Regulation .12 adopted as an emergency provision effective November 15, 1989 (16:26 Md. R. 2782); adopted permanently effective February 19, 1990 (17:3 Md. R. 297)

**Administrative History:** Regulation .12 amended effective February 18, 1991 (18:3 Md. R. 305)

**Administrative History:** Regulation .12 amended as an emergency provision effective September 8, 2003 (30:19 Md. R. 1327); amended permanently effective December 11, 2003 (30:24 Md. R. 1740)

**Administrative History:** Regulation .12B amended effective November 23, 2006 (33:23 Md. R. 1794)

**Administrative History:** Regulation .13 adopted effective August 17, 1992 (19:16 Md. R. 1474)

**Administrative History:** Regulation .14 adopted as an emergency provision effective September 8, 2003 (30:19 Md. R. 1327); adopted permanently effective December 11, 2003 (30:24 Md. R. 1740)

**Administrative History:** Chapter revised effective January 9, 2012 (38:27 Md. R. 1764)

**Administrative History:** Regulation .01B amended effective October 28, 2013 (40:21 Md. R. 1774); June 4, 2018 (45:11 Md. R. 578)

**Administrative History:** Regulation .02 amended effective June 4, 2018 (45:11 Md. R. 578)

**Administrative History:** Regulation .03 amended effective June 4, 2018 (45:11 Md. R. 578)

**Administrative History:** Regulation .03C amended effective January 18, 2016 (43:1 Md. R. 13)

**Administrative History:** Regulation .05F amended effective June 4, 2018 (45:11 Md. R. 578)

**Administrative History:** Regulation .06 amended effective June 4, 2018 (45:11 Md. R. 578)

**Administrative History:** Regulation .08B amended effective February 13, 2017 (44:3 Md. R. 188)

**Administrative History:** Regulation .08I, J amended effective August 29, 2016 (43:17 Md. R. 953)

**Administrative History:** Regulation .10A amended effective June 4, 2018 (45:11 Md. R. 578)

**Administrative History:** Regulation .13 amended effective April 15, 2013 (40:7 Md. R. 610)

**Administrative History:** Regulation .14A amended effective October 28, 2013 (40:21 Md. R. 1774)

**Administrative History:** Regulation .16 adopted effective June 4, 2018 (45:11 Md. R. 578)

#### Regulation .01 Definitions.

*COMAR 10.03.01.01*

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

  (1) Amendment.

    (a) “Amendment” means an alteration of or change to a vital record based on a court order or documentation specified in this chapter.

    (b) “Amendment” includes more than one alteration of or change to a vital record, if the alterations or changes are specified in the same court order or the same request supported by documentation specified in this chapter.

  (2) “Amendment to change a name” means changing or altering any part of the name on a vital record.

  (3) “Attending clinician” means the physician, nurse midwife, or direct-entry midwife in charge of a birth outside an institution.

  (4) Authorized Representative.

    (a) “Authorized representative” means a parent, guardian, or other representative of the subject of the vital record who presents evidence, satisfactory to the Secretary, that that individual is an authorized representative.

    (b) “Authorized representative” includes but is not limited to:

      (i) A member of the immediate or surviving family;

      (ii) A direct ascendant or descendent;

      (iii) An executor;

      (iv) An attorney; or

      (v) After October 1, 1999, a confidential intermediary or the Director of the Social Services Administration of the Department of Human Services.

  (5) “Common carrier” means a public transportation business, line, or system which moves persons or goods from place to place. For the purpose of these regulations, “common carrier” does not include a funeral director's hearse or vehicle.

  (6) “Confidential intermediary” means an individual or child placement agency qualified by the Director of the Social Services Administration of the Department of Human Services for the purpose of providing search, contact, and reunion services, as defined at §B(19) of this regulation.

  (7) “Correction of a name” means altering the spelling of a name to eliminate an obvious misspelling, such as Jaon to Joan, or to eliminate a spelling contrary to the one used by the family, such as Smith to Smythe.

  (8) “Dead body” means a lifeless human body or parts of a body or its bones from the condition of which it reasonably may be concluded that death has occurred. The term “dead body” does not apply to amputated parts.

  (9) “Delayed birth registration” means registration of a birth when the child is more than 1 year old.

  (10) “Department” means the Maryland Department of Health.

  (11) “Direct-entry midwife” means an individual licensed to practice direct-entry midwifery under Health Occupations Article, Title 8, Subtitle 6C, Annotated Code of Maryland.

  (12) “Electronic signature” means an electronic process associated with a record and executed by an individual with the intent to sign the record.

  (13) “Fetal death” means death before the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy. The death is indicated by the fact that after the separation, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.

  (14) “Filing” means the presentation of a certificate, report, or other record provided for in this subtitle, of a birth, death, fetal death, adoption, marriage, or divorce for registration by the Secretary.

  (15) “Final disposition” means the burial, interment, cremation, or other disposition of a dead body or fetus.

  (16) “Human remains” means a dead body or dead fetus for whom a death certificate is required to be filed under this chapter or Health-General Article, Title 4, Subtitle 2, Annotated Code of Maryland.

  (17) “Institution” means any establishment, public or private:

    (a) Which provides in-patient medical, surgical, or diagnostic care or treatment;

    (b) Which provides nursing, custodial, or domiciliary care to two or more unrelated individuals; or

    (c) To which persons are committed by law.

  (18) “Live birth” means the complete expulsion or extraction from its mother of a product of human conception, irrespective of the period of gestation, which, after separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscle, whether the umbilical cord has been cut or the placenta is attached.

  (19) “Mortician” means a funeral director and mortician as defined in Health Occupations Article, Title 7, Annotated Code of Maryland, or other person who is authorized to make final disposition of the human remains.

  (20) “Nurse midwife” means an individual certified to practice as a nurse midwife under Health Occupations Article, Title 8, Annotated Code of Maryland.

  (21) “Physician” means a person authorized or licensed to practice medicine in this State pursuant to the provisions of Health Occupations Article, Title 14, Annotated Code of Maryland.

  (22) “Physician Assistant” means an individual who is licensed under Health Occupations Article, Title 15, Annotated Code of Maryland, to practice medicine with physician supervision.

  (23) “Registration” means the acceptance by the Secretary and the incorporation in the Department's official records of certificates, reports, or other records provided for in this subtitle, of births, deaths, fetal deaths, adoptions, marriages, or divorces.

  (24) “Search, contact, and reunion service” means a service to:

    (a) Locate adopted individuals and biological parents of adopted individuals;

    (b) Assess the mutual desire for communication or disclosure of information between adopted individuals and biological parents of adopted individuals; and

    (c) Provide, or provide referral to, counseling for adopted individuals and biological parents of adopted individuals.

  (25) “Secretary” means the Secretary of Health.

  (26) “Vital records” means records of birth, death, fetal death, marriage, divorce, adoption, and adjudication of paternity required by law to be registered with the Secretary.

#### Regulation .02 Preparation of Certificates.

*COMAR 10.03.01.02*

A. An individual who prepares a birth, death, or fetal death certificate shall file the record using the electronic vital records registration system maintained by the Department unless otherwise directed by the Secretary.

B. Electronic registration may be phased in, as determined by the Secretary, until an electronic vital records registration system is fully implemented.

C. An institution, mortician, or attending clinician filing fewer than 10 certificates in a calendar year may not be required to use an electronic vital records registration system.

D. An individual who files a record using an electronic vital records registration system shall attest to the record’s accuracy by electronic signature.

E. An individual who is required to file records via the electronic vital records registration system:

  (1) Shall participate in training, as determined by the Secretary, on the proper use of the system; and

  (2) May be required to successfully complete a certification test on the proper filing of vital records before being granted access to the system.

F. A record that is not prepared electronically shall be:

  (1) Typed or written plainly in black unfading ink; and

  (2) Signed in black unfading ink to attest to the accuracy of the record.

#### Regulation .03 Birth Registration.

*COMAR 10.03.01.03*

A. Birth Registration Notice.

  (1) The Secretary may issue a birth registration notice to parents named on the certificate stating that the birth certificate of their child has been registered.

  (2) The notification in §A(1) of this regulation may not be an official copy of a birth certificate but may be used for proof of age at the discretion of any reviewing agency.

B. Name on Certificate.

  (1) Amendment to Change a Name.

    (a) The name of an individual born in this State may be changed on that individual's birth certificate once without a court order if, within 12 months of birth, the Department receives:

      (i) A written request from both parents named on the certificate requesting the change of name; and

      (ii) An affidavit from both parents sworn before a notary public stating that they are the true parents of the child and are making this request of their own free will.

    (b) A subsequent change to the name within 12 months of the birth shall require a court order.

    (c) A change to the name after 12 months of the birth shall require a court order.

  (2) Correction of Spelling of the Name.

    (a) A name on a birth certificate may be corrected to its proper spelling at any time upon proof that the name as shown on the birth certificate is incorrect and that the requested spelling is the proper spelling.

    (b) Documentation required by §B(4) of this regulation shall be necessary proof for the change to be made.

  (3) Adding a Name.

    (a) When a person has never had a first and last name placed on a birth record, a name may be added upon proof that the name is the name in use.

    (b) If a first name has never been placed on a birth record by a parent and the last name is different than the name being used by the subject of the birth record, the Secretary shall replace the last name on the individual's birth certificate when adding the first name, if the individual provides proof that the name is the name used by the individual.

    (c) Documentation required by §B(4) of this regulation shall be necessary proof for the addition of a name.

  (4) Documents Needed to Correct or Add a Name.

    (a) If the subject of the vital record is under 7 years old, one or more of the following documents shall be submitted:

      (i) A notarized letter from a parent citing the correct name;

      (ii) A notarized letter from the hospital citing the correct name;

      (iii) A notarized letter from the attendant at birth citing the correct name;

      (iv) A notarized physician's office record of the birth citing the correct name.

    (b) The Department reserves the right to require more than one of the documents listed in §B(4)(a) of this regulation to be submitted as sufficient proof.

    (c) If the subject of the vital record is 7 years old or older, two or more of the following documents citing the correct name shall be submitted:

      (i) Baptismal or other church records. To be acceptable, a baptismal record shall be an original certificate or book record made at the time of baptism, or a copy of the certificate or book record executed under church seal by the custodian of the church record, or a notarized statement attesting to the baptism and bearing the signature of the custodian of the church record or records.

      (ii) Insurance policy.

      (iii) Hospital or clinic record.

      (iv) Physician's office record of the birth.

      (v) Pre-kindergarten record or grade school record.

      (vi) Family Bible record. The Bible shall be exhibited to the Secretary, State registrar, or local registrar for execution of a certificate of inspection upon a form supplied by the Secretary.

      (vii) Record of employment.

      (viii) Record of military service.

      (ix) Marriage license.

      (x) Record from federal census.

      (xi) Birth certificate of a child of the subject of the vital record.

      (xii) Social Security Administration record of the subject of the vital record's original application for a Social Security Number.

      (xiii) Other pertinent records which meet the Secretary's approval and corroborate the name of the subject of the vital record.

    (d) The Department reserves the right to:

      (i) Require more than two of the documents listed in §B(4)(c) of this regulation to be submitted as sufficient proof to correct or add a name;

      (ii) Refuse to correct or add a name if the Department finds the documentation submitted unsatisfactory proof of the facts alleged.

C. Amending or Correcting Data on Birth Certificate Other than Name.

  (1) To amend or correct data other than the name on a birth certificate, the following documents and information shall be submitted:

    (a) For date of birth, time of birth, sex (other than changed by surgery), and place of birth of the subject of the vital record:

      (i) A letter citing the correct data from the medical records director of the hospital in which the birth occurred;

      (ii) A letter citing the correct data from the physician, nurse midwife, or attending clinician in attendance at birth; or

      (iii) A notarized letter citing the correct data from an attendant at birth other than the one set forth in §C(1)(a)(ii) of this regulation.

    (b) For a parent’s data to be amended or corrected, at least two documents from among those listed below:

      (i) Parent's birth certificate;

      (ii) Parent’s baptismal or other church records (refer to specifications under §B(4)(c)(i) of this regulation);

      (iii) Parent's pre-kindergarten or grade school records;

      (iv) Other pertinent records which meet the Secretary's approval and corroborate the parent's data.

    (c) For a parent’s name to be replaced by another individual’s name, the individual requesting the replacement shall obtain an order from a court of competent jurisdiction that orders that:

      (i) The currently listed parent’s name and any other information about that individual be deleted from the birth certificate; and

      (ii) A specified individual’s name and other parent’s information as required for a birth certificate be added for the newly named individual.

  (2) The Department reserves the right to require additional documentation or to refuse to amend or correct information on a birth certificate if it finds the documentation submitted unsatisfactory proof of the facts alleged.

D. Method for Amending or Correcting Data on Birth Certificates.

  (1) Amendments and corrections under this regulation shall be made by:

    (a) Placing a line through the original data and entering new data in black ink; or

    (b) Entering the amendment or correction on electronic media.

  (2) The individual who makes the amendment or correction shall:

    (a) Record the date the correction or amendment was made;

    (b) Record the microfilm number if the amendment or correction is made on a paper copy of a record; and

    (c) Initial the record or provide an electronic signature.

E. Certificate for Adjudication of Paternity Record. If the child's name is to be changed, the court order or paternity decree shall state that the name is to be changed and provide the name as it is to appear on the record.

F. Audit of Birth Records.

  (1) All institutions that register births through the electronic vital records registration system shall be:

    (a) Subject to an audit of the accuracy of the birth records they submit, at an interval determined by the Secretary; and

    (b) Required to make the medical records available for review by the auditor for comparison to the items captured on the birth record.

  (2) All attending clinicians in charge of births outside an institution who register those births via the electronic vital records registration system shall be:

    (a) Subject to an audit of the accuracy of the birth records they submit, at an interval determined by the Secretary; and

    (b) Required to make the medical records available for review by the auditor for comparison to the items captured on the birth record.

#### Regulation .04 Delayed Birth Registration.

*COMAR 10.03.01.04*

A. Certificate Form. Delayed birth registrations, certificates, and all copies of them shall include, in addition to other items:

  (1) The word “DELAYED”, prominently printed;

  (2) The date of filing; and

  (3) An abstract of the supporting evidence, giving a description of the essential features of the documents and the relevant content of them (any inconsistencies shall be specifically noted).

B. Acceptable Records.

  (1) Documents listed under Regulation .03B(4) of this chapter are the records which may be submitted as proof of the facts alleged.

  (2) The name, birth date, and birthplace shall be established by three supporting records.

  (3) The parentage shall be established by at least one record.

  (4) Supporting records shall be at least 3 years old unless the individual is under 7 years old.

C. Examination and Approval of Evidence.

  (1) The supporting records shall be submitted to the Secretary for approval, provided that bulky records, difficult to transport, may be submitted to a local health officer or a notary public for execution of a certificate of inspection, upon a form to be provided by the Secretary.

  (2) Supporting evidence may not be regarded as finally approved unless accepted by the Secretary.

D. Cancellation of Records.

  (1) When the Secretary is satisfied that a delayed birth certificate was obtained through fraud or misrepresentation, the Secretary shall send to the person named in the certificate a notice in writing of the intention to cancel the certificate. The notice shall give this person an opportunity to appear and show cause why the certificate should not be cancelled.

  (2) The notice may be served on the person named in the certificate or, in the case of a minor or incompetent person, to the person's parent or guardian by forwarding the notice by registered mail to the person's last known address on file in the Department.

  (3) Unless the person named in the certificate, or the parent or guardian, within 30 days after the date of mailing the notice, shows cause satisfactory to the Secretary why the certificate should not be cancelled, the Secretary shall cancel the certificate.

#### Regulation .05 Death Registration — Fetal Deaths.

*COMAR 10.03.01.05*

A. A certificate for fetal death of 20 or more weeks gestation shall be filed regardless of the disposition of the remains.

B. If the gestation period is unknown, but the fetus weighs 350 grams or more, a fetal death certificate shall be filed.

C. A certificate for fetal death under 20 weeks gestation need not be filed unless the fetus is transported from place of delivery for cremation or private burial.

D. A fetal death certificate need not be filed if the gestation period is under 20 weeks and the remains are to be used for scientific or educational purposes by a hospital or other medical facility.

E. A dead fetus of any length of gestation may be cremated by a hospital if:

  (1) The hospital has the facilities;

  (2) The hospital obtains the written permission from the responsible parent or parents; and

  (3) The case is not required to be referred to the Medical Examiner.

F. When a fetus of 20 or more weeks gestation period is retained or cremated by a hospital, the hospital administrator shall enter his name on the certificate as the funeral director or the person acting as funeral director.

#### Regulation .06 Transportation of Human Remains — Burial-Transit Permit.

*COMAR 10.03.01.06*

A. The mortician who takes custody of human remains shall obtain a burial transit permit before final disposition or removal of the human remains from the State. The form of the burial-transit permit shall be prescribed by the Secretary.

B. The burial transit permit shall accompany the human remains to their final destination.

C. The individual required to provide the date and place of final disposition on a burial transit permit shall submit the information using the electronic vital records registration system maintained by the Department unless otherwise directed by the Secretary.

D. When human remains are to be shipped by common carrier, the casket containing the human remains or the outer case shall be so constructed as to prevent seepage or escape of odors.

#### Regulation .07 Disinterment and Reinterment Permits.

*COMAR 10.03.01.07*

A. When human remains are to be removed from a cemetery or other final resting place and transferred to another cemetery or location, a disinterment and reinterment permit shall be obtained from the local health department in Baltimore City or the county in which the human remains are located or the Maryland Department of Health. The form of this permit shall be prescribed by the Secretary. The Department or local health department may only issue a permit on written authorization from the State's Attorney of the jurisdiction in which the human remains are located or in compliance with a court order. If the human remains are moved to a grave or tomb within the same cemetery for relocation purposes only, a permit is not required.

B. When it is required to disinter human remains for an autopsy purpose, even though the human remains are to be reinterred in the same cemetery, an application for a disinterment and reinterment permit shall be made to the local health department or Maryland Department of Health by the Medical Examiner, or by the State's Attorney of Baltimore City or any county of Maryland when acting in the State's Attorney's official capacity in investigating the death.

C. When it is proposed to disinter and relocate a number of human remains, only one application shall be made by the mortician. The mortician shall submit with the application an original and copy of a list of the human remains to be disinterred. One disinterment and reinterment permit will be issued. The original of the list shall be attached to the permit and made a part of it, and a copy or electronic file of the list shall be retained by the local health department or Maryland Department of Health. If the names of human remains are not known, this fact shall be indicated on the application. The mortician shall include in the application an identification number, grave space grid number, or other means to identify every one of the human remains to be disinterred and reinterred.

D. The application for a disinterment and reinterment permit shall be made on a form prescribed by the Secretary. Upon approval of the completed application, the Secretary, Commissioner of Health of Baltimore City, or the county health officer or their designees, depending on where the human remains are located, shall sign and issue a disinterment and reinterment permit to:

  (1) An individual qualified in the interment of human remains, such as a mortician or cemeterian;

  (2) An individual qualified in the funerary rites appropriate to the cultural affiliation of the human remains, such as a minister, priest, or other religious leader; or

  (3) An anthropologist or archaeologist.

E. The disinterment and reinterment permit shall be endorsed by the cemetery authority from which the human remains are disinterred, and also by the cemetery authority in which the human remains are reinterred. The authority of the latter cemetery shall return the permit to the Maryland Department of Health, the Baltimore City Health Department, or the local health department within 10 days after reinterment if reinterment took place in a Maryland county or Baltimore City. If there is no cemetery authority, the mortician shall endorse the permit and return it to the appropriate health department within the time limit specified in this section.

F. A disinterred coffin or casket containing human remains shall be so constructed or encased as to prevent seepage or escape of odors.

G. Maintenance of Disinterment and Reinterment Permits.

  (1) The Department and each local health department shall maintain a record of permits issued.

  (2) A local health department shall provide documentation to the Department relating to a permit issued by the local health department.

  (3) The Department shall maintain an up-to-date electronic file of all permits issued in the State.

H. A disinterment and reinterment permit expires on the 30th day after the date of issuance.

I. Except as provided in Health-General Article, §4-215(e)(5), Annotated Code of Maryland, 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:

  (1) The site is historic property, as defined in Article 83B, §5-601, Annotated Code of Maryland; and

  (2) Disclosure would create a substantial risk of harm, theft, or destruction to the site.

#### Regulation .08 Inspection of Records and Disclosure of Information.

*COMAR 10.03.01.08*

A. On request, for birth, death, and marriage records only, the Secretary may disclose data or issue certified copies of vital records, original certificates, or information when satisfied that the applicant has a direct and tangible interest in the content of the record. For divorce records, the Secretary may only verify data or issue information when satisfied that the applicant has a direct and tangible interest in the content of the record.

B. Evidence of Direct or Tangible Interest.

  (1) In the case of birth records, a direct and tangible interest shall be evidenced by a request from:

    (a) The subject of the vital record;

    (b) A parent named on the birth certificate;

    (c) The subject of the vital record's legal guardian;

    (d) The surviving spouse of the subject of the vital record;

    (e) An authorized representative of the subject of the vital record;

    (f) A confidential intermediary authorized by the Director of the Social Services Administration of the Department of Human Services in accordance with Family Law Article, Title 5, Subtitle 3A or 4B, Annotated Code of Maryland;

    (g) The Director of the Social Services Administration of the Department of Human Services in accordance with Family Law Article, Title 5, Subtitle 3A or 4B, Annotated Code of Maryland;

    (h) An adoptee 21 years old or older who requests a copy of the adoptee's original certificate of birth, if the adoption was ordered by the court on or after January 1, 2000; or

    (i) A biological parent of an adoptee 21 years old or older who requests a copy of the adoptee's original certificate of birth, if the adoption was ordered by the court on or after January 1, 2000.

  (2) In the case of death or fetal death records, a direct and tangible interest shall be evidenced by a request from:

    (a) Surviving relatives;

    (b) An authorized representative;

    (c) A person who is a beneficiary of the deceased;

    (d) An individual who wishes to establish an estate in the name of the deceased;

    (e) A person who paid to the deceased while the deceased was alive or who has paid to or is trying to pay to the deceased's beneficiaries insurance benefits, pension benefits, welfare benefits, or other benefits;

    (f) A person who demonstrates to the Secretary that the individual is trying to carry out a legal duty that was the responsibility of the deceased;

    (g) A person who presents a subpoena that commands that a copy of the record be produced, if the subpoena is issued by:

      (i) A court;

      (ii) An administrative body empowered by statute to issue a subpoena; or

      (iii) A person empowered by statute to issue a subpoena;

    (h) A person who is a party or who represents a party in litigation in which there is an issue as to whether the subject of the record is deceased;

    (i) A person who needs to prove that a beneficiary who is the subject of the record is deceased;

    (j) A person who needs to prove that the subject of the record is deceased so that a piece of property may be transferred with a clear title;

    (k) A person who is a creditor of the deceased;

    (l) A government official who provides documentation satisfactory to the Secretary that a requested death certificate is required in order to carry out the duties or functions of the official’s office; or

    (m) A hospital official who requests information pertaining to a patient whose cancer diagnosis was reported by the official's hospital to the Maryland Cancer Registry.

  (3) In the case of marriage records, the direct and tangible interest shall be evidenced by a request from:

    (a) The married parties; or

    (b) An authorized representative.

  (4) In the case of information regarding divorce, a direct and tangible interest shall be evidenced by a request from:

    (a) The divorced parties; or

    (b) An authorized representative.

C. Birth Records in Cases of Adoption Involving a Confidential Intermediary.

  (1) A confidential intermediary may apply to the Secretary for:

    (a) The original certificate of birth and any records that relate to the new certificate of birth of an adopted individual;

    (b) The new certificate of birth that was substituted for the original certificate of birth of an adopted individual under Health-General Article, §4-211, Annotated Code of Maryland; and

    (c) The report of the decree or judgment of adoption filed by the clerk of the court under Health-General Article, §4-211, Annotated Code of Maryland.

  (2) To apply for a copy of a record listed in §C(1) of this regulation, a confidential intermediary shall submit to the Secretary:

    (a) A written application, as required by the Secretary; and

    (b) A written statement signed by the Director of Social Services or the Adoption Program Manager of the Department of Human Services and witnessed by a notary public that authorizes the confidential intermediary to obtain a copy of the requested record.

  (3) If a confidential intermediary complies with the requirements set forth at §C(2) of this regulation, the Secretary shall give a copy of a requested record that is on file with the Secretary to the confidential intermediary.

D. Birth Records for Adoptions Finalized on or after January 1, 2000.

  (1) This section of this regulation:

    (a) Applies only to adoptions finalized on or after January 1, 2000; and

    (b) Does not bar:

      (i) An adoptee or biological parent from applying for search, contact, and reunion services under Family Law Article, Title 5, Subtitle 4B, Annotated Code of Maryland; or

      (ii) The Director of Social Services of the Maryland Department of Human Services or a confidential intermediary from obtaining a copy of a record under Family Law Article, §5-4B-04(c) or 5-4B-06(b) or (c), Annotated Code of Maryland.

  (2) An adoptee 21 years old or older may apply to the Secretary for:

    (a) An uncertified copy of the adoptee's original certificate of birth;

    (b) A copy of records that relate to the adoptee's new certificate of birth, if any; and

    (c) A copy of the report of the adoptee's order of adoption filed by the clerk of the court under Health-General Article, §4-211, Annotated Code of Maryland.

  (3) If an adoptee is 21 years old or older, a biological parent of the adoptee may apply to the Secretary for:

    (a) An uncertified copy of the adoptee's original certificate of birth;

    (b) A certified copy of the new certificate of birth, if any, that was substituted, under Health-General Article, §4-211, Annotated Code of Maryland, for the adoptee's original certificate of birth;

    (c) A copy of all records that relate to the adoptee's new certificate of birth; and

    (d) A copy of the report of the adoptee's order of adoption filed by the clerk of the court under Health-General Article, §4-211, Annotated Code of Maryland.

  (4) The Secretary shall inform an applicant applying for a record as set forth in §D of this regulation of the availability of adoption search, contact, and reunion services, as set forth in Family Law Article, Title 5, Subtitle 4B, Annotated Code of Maryland.

  (5) A person applying for a record under §C(1) and (2) of this regulation shall apply in writing on a form as required by the Secretary and shall submit the form with the individual's signature witnessed by a notary public.

  (6) The Secretary shall give a copy of the requested record that is on file with the Secretary to the applicant, subject to the restrictions set forth at §E of this regulation.

E. Disclosure Vetoes.

  (1) File with the Director of the Social Services Administration of the Maryland Department of Human Services a disclosure veto to bar disclosure of any information concerning the individual filing the disclosure veto in a record accessible under §D of this regulation;

  (2) Cancel a disclosure veto at any time; and

  (3) Refile a disclosure veto at any time.

F. Birth certificate information may not be disclosed if the information is to be used for commercial solicitation or private gain.

G. Duties of the Secretary of Health.

  (1) Subject to §G(3) and (4) of this regulation, the Secretary shall give to an applicant who meets the requirements of §D of this regulation a copy of each record that the applicant requests and that the Secretary has on file.

  (2) When a biological parent applies for a record, the Secretary shall remove from the copy all information as to:

    (a) The other biological parent, if that parent has filed a disclosure veto in accordance with §E of this regulation; and

    (b) The adoptee and each adoptive parent, if the adoptee has filed a disclosure veto in accordance with §E of this regulation.

  (3) When an adoptee applies for a copy of a record, the Secretary shall remove from the copy of the record to be given to the adoptee all information as to the biological parent, if the biological parent has filed a disclosure veto in accordance with §E of this regulation.

  (4) The Secretary shall give the applicant for a birth record under §§C and D of this regulation:

    (a) An uncertified copy of the birth certificate, if a birth certificate is requested; and

    (b) A copy of a notice of the adoption search, contact, and reunion services available under Family Law Article, Title 5, Subtitle 4B, Annotated Code of Maryland.

H. Identification of Applicant Data. An applicant who applies for a vital record shall submit:

  (1) A completed and signed application form, as provided by the Department; and

  (2) If applying in person, the original of, and if applying by mail, a copy of, proof of identify in the form of:

    (a) One of the following valid, unexpired, government-issued documents that includes an expiration date:

      (i) Driver's license;

      (ii) Nondriver photo identification card; or

      (iii) Passport;

    (b) A signed statement that the applicant does not have one of the identification documents set forth in §H(2)(a) of this regulation and, in addition to the signed statement, two of the following documents or copies of the following documents that contain the applicant's name and current address:

      (i) Utility bill;

      (ii) Car registration form;

      (iii) Pay stub;

      (iv) Bank statement;

      (v) Income tax return;

      (vi) Income tax W-2 form;

      (vii) Lease or rental agreement; or

      (viii) Letter from a government agency requesting a copy of a vital record; or

    (c) A signed statement that the applicant does not have the identification documents set forth in §H(2)(a) and (b) of this regulation and, in addition to the signed statement, a document other than the ones set forth in §H(2)(a) and (b) of this regulation that allows the Secretary to corroborate the identity of the applicant.

I. Fees Collected by the Department.

  (1) The Department shall collect a $12 fee when the Department:

    (a) Issues a certified or abridged copy of a:

      (i) Death certificate provided concurrently with an initial requested death certificate;

      (ii) Fetal death certificate;

      (iii) Marriage certificate;

      (iv) Verification of divorce certificate;

      (v) Certificate of foreign birth; or

      (vi) Certificate of birth resulting in stillbirth; or

    (b) Issues a report that a search of the fetal death, marriage, or divorce files was made and a requested record is not on file;

    (c) Makes an amendment to a fetal death or marriage certificate pursuant to a request made more than 1 year after the certificate was registered with the Department; or

    (d) Processes an adoption, foreign adoption, or legitimation.

  (2) The Department shall collect a $10 fee when the Department:

    (a) Issues a certified or abridged copy of:

      (i) A birth certificate; or

      (ii) The first copy of a death certificate issued in a single transaction;

    (b) Issues a report that a search of the birth or death certificate files was made and a requested record is not on file; or

    (c) Makes an amendment to a birth or death certificate pursuant to a request made more than 1 year after the certificate was registered with the Department.

J. Fees Collected by Local Health Departments.

  (1) A local health department that issues birth certificates shall set and collect a fee for processing and issuing:

    (a) A birth certificate; or

    (b) A report that a search of the files was made and the requested record is not on file.

  (2) From the fee collected for providing a certificate or report under §J(1) of this regulation, the local health department shall transfer $10 to the General Fund of the State.

K. Verification Requests. A federal, State, county, municipal government agency, or an accredited private social or welfare agency entitled to access to vital records may be charged a fee for verification of the data in this regulation.

L. Certified Copies. Copies of records shall be only from original records on file with the Secretary. When a certified copy is issued, each certification shall contain:

  (1) A statement that it is a true copy of a record on file with the Secretary;

  (2) The date issued;

  (3) The registrar's signature; and

  (4) The seal of the Secretary.

M. Reproduction of Certificates Permitted. A person or agency may photocopy a certified copy of a birth, death, fetal death, or marriage certificate for any nonfraudulent and nondeceptive purpose.

N. Statistical or Research Use of Vital Records Data. The Secretary may permit use of data on vital records for statistical or research purposes, subject to conditions the Secretary may impose to ensure that the use of the data is limited to the purposes in this section.

#### Regulation .09 Inspection of Records and Disclosure of Information — Maryland Certificate of Foreign Birth.

*COMAR 10.03.01.09*

A. The Secretary shall prepare and register a Maryland certificate of foreign birth upon a request that the certificate be prepared from the court, an adopting parent, or an adopted individual 18 years old or older, if the adoption took place:

  (1) Through a court of competent jurisdiction in this State; or

  (2) Under the laws of a jurisdiction or country other than the United States:

    (a) By an adopting parent who is a resident of this State; and

    (b) With an IR-3 visa or IH-3 visa being granted to the adopted individual by the United States Immigration and Naturalization Service under the Immigration and Nationality Act.

B. In order for the Secretary to prepare a Maryland certificate of foreign birth pursuant to §A(2) of this regulation, a person shall provide to the Secretary:

  (1) An application form, as provided by the Department;

  (2) An official and authenticated copy with valid stamps and seals of the adoption decree from the foreign jurisdiction or country where the adopted individual was adopted;

  (3) A certified translation of the foreign adoption decree, if the decree is not in English;

  (4) Proof of the date and place of the adopted individual's birth, as set forth in §C(1) of this regulation;

  (5) Proof of the IR-3 visa or IH-3 visa status of the adopted individual; and

  (6) Proof that the adopting parent is a resident of this State, as set forth in §C(2) of this regulation.

C. To provide proof of the:

  (1) Date and place of an adopted individual's birth, a person shall provide to the Secretary:

    (a) A birth certificate or other birth record for the adopted individual from the jurisdiction or country where the individual was born; and

    (b) A certified translation of the foreign birth certificate or other birth record, if the foreign birth certificate or other birth record is not in English; and

  (2) Maryland residency of an adopting parent, an individual shall provide to the Secretary, subject to the restrictions set forth in §D of this regulation, one or more of the following documents relating to the parent:

    (a) Most recent Maryland tax return;

    (b) Most recent Maryland property tax bill;

    (c) Local gas and electric bill that is no more than 4 months old;

    (d) Valid Maryland driver's license; or

    (e) Another record that corroborates the Maryland residency.

D. The Secretary may:

  (1) Require more than one of the documents listed in §C(2) of this regulation to be submitted to establish Maryland residency; and

  (2) Refuse to issue a certificate of foreign birth if the Secretary finds the documentation submitted does not conclusively establish Maryland residency.

E. The Secretary shall prepare a certificate of foreign birth with the:

  (1) Name of the subject of the record being the name of the adopted individual as the individual's name appears or is set in the foreign adoption decree; and

  (2) Names of the adopting parents recorded as the parents of the adopted individual.

F. In order for the Secretary to enter as the subject of a certificate of foreign birth a name different from the name of the adopted individual in the foreign adoption decree, a person shall provide to the Secretary an order from a court of competent jurisdiction that directs the Secretary to prepare the certificate with the different name for the adopted individual.

G. The Secretary shall amend the subject's name on a certificate of foreign birth that has already been prepared and registered on receipt of:

  (1) An order of a court of competent jurisdiction that changes the adopted individual's name; and

  (2) A request from the adopted individual, the adopting parents, or a guardian or legal representative of the adopted individual that the amendment be made.

H. The Secretary shall include on the Maryland certificate of foreign birth:

  (1) The words “Certificate of Foreign Birth”;

  (2) The adopted individual's actual country of birth; and

  (3) A statement that the Maryland certificate of foreign birth is not evidence of United States citizenship for the individual for whom it is issued.

#### Regulation .10 Birth Certificate of a Deceased Person.

*COMAR 10.03.01.10*

A. On presentation of an official death certificate, a birth certificate on a deceased individual may be issued to:

  (1) A parent;

  (2) A surviving spouse;

  (3) A legal guardian; or

  (4) An authorized representative of the deceased who presents an affidavit attesting to the purpose for obtaining the record.

B. The birth record shall be stamped “DECEASED” and the date of death shall be recorded on it.

#### Regulation .11 Verification of Data.

*COMAR 10.03.01.11*

A. Birth, Death, and Marriage Verification.

  (1) Verification of the facts contained on the vital records in this section may be furnished by:

    (a) The Secretary or, for births and deaths only, the local health officer of the county of the occurrence of the event, to any of the agencies cited in Regulation .08K of this chapter, in the conduct of their official duties; or

    (b) The Secretary to a government official who requests the verification in order to carry out the duties or functions of the official's office as specified in Public Law 108-458 or Public Law 109-13.

  (2) The verifications in §A(1) of this regulation shall be on forms prescribed by the Secretary or on comparable forms which are furnished by the requesting agency or government official and are acceptable to the Secretary.

B. Divorce and Annulment of Marriage Verifications.

  (1) Verifications of the facts in this section shall be made available to persons who are authorized by either subject of the record, including those cited in Regulation .08K of this chapter.

  (2) The verifications in §B(1) of this regulation shall contain the:

    (a) Names of the parties involved;

    (b) Type of divorce action or annulment;

    (c) County in which the divorce or annulment action took place;

    (d) Date of the decree; and

    (e) Signature of the authorized representative of the Secretary.

#### Regulation .12 Reports of Divorce and Annulment.

*COMAR 10.03.01.12*

A. The parties to a divorce or an annulment of marriage action, or their respective attorneys, shall provide the necessary information to the clerk of the appropriate court for the clerk to prepare and forward to the Secretary the required report of divorce or annulment of marriage.

B. Divorce or annulment of marriage report records maintained by the Secretary are not official copies of the decrees, and certified copies of the decrees may not be issued by the Secretary.

C. A copy of the decrees in §B of this regulation shall be obtained from the appropriate circuit court of the several counties of the State or Baltimore City, depending on where the divorce or annulment action took place.

#### Regulation .13 Commemorative Birth Certificate.

*COMAR 10.03.01.13*

A. The commemorative birth certificate shall:

  (1) Cost $50 per copy, except under certain circumstances to be determined by the Secretary of Health, and be available for issuance to the subject of the vital record or an authorized representative of the subject of the vital record, or both, or an order of a court of competent jurisdiction;

  (2) Constitute a certified copy of the original birth record and have the same legal status and be treated with the same protections afforded the photocopied or electronically produced certified copy of the original birth certificate; and

  (3) Be in a form consistent with the need to protect the integrity of vital records but suitable for display.

B. Funds collected for this certificate shall be paid into the Children's Trust Fund established under Health-General Article, §13-2207, Annotated Code of Maryland. Up to $25 of each $50 collected shall go to the Department for production costs.

#### Regulation .14 Death Certificate — Amendment.

*COMAR 10.03.01.14*

A. In order for the name of the deceased, the cause of death and medical certification, the manner of death, the date and time of death, and the place where the death occurred to be amended on a death certificate, the facts necessitating the amendment shall be certified to the Secretary by the physician, physician assistant, or nurse practitioner who filled out and signed the death certificate, or by the medical examiner.

B. When a death certificate is filled out and signed by the medical examiner, only the medical examiner may certify to the Secretary the facts necessitating an amendment on the death certificate to the name of the deceased, the cause of death and medical certification, the manner of death, the date and time of death, and the place where the death occurred.

#### Regulation .15 Certificate of Birth Resulting in Stillbirth.

*COMAR 10.03.01.15*

A. The Secretary shall prepare a Maryland certificate of birth resulting in stillbirth upon the request of the parent or parents of a stillborn child.

B. In order for the Secretary to prepare a Maryland certificate of birth resulting in stillbirth:

  (1) A fetal death shall be registered pursuant to Regulation .05A of this chapter; and

  (2) The parent or parents requesting the certificate of birth resulting in stillbirth shall be named on the registered fetal death certificate.

C. Information on Certificate.

  (1) Except as provided in §C(2) of this regulation, the Secretary shall include on the certificate of birth resulting in stillbirth the following information as it appears on the fetal death certificate:

    (a) Name of fetus;

    (b) Date of delivery;

    (c) Mother's maiden name;

    (d) Mother's married name;

    (e) Father's name; and

    (f) Jurisdiction of delivery, specifying:

      (i) A county; or

      (ii) Baltimore City.

  (2) The Secretary shall include on a certificate of birth resulting in stillbirth the words, “Not a Certificate of Live Birth”.

  (3) If the parent or parents do not wish to provide a name for the stillborn child, the Secretary may not include on the certificate of birth resulting in stillbirth any name for the stillborn child other than that appearing on the fetal death certificate.

  (4) If the parent or parents want to add a name to appear on the certificate of birth resulting in stillbirth for the stillborn child that does not appear on the fetal death certificate or amend the name for the stillborn child, the parent or parents shall follow the procedure for additions and amendments to a name on a birth certificate, as set forth in Regulation .03B of this chapter.

#### Regulation .16 Births Outside an Institution.

*COMAR 10.03.01.16*

A. An attending clinician in charge of a birth outside an institution shall:

  (1) Prepare the forms required by the Secretary to register the birth; and

  (2) File the forms.

B. If a birth occurs outside an institution and an attending clinician is not in charge of the birth, the local health officer or designee of the jurisdiction where the birth occurs shall:

  (1) Verify the facts regarding the birth by obtaining the documentation required by §D of this regulation;

  (2) Sign the birth record; and

  (3) File the birth record with the Secretary.

C. If the facts regarding a birth cannot be verified by the local health officer of the jurisdiction where the birth occurs, in order for the Secretary to create a birth record, an individual listed in Health-General Article, §4-208(b), Annotated Code of Maryland, shall obtain an order from a court of competent jurisdiction that:

  (1) Lists the facts about the birth; and

  (2) Authorizes the Secretary to create the birth record according to the facts.

D. The following documentation shall be required to verify a birth outside an institution when an attending clinician is not in charge of the birth:

  (1) A valid, unexpired, government-issued identification document for the child’s mother in the form of a:

    (a) Driver’s license;

    (b) State-issued photo identification card;

    (c) Passport;

    (d) Permanent resident card;

    (e) Military identification card; or

    (f) A signed statement the mother does not have any of the identification documents listed in §D(1)(a)—(e) of this regulation and two of the following documents that contain the applicant’s name and current address:

      (i) Utility bill;

      (ii) Car registration form;

      (iii) Pay stub;

      (iv) Bank statement;

      (v) Income tax return;

      (vi) Income tax W-2 form;

      (vii) Lease or rental agreement; or

      (viii) Letter from a government agency;

  (2) Evidence of pregnancy in the form of:

    (a) A prenatal or postnatal medical record that is consistent with the date of delivery and includes the:

      (i) Mother’s name, date of birth, and date of health exam; and

      (ii) Health care provider’s signature, printed name, signature date, and license number;

    (b) A statement from a physician or certified nurse midwife licensed in the United States, or a direct-entry midwife licensed in Maryland, who has first-hand knowledge of the pregnancy and is willing to attest to the fact of pregnancy;

    (c) Preregistration with the local health department during pregnancy, including a face-to-face interview and physical examination;

    (d) Documentation of a home visit by a public health nurse or other health care provider who has first-hand knowledge of the pregnancy; or

    (e) Other evidence acceptable to the Secretary;

  (3) Evidence of live birth in the form of:

    (a) A statement from a physician, certified nurse midwife, or other licensed health care provider who saw or examined the infant within the first 2 weeks of life;

    (b) An observation of the infant during a home visit by a public health nurse or licensed health care provider during the first 2 weeks of life; or

    (c) Other evidence acceptable to the Secretary; and

  (4) Evidence of place of delivery in the State as follows:

    (a) If the birth occurred in the mother’s place of residence, evidence of place of delivery shall be in the form of:

      (i) A driver’s license or other State-issued identification document that includes the mother’s current Maryland address;

      (ii) A rent receipt, mortgage statement, or deed that includes the mother’s name and Maryland address;

      (iii) A recent pay stub that includes the mother’s name and Maryland address; or

      (iv) Other evidence acceptable to the Secretary;

    (b) If the birth occurred outside the mother’s place of residence and the mother is a resident of Maryland, evidence shall be in the form of:

      (i) An affidavit from the tenant of the premises where the birth occurred stating that the mother was present on those premises at the time of the birth;

      (ii) Evidence of the affiant’s residence similar to that required in §D(4)(a) of this regulation; and

      (iii) Evidence of the mother’s residence in the State similar to that required in §D(4)(a) of this regulation; or

    (c) If the mother is not a resident of Maryland, evidence shall consist of clear and convincing evidence acceptable to the Secretary.

### Chapter 02 — Release of Confidential Information in the Maternal and Child Health Bureau

**Authority:** Health-General Article, §§2-104(b), 4-102, 4-301—4-309, and 15-125, Annotated Code of Maryland

**Administrative History:** Effective date: July 20, 1950

**Administrative History:** Chapter revised effective December 20, 1993 (20:25 Md. R. 1946)

**Administrative History:** Regulation .01 amended effective October 22, 2007 (34:21 Md. R. 1914); March 14, 2016 (43:5 Md. R. 385)

**Administrative History:** Regulation .02 amended effective October 22, 2007 (34:21 Md. R. 1914)

**Administrative History:** Regulation .02B amended effective March 14, 2016 (43:5 Md. R. 385)

**Administrative History:** Regulation .03 amended effective October 22, 2007 (34:21 Md. R. 1914); March 14, 2016 (43:5 Md. R. 385)

#### Regulation .01 Confidential Information.

*COMAR 10.03.02.01*

All information relating to personal facts and circumstances, such as names and addresses, medical examinations, and financial resources, obtained by the State or local staff administering the programs of the Maternal and Child Health Bureau shall be treated as confidential and may not be disclosed without the individual’s consent, except as may be necessary to provide services to individual mothers and children or as otherwise required by law. Information may be disclosed, however, in summary, statistical, or other form which does not identify individuals.

#### Regulation .02 Disclosure of Confidential Information.

*COMAR 10.03.02.02*

All records and information shall be held confidential and may not be disclosed without the individual's consent, except as may be necessary to provide services to the individual mother or child or as otherwise required by law. This means that:

A. Confidential information may be released without the patient's or parent's consent to agencies, institutions, or individuals who are authorized to provide maternal and child health services to the mother or child as a part of the program of the Maryland Department of Health.

B. Confidential information may be released to other public agencies to the extent that they are authorized to provide services for the health and welfare of the mother or child for whom the patient, or the patient’s parent in the case of a minor, has requested services. In these circumstances, the information may be disclosed only if written assurances are given to the Maternal and Child Health Bureau that:

  (1) The confidential character of the information will be preserved;

  (2) The confidential information will be used only for the purpose for which it is disclosed;

  (3) The purposes for the disclosure are reasonably related to the purposes of the program of the Maryland Department of Health and the functioning of the other agencies; and

  (4) The standards of protection established by the other agencies to which the confidential information is released are of equal or greater stringency than those established by the Maryland Department of Health itself.

#### Regulation .03 Responsibility for Confidential Records and Information.

*COMAR 10.03.02.03*

The Director of the Maternal and Child Health Bureau, working under the Secretary of Health:

A. Is responsible for carrying out this regulation and procedures;

B. Shall initiate suitable office practices to assure the protection of confidential records; and

C. Is responsible for informing staff employees who have access to confidential records and information.

#### Regulation .04 Permissible Disclosure.

*COMAR 10.03.02.04*

Information may be disclosed in summary, statistical, or other form, which does not make it possible to identify any particular individual.