<?xml version='1.0' encoding='utf-8'?>
<chapter num="07" heading="Sexually Transmitted Infections — Expedited Partner Therapy for Chlamydia, Gonorrhea, and Trichomoniasis" title_num="10" subtitle_num="06">
  <regulation prefix="Regulation" num=".01" heading="Purpose and Scope.">
    <paragraph num="A.">
      <text>The purpose of expedited partner therapy in Maryland is to:</text>
      <paragraph num="(1)">
        <text>Provide antibiotic therapy to any partner of a patient diagnosed with chlamydia, gonorrhea, or trichomoniasis without a personal physical assessment of the partner, and without having a previous provider-patient relationship with the partner;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Contain and stop the further spread of chlamydia, gonorrhea, and trichomoniasis; and</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Reduce the likelihood of reinfection in the diagnosed patient.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>This chapter applies to the provision of expedited partner therapy, as described in §A of this regulation, in public and private health care settings.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".02" heading="Definitions.">
    <paragraph num="A.">
      <text>In this chapter, the following terms have the meanings indicated.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Terms Defined.</text>
      <paragraph num="(1)">
        <text>“Antibiotic therapy” means the oral antibiotic treatment regimens:</text>
        <paragraph num="(a)">
          <text>Currently recommended by the Centers for Disease Control and Prevention for the treatment of chlamydia and gonorrhea through expedited partner therapy; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>For the treatment of trichomoniasis through expedited partner therapy:</text>
          <paragraph num="(i)">
            <text>In accordance with Regulation .05A of this chapter; and</text>
          </paragraph>
          <paragraph num="(ii)">
            <text>As authorized by Health-General Article, §18-214.1, Annotated Code of Maryland.</text>
          </paragraph>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>“Department” means the Maryland Department of Health.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>“Expedited partner therapy (EPT)” means the prescribing or dispensing of antibiotic therapy to any partner of a patient diagnosed with chlamydia, gonorrhea, or trichomoniasis by certain health care providers without making a personal physical assessment of the partner, and without having a previous provider-patient relationship with the partner, in order to contain and stop the further spread of the infection and reduce the likelihood of reinfection in the diagnosed patient.</text>
      </paragraph>
      <paragraph num="(4)">
        <text>“Health officer” means the health officer in each of the 23 counties and the Commissioner of Health in Baltimore City, or the duly designated representative of the health officer, or both.</text>
      </paragraph>
      <paragraph num="(5)">
        <text>“Partner” means an individual with whom one has, or has had, oral, anal or vaginal sexual contact.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Partners Eligible for EPT.">
    <text>Partners eligible for EPT are:</text>
    <paragraph num="A.">
      <text>Any partner within 60 calendar days of the patient’s diagnosis; or</text>
    </paragraph>
    <paragraph num="B.">
      <text>The most recent partner of a patient if the patient has not had sex in the 60 days before diagnosis.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04" heading="Health Care Providers Authorized to Prescribe and Dispense EPT.">
    <text>Notwithstanding any other provision of law, and only in accordance with their current scope of practice, EPT may be prescribed or dispensed by the following health care providers:</text>
    <paragraph num="A.">
      <text>A physician licensed under Health Occupations Article, Title 14, Annotated Code of Maryland;</text>
    </paragraph>
    <paragraph num="B.">
      <text>An authorized physician assistant licensed under Health Occupations Article, Title 15, Annotated Code of Maryland, acting in accordance with Health Occupations Article, §15-302.2, Annotated Code of Maryland;</text>
    </paragraph>
    <paragraph num="C.">
      <text>An advanced practice registered nurse with prescriptive authority licensed under Health Occupations Article, Title 8, Annotated Code of Maryland, acting in accordance with Health Occupations Article, §8–508, Annotated Code of Maryland; and</text>
    </paragraph>
    <paragraph num="D.">
      <text>A registered nurse employed by a local health department who complies with:</text>
      <paragraph num="(1)">
        <text>The formulary developed and approved under Health-General Article, §3-403(b), Annotated Code of Maryland; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>The requirements established under Health Occupations Article, §8-512, Annotated Code of Maryland.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04-1" heading="Pharmacists Authorized to Dispense EPT.">
    <text>Notwithstanding any other provision of law, a pharmacist licensed under Health Occupations Article, Title 12, Annotated Code of Maryland, may dispense antibiotic therapy for EPT prescribed in accordance with Regulation .04 of this chapter.</text>
  </regulation>
  <regulation prefix="Regulation" num=".05" heading="Prescribing and Dispensing EPT Medications.">
    <paragraph num="A.">
      <text>Antibiotic therapy prescribed or dispensed for EPT shall be in accordance with treatment recommendations from the Centers for Disease Control and Prevention.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Prescribing.</text>
      <paragraph num="(1)">
        <text>A separate prescription shall be issued for each partner.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>The designation “EPT” or “Expedited Partner Therapy” shall be included on the face of the prescription for each prescription issued.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>If the partner’s name is known, the prescription shall be issued in the partner’s name.</text>
      </paragraph>
      <paragraph num="(4)">
        <text>If the partner’s name is unknown, the written designation “EPT” or “expedited partner therapy” shall be sufficient for the pharmacist to fill the prescription.</text>
      </paragraph>
      <paragraph num="(5)">
        <text>An EPT prescription may not be refilled.</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>Dispensing. Each EPT medication label shall:</text>
      <paragraph num="(1)">
        <text>Include:</text>
        <paragraph num="(a)">
          <text>The designation “EPT” or “Expedited Partner Therapy”; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>The partner’s name, if known; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>Comply with Health Occupations Article, §12-505, Annotated Code of Maryland.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".06" heading="Counseling and Educational Information Requirements.">
    <paragraph num="A.">
      <text>A health care provider prescribing or dispensing EPT to a patient shall:</text>
      <paragraph num="(1)">
        <text>Counsel the patient to encourage each partner to seek a personal physical assessment; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Provide the patient with educational information for each partner, in accordance with §C of this regulation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>A pharmacist dispensing EPT shall provide educational information for each partner, in accordance with §C of this regulation.</text>
    </paragraph>
    <paragraph num="C.">
      <text>The educational information, that is available or comparable to that available on the Department’s website, shall include:</text>
      <paragraph num="(1)">
        <text>Advice for the partner to seek a medical evaluation;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Information about chlamydia, gonorrhea, and trichomoniasis;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Medication instructions;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Warnings about adverse drug or allergic reactions; and</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Advice to abstain from sexual activity as required during treatment.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".07" heading="Documenting EPT in a Medical Chart.">
    <paragraph num="A.">
      <text>A health care provider prescribing or dispensing EPT shall document the provision of EPT in the patient’s chart.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Documentation shall include the:</text>
      <paragraph num="(1)">
        <text>Number of EPT prescriptions or medications provided to the patient for each partner; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Medication and dosage being provided to the patient for each partner.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".08" heading="Reporting of Chlamydia and Gonorrhea by a Health Care Provider or Institution.">
    <paragraph num="A.">
      <text>This chapter may not affect the obligation of a health care provider or institution to report to a health officer cases of chlamydia and gonorrhea and the treatment provided to those cases in accordance with COMAR 10.06.01.04.</text>
    </paragraph>
    <paragraph num="B.">
      <text>When reporting a case of chlamydia or gonorrhea for which EPT was prescribed or dispensed, a health care provider or institution shall report the number of partners for whom:</text>
      <paragraph num="(1)">
        <text>Prescriptions were provided; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Medications were dispensed.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <annotations>
    <annotation type="Authority">Health-General Article, §§2-104(b), 18-102, 18-201, 18-202, and 18-214.1, Annotated Code of Maryland</annotation>
    <annotation type="History" subtype="Administrative History">Effective date: March 28, 2016 (43:6 Md. R. 406)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .01A amended effective March 26, 2018 (45:6 Md. R. 318)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02B amended effective March 26, 2018 (45:6 Md. R. 318)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .04-1 adopted effective March 26, 2018 (45:6 Md. R. 318)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05A, B amended effective March 26, 2018 (45:6 Md. R. 318)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .06C amended effective March 26, 2018 (45:6 Md. R. 318)</annotation>
  </annotations>
</chapter>