This chapter applies to programs or activities that meet the definition of youth camp as defined in COMAR 10.16.06.02. In this chapter, the following terms have the meanings indicated. Terms Defined. “Acute illness” means an abnormal condition of the body with rapid onset associated with recognizable symptoms and signs, such as chicken pox, gastroenteritis, influenza, or streptococcal sore throat, which has a short course of duration, as opposed to a chronic illness of long duration lasting 30 calendar days or more. Administer Medication. “Administer medication” means the act of providing, preparing, or applying a medication. “Administer medication” does not include: Reminding a camper to take a medication; or Providing physical assistance with opening and removing a medication from the container or locked storage. “Adult” has the meaning stated in COMAR 10.16.06.02. “Agent” means an individual who: Is at least 18 years old; Has successfully completed, at the expense of an applicant, an emergency epinephrine educational training program approved by the Department; and Is appointed by a certificate for emergency epinephrine holder to administer emergency use epinephrine in an emergency situation. “Anaphylaxis” means a sudden, severe, and potentially life-threatening allergic reaction that occurs when an individual is exposed to an allergen. “Applicant” means an individual applying for a Certificate for Emergency Epinephrine. “Camp” means a youth camp as defined in COMAR 10.16.06.02. “Camper” has the meaning stated in COMAR 10.16.06.02. “Certificate” means a document showing the authority to operate a youth camp, issued by the Maryland Department of Health pursuant to COMAR 10.16.06 and Health-General Article, §14-403, Annotated Code of Maryland, which displays the name of the person granted the authority. “Certificate for emergency epinephrine” means a certificate or an endorsement on the operating certificate of a youth camp issued by the Maryland Department of Health to an individual who operates a youth camp under COMAR 10.16.06 to obtain, store, and administer emergency use epinephrine. “Certificate for emergency epinephrine holder” means an individual who is authorized by the Maryland Department of Health to obtain, store, and administer emergency use epinephrine to be used in an emergency situation. “Day” has the meaning stated in COMAR 10.16.06.02. “Department” has the meaning stated in COMAR 10.16.06.02. “Director” has the meaning stated in COMAR 10.16.06.02. “Emergency medication” means a medication, identified by a camper’s plan of action for use in case of a medical emergency, for a camper with an identified medical problem. “Emergency use epinephrine” means a portable, disposable drug delivery device or product approved by the federal Food and Drug Administration that contains a premeasured single dose of epinephrine that is used to treat anaphylaxis in an emergency situation. “Health supervisor” means an individual who: Provides health services for a camp; and Is licensed by the State as a: Physician; Certified nurse practitioner; or Registered nurse. Identified Medical Problem. “Identified medical problem” means a chronic physical condition diagnosed by a licensed health care professional that: Requires specific medical treatment and supervision; and If untreated, can adversely affect the general health of the camper. “Identified medical problem” includes, but is not limited to: Asthma; Cancer; Diabetes; and Epilepsy. “Identified medical problem” does not include a chronic physical condition, which does not typically cause other medical problems or have an adverse effect on the general health of the camper, such as: Blindness; Deafness; or A developmental disability. “Medication” means any nonprescription or prescription medication present at camp. “Operate” means to supervise, control, conduct, or manage a youth camp as: An owner; An agent of the owner; A lessee of the owner; A director; or An independent contractor. “Operator” has the meaning stated in COMAR 10.16.06.02. “Person” has the meaning stated in COMAR 10.16.06.02. “Secretary” has the meaning stated in COMAR 10.16.06.02. “Self-administer medication” means the act of an individual’s ingesting, injecting, or applying the individual’s own medication when the individual: Identifies the individual’s own medication; and Follows the directions for use, including the correct route, dose, and frequency. “Successfully completed” means to pass a written examination with a grade of 75 percent or higher. An operator shall prepare and implement a written health program that: Is approved annually, in writing, by a physician, certified nurse practitioner, or registered nurse licensed to practice in the State; Is on file in the headquarters or office of the camp and is available to the camp staff members; Includes the name, title, and license number of the health supervisor; Includes procedures for the camp staff members to: Obtain camper, staff, and volunteer health information; Notify the camp health supervisor when a camper has an identified medical problem to ensure that there is a plan of action at the camp in case of a medical emergency; Disseminate information to staff members that work with a camper having a health problem; Care for a camper with an identified medical problem; Maintain confidentiality regarding all health information on campers and staff members; Observe campers each day for easily discernible signs of injury or illness; Handle health emergencies and accidents; Use emergency ambulance services and 911 services; Care for and supervise an injured or ill camper until the camper is returned to the parent, guardian, or the parent’s or guardian’s designee; Notify a parent, guardian, or the parent’s or guardian’s designee when a camper is observed to be injured or ill; Report health situations in accordance with Regulations .06 and .07 of this chapter; and Prevent the spread of an infectious disease using: Hand washing procedures; Personal protective equipment; Personal hygiene; and An exposure control plan; Includes procedures for handling medication at camp in accordance with Regulation .14 of this chapter; and If using electronic records, includes procedures for, in the event that a power or server outage prevents access to the electronic record: Accessing camper, staff, and volunteer health information; Documenting injuries, illnesses, and other reportable diseases and conditions in a paper health log; and Documenting medication administration on a paper form. An operator shall ensure and document that, not more than 30 calendar days before working at the camp, each staff member or volunteer: Is trained in the health program; Demonstrates knowledge of the health program procedures; and Is provided with the opportunity to discuss the procedures and have any questions answered by a supervisor. A staff member or volunteer shall conduct health procedures according to the health program. An operator shall ensure that: A camp health supervisor is: Available for consultation at all times when campers are present at a camp; and On site at all times when campers are present in a camp where 50 percent or more of the campers have identified medical problems; Two adults with cardiopulmonary resuscitation certification by a national organization with a training program in cardiopulmonary resuscitation are on duty at all times; If a camp has campers participating in a trip and campers remaining at camp, an adult with cardiopulmonary resuscitation certification by a national organization with a training program in cardiopulmonary resuscitation is on duty: With the trip; and At the camp; The cardiopulmonary resuscitation certification by the national organization is appropriate to the age of campers and staff members; Two adults with first aid certification by a national organization with a training program in first aid are on duty at all times; and If a camp has campers participating in a trip and campers remaining at camp, an adult with first aid certification by a national organization with a training program in first aid is on duty: With the trip; and At the camp. An operator shall ensure that: A camp staff member records in the camp health log, for all injuries, illnesses, medication errors, and reportable diseases and conditions as delineated in COMAR 10.06.01, the: Date; Name of individual; Ailment; Treatment prescribed; and Name of the individual administering care or initials of the individual administering care if a list of names and initials is provided at the front of the health log; The camp health log is: Written on lined paper; Maintained in a confidential manner; Stored in a locked compartment; Available at all times for review by the Department; and Retained for a period of 3 years; Each entry in the camp health log is: Recorded in ink and no lines are skipped, providing a permanent record that is not easily modified; and Legibly signed by the individual administering care at the camp; and The camp health log is a: Bound volume, such as a composition notebook; Spiral book with sequentially numbered pages; or Dedicated paper record per individual. For all campers, staff members, and volunteers, an operator shall ensure that: An injury or illness that results in death or that requires resuscitation or admission to a hospital is reported: Immediately to the health supervisor and, in the case of a minor, to the minor’s parent or guardian; Verbally to the Department within 24 hours; and To the Department within 1 week of the incident, on a form that meets the requirements of Regulation .07 of this chapter; An injury that is treated at an off-site medical facility and that results in a positive diagnosis through clinical examination, laboratory test, or X-ray is reported: Immediately to the health supervisor and, in the case of a minor, to the minor’s parent or guardian; and To the Department within 4 weeks of the end of camp on a form that meets the requirements of Regulation .07 of this chapter; When a camp health supervisor is on duty at the camp, an accident with no apparent injury, such as a fall from a horse, a fall from equipment, or impact from sports equipment, is reported immediately to the health supervisor; When a camp health supervisor is only available for consultation and not on duty at the camp, the minor’s parent or guardian is notified as soon as possible and before the end of the camp day, verbally or in writing, of: An illness or injury that is not included in §A or B of this regulation; or An accident with no apparent injury, such as: A fall from a horse; A fall from equipment; or Impact from sports equipment; An outbreak of a disease or a condition that is required to be reported pursuant to COMAR 10.06.01 is reported: Immediately to the health supervisor and in the case of a minor, to the minor’s parent or guardian; Verbally to the Department within 24 hours; and To the Department within 1 week of the incident on a form that meets the requirements of Regulation .07 of this chapter; A medication error or incident that required the administration of emergency use epinephrine is reported: Immediately to the health supervisor and, in the case of a minor, to the minor’s parent or guardian; and To the Department within 4 weeks of the end of camp on a form that meets the requirements of Regulation .07 of this chapter; and A camp health supervisor and camp director shall: Annually review all health log records and identify opportunities to reduce incidents, accidents, injuries, and medication errors; and Make available to the Department for review written documentation of the findings of the review of health log records. An operator shall ensure that: Any reportable condition described in Regulation .06 of this chapter is reported to the Department on a form prescribed by the Department; Each report form is: Completed in duplicate; and Signed and dated by the person completing the form; The original report form is maintained for at least 3 years; and A copy of the report is forwarded to the Department with personal identifiers removed to maintain confidentiality. An operator shall ensure that each camper has on file at the time of admission to a youth camp a written personal health record that includes: The name of the camper’s primary care physician or other provider of medical care; Pertinent information on any health problem including a physical, psychiatric, or behavioral problem; The name and phone number of a parent or legal guardian and at least one additional person to contact in an emergency situation; and For a camper who currently resides: Within the United States, a United States territory, or the District of Columbia, documentation of: The camper’s residence; and Immunization exemptions because of a parental or guardian objection or medical contraindication; or Outside the United States, a United States territory, or the District of Columbia, documentation of: The camper’s residence; and Record of vaccination or immunity on a form prescribed by the Department. An operator shall ensure that each staff member or volunteer has on file at the time of employment or volunteering at a youth camp a written personal health record that includes: The name of the staff member’s primary care physician or other provider of medical care; Pertinent information on any health problem including a physical, psychiatric, or behavioral problem; The name and phone number of a person to contact in an emergency; and For a staff member or volunteer who currently resides: Within the United States, a United States territory, or the District of Columbia, documentation of: The staff member’s or volunteer’s residence; and Immunization exemptions because of a parental or guardian objection or medical contraindication; or Outside the United States, a United States territory, or the District of Columbia, documentation of: The staff member’s or volunteer’s residence; and Record of vaccination or immunity on a form prescribed by the Department. All of the following records may be kept electronically: A health log; A camper health record; A staff or volunteer health record; A Medication Administration Authorization Form; A Medication Administration Form; A Medication Final Disposition Form; or When an operator uses standing orders for medication administration, a parent or guardian consent form. The camp operator shall ensure that an electronic record under §A of this regulation is: Capturing the same required information as the paper record being replaced; Password protected; Accessed only by authorized staff members; Permanent and will not be deleted; Capable of tracking staff member use of the system and producing an auditable record; Maintained in a confidential manner; Available at all times for review by the Department upon request; and Retained for a period of 3 years. If the electronic record under §A of this regulation is unavailable for any reason, the camp operator shall: Provide a paper health log that meets the requirements of Regulation .05 of this chapter; Record all injuries, illnesses, medication errors, and reportable diseases and conditions as defined in COMAR 10.06.01 in the paper health log until access to the electronic record is restored; Transcribe all information recorded in the paper health log into the electronic record once access to the electronic record is restored; Annotate the paper health log to indicate that transcription has occurred; Retain the paper health log according to the time frame specified in Regulation .05 of this chapter; and Provide an alternative means to access the electronic record. During an outbreak of a vaccine-preventable disease at a camp, the camp operator shall exclude: A camper who does not have documented vaccination or immunity to the relevant vaccine-preventable disease from attending the camp; and An individual who does not have documented vaccination or immunity to the relevant vaccine-preventable disease from working or volunteering at the camp. An operator shall ensure that camp staff members: Monitor a camper for signs and symptoms of acute illness such as vomiting, diarrhea, or a fever; Arrange for first aid or medical treatment upon observing a sign or symptom of acute illness; Restrict an affected camper from participating in camp activities so that the camper’s illness is not communicated to another individual; Provide supervision for an affected camper so that the camper is within sight and hearing of the supervising staff member; and Upon observing a sign or symptom of acute illness: Report an illness in accordance with Regulation .06E of this chapter; and Except for a residential camp as defined in COMAR 10.16.06.02, notify the camper’s parent, guardian, or other designated person that the camper may not remain at camp. When an acute illness is reported to the health supervisor, the health supervisor shall: Provide medical consultation or treatment; and Report the situation to the local health department in accordance with COMAR 10.06.01. If a camper is exhibiting a symptom of acute illness, an operator may not: Admit an individual to a camp; or Except for a residential camp as defined in COMAR 10.16.06.02, allow a camper to remain in a camp. An operator may not knowingly allow an individual to participate, work, or volunteer at camp during the period of communicability of a disease or condition listed in COMAR 10.06.01, unless: The individual is under the care of a licensed health care practitioner; and A licensed health care practitioner or local health officer as applicable approves, in writing, the individual’s attendance. An operator shall ensure that: A health treatment area: Is maintained within the camp for the temporary isolation and treatment of sick or injured campers; Affords privacy, quiet, continual supervision, and protection from the elements; Is equipped with: First aid supplies specified by the health supervisor; and Provisions for sanitary hand washing; and In the case of a residential camp as defined in COMAR 10.16.06.02, except for a primitive camp as defined in COMAR 10.16.06.02, provides: Hot and cold running water; A bathroom with a flush toilet; A hand sink; A shower; An isolation and convalescent area; and Exterior lighting; and Staff members or volunteers wash their hands before and after treatment. An operator shall ensure that: Except for medication covered by standing orders as described in §I of this regulation, before administration of a medication, written authorization is provided on a Medication Administration Authorization Form meeting the requirements of §F of this regulation; Except for a primitive camp as defined in COMAR 10.16.06.02, emergency medication, or while a medication is being administered, medication is kept in a locked storage compartment; A prescription medication is kept in the original container bearing a pharmacy label that includes the: Prescription number; Date filled; Authorized prescriber’s name; Patient’s name; Name of the medication; Dose of the medication; Route of administration for the medication; Time or frequency of administration for the medication; and Expiration date; A nonprescription medication is kept in the original container that includes the directions for use; Medication is given to the camper from the original container; The directions provided in the prescriptive order for the medication found on the Medication Administration Authorization Form or the standing order is followed; The staff member or designated volunteer administering the medication or supervising a camper who is self-administering medication knows the side effects and toxic effects of the medication; Medication is kept in a secure manner; Emergency medications are handled according to §D of this regulation; Medication is stored according to the manufacturer’s directions; A staff member or designated volunteer documents medication administration on a Medication Administration Form meeting the requirements of §G of this regulation; A staff member or designated volunteer documents the final disposition of the medication on a Medication Final Disposition Form meeting the requirements of §H of this regulation; Except as allowed in §A(14) of this regulation, within 2 weeks after the end of the camping session or when the medication is discontinued, medication is: Returned to: The parent; The guardian; or An individual designated by the parent or guardian who has authorization to pick-up the camper and the medication; or Destroyed; and If authorized by the parent or guardian, a camper may take their medication with them at the end of the camping session. Staff Administration — Routine Medication. Except as allowed in §E of this regulation, an operator shall ensure that a routine medication, other than insulin, is administered by: A licensed or certified professional: Who is authorized to practice in Maryland; and Whose scope of practice includes medication administration; or An adult staff member or a volunteer who: Is designated by the operator; and On an annual basis successfully completes a training course approved annually by the Department. Staff Administration — Insulin. Except as allowed in §E of this regulation, an operator shall ensure that insulin is administered by a licensed or certified professional: Who is authorized to practice in Maryland; and Whose scope of practice includes medication administration. Staff Administration — Emergency Medication. Except as allowed in Regulation .15 of this chapter, an operator shall ensure that: Emergency medication is: Carried by the camper needing the medication if authorized according to §E(2) of this regulation; Carried by an adult staff member or volunteer directly supervising the camper; or Stored at a designated easily accessible location; and Emergency medication is administered by: The camper so long as the camper is capable and authorized to self-administer according to §E of this regulation; An adult staff member or volunteer meeting the requirements of §B of this regulation; or An adult staff member or volunteer trained by a health supervisor. An operator may allow a camper to self-carry an emergency medication if both the parent or guardian and a licensed or authorized prescriber have provided written consent for the camper to self-carry the emergency medication. Self-Administration. An operator may allow a camper to self-administer medication, including insulin, if: Both the parent or guardian and a licensed or authorized prescriber have provided written consent for the camper to self-administer the medication; The health supervisor has designated an adult staff member or volunteer to supervise the camper while the camper is self-administering medication; and The designated adult staff member or volunteer supervises the camper while the camper is self-administering medication. Medication Administration Authorization Form. A Medication Administration Authorization Form shall include: The written prescriptive order for the medication that includes: The child’s name; The child’s date of birth; The condition for which the medication is being administered; Whether or not the medication is an emergency medication; The name of the medication; The dose of the medication; The route of administration for the medication; The time or frequency of administration for the medication; If PRN, the frequency and for what symptoms the medication should be administered; The known side effects of the medication specific to the camper; The date medication administration shall begin; The date medication administration shall end, not to exceed 1 year from the beginning date; The authorized prescriber’s name; The authorized prescriber’s title; The authorized prescriber’s telephone number; The authorized prescriber’s fax number; The authorized prescriber’s address; The authorized prescriber’s signature; and The date the form is signed by the authorized prescriber; The following statement: “I request the authorized youth camp operator, staff member or volunteer to administer the medication or to supervise the camper in self-administration as prescribed by the above authorized prescriber. I certify that I have legal authority to consent to medical treatment for the child named above, including the administration of medication at the facility. I understand that at the end of the authorized period an authorized individual must pick up the medication; otherwise, it will be discarded. I authorize camp personnel and the authorized prescriber indicated on this form to communicate in compliance with HIPAA”; The parent’s or guardian’s signature; The date the parent or guardian signed the form; The parent’s or guardian’s primary phone number; The parent’s or guardian’s alternative phone number; If a camp allows a camper to self-administer medication, authorization to self-administer medication that includes: The following statement: “I authorize self-administration of the above listed medication for the child named above under the supervision of the youth camp operator, a designated staff member or volunteer”; The signature of the authorized prescriber and the date the form is signed under the statement in §F(7)(a) of this regulation; and The signature of the parent or guardian and the date the form is signed under the statement in §F(7)(a) of this regulation; and If a camp allows a camper to self-carry emergency medication, authorization to self-carry emergency medication that includes whether the: Authorized prescriber gives permission for the child to self-carry emergency medication; and Parent or guardian gives permission for the child to self-carry emergency medication. Medication Administration Form. A Medication Administration Form shall include the: Child’s name; Child’s date of birth; Name of the medication; Dose of the medication; Route of administration for the medication; Time or frequency of administration for the medication; Amount of medication administered; Date and time of administration; and Name of the individual who: Administered the medication to the child; or Supervised self-administration if the child self-administered the medication. Medication Final Disposition Form. A Medication Final Disposition Form shall include: The child’s name; The child’s date of birth; The name of the medication; The final disposition of the medication; Documentation that the medication is returned to the parent or guardian, or authorized individual, including the: Name of the individual to whom the medication was returned; and Signature of the staff member or volunteer who returned the medication; and A section for documenting that the medication was destroyed that includes the: Signature of the individual responsible for destroying the medication; Signature of the individual witnessing the destruction of the medication; and Dates each individual signed the form. Standing Orders. When standing orders from a licensed or certified professional authorized to prescribe medication are used in place of the Medication Administration Authorization Form required in §A(1) of this regulation, an operator shall ensure that: Written permission is obtained from the child’s parent or guardian to administer the medication; and The medication is administered by a staff member or volunteer who meets the requirements in §B of this regulation. Medications at Primitive Camps. Except for emergency medication that the camper is authorized to self-carry according to §E(2) of this regulation, in a primitive camp as defined in COMAR 10.16.06.02, medication is kept inaccessible to the camper. Staff Member or Volunteer Medication. An operator shall: Provide a means to secure medication for a staff member or volunteer when a medication is brought to camp; and Ensure that all staff member or volunteer medications are maintained in a secure manner at all times. Except when a staff member or volunteer is self-administering a medication, an operator shall: Ensure that a staff member or volunteer: Provides written authorization on a Medication Administration Authorization Form meeting the requirements of §F of this regulation for each medication brought to camp; and Who is an adult, signs the Medication Administration Authorization Form in lieu of a parent or guardian; and For a staff member or volunteer taking medication, have on file for each medication: A Medication Administration Authorization Form; A Medication Administration Form; and A Medication Final Disposition Form. Form Retention. An operator shall retain for 3 years and make available to the Department the completed: Medication Administration Authorization Form; Medication Administration Form; Medication Final Disposition Form; and Record of successful training for each staff member or volunteer who is trained to administer medication under §B(2) of this regulation. An individual may apply, on a form prescribed by the Department, for a certificate for emergency epinephrine, which shall be valid for up to 1 year if the applicant: Is an operator of a youth camp; Is at least 18 years old; and Has successfully completed, at the applicant’s expense, an emergency epinephrine educational training program approved by the Department. The applicant shall submit to the Department with the form required in §A of this regulation a written policy that includes: Designation of agents; The name of the approved emergency epinephrine educational training program; and Procedures to: Store emergency use epinephrine; Notify a parent or guardian that emergency use epinephrine is available at camp; Maintain the emergency use epinephrine in a secure manner; Report use of emergency use epinephrine according to Regulation .06 of this chapter; Train an emergency epinephrine certificate holder and agent annually; and Maintain documentation of an emergency epinephrine certificate holder and agent training for 3 years. A provider of an emergency epinephrine educational training program may apply to the Department to have the training program recognized as approved for 5 years by submitting: An application form prescribed by the Department; A copy of all training program materials, including but not limited to handouts, presentations, and exams; and The following credentials of the instructor: Name; License type as required in §E of this regulation; and License number. An emergency epinephrine educational training program shall include: The signs and symptoms of anaphylaxis; Use of an emergency use epinephrine pen; Follow-up procedures with a parent or guardian after an emergency use epinephrine is administered; A skills demonstration; and A written examination. An individual teaching an emergency epinephrine educational training program shall be licensed as a physician, a registered nurse, or a certified nurse practitioner. The Department shall: Issue a certificate for emergency epinephrine to an applicant who meets the requirements in §§A and B of this regulation; Deny, revoke or suspend a certificate for emergency epinephrine from an applicant who does not meet the requirements in §§A and B of this regulation; Approve an emergency epinephrine educational training program if the training program meets the requirements of §C of this regulation; Disapprove an emergency epinephrine educational training program if the training program does not meet the requirement of §C of this regulation; and On or before January 31 of each year, publish a report summarizing the information obtained from the Reportable Incident Report Forms submitted to the Department related to the use of emergency use epinephrine at youth camps. A physician licensed to practice medicine in the State may prescribe emergency use epinephrine in the name of a certificate for emergency epinephrine holder. A pharmacist licensed to practice pharmacy in the State or a physician may dispense emergency use epinephrine under a prescription issued to a certificate for emergency epinephrine holder. A certificate for emergency epinephrine holder may: On presentment of a certificate for emergency epinephrine, receive from any physician licensed to practice medicine in the State a prescription for auto-injectable epinephrine; and Possess and store prescribed auto-injectable epinephrine. In an emergency situation when physician or emergency medical services are not immediately available, a certificate for emergency epinephrine holder or agent may administer emergency use epinephrine to an individual who is experiencing or believed in good faith by the certificate for emergency epinephrine holder or agent to be experiencing anaphylaxis. Except as otherwise provided in the Administrative Procedure Act, State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland, or in this regulation, before the Department takes any final action to deny, suspend, or revoke a certificate for emergency epinephrine the Department shall give the person against whom the action is contemplated an opportunity for a hearing. The Department shall give the applicant for a certificate for emergency epinephrine: Written notice of the denial, suspension, or revocation of the certificate for emergency epinephrine; The reasons for the denial, suspension, or revocation; and In accordance with §A of this regulation, an opportunity for a hearing. A person shall request a hearing, if a hearing is desired, by submitting to the Department a written request for a hearing. To preserve the right to a hearing, a person shall submit the written request within 10 calendar days of the receipt of the denial, suspension, or revocation notice. Family Law Article, §§5-560 — 5-568, 5-704, and 5-705; Health-General Article, §§2-104, 13-701 — 13-708, 14-402(d), 14-403, 18-318, and 18-403;Health Occupations Article, §§8-6A-01 — 8-6A-16 and 14-306; Annotated Code of Maryland Effective date: Regulations .01—.13, .15, and .16 adopted effective March 28, 2016 (43:6 Md. R. 408) Regulation .02B amended effective February 16, 2026 (53:3 Md. R. 122) Regulation .03A amended effective February 27, 2017 (44:4 Md. R. 254) Regulation .06F amended effective February 16, 2026 (53:3 Md. R. 122) Regulation .14 adopted as an emergency provision effective June 30, 2016 (43:15 Md. R. 861); emergency expired effective December 26, 2016 Regulation .14 adopted effective February 27, 2017 (44:4 Md. R. 254) Regulation .15 amended effective February 16, 2026 (53:3 Md. R. 122)