This chapter governs the procedure for the involuntary admission of individuals to inpatient mental hygiene facilities, including State facilities, private psychiatric facilities, acute general hospitals with inpatient psychiatric units, and Veterans' Administration hospitals pursuant to Health-General Article, §§10-603, 10-613 — 10-617, 10-620, 10-631 — 10-633, and 10-803— 10-806, Annotated Code of Maryland. This chapter is not intended to impose any exhaustion requirement upon an individual as a prerequisite to the individual's pursuing concurrently or in any order any available legal remedy to obtain release from an inpatient facility. In this chapter, the following terms have the meanings indicated. Terms Defined. “Administration” means the Behavioral Health Administration. “Administrative law judge (ALJ)” means an individual in the Office of Administrative Hearings who is authorized under State Government Article, §9-1604, Annotated Code of Maryland, to conduct hearings under this chapter. “Application for involuntary admission (Application for IVA)” means the application required under Health-General Article, §§10-614 and 10-615, Annotated Code of Maryland, to initiate the IVA of an individual to an inpatient facility. “Change of status hearing” means the IVA hearing that is convened when appropriate staff at an inpatient facility complete the application and certificates for IVA on behalf of an individual who is voluntarily admitted or court-ordered to the inpatient facility. “Department” means the Maryland Department of Health. “Discharge” means authorization by a physician for a voluntarily or involuntarily admitted individual to leave an inpatient facility. “Discharge summary” means a written evaluation by a physician that includes, at a minimum, the individual's diagnoses, summary of the treatment provided and progress during the current stay at the discharging inpatient facility, current mental status, prescribed medications, and treatment recommendations. “Geriatric Evaluation Services (GES)” means the staff of the county health departments that evaluate the appropriateness of admissions to State facilities or Veterans' Administration hospitals of individuals 65 years old or older. “Indigent” means that an individual has neither sufficient property to support the individual nor anyone able to support the individual to whom the individual is entitled to look for support. “Individual treatment plan (ITP)” means a treatment plan prepared for an individual in an inpatient facility according to the requirements outlined in Health-General Article, §10-706, Annotated Code of Maryland, and COMAR 10.21.03. Inpatient Facility. “Inpatient facility” means an inpatient institution that provides evaluation, care, or treatment for individuals who have mental disorders. “Inpatient facility” includes a Veterans' Administration (VA) hospital. “Involuntary admission (IVA)” means that an individual has been admitted to an inpatient facility by an ALJ following an IVA hearing pursuant to Health-General Article, §10-632, Annotated Code of Maryland. “Involuntary admission hearing (IVA hearing)” means an administrative proceeding at which an administrative law judge determines whether an individual who has been confined in an inpatient facility on the basis of application and certificates for IVA is retained as an inpatient or released from the inpatient facility without being admitted. “Medical clearance” means that an individual has been evaluated by a physician, a physician's assistant, or a nurse practitioner, and the evaluator has confirmed with the receiving inpatient facility that the receiving facility has the capacity to provide the necessary and appropriate medical management of the individual. “Medical record” means a record as defined in Health-General Article, Title 4, Subtitle 3, Annotated Code of Maryland. Mental Disorder. “Mental disorder” means a behavioral or emotional illness that results from a psychiatric or neurological disorder. “Mental disorder” includes a mental illness that substantially impairs the mental or emotional functioning of an individual so as to make care or treatment necessary or advisable for the welfare of the individual or for the safety of the person or property of another. “Mental disorder” does not include mental retardation or a primary diagnosis of alcohol or drug abuse. “Nolle pros” means “nolle prosequi” as set forth in Maryland Rule 4-247. “Observation status” means the status of an individual between the time the individual is initially confined in an inpatient facility on the basis of application and certificates for IVA and the time the individual is either admitted, voluntarily or involuntarily, to the inpatient facility or is released by a physician or by an ALJ from the inpatient facility without being admitted. “Office of Administrative Hearings (OAH)” means the office created under State Government Article, §9-1602, Annotated Code of Maryland. “Office of the Public Defender (OPD)” means the office created under Article 27A, Annotated Code of Maryland. “Party” means the inpatient facility or the individual for whom an IVA hearing has been convened. “Petition for emergency evaluation” means a petition filed under the provisions of Health-General Article, §§10-620 — 10-629, Annotated Code of Maryland, to initiate the evaluation of an individual in an emergency facility that is designated by the Department, under the provisions of Health-General Article, §10-621, Annotated Code of Maryland, to perform emergency psychiatric evaluations. “Physician” means an individual who is licensed under Health Occupations Article, Title 14, Annotated Code of Maryland, to practice medicine in this State or, if the individual is working in a Veterans' Administration Hospital, authorized by the U.S. Department of Veterans' Affairs to practice medicine. “Physician’s, psychologist’s, or psychiatric nurse practitioner’s certificate” means the certificate completed according to the provisions of Health-General Article, §§10-616 — 10-617, Annotated Code of Maryland. “Presenter” means the individual, including an assistant attorney general, designated by the chief executive officer of an inpatient facility, who acts on behalf of the inpatient facility at an IVA hearing. “Psychiatric nurse practitioner” means an individual licensed under Health-Occupations Article, Title 8, Annotated Code of Maryland, to practice nursing in this State as a certified registered nurse practitioner-psychiatric mental health (CRNP-PMH). “Psychiatrist” means a physician who is identified as a specialist in psychiatry by the Board of Physician Quality Assurance or, if the physician is working in a Veterans' Administration Hospital, by the U.S. Department of Veterans' Affairs. “Psychologist” means an individual who is: Licensed under Health Occupations Article, Title 18, Annotated Code of Maryland, to practice psychology or, if the individual is working in a Veterans' Administration Hospital, authorized by the U.S. Department of Veterans' Affairs to practice psychology; and Listed in the National Register of Health Service Providers in Psychology. “Release” means the authorization for an individual who is confined in an inpatient facility on the basis of application and certificates for IVA to leave the inpatient facility: Given by a physician during the observation status period; or Ordered by an ALJ at an IVA hearing. “Secretary” means the Secretary of Health. “Semiannual hearing” means the hearing that is held not sooner than 5 months or later than 6 months following an involuntarily admitted individual's last IVA hearing. “State inpatient facility” means an inpatient institution that is owned or operated by the State and that provides evaluation, care, or treatment for individuals who have mental disorders. “Stet” means the postponement of a trial pursuant to Maryland Rule 4-248. “Voluntary admission” means that an individual has been admitted to an inpatient facility on the basis of: A signed and endorsed formal application for voluntary admission pursuant to Health-General Article, §10-609 or 10-610, Annotated Code of Maryland; An informal request for admission pursuant to Health-General Article, §10-609, Annotated Code of Maryland; or If the voluntary admission is to a VA hospital, the procedure established by the VA hospital. “Working day” means any day except Saturday, Sunday, or a holiday on which State offices are closed. An applicant for IVA shall: Have a legitimate interest in the welfare of the individual for whom IVA is sought; Submit an application on the form required by: The Veterans' Administration, if the application is submitted to a Veterans' Administration hospital; or The Administration, if the application is submitted to an inpatient facility other than a Veterans' Administration hospital; Fill out the appropriate form completely; and Sign and date the application form. The Administration shall provide an application form that includes the following: The statutory authority for the application; The form number (MDH34) and revision date; Spaces for the: Name of the inpatient facility to which the application for IVA is submitted; Name of the individual for whom IVA is sought; Name, home or agency address, telephone number, and relationship to the individual or official capacity of the applicant; and Signature of the applicant and the date that the application is made. The following shall be submitted when initiating the IVA of an individual: An application for IVA completed under the provisions of Regulation .03 of this chapter; and A certificate completed by: Two physicians; One physician and one psychologist; or One physician and one psychiatric nurse practitioner. The Secretary shall provide the certificate that includes the following: The statutory authority for the certificate; The form number (MDH2) and revision date; A list of the appropriate documentation that shall be attached to one of the certificates; A statement that the certificate may not be used for the IVA of an individual if the examination on which the certificate is based was done: More than 1 week before the certificate is signed; or More than 30 days before the inpatient facility or the Veteran’s Administration hospital receives the application for admission; A list of the State inpatient facilities and the catchment areas from which each facility accepts referrals; Spaces for the following information: The name, address, and telephone number of the certifying physician, psychologist, or psychiatric nurse practitioner; The name, address, identifying data, and the next of kin of the individual for whom the certificate is made; The date that the physician, psychologist, or psychiatric nurse practitioner examined the individual; A diagnosis of a mental disorder of the individual; An opinion that: The individual needs inpatient care or treatment; and Admission to an inpatient facility is needed for the protection of the individual or another; and The individual's: Current medications; and Emergency medications; A statement of whether the individual who completes the certificate is a physician, psychologist, or psychiatric nurse practitioner; The statement that the physician, psychologist, or psychiatric nurse practitioner: Has no financial interest, through ownership or compensation, in a proprietary inpatient facility, and admission to that proprietary inpatient facility is sought for the individual whose status is being certified; and Is not related, by blood or marriage, to the individual or to the applicant; and Space for the signature of the physician, psychologist, or psychiatric nurse practitioner and for the date and time the certificate is signed. To complete a certificate for IVA, a physician, psychologist, or psychiatric nurse practitioner shall: Personally examine an individual for whom an application for IVA has been completed under the provisions of Regulation .03 of this chapter; Completely fill out the form described under §B of this regulation; Sign, date, and time the certificate not later than 1 week following the examination required under §C(1) of this regulation; and Attach to one of the certificates for IVA copies of any available current medical reports or records that support the individual's need for involuntary care or treatment in an inpatient facility, with reports including at a minimum: The diagnosis of mental disorder, current symptoms, and psychiatric history; A summary of the medical history, including documentation of medical clearance; An explanation of why the individual meets the following requirements for IVA: The individual has a mental disorder; The individual needs inpatient care or treatment; The individual presents a danger to the life or safety of the individual or of others; The individual is unable or unwilling to be admitted voluntarily; There is no available, less restrictive form of intervention that is consistent with the welfare and safety of the individual; and Unless the individual is an emergency evaluee, if the individual is 65 years old or older and is being referred for admission to a State inpatient facility or a VA hospital, a GES team has determined that there is no available, less restrictive form of care or treatment that is adequate for the needs of the individual; If the individual is an emergency evaluee, a copy of the petition for emergency evaluation; and If the individual is discharged from an inpatient facility after appropriate staff at the inpatient facility have completed application and certificates for IVA to initiate the direct confinement of the individual in another inpatient facility: The information outlined in §C(4)(a) — (d) of this regulation; The discharge summary; A copy of the individual's most recent ITP completed in accordance with Health-General Article, §10-706, Annotated Code of Maryland, and COMAR 10.21.03; and Copies of all voluntary and involuntary admissions documents relating to the current admission at the inpatient facility from which the individual is discharged. An inpatient facility may not use for the admission of an individual a certificate that: Is based on an examination that was done: More than 1 week before the certificate is signed; or More than 30 days before the inpatient facility receives the application for admission; or Was previously used in connection with the taking into confinement on observation status an individual who subsequently was admitted to or released or discharged from an inpatient facility. If an individual is confined on observation status in an inpatient facility on the basis of an application and certificates for IVA, staff at the inpatient facility shall inform the individual of the individual's status and rights: By giving the individual the Notice of Status and Rights form described under §C of this regulation and provided by the Administration; By explaining the information on the form to the individual in English or in the language and terms that are appropriate to the individual's condition and ability to understand; and At the following times: Within 12 hours of the individual's initial confinement in an inpatient facility on the basis of application and certificates for IVA under the provisions of Regulations .03 and .04 of this chapter; When certificates for IVA are executed for the purpose of changing the individual's status in accordance with Regulation .08B of this chapter; and When certificates are executed for the purpose of recertifying the individual for a semiannual hearing in accordance with Health-General Article, §10-806(d), Annotated Code of Maryland, and Regulation .08C of this chapter. Staff shall file a copy of the Notice of Status and Rights form in the individual's medical record and give copies to: When possible, the individual's parent, guardian, or next of kin; and If the individual does not understand the notice, the individual's: Parent, guardian, or next of kin; The applicant for IVA; and Any other person who has significant interest in the status of the individual. The Administration shall provide a Notice of Status and Rights form that includes the following: The statutory authority for the notice; The form number (MDH33) and revision date; A statement of the rights provided under Health-General Article, §10-631, and Title 10, Subtitle 7, Annotated Code of Maryland; The right and access to legal counsel provided under Health-General Article, §10-631(a)(2) — (4), Annotated Code of Maryland; The hearing rights enumerated under Health-General Article, §10-632, Annotated Code of Maryland, and Regulation .09C of this chapter; The right to request a judicial hearing on the cause and legality of the individual's admission and continued detention according to Health-General Article, §§10-804 and 10-805, Annotated Code of Maryland; and Spaces for: The name of the individual; The name of the inpatient facility; The basis for the individual's status and the provisions of law pertaining to the status; The signature of the individual and date that the individual received the notice; An explanation, if the individual does not sign the notice; An indication of whether the notice is given to a parent, guardian, or next of kin; An indication of whether the individual understands the notice; and Signature of inpatient facility staff who gives the notice to the individual and date that the notice is given. Staff at an inpatient facility shall inform an individual of the individual's right to an IVA hearing in accordance with the requirements for providing Notice of Status and Rights delineated in Regulation .05 of this chapter. Staff shall give the Notice of Hearing: Orally; and On the form provided by the OAH which shall include: The date, time, and place that the hearing will be held; The legal authority for and purpose of the hearing; A short statement explaining why the individual's involuntary admission is being sought; The standards delineated in Health-General Article, §10-632, Annotated Code of Maryland, that govern whether the individual shall be involuntarily admitted; Notice of the individual's right to consult with an attorney of the individual's choice and, if the individual is unable to afford an attorney, the availability of representation at the hearing through the Office of the Public Defender, Mental Health Division; and A list of the individual's rights at a hearing as set forth in Regulation .09C of this chapter. Staff shall file a copy of the Notice of Hearing form in the individual's medical record and give a copy to the individual's parent, guardian, or next of kin. Upon a properly executed application executed in accordance with Regulation .03 of this chapter and certificates for IVA and all required attachments in accordance with Regulation .04 of this chapter, an inpatient facility that accepts individuals who are referred for IVA may take an individual into confinement on observation status. GES Evaluation. If an individual is an emergency evaluee, and the individual is 65 years old or older, on the first working day after the individual is taken into confinement on observation status, staff at a State inpatient facility or Veterans' Administration hospital shall: Notify the GES team in the county where the individual resides; and Document whether the GES grants clearance for the involuntary admission of the individual. Examination. A psychiatrist shall examine an individual if the individual remains confined on observation status in an inpatient facility within 24 hours of the initial confinement. If a physician who examines an individual confined on observation status determines that the individual does not meet the requirements for IVA outlined in Health-General Article, §10-617, Annotated Code of Maryland, and Regulation .04C(4)(c) of this chapter, the physician shall: If the individual meets the requirements for voluntary admission, offer the individual an application for voluntary admission; or Immediately release the individual, following: Notification to the parent or guardian that the individual is being released, if the individual is a minor or is a disabled adult who is under guardianship of the parent or guardian under the provisions of Estates and Trusts Article, §13-708, Annotated Code of Maryland; and Preparation of a written aftercare plan in accordance with Health-General Article, §10-809, Annotated Code of Maryland. Medical Records. An inpatient facility shall maintain the medical records for individuals who are confined on observation status separate from the inpatient medical records of the facility. The inpatient facility may not disclose an individual's observation status medical record in any way that would indicate that the individual had been present in the inpatient facility, except: For the sole purposes of: Providing notice of admission status and rights and notice of hearing to the individual's parent, guardian, or next of kin, in accordance with Regulations .05 and .06 of this chapter; Calling witnesses to testify at the individual's IVA hearing; and Fulfilling the provisions of Health-General Article, Title 4, Subtitle 3, Annotated Code of Maryland; or Upon the authorization of the individual. Staff at the inpatient facility where an individual is confined may use prior observation status medical records, as necessary, to provide for the proper care or treatment of the individual. Rights. An individual who is confined on observation status in an inpatient facility shall be entitled to the rights granted in accordance with Health-General Article, Title 10, Subtitle 7, and Title 4, Subtitle 3, Annotated Code of Maryland. An individual taken into an inpatient facility in accordance with §A of this regulation shall remain confined on observation status until the individual is: Voluntarily admitted to the inpatient facility in accordance with the provisions of Health-General Article, §10-609 or 10-610, Annotated Code of Maryland, and if the individual is: A minor, a parent or guardian who is not a representative of a State agency signs an application for voluntary admission of a minor, in accordance with Health-General Article, §10-610, Annotated Code of Maryland; A minor who is confined in a State inpatient facility, a parent or guardian has not previously executed an application for voluntary admission of a minor during the minor individual's current confinement in the State inpatient facility; and Not a disabled adult who is under guardianship of the person under the provisions of Estates and Trusts Article, §13-708, Annotated Code of Maryland; Released by a physician of the inpatient facility before the scheduled IVA hearing pursuant to §C(2)(b) of this regulation; Admitted to the inpatient facility by an ALJ following an IVA hearing in accordance with Health-General Article, §10-632, Annotated Code of Maryland, and Regulation .09G of this chapter; or Released from the inpatient facility by an ALJ following an IVA hearing in accordance with Health-General Article, §10-632, Annotated Code of Maryland, and Regulation .09G of this chapter. Discharge of an Individual on Observation Status and Referral for Direct IVA at Another Inpatient Facility. An inpatient facility may refer for IVA to another inpatient facility an individual who is confined on observation status only if the receiving inpatient facility agrees to have the hearing held within 10 days of the individual's initial confinement in the discharging inpatient facility on the basis of application and certificates for IVA. Payment or Reimbursement for Care or Treatment. Payment or reimbursement for care or treatment of an individual who is confined on observation status in, or who is involuntarily admitted to, an inpatient facility shall be in accordance with the provisions of Health-General Article, Title 16, Subtitle 2, Annotated Code of Maryland. Initial Hearing. When an individual is confined on observation status in an inpatient facility on the basis of application and certificates for IVA, inpatient facility staff shall: Schedule a hearing to take place within 10 days of the individual's initial confinement in the inpatient facility; Notify the OAH and the OPD that the hearing has been scheduled; and Give the Notice of Status and Rights in accordance with Regulation .05 of this chapter, and Notice of Hearing in accordance with Regulation .06 of this chapter. The ALJ may postpone the hearing for good cause or by agreement of the parties, and the postponement shall be: For not more than 7 days; On the record; and One time only. Change of Status Hearing. An inpatient facility that accepts individuals who are referred for IVA may initiate the procedure outlined in this section to change the admission status of an individual when, in the clinical judgment of the individual's treating physician, the individual meets the requirements for IVA outlined in Health-General Article, §10-617, Annotated Code of Maryland, and Regulation .04C(4)(c) of this chapter, and the individual is: Admitted voluntarily pursuant to Health-General Article, §10-609, Annotated Code of Maryland, and the individual requests discharge or otherwise demonstrates that the individual is unwilling or unable to continue to agree to voluntary treatment; A minor who is admitted on the basis of an application for voluntary admission of a minor signed by the parent or guardian, pursuant to Health-General Article, §10-610, Annotated Code of Maryland, and the: Parent or guardian requests release of the minor; or Minor has been admitted to a State inpatient facility, and the minor is in need of care or treatment for longer than 20 days; or Admitted on the basis of a court order pursuant to Health-General Article, §12-104 or 12-110, Annotated Code of Maryland, and the Office of the State's Attorney or the court has agreed to dismiss, nolle prosequi, or stet the charges. Two physicians or one physician and one psychologist shall evaluate the individual and, if the individual meets the requirements for IVA outlined in Health-General Article, §10-617, Annotated Code of Maryland, and Regulation .04C(4)(c) of this chapter, shall submit an application for IVA of the individual in accordance with the provisions of Regulation .03 of this chapter and complete certificates for IVA in accordance with the provisions of Regulation .04 of this chapter: Within 3 days of the request for discharge, if the individual was admitted on the basis of a formal, written application for voluntary admission; Before 4 p.m. on the day of the request for discharge, if the individual was admitted voluntarily on the basis of an informal request; Before the expiration of the 20-day maximum stay, if the individual is a minor who was admitted to a State inpatient facility on the basis of an application for voluntary admission signed by the parent or guardian; and By the close of business of the next working day following official notification that the charges have been dismissed, nolle prossed, or stetted. Following completion of the application and certificates for IVA under §B(2) of this regulation, staff at the inpatient facility shall: Schedule a hearing to take place within 10 days of the completion of application and certificates for IVA in accordance with §B(2) of this regulation; Notify the OAH and the OPD that the hearing has been scheduled; Give the Notice of Status and Rights in accordance with Regulation .05 of this chapter, and Notice of Hearing pursuant to Regulation .06 of this chapter; and If the individual is 65 years old or older and is in a State inpatient facility or Veterans' Administration hospital, and during the individual's current stay in the State facility or Veterans' Administration hospital the individual has not been approved for IVA by the GES: Notify the GES in the county of the individual's last residence that application and certificates for IVA have been completed; and Document that the GES team has determined that there is no available, less restrictive form of care or treatment that is adequate for the needs of the individual. If an inpatient facility does not accept individuals who are referred for IVA, and an individual is admitted voluntarily, pursuant to Health-General Article, §10-609, Annotated Code of Maryland, if the individual requests to be discharged from the inpatient facility or otherwise demonstrates that the individual is unwilling or unable to continue to agree to voluntary treatment, before discharging the individual, staff at the inpatient facility: May initiate the procedure outlined in §B(2) of this regulation and arrange to refer the individual to an inpatient facility that accepts individuals who are referred for IVA; and Shall assure that a hearing shall be held at the receiving inpatient facility within 10 days of completion of application and certificates for IVA in accordance with §B(2) of this regulation. Semiannual Hearing. Facility staff shall schedule a hearing for the purpose of determining whether an individual continues to meet the requirements for IVA outlined in Health-General Article, §10-617, Annotated Code of Maryland, and Regulation .04C(4)(c)(i) — (v) of this chapter: Not sooner than 5 months or later than 6 months from the date that the individual is involuntarily admitted to an inpatient facility following an IVA hearing in accordance with §A or B of this regulation; and Semiannually after that. At least 7 days before the date a semiannual hearing is scheduled to take place: Two physicians or one physician and one psychologist or one physician and one psychiatric nurse practitioner shall complete certificates for IVA in accordance with the provisions of Regulation .04 of this chapter; Staff at the inpatient facility shall give the Notice of Status and Rights in accordance with Regulation .05 of this chapter, and Notice of Hearing pursuant to Regulation .06 of this chapter; Staff at the inpatient facility shall notify the OAH and the OPD that a hearing has been scheduled; and If the individual is 65 years old or older and is in a State inpatient facility or Veterans' Administration hospital, and during the individual's current stay in the State inpatient facility or Veterans' Administration hospital the individual has not been approved for IVA by the GES, State inpatient facility or Veterans' Administration hospital staff shall: Notify the GES in the county of the individual's last residence that certificates for IVA have been completed; and Document that the GES team has determined that there is no available, less restrictive form of care or treatment that is adequate for the needs of the individual. A parent or guardian of a minor individual may not execute an application for voluntary admission of the minor at the time that a semiannual hearing is scheduled for the minor. Powers and Duties of ALJ. An ALJ from the OAH shall conduct a hearing at the inpatient facility according to the rules of procedure outlined in COMAR 28.02.01. Location. Unless the ALJ, for good cause, relocates a hearing, the hearing shall take place in the inpatient facility where the individual is confined, and the inpatient facility shall provide a room that: During the hearing, is used for no other purpose; Has sufficient space and adequate and appropriate furnishings to accommodate the ALJ, the parties, and any others participating in the hearing; and Includes a speaker telephone that is adequate for the purpose of taking testimony by telephone. Rights of Parties. At a hearing, the parties have the right to: Be represented by counsel; Present witnesses; Cross-examine witnesses presented by the other party; Present documentary or other relevant evidence; Submit rebuttal evidence; and Present summation and argument. In addition, an individual has the right to: Wear the individual's own clothes; and Be present or waive the right to be present, if the waiver is: Knowingly and intelligently made; Witnessed by the individual's counsel; and Witnessed by the ALJ. Record of Hearing. The ALJ shall make and maintain a record of the hearing, and the record shall: Be an audio recording of the oral proceedings before the ALJ; Include a full description of the documentary evidence submitted at the hearing, but may not include the physical evidence itself; Be maintained for a period of 3 years following the hearing; and Upon request, be made available to a party to the hearing or to a party's counsel or authorized representative to listen to the record. Upon request by a party to the hearing, the OAH shall transcribe the record, and the record shall be: Paid for by the requesting party in accordance with the charges established in State Government Article, §10-621, Annotated Code of Maryland, and COMAR 10.01.08.14; or Provided without cost to an individual who: Has filed an appeal in proper person; and Is indigent. Testimony. The ALJ shall require the inpatient facility to provide for the testimony of one of the following, who has personally examined the individual within 48 hours before the hearing: A psychiatrist; A physician in an accredited residency program in psychiatry if the physician in the residency program in psychiatry is under the supervision of the psychiatrist who is responsible for the treatment of the individual who is the subject of the hearing; or A psychologist. Unless the inpatient facility demonstrates exceptional and compelling circumstances, the ALJ shall require the examining psychiatrist, physician in the residency program in psychiatry identified under §E(1)(b) of this regulation, or psychologist, to testify in person at the hearing. If the ALJ determines that a certifying physician or, psychologist, has not submitted adequate information with the certificate and that additional testimony from the certifying physician or, psychologist, may materially assist the ALJ to make an informed decision, the ALJ may; Require the certifying physician or, psychologist, to attend and testify at the hearing; or Receive the testimony of the certifying physician or, psychologist, by telephone. Burden of Proof. The burden of proof is on the inpatient facility to demonstrate by clear and convincing evidence that: The individual has a mental disorder; The individual needs inpatient care or treatment; The individual presents a danger to the life or safety of the individual or of others; The individual is unable or unwilling to be admitted voluntarily; There is no available, less restrictive form of intervention that is consistent with the welfare and safety of the individual; and If the individual is 65 years old or older and is being referred for admission to a State inpatient facility or VA hospital, a GES team has determined that there is no available, less restrictive form of care or treatment that is adequate for the needs of the individual. Findings and Conclusions. After the evidence and testimony are presented, and following summation and argument by the parties, the ALJ shall: Consider all evidence and testimony of record; Rule on issues raised by the individual that relate to the process by which the: Individual was taken into and confined during observation status; Individual's admission status was changed according to the provisions of Regulation .08B of this chapter; or Individual is presented for a semiannual hearing under the provisions of Regulation .08C of this chapter; Order the release of the individual from the inpatient facility if: An error in the process occurred; The error in the process is substantial; and No other available remedy is consistent with due process and the protection of the individual's rights; Order the release of the individual from the inpatient facility unless the inpatient facility meets the burden of proof outlined in §F of this regulation; State on the record the: Findings, including whether the individual waived the right to attend the hearing; Conclusions of law on any relevant issue presented; Right of the individual to appeal the decision of the ALJ pursuant to State Government Article, §§10-215 and 10-216, Annotated Code of Maryland, and the procedure for requesting an appeal; and Right of the individual to seek judicial release from the inpatient facility pursuant to the provisions of Health-General Article, §§10-804 and 10-805, Annotated Code of Maryland; and Give to the individual a written decision which shall: Be on the form provided by the OAH; Include the conclusions and the rights enumerated under §G(5) of this regulation; State whether the inpatient facility has proven that the individual meets each of the requirements for IVA outlined in Health-General Article, §10-617, Annotated Code of Maryland, and §F of this regulation; and By copy, be: Given to the presenter; Filed in the individual's medical record; and If the individual is a minor, given to the individual's parent or guardian if the parent or guardian is present at the hearing. If an individual is released from an inpatient facility by an ALJ under the provisions of Regulation .09G(3) of this chapter, and the individual’s treating physician, psychologist, or psychiatric nurse practitioner determines, based on the individual’s behavior and clinical condition after the hearing, that the individual meets the requirements for IVA outlined in Health-General Article, §10-617, Annotated Code of Maryland, and Regulation .04C(4)(c)(i) — (v) of this chapter: After the individual has been given the opportunity to leave the inpatient facility, the treating physician, psychologist, or psychiatric nurse practitioner may file a petition for emergency evaluation as the means of initiating an emergency psychiatric evaluation; and The inpatient facility may not accept the application and certificates for IVA that initiated the individual's initial confinement under Regulation .07A of this chapter for the purpose of taking the individual into confinement on observation status following the release. Unless an individual is discharged from one State inpatient facility and referred for IVA in another State inpatient facility: When an inpatient facility discharges an individual who has been involuntarily admitted pursuant to Health-General Article, §10-632, Annotated Code of Maryland, and Regulation .09G of this chapter, and refers the individual for IVA in another inpatient facility, appropriate staff at the discharging inpatient facility shall: Complete an application and certificates for IVA, including the required documentation outlined in Regulation .04C(4) of this chapter; and On or before the date of the referral for IVA, provide all the records necessary for the continuing care or treatment of the individual pursuant to Health-General Article, §§4-306(a)(5), 4-307(h)(1)(i), 10-807(d), and 19-308.2, Annotated Code of Maryland. Upon arrival of an individual who is referred for IVA and receipt of the documentation listed in §A of this regulation, the receiving inpatient facility shall: Take the individual into observation status in accordance with Regulation .07 of this chapter; and Schedule an IVA hearing in accordance with the provisions of Regulation .08A of this chapter. Health-General Article, §§7.5-204 — 7.5-205, 10-603, 10-615 — 10-616, 10-619 and 10-806(d)(3), Annotated Code of Maryland Effective date: December 5, 1970 Amended effective October 1, 1973 Chapter revised effective October 12, 1981 (8:20 Md. R. 1635) Annotation: COMAR 10.21.01.04B and .07E cited in Attorney General Opinion No. 86-031 (May 12, 1986) Regulations .01 — .10 repealed and new Regulations .01 — .11 adopted effective September 28, 1992 (19:19 Md. R. 1708) Regulation .02 amended effective September 13, 1993 (20:18 Md. R. 1430) Regulation .02B amended effective March 28, 2016 (43:6 Md. R. 409); January 2, 2017 (43:26 Md. R. 1445) Regulation .04 amended effective March 28, 2016 (43:6 Md. R. 409) Regulation .04B amended effective January 2, 2017 (43:26 Md. R. 1445) Regulation .08C amended effective March 28, 2016 (43:6 Md. R. 409) Regulation .09 amended effective September 13, 1993 (20:18 Md. R. 1430) Regulation .10 amended effective March 28, 2016 (43:6 Md. R. 409)