These regulations govern how an individual becomes licensed in Maryland to practice medicine. In this chapter, the following terms have the meanings indicated. Terms Defined. “ABMS” means the American Board of Medical Specialties. “ACCME” means the Accreditation Council on Continuing Medical Education. “ACGME” means the Accreditation Council for Graduate Medical Education. “Accredited training program” means a postgraduate clinical medical education program which is: Certified by the: Accreditation Council for Graduate Medical Education (ACGME) or its successor; or American Osteopathic Association (AOA) or its successor; Accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC) or its successor; A postgraduate clinical medical education program that meets all of the following criteria: Is in a specialty or subspecialty area, or both, that is not being accredited by the ACGME, AOA or RCPSC but meets all the requirements for accreditation of Accreditation Council for Graduate Medical Education, the American Osteopathic Association, or the Royal College of Physicians and Surgeons of Canada; Is directed by a physician who is actively licensed to practice medicine in the United States, its territories or possessions, Puerto Rico, or Canada; Is concurrently offered with ACGME-accredited programs; and Is taught at a hospital that is accredited by The Joint Commission or its successor or predecessor; or A program conducted in the United States of America or Canada that is the equivalent of §B(3)(a), (b), or (c) of this regulation as determined by the Board of Physicians. “AOA” means the American Osteopathic Association. “Applicant” means an individual applying for initial licensure as a physician in Maryland. “Application period” means the time between the Board's receipt of an application and the issuance of a license or the closure of an application through withdrawal, determination of ineligibility, or denial of application. “Board” means the Board of Physicians. “Board-certified” means the physician is certified by a public or private board, including a multidisciplinary board, and the certifying board is: A member of ABMS; An AOA certifying board; The Royal College of Physicians and Surgeons of Canada; or The College of Family Physicians of Canada. “CME” means continuing medical education. “ECFMG” means the Educational Commission for Foreign Medical Graduates or its successor. “FCVS” means the Federal Credentialing Verification Services of the Federation of State Medical Boards of the United States, Inc. “Federation” means the Federation of State Medical Boards of the United States, Inc. “FLEX examination” means the Federation Licensing Examination designed by the Federation of State Medical Boards in cooperation with the National Board of Medical Examiners. “FLEX weighted average” means the method of calculating the grade of the FLEX examination by which the test results on the first day count 1/6, the second day 2/6, and the third day 3/6. “Foreign medical school” means a medical school located outside the United States or its territories, Canada, or Puerto Rico. “LCME” means Liaison Committee on Medical Education, an organization that accredits programs in medical education leading to the doctor of medicine degree in the United States and territories and, in cooperation with the Committee on Accreditation of Canadian Medical Schools, in Canada. “Oral Proficiency Interview (OPI)” means the examination of the American Council on the Teaching of Foreign Languages designed to evaluate the spoken English proficiency of those whose native language is not English. "Orientation program” means a program of information approved by the Board which includes: The statutes and regulations governing the practice of medicine in Maryland; Boundary issues; and The role and functions of the Board. “Postgraduate training” means clinical and medical training for medical school graduates, including but not limited to, internships, residencies, and fellowships. “Professional school” means a school whose curricula lead to a professional license, certification, or registration issued under the Health Occupations Article, Annotated Code of Maryland, including the medical school of graduation or the medical school, where an applicant obtained medical education, that is affiliated with the institution that conferred the medical degree on the applicant. “Recertification” means successfully meeting all of the specified recertification requirements of a medical licensing authority or specialty board recognized by the Board. “Speech impairment” means a disorder of the voice, articulation, speech sounds, or fluency in the speaker's native language. “SPEX” means the Special Purpose Examination prepared by the Federation of State Medical Boards. “Successfully completed year of postgraduate training” means: 12 months of accredited postgraduate training in one integrated program in which the: Applicant completed all the requirements; Program director rated the applicant's performance as satisfactory; and Applicant's performance was such that the applicant qualified for advancement without academic or clinical probationary conditions to the next year and next progressive level of responsibility in a designated specialty program; or A year of accredited postgraduate training which the applicant completed in a manner that satisfied the requirements of §B(20-1)(a)(i) and (ii) of this regulation but that did not satisfy the requirements of §B(20-1)(a)(iii) of this regulation, and which was followed by a year of training which the applicant completed in a manner that satisfied all of the requirements of §B(20-1)(a) of this regulation. “TOEFL” means the Test of English as a Foreign Language. “USMLE” means the United States Medical Licensing Examination. Moral Character. The applicant shall be of good moral character. Age. The applicant shall be 18 years old or older. Fee. An applicant for initial licensure shall pay the initial application fee and any additional charges set by the Board. Education and Training. The applicant shall meet at least one of the following requirements: Have a doctor of medicine degree from a school of medicine accredited by LCME at the time of the applicant's graduation and have successfully completed 1 year of postgraduate training at an accredited training program; Have a doctor of osteopathy degree from a school of osteopathy in the United States, its territories or possessions, Puerto Rico, or Canada that has standards for graduation equivalent to those established by the American Osteopathic Association (AOA) and have successfully completed 1 year of postgraduate training at an accredited training program; Have a doctor of medicine degree from any other medical school, have successfully completed the requirements for and obtained ECFMG certification, and have successfully completed 2 years of post-graduate training at an accredited training program; or Have a document stating that the applicant has successfully completed a fifth pathway program as defined in Health Occupations Article, §14-308(a)(2), Annotated Code of Maryland, have successfully completed all of the formal graduation requirements of a foreign medical school except for the postgraduate or social service components as required by the foreign country or its medical school, and have successfully completed 2 years of postgraduate training at an accredited training program. On a case-by-case basis, the Board may consider full-time teaching in an LCME-accredited medical school in the United States as an alternative to the accredited postgraduate clinical medical education programs required in §D of this regulation. The Board may consider practice in another state of the United States or in Canada as an alternative to the accredited postgraduate clinical medical education program required in §D of this regulation if: There is a minimum of 10 years clinical practice in the United States or Canada, with 3 years being within 5 years of the date of the application; and The clinical practice occurred under a full unrestricted license to practice medicine. Examination. An applicant for licensure in Maryland shall successfully complete at least one of the following examination requirements: Achieve a passing score on all parts of the National Board of Medical Examiners examination as evidenced by an endorsement of certification issued by the National Board of Medical Examiners; Achieve a score as follows: At least 75 on each part of the FLEX examination; A FLEX weighted average score of at least 75 on a FLEX examination taken before 1985 and achieved in one sitting; or A FLEX weighted average score of at least 75 on a FLEX examination taken before 1985 and be currently certified by a member board of the American Board of Medical Specialties; Achieve a passing score, as evidenced by receipt of either a Diplomate Certification or a Certification of Completion issued by the National Board of Osteopathic Medical Examiners after January 1, 1971, on: All parts of the examination of the National Board of Osteopathic Medical Examiners (NBOME); All levels of the Comprehensive Osteopathic Medical Licensing Examination (COMLEX); or A combination of these examinations; Achieve the recommended passing score on all levels of the Comprehensive Osteopathic Medical Licensing Exam of the National Board of Osteopathic Medical Examiners; Achieve passing scores on any of the following examination combinations: NBOME Part 1 + NBOME Part 2 + COMLEX Level 3; NBOME Part 1 + COMLEX Level 2 + COMLEX Level 3; NBOME Part 1 + COMLEX Level 2 + NBOME Part 3; COMLEX Level 1 + NBOME Part 2 + NBOME Part 3; COMLEX Level 1 + COMLEX Level 2 + NBOME Part 3; or COMLEX Level 1 + NBOME Part 2 + COMLEX Level 3; Achieve a passing score on all parts of the examination of any state board or the District of Columbia Board of Medicine in the United States; Achieve a passing score on all steps of the United States Medical Licensing Examination (USMLE); If completed before the year 2000, achieve passing scores on any of the following examination combinations: USMLE Step 1 + NBME Part II + NBME Part III; USMLE Step 1 + USMLE Step 2 + NBME Part III; USMLE Step 1 + NBME Part II + USMLE Step 3; NBME Part I + USMLE Step 2 + USMLE Step 3; NBME Part I + USMLE Step 2 + NBME Part III; NBME Part I + NBME Part II + USMLE Step 3; FLEX Component 1 + USMLE 3; FLEX Component 2 + USMLE Step 1 + NBME Part II; FLEX Component 2 + USMLE Step 1 + USMLE Step 2; FLEX Component 2 + NBME Part I + USMLE Step 2; or FLEX Component 2 + NBME Part I + NBME Part II; or Achieve a passing score on each part of the applicable qualifying examination of the Liceniate of the Medical Council of Canada. An applicant who fails any part, step, level, or component of the examinations or combination of examinations listed in §G(1)of this regulation three or more times shall meet one of the requirements listed in §G(3) of this regulation. An otherwise qualified applicant who passes the examination after having failed the examination or any part of the examinations listed in §G(1) of this regulation or any part, step, level, or component of any of the examinations listed in §G(1) three or more times may qualify for a license only if the applicant: Has successfully completed 2 or more years of a residency or fellowship accredited by the ACGME or the AOA; Has met the following requirements: The applicant has a minimum of 5 years clinical practice of medicine in the United States or in Canada, with at least 3 of the 5 years having occurred within 5 years of the date of the application, that occurred under a full unrestricted license to practice medicine; and The applicant has no disciplinary action pending and has had no disciplinary action taken against the applicant that would be grounds for discipline under Health Occupations Article, §14-404, Annotated Code of Maryland; or Is Board-certified. Notwithstanding §G(1) of this regulation, the Board shall require an applicant to pass the SPEX examination or the Comprehensive Osteopathic Medical Variable-Purpose Examination—USA (COMVEX—USA) if the applicant: Last passed a medical licensing examination more than 15 years before this application; Has never had specialty board certification or last passed a specialty board certification examination given by a member board of the ABMS or the AOA more than 10 years before this application; Has not had a full, unrestricted medical license in at least one state of the United States or Canada within the 10-year period before this application; and Has not actively practiced clinical medicine in the United States or Canada for at least 7 of the 10 years before this application. Notwithstanding §G(1) of this regulation, the Board may require an applicant to pass the SPEX examination or the Comprehensive Osteopathic Medical Variable-Purpose Examination — USA (COMVEX — USA) if the applicant meets one or more of the conditions listed in §G(4) of this regulation. Additional Requirements. Each applicant shall submit a chronological list of all activities beginning with the date of completion of medical school through the date of application. The activities shall be listed by month and year, account for all periods of time, and include but not be limited to the following: All postgraduate training programs attended, regardless of whether the program was completed or not; Each job held, regardless of whether the job was: Medically related or not; or Compensated or not; Any other activity engaged in, including all periods of unemployment; An action, by a state licensing or disciplinary board, or a comparable body in the armed services, denying an application for licensure, reinstatement, or renewal; An action taken against the physician's license, by a state licensing or disciplinary board, or a comparable body in the armed services, including but not limited to limitations of practice, required education, admonishment, reprimand, suspension, or revocation for an act that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland; An investigation or charge brought against the physician by a licensing or disciplinary body or comparable body in the armed services; A medical or health professional license for which the physician has applied if the application was withdrawn for reasons that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland; An investigation or charge brought against the physician by a hospital, related institution, or alternative health care system that would be grounds for action under Health Occupations Article, §14-404, Annotated Code of Maryland; Any limitation or loss in privileges by a hospital, related health care facility, or alternative health care system that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland; A plea of guilty or nolo contendere, a conviction, or receipt of probation before judgment for a criminal act; A plea of guilty or nolo contendere, a conviction, or receipt of probation before judgment for an alcohol or controlled dangerous substance offense, including but not limited to driving while under the influence of alcohol or controlled dangerous substances; An arrest which would provide a basis for investigation or charge which would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland; A physical or mental condition that currently impairs the physician's ability to practice medicine; and The filing or settling of a medical malpractice action in which the physician is, or has been, named as a defendant within the past 5 years. An applicant shall submit the following additional information: Copies of the complaints, pleadings, and judgments in all malpractice claims if the applicant has had 3 or more claims in the 5 years before the filing of the application for licensure; Copies of all arrests, disciplinary actions, judgments, and final orders which occurred or were issued within the 7 years before submitting the application for licensure for driving while intoxicated, driving while under the influence of a chemical substance or medication, or any license probation, suspension, or revocation; and All medical licensure, certification, and recertification examination results and the dates when these examinations were taken. On forms supplied by the Board, an applicant shall agree to release to the Board relevant information from appropriate individuals, other institutions, and government agencies including, but not limited to, the National Practitioner Data Bank, hospitals, and other licensing bodies. On forms supplied by the Board, an applicant shall allow the Board to release information which is not statutorily protected. During the application process, an applicant for licensure shall have the duty to inform the Board by electronic or first-class mail of any of the circumstances listed in §H(1) and (2) of this regulation within 30 days of the occurrence of or notification about these circumstances. If reasonable questions regarding an applicant's physical, mental, or professional competency have been raised by the information provided on the application, the Board may request additional information regarding the applicant's competency from the chief of staff of a hospital where the applicant has practiced. English Language Competency. The applicant shall demonstrate oral and written English language competency as described in Regulation .04D of this chapter. Speech Impairment. An applicant wishing to claim speech impairment shall submit documentation of the impairment to the Board as described in Regulation .04E of this chapter. The applicant shall submit an application on a form supplied by the Board. Complete Application. A complete application for initial licensure shall include, but is not limited to, proof of the following through documentation on forms supplied by the Board: Verification of medical education; Written and electronic statements from an authorized official of each of the applicant's accredited training programs which: Summarize the experience and performance of the applicant during training; Detail all actions taken against the applicant by any training program, hospital, medical board, licensing authority, or court for an act that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland; Document specifically whether or not the applicant successfully completed the years of training; Detail any limitations of privileges during the postgraduate training years; and Detail any physical and mental health problems of the applicant that affected the applicant's ability to practice during the years of postgraduate training; Documentation of successful completion of the examination requirements as described in Regulation .03G of this chapter, including submission of all applicant’s scores sent directly to the Board from the examination authority or authorities. The Board may waive the requirement of §B(1)(b) of this regulation on a case-by-case basis, if the applicant's education or training occurred in countries with which reasonable efforts to obtain the required information have been unsuccessful. If licensure in another state preceded the requirement for ECFMG, the Board may waive the requirement for the ECFMG certificate. A complete application which contains a statement from the applicant listing all: Hospitals, following training, at which the applicant has had privileges during the preceding 5 years; and Disciplinary or adverse actions taken against the applicant by a: Hospital, Medical board, Licensing authority, Court, or Adjudicatory body. A complete application shall include: All application and licensing fees as required in Regulation .12 of this chapter, payable to the Board at the time the application is submitted to the Board; and The applicant's Social Security number which the Board shall use only for evaluation and identification of applicants and licensees, but may not disclose in any other context. Additional Requirements. Review of an application for licensure shall include: Verification of licensure from all states where the applicant has ever held a license; Verification of voluntary licensure nonrenewal, or voluntary surrender of license while the applicant was in good standing and not under disciplinary charges or investigation at the time the license was surrendered from states where the applicant no longer holds a license; Information in the data bank of the Federation pertaining to the qualifications of the applicant; Information in the National Practitioner Data Bank including but not limited to the following: Medical malpractice judgments against the applicant; Settlements made by the applicant in medical malpractice actions; Actions taken against the applicant or the applicant's license by state disciplinary or licensing authorities; and Actions taken against the applicant or the applicant's privileges by a hospital or hospital disciplinary authority which result in a loss, limitation, or suspension of privileges for a period greater than 30 days; and If reasonable questions regarding an applicant's physical, mental, or professional competency have been raised by the information provided on the application, original letters of reference from all of the hospitals at which the applicant has had privileges, describing the kind of experience received, the performance of the applicant, and explaining under what circumstances those privileges were limited, revoked, or allowed to lapse. English Language Competency. The applicant shall demonstrate oral and written competency in English by any of the following: Documentation of graduation from a recognized English-speaking high school or undergraduate school after at least 3 years of enrollment; Documentation of graduation from a recognized English-speaking professional school; Documentation of a passing score on the USMLE step 2 Clinical Skills; or Documentation of receiving: A score of at least 26 on the “Speaking Section” of the Internet-Based TOEFL; or A score of Advanced or higher on the OPI. Claims of Speech Impairment. Applicants wishing to claim a speech impairment after failing either the TOEFL or the OPI shall submit documentation of this impairment on forms supplied by the Board. Documentation of a speech impairment shall be submitted from a: Licensed physician; and Speech-language pathologist who is currently licensed to practice speech pathology in the United States. Documentation should be submitted with the applicant’s initial application but, in all cases, shall be submitted before the applicant’s second attempt at passing the TOEFL or the OPI. After the second examination, documentation of an impairment may not be submitted or accepted unless there has been an intervening medical/surgical event which has created the impairment. The applicant shall be allowed to claim the impairment only if: This event was reported to the Board before a third examination; and The Board determines that the medical/surgical event did indeed create the impairment. If the applicant has properly claimed and documented a speech impairment, the Board shall accept the documentation if the applicant is able to prove the ability to communicate with allied health personnel and patients. Proof shall include: Documentation from 3 licensed physicians that the applicant can communicate in a professionally competent manner with patients and health care providers; or A hearing before the Board where the applicant is asked to describe the manner in which the applicant would obtain a history and physical examination from a typical patient. The certifying or verifying authority shall send all certificates and verifications directly to the Board for applicants. The Board may not accept certificates and verifications sent to, or by, the applicant. If any of the documents required under this chapter are in a language other than English, the applicant shall submit the certified translation and bear the expense of translation by a certified translator. The Board has designated a 4-month period for acting upon applications as follows: Within 60 days after receipt of an application, the Board or its Executive Director will determine whether an application is complete; If the Board or the Executive Director determines that the application is not complete, the Executive Director or the Executive Director's designee shall send a notice of deficiency to the applicant; Upon receipt of the notice, the applicant shall correct the deficiency within 60 days or other period specified in the notice; If the applicant fails to correct the deficiency within the required period, the application may lapse and the applicant shall be required to submit a new application and pay the required fees. Withdrawal of Application. An applicant may not withdraw an application for initial licensure, renewal of a license, or reinstatement of a license without permission of the Board, if: The applicant is currently charged in another jurisdiction with conduct which would be grounds for discipline under the Health Occupations Article, §14-404, Annotated Code of Maryland, if the applicant were licensed in this State; The applicant is under investigation in another jurisdiction for an allegation concerning conduct that would be grounds for discipline under Health Occupations Article, §14-404, Annotated Code of Maryland, if the applicant were licensed in this State; or The Board is investigating the applicant or application or has issued a notice of intent to deny licensure. In determining whether to allow the withdrawal of a licensure application, the Board may consider such factors as the following: Issues of competence or conduct which caused the matter to be investigated; Duty to protect the public in other jurisdictions from duplicative expenditures on investigation of licensure applications; and Truthfulness of the applicant during the application process. The Board may accept documentation from the FCVS as evidence of having met some of the requirements of Regulations .03 and .04 of this chapter. Inactive Status. A licensee in good standing who will not practice medicine in this State may apply for inactive status. A licensee applying for an inactive license shall pay the inactive license fee and any additional charges set by the Board. A licensee may apply for inactive status if the licensee has an unrestricted active license to practice medicine in this State or is within 60 days of the expiration of the licensee’s unrestricted active license. Renewal. An inactive status shall be renewed every 2 years. At the end of 2 years, a licensee with inactive status shall complete the renewal application, and pay the renewal fee, and any charges set by the Board. If the licensee fails to renew their inactive license for any reason, the license will expire. A licensee with an inactive license may not: Practice medicine within Maryland; Prescribe medication within Maryland; or Conduct peer reviews of physicians within Maryland. A licensee on inactive status shall have the duty to inform the Board by [electronic] email or first-class mail of any of the circumstances listed in Regulation .03H(1) and (2) of this chapter within 30 days of the occurrence of or notification about these circumstances. The inactive status of a licensee does not deprive the Board of its authority to institute or continue a disciplinary proceeding against a licensee. To reinstate a license to active status, a licensee on inactive status shall apply for reinstatement on a form supplied by the Board and meet the requirements for reinstatement in Regulation .11 of this chapter, including the continuing medical education requirements. The physician may not practice medicine until the license is reinstated to active status. Emeritus Status. A licensee who meets the requirements under §B(3) of this regulation, who will not practice medicine in this State, and who is retired from practicing medicine in this State may apply for emeritus status. A licensee applying for emeritus status shall complete the emeritus application and pay the application fee as set by the Board. A licensee may apply for emeritus status if the licensee: Has practiced medicine in Maryland for at least 10 years; Has an active, unrestricted license to practice medicine in Maryland or is within 60 days of the expiration of an active, unrestricted license; Has never been the subject of disciplinary action that has resulted in revocation or suspension of a medical license in any jurisdiction in which they have been licensed to practice medicine; Is not under investigation by the Board; and Is in good standing. A licensee with emeritus status may not: Practice, offer to practice, or attempt to practice medicine within Maryland; Delegate medical acts within Maryland; Prescribe medication within Maryland; or Conduct peer review of physicians within Maryland. A licensee with emeritus status shall complete the renewal application and pay the emeritus renewal fee and any charges set by the Board every third renewal cycle. A licensee on emeritus status shall have the duty to inform the Board by email or first-class mail of any of the circumstances listed in Regulation .03H(1) and (2) of this chapter, including a change of address, within 30 days of the occurrence of or notification about these circumstances. The emeritus status of a licensee does not deprive the Board of authority to institute or continue a disciplinary proceeding against a licensee. To reinstate a license to active status, a physician whose license is on emeritus status shall apply for reinstatement on a form supplied by the Board and meet the requirements for reinstatement in Regulation .11 of this chapter, including the continuing medical education requirements. The physician may not practice medicine until the license is reinstated to active status. Moral Character. The applicant for a limited license for postgraduate teaching shall be of good moral character. Age. The applicant for a limited license for postgraduate teaching shall be 18 years old or older. Education, Training, and Experience. To meet the education and training requirements, a qualified applicant for a limited license for postgraduate teaching shall have: Graduated from an LCME-accredited medical school or a foreign medical school that is listed in the World Directory of Medical Schools at the time of the applicant's graduation or, for doctors of osteopathy, meet the requirements of Health Occupations Article, §14-307(d)(2), Annotated Code of Maryland; Satisfactorily completed a postgraduate training program which meets the following requirements: The postgraduate training shall have been in the specialty in which the applicant will function as a postgraduate teacher, The postgraduate training shall have included at least the same number of years of specialty postgraduate training as would be required for certification by that specialty's board in the United States and submit the requirements of both to the Board, and The applicant shall submit documents both from the United States and, if the applicant's specialty postgraduate training was obtained outside the United States, from each foreign specialty board to the Board; and Passed that specialty's certifying examination in either the country where specialty postgraduate training was obtained or where the applicant is practicing. A qualified postgraduate applicant shall meet the following experience requirements: Be a member in good standing of the specialty board in the country from which the applicant is applying; and Have functioned independently as both an academician and clinician for at least 3 years after the completion of postgraduate specialty training. Fees. An applicant for a limited license for postgraduate teaching shall pay the limited license fee for postgraduate teaching and any additional charges set by the Board. Additional Requirements for Postgraduate Teaching Licenses. The Board may require additional information which includes, but is not limited to, the following: Letter from the chief of staff of any hospital where the applicant has practiced within the 5 years preceding the application for a postgraduate teaching license, detailing the applicant's competence to practice medicine; Malpractice history; Driving record including, but not limited to, convictions for driving while intoxicated or while under the influence of a chemical substance or medication; Medical licensing examination results; Physical or mental examinations, or both, by a physician or evaluation program for treatment of impaired physicians, or both, chosen by the Board. On forms supplied by the Board, an applicant shall agree to release to the Board information from other institutions and government agencies including, but not limited to, the National Practitioner Data Bank, hospitals, and other licensing bodies. During the application process, an applicant for a limited license for postgraduate teaching shall have the duty to inform the Board by electronic or first-class mail of any of the circumstances listed in Regulation .03H(1) and (2) of this chapter within 30 days of the occurrence of or notification about these circumstances. A teaching institution seeking to obtain limited licenses for their postgraduate teachers shall present the Board with the following information: Detailed evidence of the physician's qualifications and competence including the nature of the physician's proposed responsibilities, reasons for any limitations of those practice responsibilities, and the degree of supervision under which the physician will function, if any; A copy of the relevant sections of the hospital bylaws which detail the requirements for, and mechanism of, supervising physicians; and A copy of the relevant section of the hospital bylaws which detail the requirements for, and mechanism of, supervision of postgraduate physician teachers. An applicant for a postgraduate teaching license shall agree that the applicant will: Only practice within the teaching institutions and programs specified within the application; Practice medicine only in conjunction with the applicant's teaching responsibilities; and Not practice medicine outside the applicant's teaching responsibilities. English Language Competency. The applicant shall demonstrate oral and written English language competency as described in Regulation .04D of this chapter. Speech Impairment. Applicants wishing to claim speech impairments shall submit documentation of these impairments to the Board as described in Regulation .04E of this chapter. Terms and Renewal of Postgraduate Teaching Licenses. The Board shall issue a postgraduate teaching license with a term of 1 year. The Board may renew a limited license for postgraduate teaching only once for a maximum period of 1 year. All fees, not set by statute, will be set by the Board. A copy of the current fee schedule is set forth in Regulation .12 of this chapter. Fees paid to the Board are nonrefundable. The Board may not renew a license until the Comptroller of Maryland has verified that the individual has paid all undisputed taxes and unemployment insurance contributions, or arranged for repayment, as required by COMAR 10.31.02. A licensee shall renew the license every 2 years. At least 1 month before the license expires, the Board shall send to the last known address of record of the licensee, by electronic or first-class mail: A renewal notice that states: The date on which the current license expires; The date by which the renewal application shall be received by the Board for the renewal to be issued and mailed before the license expires; The amount of the renewal fee and any additional charges set by the Board; and A blank panel data sheet supplied by the Health Care Alternative Dispute Resolution Office. If the Board chooses to send renewal notices exclusively by electronic mail, the Board shall send a renewal notice by first-class mail to a licensee on request of the licensee. The failure to receive a renewal notice does not excuse a licensee from complying with §B of this regulation. Before the expiration date of the license, a licensee applying for renewal shall complete the application for renewal on a form supplied by the Board. A licensee shall inform the Board by electronic or first-class mail of any of the circumstances listed in Regulation .03H(1) and (2) of this chapter within 30 days of the occurrence of or notification about these circumstances. A licensee applying for renewal shall complete the CME requirements as defined in Regulation .10 of this chapter. A licensee applying for renewal shall pay the renewal fee and any additional charges set by the Board. After the expiration date of the license, the physician is no longer licensed to practice medicine. The Board may impose a fine of up to $50,000 for practicing without a license if a formerly licensed physician: Fails to submit an application and to pay the requisite renewal fee within 60 days of the expiration of the license; or Practices medicine 60 days after the expiration of the license or thereafter. A holder of a restricted license to practice osteopathy shall renew the license every year as follows: Submit a renewal form supplied by the Board; and Pay a renewal fee and any additional charges set by the Board. A licensee applying for the first renewal shall have completed an orientation program approved by the Board. The Board may defer this requirement for physicians practicing out of State or in cases of individual hardship. A licensee with an expired license may not: Practice medicine within Maryland; Prescribe medicine within Maryland; or Conduct peer review of physicians within Maryland. A physician whose license is expired and who wishes to practice medicine in Maryland shall apply for reinstatement on a form supplied by the Board and meet the requirements for reinstatement in Regulation .11 of this chapter, including the continuing medical education requirements. The physician is not licensed to practice medicine until the license is reinstated. Definitions. In this regulation, the following terms have the meanings indicated. Terms Defined. “2-year period” means: For license renewal, the 2 years preceding the expiration of the physician license; or For license reinstatement, the 2 years preceding the date of the submission of the application for reinstatement of the physician license. “Applicant” means: A licensed physician applying for renewal of the physician license; or A physician applying for reinstatement of the physician license. The Board recognizes and accepts CME activities which serve to maintain, develop, or increase knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession, and are within the basic medical sciences, the disciplines of clinical medicine, and the provision of health care to the public. Requirements. In accordance with the requirements specified in §C(2) of this regulation, in a 2-year period, an applicant shall earn at least 50 credit hours of Category I or II CME, with at least 25 of those CME credit hours being Category 1. The Board shall recognize for Category I or II CME credit those activities which meet at least one of the following additional requirements for the activity: Be accredited as Category I or II by the ACCME; Be sponsored by an international, national, or state medical society, and meet the standards adopted by the ACCME; Be an accredited training program and have been attended by the applicant within a 2-year period, on the basis of either of the following: 1 year of full-time service earns 50 CME credit hours; and Full-time service for a portion of a year earns 1 credit hour per week; and Is a service performed by a Board designee and involves medical record review for the Board and the service is performed without compensation and is credited up to a maximum of 10 credit hours for a 2-year period. On the application form for renewal or reinstatement, the applicant shall attest to the fact that the applicant has completed the CME requirement. Documentation of CME Credits. The applicant has the affirmative obligation to obtain the requisite documentation of CME attendance and retain this documentation for the succeeding 6 years for possible inspection by the Board. The applicant shall be considered to have met the requirements of §C(1) of this regulation if the applicant: Currently holds an active time-limited certification issued by: A member of the American Board of Medical Specialties; An American Osteopathic Association Certifying Board; The Royal College of Physicians and Surgeons of Canada; or The College of Family Physicians of Canada; and Provides proof of maintenance of a time-limited Board certification that is dated no longer than 5 years prior to the renewal date. The required documentation of attendance at a CME program as described in §C(2)(a) and (b) of this regulation shall be a certificate or other documentation of attendance which shall: Contain at a minimum the: Program title; Sponsor's name; Physician's name; Inclusive date or dates and location of the CME event; CME category designation and the number of designated or prescribed CME credit hours; and Documented verification of successful completion by stamp, signature, hospital printout, or other official proof; and Demonstrate that the CME activity fell within a 2-year period. The required documentation of attendance at an accredited residency or fellowship as described in §C(2)(c) of this regulation shall be a certificate or other form of documentation which shall contain at the minimum the: Program title; ACGME accredited sponsor's name and location; Physician's name; Inclusive dates of the residency or fellowship; Specialty area of residency or fellowship; and Documented verification of completion by the sponsor. The Board shall apply the CME requirement to all renewal and reinstatement applications after the first renewal, or, in the case of an applicant who has never renewed, after initial licensure. A physician who has failed to renew a license by the license expiration date and whose license has been placed on inactive status or whose license has been placed on emeritus status shall apply for reinstatement on a form supplied by the Board in order to resume the practice of medicine in this State. A physician applying for reinstatement shall pay a reinstatement fee and any additional charges set by the Board. A physician applying for reinstatement shall submit documentation of completing the required number of CME hours for reinstatement as defined in Regulation .10 of this chapter. A physician applying for reinstatement may be denied reinstatement subject to the hearing provisions of Health Occupations Article, §14-405, Annotated Code of Maryland, for any of the grounds listed in Health Occupations Article, §14-404, Annotated Code of Maryland. A physician applying for reinstatement shall provide the Board with a detailed description of activities which have occurred since the last renewal application or, in the case of a physician who has never renewed, since the date when a medical licensure application was submitted to the Board. This description may include, but not necessarily be limited to, the information required under Regulations .03 and .04 of this chapter. A physician applying for reinstatement may be required to pass the SPEX or COMVEX-USA examination if the physician: Last passed a medical licensing examination more than 15 years before this application; Has never had specialty board certification or last passed a specialty board certification examination given by a member board of the ABMS or the AOA Bureau of Osteopathic Specialists more than 10 years before this application; Has not had a full, unrestricted medical license in at least one state of the United States or Canada within the 10-year period before this application; or Has not actively practiced clinical medicine in the United States or Canada for at least 7 of the 10 years before this application. The physician shall include a statement on the application form for reinstatement agreeing to the above examination requirements. The fees are as follows: Application fees. Original physician or osteopath licensure application, American and foreign school graduate ... $310; Conceded eminence application ... $1,090; Physician license fee per month until expiration of initial license ... $20; Physician inactive license ... $218; Postgraduate teaching license ... $300; Physician emeritus license ... $120; Renewal fees: Physician biennial license renewal ... $486; Inactive biennial renewal fee ... $218; Physician emeritus renewal fee ... $120; Physician reinstatement fee ... $700; Other fees: Replacement of license for a name change ... $25; Permit to dispense prescription drugs ... $1,050; Written verification of licensure ... $50; Electronic records ... $45 plus $0.05 per record. A physician may place advertisements. An advertisement may not contain: Statements containing misrepresentation of facts; Statements that cannot be verified by the Board for truthfulness; Statements likely to mislead or deceive because in context the statements make only a partial disclosure of relevant facts; Statements intended to, or likely to, create false or unjustified expectations of favorable results; Statements specifying a fee for professional service which does not include the cost of all related procedures, services, and products which to a substantial likelihood will be necessary for the completion of the advertised service as it would be understood by an ordinarily prudent person; Statements advertising discounted or free services, examinations, or treatments when there will be an additional charge for any additional services, examinations, or treatments which are performed as a result of and within 72 hours of the initial office visit in response to the advertisement unless the professional services rendered are a result of a bona fide emergency; Statements conveying the impression that the physician could improperly influence any public body, official, corporation, or any person on behalf of a patient; Statements containing representations or implications that in reasonable probability can be expected to cause an ordinary prudent person to misunderstand or be deceived; or Statements containing representations that the physician is willing to perform any procedure which is illegal under the laws or regulations of Maryland or the United States. A physician who is not board certified as defined in Regulation .02B(9) of this chapter may not use the term “board certified” to describe the physician’s qualifications or make any representation that the physician has received formal recognition as a specialist in any aspect of the practice of medicine. A physician who is board certified may not use the term “board certified” to indicate certification or expertise in a specialty or subspecialty area other than that in which the physician is certified by the certifying board. An advertisement may represent that a physician subspecializes in an area of medicine if the physician first identifies the physician's specialty. This regulation does not prevent a physician from accurately describing a focus of the physician's practice in a field within the scope of the physician's training and board certification. A physician shall also be accountable under this regulation if he uses an agent, partnership, professional association, or health maintenance organization to implement actions prohibited by this regulation. An advertisement may state a range of prices for specifically described services if reasonable disclosure of all relevant variables and consideration is made. The Board shall keep a record of those physicians who have been: Identified by the Board of Physician Quality Assurance as specialists before October 1, 1996; or Certified by the American Board of Medical Specialties and the American Osteopathic Association. A physician may not engage in solicitation, including in-person, telephone, or direct mail solicitation which: Amounts to fraud, undue influence, intimidation, or overreaching; Contains statements which would be improper under Regulation .13B of this chapter. A physician shall also be accountable under this regulation if he uses an agent, partnership, professional association, or health maintenance organization to implement actions prohibited by this regulation. A physician shall be licensed to practice only under the name on the license. A licensee wishing to change the name under which the licensee practices shall obtain the Board's approval under Regulation .15B and C of this chapter. The failure of a licensee to practice under the name on the license shall be considered unprofessional conduct by the Board and grounds for disciplinary action. The Board shall issue a replacement license or registration card if the original license is lost, destroyed, stolen, or damaged, or if there has been a change of the licensee's name. The Board shall require that the following accompany requests for replacement licenses: The proper fee; Any required application forms which are to include the reason for the replacement license request; A passport quality photograph of the licensee, taken within 60 days of the application, affixed to the affidavit form supplied by the Board; and Return of the original license if the license is damaged or a replacement is sought for reasons of a name change. If the request for a replacement license results from a change of name, the licensee shall submit a certified copy of the official document (marriage certificate, divorce decree, court order, or other document) indicating the name change, date, and place of change. If the change occurred during naturalization, the applicant shall also include the naturalization number, name and address of the court, and the date of naturalization, as well as the name change. The Board shall issue a replacement license which bears the same number and expiration date as the original and shall print “Replacement” and the date of replacement across the front of the license. Requirements. An applicant for initial licensure by reciprocity shall: Have an active, unrestricted license to practice medicine in another jurisdiction that: At the time the applicant was licensed, had licensure requirements substantially equivalent to the Board’s current licensure requirements as set forth in Regulation .03 of this chapter; and Offers a similar reciprocal licensure process to physicians licensed by the Board; Be in good standing under the laws of every jurisdiction where the individual is licensed; and Submit to a State and national criminal history records check in accordance with Health Occupations Article, §14-308.1, Annotated Code of Maryland. Documentation. An applicant for initial licensure by reciprocity shall submit: An application for reciprocity on a form provided by the Board; The application fee as set by the Board; Evidence of compliance with §A of this regulation; and Any additional documentation set forth in Regulation .04 of this chapter that is needed for the Board to evaluate an application. On receipt of the documentation required in §B of this regulation, the Board shall process the application for initial license by reciprocity in an expedited manner. The Board may not issue a license if the criminal history records information, pursuant to §A of this regulation, has not been received. After a license is issued, the licensee is subject to the Board’s jurisdiction and shall comply with all laws and regulations governing the practice of medicine in the State. Health Occupations Article, §§1-213, 14-101, 14-205—14-207, 14-301, 14-302, 14-304—14-307, 14-310, 14-311, 14-313, 14-314, 14-316—14-318, 14-320, 14-320.1, 14-503, 14-505, and 14-606, Annotated Code of Maryland Effective date: May 7, 1971 Amended effective November 9, 1971; March 31, 1976 (3:7 Md. R. 401) Chapter revised effective March 16, 1977 (4:6 Md. R. 507) Regulation .02 amended effective July 25, 1980 (7:15 Md. R. 1425) Regulation .05B amended effective February 20, 1981 (8:4 Md. R. 342) Regulation .08C amended effective May 5, 1978 (5:9 Md. R. 684) Regulation .08D adopted effective February 20, 1981 (8:4 Md. R. 342) Regulations .09 and .10 adopted effective July 25, 1980 (7:15 Md. R. 1425) Chapter revised effective December 20, 1982 (9:25 Md. R. 2484) Regulation .04A adopted as an emergency provision effective June 1, 1983 (10:12 Md. R. 1070); emergency status extended at 10:15 Md. R. 1342 and 10:23 Md. R. 2060 Chapter revised effective January 30, 1984 (11:2 Md. R. 113) Regulation .11 adopted as an emergency provision effective July 1, 1991 (18:14 Md. R. 1607); emergency status expired January 1, 1992 (Emergency provisions are temporary and not printed in COMAR) Regulation .11 adopted effective January 2, 1992 (18:25 Md. R. 2751) Chapter revised effective August 1, 1994 (21:15 Md. R. 1306) Regulation .02B amended effective October 7, 1996 (23:20 Md. R. 1423); April 5, 1999 (26:7 Md. R. 543); October 2, 2000 (27:19 Md. R. 1725); June 25, 2001 (28:12 Md. R. 1110) Regulation .03 amended effective October 2, 2000 (27:19 Md. R. 1725); June 25, 2001 (28:12 Md. R. 1110); July 22, 2002 (29:14 Md. R. 1075) Regulation .03F amended effective October 7, 1996 (23:20 Md. R. 1423); April 5, 1999 (26:7 Md. R. 543) Regulation .03G amended effective October 7, 1996 (23:20 Md. R. 1423) Regulation .03G amended as an emergency provision effective October 28, 2002 (29:23 Md. R. 1807); amended permanently effective February 17, 2003 (30:3 Md. R. 180) Regulation .03G amended effective December 9, 2004 (31:24 Md. R. 1726); November 7, 2005 (32:22 Md. R. 1756); February 22, 2010 (37:4 Md. R. 341) Regulation .04 amended effective April 5, 1999 (26:7 Md. R. 543) Regulation .04B—E amended effective October 7, 1996 (23:20 Md. R. 1423) Regulation .05 amended effective October 7, 1996 (23:20 Md. R. 1423) Regulation .06C, E, H amended effective October 7, 1996 (23:20 Md. R. 1423) Regulation .08E, G—I amended effective October 7, 1996 (23:20 Md. R. 1423) Regulation .08K adopted effective April 5, 1999 (26:7 Md. R. 543) Regulation .09B, D amended effective October 7, 1996 (23:20 Md. R. 1423); October 20, 1997 (24:21 Md. R. 1450); April 17, 2000 (27:7 Md. R. 705) Regulation .10E amended effective April 5, 1999 (26:7 Md. R. 543) Regulation .10F amended and J adopted effective October 7, 1996 (23:20 Md. R. 1423) Regulation .11 amended effective April 5, 1999 (26:7 Md. R. 543); March 20, 2000 (27:5 Md. R. 705); April 2, 2001 (28:6 Md. R. 621) Regulation .12 amended effective December 29, 1997 (24:26 Md. R. 1759); April 17, 2000 (27:7 Md. R. 705) Regulation .13A amended effective October 7, 1996 (23:20 Md. R. 1423) Regulation .15A, D amended effective October 7, 1996 (23:20 Md. R. 1423) Regulation .16 amended effective July 22, 2002 (29:14 Md. R. 1075) Regulation .16B amended effective October 7, 1996 (23:20 Md. R. 1423) Regulation .17 amended effective October 7, 1996 (23:20 Md. R. 1423); April 5, 1999 (26:7 Md. R. 543) Regulation .17 repealed effective July 22, 2002 (29:14 Md. R. 1075) Chapter revised effective September 29, 2014 (41:19 Md. R. 1080) Regulation .02B amended effective August 26, 2019 (46:17 Md. R. 727) Regulation .03G amended effective August 7, 2023 (50:15 Md. R. 682) Regulation .04B amended effective August 15, 2016 (43:16 Md. R. 900) Regulation .05 amended effective December 11, 2023 (50:24 Md. R. 1042) Regulation .06C amended effective August 26, 2019 (46:17 Md. R. 727) Regulation .08 amended effective January 2, 2017 (43:26 Md. R. 1446) Regulation .10 amended effective January 2, 2017 (43:26 Md. R. 1446); September 30, 2024 (51:19 Md. R. 854) Regulation .11 amended effective December 11, 2023 (50:24 Md. R. 1042) Regulation .11G amended effective January 2, 2017 (43:26 Md. R. 1446) Regulation .11I repealed effective January 2, 2017 (43:26 Md. R. 1446) Regulation .11I, J adopted as an emergency provision effective January 4, 2022 (49:4 Md. R. 298); emergency status expired effective July 3, 2022 Regulation .12 amended effective December 11, 2023 (50:24 Md. R. 1042) Regulation .12B amended effective April 23, 2018 (45:8 Md. R. 422) Regulation .12E amended effective July 20, 2015 (42:14 Md. R. 880) Regulation .13A amended effective August 28, 2017 (44:17 Md. R. 835) Regulation .17 adopted effective June 19, 2017 (44:12 Md. R. 588) Regulation .17F adopted as an emergency provision effective January 4, 2022 (49:4 Md. R. 298); emergency status expired effective July 3, 2022 These regulations govern procedures for disciplinary and licensing matters before the Board of Physicians. In this chapter, the following terms have the meanings indicated. Terms Defined. “Administrative action” means an order issued by the Board for reasons other than the disciplinary grounds under Health Occupations Article, §14-404, Annotated Code of Maryland, and that is not considered a disciplinary action. “Administrative expungement” means the classification of a record by the Board as confidential, not for public release, and removed from the licensee’s public individual profile. “Administrative law judge (ALJ)” means a hearing officer delegated the duty of conducting evidentiary hearings for the Board or disciplinary panel. “Administrative Procedure Act” means State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland. “Administrative prosecutor” means the attorney assigned from the Office of the Attorney General to prosecute administrative charges. Administrative Reinstatement. “Administrative reinstatement” means the reactivation of an inactive or expired license. “Administrative reinstatement” does not include postdisciplinary reinstatement. “Advisory letter” means a nonpublic letter issued by a disciplinary panel which informs, educates, or admonishes an individual licensed by the Board in regard to the practice of medicine or an allied health profession. “Allied health professional” means an individual who is licensed by the Board under: Health Occupations Article, §§14-5A—14-5F, Annotated Code of Maryland; or Health Occupations Article, Title 15, Annotated Code of Maryland. “Applicant” means an individual who has submitted an application to: The Board for initial licensure, for administrative expungement, or for administrative reinstatement; or Disciplinary panel for postdisciplinary reinstatement. “Board” means the Maryland State Board of Physicians. “Board counsel” means the attorney assigned from the Office of the Attorney General for the purpose of advice on legal matters before the Board or a disciplinary panel. “Cease and desist order” means an order of the Board issued under Health Occupations Article, §14-206(e), Annotated Code of Maryland, prohibiting an individual from practicing medicine without a license or from taking an action for which there are grounds for discipline under Health Occupations Article, §14-404, and which poses a serious risk to the health, safety, and welfare of a patient. “Charging document” means written notification that sets forth the grounds upon which the Board or a disciplinary panel is taking administrative action against the respondent or applicant. Complaint. “Complaint” means an allegation or report that: A Board licensee has committed a prohibited act for which a disciplinary panel can take disciplinary action or impose a fine; An individual is practicing medicine without a license; or A licensed physician has acted necessitating a Board action under Health Occupations Article, §14-206(e)(2), Annotated Code of Maryland. “Complaint” includes, but is not limited to, the following: Issuance of a certificate of merit in a malpractice claim; A report from a hospital or related institution, or an alternative health system, pursuant to Health Occupations Article, §14-413 or 14-414, Annotated Code of Maryland; A law enforcement report; A report from another country, state, or jurisdiction or the armed services of the United States; A malpractice insurance report; A report from another federal or state agency or court in any country, state, or jurisdiction; Consumer complaints; Media publications; Statements on applications for licensure, renewal, or reinstatement; and Other information, from whatever source, which warrants investigation. “Contested case” has the meaning stated in State Government Article, §10-202(d), Annotated Code of Maryland. “Disciplinary panel” means a panel established under Health Occupations Article, §14-401, Annotated Code of Maryland, which: Is composed of 11 Board members; and Addresses: Complaints and disciplinary actions against licensed physicians and allied health professionals; and Postdisciplinary licensure reinstatements. “Disposition agreement” means a formal nonpublic agreement by which the health care provider agrees to comply with certain conditions and the disciplinary panel stays further investigation or forgoes further action on a matter based on compliance with those conditions. “Final order” means: The final written decision of the Board or disciplinary panel which results from a contested case proceeding or other formal proceeding and which contains findings of fact, conclusions of law, and a disposition which: Denies a license; Sanctions by reprimand, probation, fine, consent order, suspension, or revocation; Dismisses charges; Accepts a surrender of a license; or Denies administrative reinstatement of a license; An order that denies postdisciplinary reinstatement of a license; or An order to cease and desist from the practice of medicine. “Fine” means a monetary penalty. “Imperatively requires” means that an action shall be undertaken pursuant to State Government Article, §10-226(c)(2), Annotated Code of Maryland, as a result of factual contentions which raise a substantial likelihood of risk of serious harm to the public health, safety, or welfare before an evidentiary hearing governed by the Administrative Procedure Act is likely to be completed and result in a final order. Investigation. “Investigation” means the gathering of the information necessary for the Board or a disciplinary panel to determine one or more of the following: Whether there is reasonable cause to charge the respondent with a violation of the Medical Practice Act or another statute which gives a disciplinary panel disciplinary authority; Whether an applicant is eligible for licensure or administrative reinstatement; The facts necessary for the Board to issue a declaratory ruling; or Whether an individual has complied with any disciplinary panel order. “Investigation” includes: A preliminary investigation; and A full investigation. “Involved medical specialty” means the area of medical specialty whose practitioners, in the disciplinary panel’s opinion: Treat the medical or surgical ailment, symptom, or problem in question; and Would likely be familiar with the risks and benefits of treatments provided for that ailment, symptom, or problem. “Licensure” means permission to engage in a health care profession regulated by the Board. “Medical Practice Act” means Health Occupations Article, §§14-101—14-702, Annotated Code of Maryland. “Peer review” means an evaluation by a physician or physicians with special qualifications to judge the matter at hand, based on professional involvement within the involved medical specialty or specialties, of an act or acts of medical or surgical care, or other acts connected with medical practice, by an applicant or licensee. “Post deprivation hearing” means a disciplinary panel hearing scheduled after the disciplinary panel has issued an order for summary suspension pursuant to State Government Article, §10-226(c)(2), Annotated Code of Maryland, and at which the respondent has the opportunity to explain why the disciplinary panel should rescind the order of summary suspension. “Postdisciplinary reinstatement” means: The reactivation of a revoked or suspended license; or The reactivation of a license surrendered while the licensee was under investigation or subject to disciplinary charges. “Predeprivation hearing” means a disciplinary panel hearing at which the respondent has the opportunity to explain why the disciplinary panel should not issue an order for summary suspension pursuant to State Government Article, §10-226(c)(2), Annotated Code of Maryland. “Preliminary investigation” means the initial review of a complaint or application irregularity which is the basis for the decision on whether to assign the case to a disciplinary panel for a full investigation or whether to close the investigation due to lack of jurisdiction or because, even if there were a full investigation, there still would not be a legal or factual basis for the issuance of a charging document. “Prohibited act” means any conduct for which the Board or a disciplinary panel can issue a sanction. “Proposed decision” means the proposed findings of fact and, where required by the delegation order from the Board or a disciplinary panel, the proposed conclusions of law and proposed disposition issued by the administrative law judge. “Public individual profile” means the licensee profile maintained by the Board in accordance with Health Occupations Article, §14-411.1, Annotated Code of Maryland. “Recusal” means disqualification by a Board or disciplinary panel member from participating in a proceeding because of a legal interest or prejudice in the case before the Board or disciplinary panel. “Respondent” means an individual who has been: Given notice to answer allegations concerning violations of a statute over which the Board or a disciplinary panel has jurisdiction; Notified as to a potential summary suspension pursuant to State Government Article, §10-226(c), Annotated Code of Maryland; or Given notice to answer allegations concerning violations of a Board or disciplinary panel order. “Revocation” means the removal of a health care provider’s license to practice a health occupation. “Sanction” means an action by the Board or a disciplinary panel which: Reprimands; Places on probation; Fines; Suspends or revokes a license; Disciplines by a consent order; or Accepts a letter of surrender in lieu of charges or further investigation or prosecution. “Sanctioning guidelines” means guidelines set out in Regulation .10 of this chapter, indicating the minimum and maximum penalty associated with each ground for discipline and mitigating or aggravating circumstances which could result in imposition of a penalty below the minimum or above the maximum. “Show cause” means a demand by letter or order issued by a disciplinary panel, which directs the respondent to: Respond either in writing or by an appearance before the Board or a disciplinary panel; and Present reasons and argument why a particular order should not be entered. “Special qualifications to judge the matter at hand” means those credentials which qualify a peer reviewer as a member of the involved medical specialty in a particular case. “Stay” means the withholding of disciplinary panel action against a health care provider. “Stet” means the act of staying further action in a proceeding, subject to the proceeding being reopened at a later date. “Summary suspension” means a denial for an indefinite period of the right to use a license. “Surrender” means the voluntary relinquishing of a Board license to a disciplinary panel. “Suspension” means a denial of the right to use a license. This regulation applies to: Proceedings under Health Occupations Article, §1-307, 14-405, 14-5A-17(b), 14-5B-14(b), 14-5C-17(b), 14-5D-15, 14-5E-16(b), 14-5F-18(b) or 15-315, Annotated Code of Maryland; and To the extent specifically provided in this regulation, cease and desist orders. This regulation does not apply to procedures pursuant to Health Occupations Article, §14-404(b), 14-5A-17(c), 14-5B-14(c), 14-5C-17(c), 14-5D-14(b), 14-5E-16(c), or 14-5F-18(c) or 15-314(b), Annotated Code of Maryland. Investigation of Complaints. Designated staff shall undertake a preliminary investigation regarding an allegation of grounds for disciplinary or other action brought to the Board’s attention before the allegation is assigned to a disciplinary panel. A complaint concerning alleged grounds for discipline of a Board licensee shall be assigned to a disciplinary panel which: Shall review a complaint in light of the preliminary investigation; and May direct further investigation, referral for peer review, closure without charges, or closure with an advisory letter. Participation in the complaint review process is not ordinarily a basis for recusal of a disciplinary panel member from further proceedings in the case. Investigative Subpoenas. Except as provided in §C(4)(b) of this regulation, upon the receipt of a timely written request from a psychiatrist who is the subject of a complaint concerning the quality of the psychiatric care provided by that psychiatrist, a quorum of a disciplinary panel shall review a subpoena for mental health records made or held by that psychiatrist before the subpoena is enforced. Section C(4)(a) of this regulation does not apply to: Any subpoena other than an investigative subpoena; A subpoena issued in response to an investigation opened based upon a patient complaint; A subpoena issued as a result of a complaint or action by a law enforcement agency; A subpoena issued as a result of a complaint from a health care professional; A subpoena for records if the executive director or the deputy director determines that there is a reasonable possibility that the records will be destroyed, secreted, lost, or altered if the subpoena is not promptly enforced; or A subpoena if the executive director or deputy director determines that there is a reasonable possibility of imminent harm to the public health, safety, or welfare, including the health, safety, or welfare of an individual patient. Section C(4)(b) of this regulation does not affect any rights which an individual may have under Health-General Article, Annotated Code of Maryland, to contest a subpoena in court. Review by the Peer Reviewers. After being assigned a complaint, a disciplinary panel shall have the matter reviewed by peer reviewers if the complaint concerns an allegation that a physician failed to: Meet the standards of quality medical care; or Keep adequate medical records. The disciplinary panel shall obtain reports from at least two different peer reviewers in each case for each allegation referred for peer review. If one or both peer reviewers conclude that a violation of the standard of care has occurred, the disciplinary panel shall make the final peer review report, consisting of the reports of each individual peer reviewer, available to the respondent for review before the disciplinary panel considers whether to issue charges. The disciplinary panel shall redact the names of the peer reviewers before making the report available under this section. The respondent may provide a written response to the peer review report within 10 business days after the report was sent to the respondent by electronic mail or 13 business days if the report was sent via U.S. postal service. The disciplinary panel shall: Consider both the final peer review report and any written response submitted within the time period specified in §D(4) of this regulation; and Determine whether there is reasonable cause to charge a respondent with failure to meet appropriate standards of quality care. Prosecution of Complaint. Except as provided in §E(2) of this regulation, a disciplinary panel may not bring charges against a licensee based solely on events contained in a complaint the disciplinary panel received more than 6 years after: The day the complainant actually discovered the facts that form the basis of the complaint; or The day when a reasonable person exercising due diligence should have discovered the facts that form the basis of the complaint. The prohibition in §E(1) of this regulation does not apply to complaints that are based on any of the following: Criminal convictions; Sexual misconduct; Other boundary violations; Reciprocal actions under Health Occupations Article, §14-404(a)(21), Annotated Code of Maryland; Ongoing substance abuse; Fraudulent concealment of material information; or Acts that occurred while a patient was a minor. After reviewing the completed investigative information and reports, a disciplinary panel shall make its determination to: Close a complaint investigation without charges; Take informal action by issuing a nonpublic advisory letter; Request the respondent to enter into a disposition agreement with the disciplinary panel if the respondent suffers from substance abuse or a physical, mental, or emotional condition which may otherwise jeopardize medical care; Except as provided in §E(1) of this regulation, vote to charge a respondent with a violation of a ground under Health Occupations Article, §14-404, Annotated Code of Maryland, or COMAR 10.32.07, or another statute which gives the Board or disciplinary panel authority; Vote to deny administrative reinstatement; or Accept a surrender on terms acceptable to the disciplinary panel. Summary Suspension. In addition to charging, the disciplinary panel assigned to the complaint may vote to summarily suspend or vote an intent to summarily suspend the license of the respondent pursuant to State Government Article, §10-226(c), Annotated Code of Maryland. A vote to summarily suspend the license of the respondent may be taken before the disciplinary panel charges the respondent. After a vote to take formal action under §E(3)(d) or (e) and (4) of this regulation, the disciplinary panel shall refer the matter to the administrative prosecutor for prosecutorial action. Based upon a review of the case, the prosecutor may refer the matter back to the disciplinary panel for further consideration. If the disciplinary panel issues charges, the disciplinary panel shall serve it upon the respondent by regular mail or hand delivery at the address the respondent maintains for purposes of licensure notice. The disciplinary panel may delegate the issuance and service of the charges to the administrative prosecutor. The disciplinary panel, in the notice of administrative reinstatement, shall provide the respondent with an opportunity to request a hearing within 30 days from receipt of service. Disciplinary Committee for Case Resolution (DCCR). After service of the charging document, the respondent and the complainant shall be offered a meeting with the disciplinary panel that was originally assigned the complaint and which sits as a DCCR. The meeting is a voluntary, informal settlement, proceeding to explore the possibility of a consent order or other resolution of the matter. The proceedings concerning a summary suspension are governed by Regulation .08 of this chapter and do not entail a meeting before a DCCR. If the respondent and the administrative prosecutor each do not agree with the proposed settlement offered by the DCCR, the matter proceeds to a hearing before the Office of Administrative Hearings. Except for the DCCRs consideration of a proposed resolution of a case achieved through the conference with the DCCR, the disciplinary panel, the parties, and the complainant may not make use of any commentary, admissions, facts revealed, or positions taken, including any disposition recommended by the DCCR, in the subsequent stages of the disciplinary proceedings unless the subject matter is available from other sources or is otherwise discovered. The respondent, administrative prosecutor, and complainant are prohibited from revealing this material. The complainant and respondent may attend and participate as authorized by statute. The complainant may be accompanied by Board staff but not by any other person. Representation; Parties. The respondent may appear in proper person or be represented by counsel in any matter before a disciplinary panel and during any stage of the disciplinary proceedings. The respondent may be represented only by an attorney admitted to the Maryland Bar or specially admitted to practice law in Maryland under Rule 14 of the Maryland Rules Governing Admissions to the Bar found in the Maryland Rules. The administrative prosecutor shall present evidence and argument at an evidentiary hearing on the charges and arguments before a disciplinary panel in the exceptions process as specified in Regulation .05 of this chapter. The administrative prosecutor is a party to the administrative proceedings: As soon as formal charges are issued; and Until a disciplinary panel’s final decision is issued. The Board or a disciplinary panel is not a party to the proceedings before an administrative law judge. The Chair, or the Chair’s designee, of a disciplinary panel assigned the complaint may issue orders necessary to regulate the proceedings under this regulation. Application. This regulation applies to cases under Health Occupations Article, §§1-307, 14-405, 14-5A-17(b), 14-5B-14(b), 14-5C-17(b), 14-5D-15, 14-5E-16(b), 14-5F-18(b) and 15-315 Annotated Code of Maryland. This regulation does not apply to cases under Health Occupations Article, §14-404(b), 14-5A-17(c), 14-5B-14(c), 14-5C-17(c), 14-5D-14(b), 14-5E-16(c), or 14-5F-18(c) or 15-314(b), Annotated Code of Maryland, or to cease and desist orders issued under Health Occupations Article, §14-206(e), Annotated Code of Maryland. Delegation. If the charges are not resolved with the DCCR, the chair of the DCCR shall refer the case to the other disciplinary panel which shall delegate to an administrative law judge responsibility to make: Proposed findings of fact; Proposed findings of fact and proposed conclusions of law; or Proposed findings of fact, proposed conclusions of law, and proposed disposition. If the disciplinary panel has delegated the case to the Office of Administrative Hearings for the issuance of proposed findings of fact only, the following apply: The delegation to the Office of Administrative Hearings is limited to making proposed findings of fact on allegations which are disputed; The disciplinary panel may rescind the delegation if: The parties jointly notify the disciplinary panel prior to the prehearing conference, or the administrative law judge notifies the disciplinary panel prior to the occurrence of the factors set out in State Government Article, §10-205(d)(2), Annotated Code of Maryland, that there are no substantial factual allegations in dispute; The notification recites the facts which are undisputed; and The disciplinary panel determines that the facts agreed upon are sufficient to decide the issue; and If a delegation to the Office of Administrative Hearings has been rescinded pursuant to §B(2)(b) of this regulation, the disciplinary panel shall set the case on the disciplinary panel docket for the disciplinary panel to issue conclusions of law and a disposition based on the undisputed material facts, after giving the parties a reasonable opportunity for written and oral argument. If the disciplinary panel has delegated the case to the Office of Administrative Hearings for the issuance of proposed findings of fact and conclusions of law only, the following apply: The delegation to the Office of Administrative Hearings is limited to making proposed findings of fact and conclusions of law on allegations which are disputed; and The disciplinary panel may rescind the delegation if: The parties jointly notify the disciplinary panel prior to the prehearing conference, or the administrative law judge notifies the disciplinary panel prior to the occurrence of the factors set out in State Government Article, §10-205(d)(2), Annotated Code of Maryland, that there are no substantial factual allegations or conclusions of law in dispute; The notification recites the facts and conclusions of law which are undisputed; and The disciplinary panel determines that the facts and conclusions of law agreed upon are sufficient to decide the issue. If a delegation to the Office of Administrative Hearings has been rescinded pursuant to §B(3)(b) of this regulation, the disciplinary panel shall set the case on the disciplinary panel docket for the disciplinary panel to issue a disposition based on the undisputed material facts and conclusions of law, after giving the parties a reasonable opportunity for written and oral argument. The disciplinary panel may rescind a delegation to an administrative law judge if prior to the start of the evidentiary hearing: The parties execute a proposed consent order settling all aspects of the case; and The disciplinary panel initially assigned the complaint agrees to that proposed consent order. Discovery. Discovery on Request. In addition to any disclosures required by §C(2) or (3) of this regulation, by written request served on the other party and filed with the administrative law judge, a party may require another party to produce, within 15 calendar days, the following: A list of witnesses to be called; and Copies of documents intended to be produced at the hearing. Mandatory Notice of Specific Defenses in Cases Involving the Standard of Quality Care. The respondent shall notify the administrative prosecutor not later than 45 days after the issuance of charges of any statement made to the respondent by the patient which was not recorded in the respondent’s medical record of the patient, and which affected the patient’s course of treatment, including but not limited to: Any refusal of hospitalization or treatment; Any report of symptoms; Any report of the effects of medication; Any report by the patient of consultations or treatment by other health care providers; and Any expressions by the patient of a preference for one course of treatment over another. The respondent shall notify the administrative prosecutor not later than 45 days after the issuance of charges of: Any consultation concerning the patient, formal or informal, with any other health care provider, which is not recorded in the patient’s medical record; or Any communication with family members of the patient which affected the patient’s course of treatment, and which is not recorded in the patient’s medical record. The notices required by §C(2)(a) and (b) of this regulation shall be in writing and shall state: The name of the declarant or consultant; The substance of the declaration or consultant report; and The date on which each communication took place. Unless the respondent has provided the notice required by §C(2) of this regulation, the administrative law judge shall exclude from the hearing any evidence described in §C(2)(a) or (b) of this regulation. Mandatory Discovery. Each party shall provide to the other party not later than 15 days prior to the prehearing conference or 45 days prior to the scheduled hearing, whichever is earlier: The name and curriculum vitae of any expert who will testify at the hearing; and A detailed written report prepared and signed by the expert summarizing the expert’s testimony, which includes the opinion offered and the factual basis and the reasons underlying the opinion. If the administrative law judge finds that the report is not sufficiently specific, or otherwise fails to comply with the requirements of this section, the administrative law judge shall exclude from the hearing: The testimony of the expert; and Any report of the expert. The administrative law judge shall consider and decide arguments concerning the sufficiency of the report at the prehearing conference and may require that the report be timely amended, if insufficient, to allow the opposing party ample opportunity to prepare for hearing. If an expert adopts the written report of the disciplinary panel’s peer reviewer or reviewers, or adopts a sufficiently specific charging document as the expert’s report, that adoption is considered to satisfy the requirements set forth in §C(3) of this regulation. Parties are not entitled to discovery of items except as listed in §C(1), (2), or (3) of this regulation. Subject to §C(7) of this regulation, both parties have a continuing duty to supplement their disclosures of witnesses and documents. Absent unforeseen circumstances which would otherwise impose an extraordinary hardship on a party, witnesses or documents may not be added to the list subsequent to: The prehearing conference, if scheduled; or If no prehearing conference is scheduled, 15 days prior to the hearing. The prohibition from adding witnesses subsequent to the prehearing conference does not apply to witnesses or documents to be used for impeachment or rebuttal purposes. Hearing. Unless the delegation has been rescinded according to §B(2), (3), or (4) of this regulation, the administrative law judge shall conduct an evidentiary hearing governed by the Administrative Procedure Act and COMAR 28.02.01. Evidence otherwise admissible under COMAR 28.02.01 may not be excluded solely on the ground that the evidence is not recited in the charging document. During these proceedings, the administrative law judge shall treat all records except for a charging document as confidential and sealed. Construction. In hearings conducted by an administrative law judge of the Office of Administrative Hearings, §C of this regulation shall, whenever possible, be construed as supplementing and in harmony with COMAR 28.02.01. In the event of a conflict between §C of this regulation and COMAR 28.02.01, §C of this regulation shall apply. The administrative law judge shall issue to the disciplinary panel, that delegated the case to the ALJ, a written proposed decision including, where applicable, proposed findings of fact, proposed conclusions of law, and a proposed disposition after the conclusion of the hearing. Application. This regulation applies to cases under Health Occupations Article, §§1-307, 14-405, 14-5A-17(b), 14-5B-14(b), 14-5C-17(b), 14-5D-15, 14-5E-16(b), 14-5F-18(b) and 15-315 Annotated Code of Maryland. This regulation does not apply to cases under Health Occupations Article, §14-404(b), 14-5A-17(c), 14-5B-14(c), 14-5C-14(c), 14-5D-14(b), 14-5E-16(f), or 14-5F-18(c) or 15-314(b), Annotated Code of Maryland, or to cease and desist orders issued under Health Occupations Article, §14-206(e), Annotated Code of Maryland. Exceptions. Written Exceptions. Any party may file with the disciplinary panel, that delegated the case to an administrative law judge, exceptions to a proposed decision of an administrative law judge within 15 days of its issuance. A party may file a response to any exceptions within 15 days of the date the exceptions are filed. The disciplinary panel may extend the period for filing exceptions and responses. The disciplinary panel may grant a party filing exceptions the opportunity to file a reply to a response within a stated period of time as determined by the disciplinary panel in any specific case. No further exceptions or responses of any kind may be accepted. Format. Written exceptions and responses to exceptions are limited to 15 pages in length, double-spaced and in at least 12-point type, and with margins of at least 1 inch. Any reply to responses to exceptions is limited to five pages in the same format. If a party attaches any part of the record to the exceptions, response, or reply, the attached pages are not to be encompassed within the applicable page limit. The disciplinary panel may require the attachment of those parts of the record cited in the exceptions in a form designated by the Board. Exceptions, responses, and replies may refer to the record by citing the exhibit number or the transcript page. The disciplinary panel chair or the disciplinary panel chair’s designee may in each case rule on specific procedural issues with respect to written exceptions. The disciplinary panel may not accept additional evidence through the written exceptions process. Oral Exceptions Hearing. If either party files exceptions, the disciplinary panel shall schedule a hearing, ordinarily 30 days after the receipt of responses to the exceptions, after which the disciplinary panel shall issue an order containing the disciplinary panel’s findings of fact, conclusions of law, and disposition. The presiding disciplinary panel member, usually the disciplinary panel chair, shall: Determine all procedural issues that are governed by this section; Make any rulings reasonably necessary to facilitate the effective and efficient operation of the hearing; and Ordinarily limit oral presentation by the respondent and the administrative prosecutor to 20 minutes each. The party who filed the first exceptions shall ordinarily proceed first. Additional Evidence. At the oral exceptions hearing, the disciplinary panel may not accept additional evidence unless: Both parties consent to the admission of additional documentary evidence and the disciplinary panel determines that acceptance of the additional evidence would promote the just and efficient completion of the process; or The disciplinary panel determines that either: A compelling reason exists that would create an obvious injustice if the additional documentary evidence were not considered and the evidence can be admitted without compromising the rights of the other party, including the other party’s opportunity to see the proffered evidence in a timely manner or cross-examine the source of the proffered document and present evidence to the contrary; or The evidence has been timely proffered before the administrative law judge and the administrative law judge abused his or her discretion in refusing to admit the evidence. If the parties do not file exceptions, the disciplinary panel shall consider the record, including the proposed decision of the administrative law judge, and issue its order based on the disciplinary panel’s findings of fact and conclusions of law. A Board staff member who testified at the hearing before the administrative law judge may not be present during disciplinary panel deliberations. Board Action. Final Order. The disciplinary panel shall issue a final order within 90 days after the conclusion of: An exceptions hearing; or Other formal disciplinary panel proceedings. Effect of Revocation Order. When a time period is not stated in an order for revocation, the disciplinary panel may not entertain an application for postdisciplinary reinstatement until at least 3 years after the date of the order. A revocation of a license may not be for less than 1 year and may be permanent. The disciplinary panel may not entertain an application for postdisciplinary reinstatement after an order of revocation unless: Any time period stated in the order has expired; The conditions set out in the order have been fulfilled; The applicant has filed a formal application and paid the fee; and The applicant meets all of the requirements for reinstatement set out in COMAR 10.32.01.10. The disciplinary panel that issued the final order revoking or suspending the respondent shall entertain applications for reinstatement pursuant to the procedures and standards of Regulation .06B of this chapter. Tolling. Except as a disciplinary panel order directs otherwise in a specific case, if a licensee subject to probation or suspension fails to renew a license: The failure to renew the license does not remove the suspension or probation from the licensee’s disciplinary record during the period of nonrenewal; Any condition of probation or condition precedent to terminating a suspension that is dependent on possessing a license is tolled until the probationer or suspended licensee again possesses a license; and The time period of probation or suspension, if any, is tolled until the probationer or suspended licensee again possesses a license. Section C(3)(a) of this regulation does not: Apply to fines; or Require the disciplinary panel to reinstate any former licensee. Postdisciplinary reinstatement after an order of suspension is subject to the following conditions: If an order suspends a license for a certain period of time, the respondent may petition the disciplinary panel that issued the order to suspend for postdisciplinary reinstatement only pursuant to that order; The disciplinary panel may not entertain early termination of the suspension; If termination of a suspension is made contingent on the happening of an event, the respondent shall establish the occurrence of the event to the satisfaction of the disciplinary panel; and If a health care practitioner whose license is suspended fails to renew the suspended license when that license expires, the health care practitioner may petition the disciplinary panel for termination of suspension only after applying for and meeting the requirements for reinstatement set out in COMAR 10.32.01.10. Postdisciplinary reinstatement of a revoked or surrendered license is subject to the following conditions: A petitioner for postdisciplinary reinstatement of a revoked or surrendered license shall submit the following: A written application for reinstatement on a form prescribed by the Board; The appropriate fee; Written responses to any questions the disciplinary panel may propose concerning the reasons the license was revoked or surrendered and the petitioner’s current fitness to practice; and Evidence of the completion of continuing medical education credits to the same extent as if the petitioner had been continuously licensed; If a license was revoked or surrendered while the licensee was under investigation or subject to disciplinary charges, the disciplinary panel may not consider the application for postdisciplinary reinstatement unless: If the letter of surrender indicates that the surrender or the revocation order is for a certain length of time, the time period has expired; or If the letter of surrender or revocation order does not indicate a time certain, 3 years have passed since the date of the order; and If the letter of surrender makes reinstatement contingent on certain conditions, those conditions have occurred; The disciplinary panel may grant postdisciplinary reinstatement of a revoked or surrendered license only in accordance with the terms of the order of revocation or the letter of surrender; The disciplinary panel may grant postdisciplinary reinstatement subject to any terms and conditions the disciplinary panel considers appropriate for public safety and the protection of the integrity and reputation of the profession; The disciplinary panel that issued the order to revoke or suspend may convene a reinstatement inquiry panel which: May conduct an informal inquiry which shall include, if requested, an opportunity for the petitioner to have a personal interview with the panel; May consider the petitioner’s history; and May consider presentations from both the petitioner and the administrative prosecutor’s office. The disciplinary panel shall consider the application form, the petitioner’s responses to the written questions, and the supporting documentation and written arguments, if any, submitted by the petitioner and the administrative prosecutor’s office, as well as the reinstatement inquiry panel’s recommendation; The disciplinary panel shall determine in its discretion if postdisciplinary reinstatement is in the interest of the health and welfare of the general public and consistent with the best interest of the profession; and A disciplinary panel decision denying reinstatement may set out when, if ever, a subsequent petition may be submitted. The disciplinary panel shall issue a final written order on the postdisciplinary reinstatement application that: Reinstates the license of the petitioner without conditions; Reinstates the license of the petitioner with one or more of the following conditions: Probation; Requirements for supervision; Further review of competence or performance; Limitations on practice; or Other conditions that the disciplinary panel considers necessary; or Denies reinstatement. An order granting or denying postdisciplinary reinstatement is an order resulting from formal disciplinary action. A petition for postdisciplinary reinstatement may be withdrawn only with the permission of the disciplinary panel. The disciplinary panel may not refund the fee except for extraordinary cause. In this regulation, “health care provider” means an individual who is a: Licensed physician; Licensed respiratory care practitioner; Licensed radiographer; Licensed nuclear medical technologist; Licensed radiation therapist; Licensed radiologist assistant; Licensed polysomnographic technologist; Licensed athletic trainer; Licensed perfusionist; Licensed naturopathic doctor; or Licensed physician assistant. Health Occupations Article, §§14-404(b), 14-5A-17(c), 14-5B-14(c), 14-5C-17(c), 14-5D-14(b), 14-5E-16(c), 14-5F-18(c) and 15-314(b), Annotated Code of Maryland, govern mandatory actions of the suspension or revocation of a license on the filing of certified docket entries, if the health care provider is convicted of or pleads guilty, including by an Alford plea, or a plea of nolo contendere to a crime involving moral turpitude. Procedures. The Office of the Attorney General through Board counsel shall provide to the disciplinary panel assigned to the case certified docket entries of the criminal court proceeding and the following documents from the court record: For a conviction, at least: The indictment, information, or other formal statement of the charges; and Documentation of the verdict and sentencing; and For a plea of guilty, including an Alford plea, or a plea of nolo contendere, at least one of the following: Stipulated statement of facts or statement of facts on the record; Plea agreement containing agreed facts; Transcript of plea agreement proceedings; or Written or transcribed opinion or statement of the judge accepting the plea. When the disciplinary panel determines that documents provided to it indicate that the respondent comes within the language and intent of Health Occupations Article, §14-404(b), 14-5A-17(c), 14-5B-14(c), 14-5C-17(c), 14-5D-14(b), 14-5E-16(c), 14-5F-18(c) or 15-314(b), Annotated Code of Maryland, and the disciplinary panel has a basis for finding preliminarily that it applies to the respondent, the disciplinary panel shall vote to issue an order requiring the respondent to show cause why the disciplinary panel should not take action under this section. After the vote to issue the show cause order, the disciplinary panel shall refer the matter to the administrative prosecutor for prosecutorial action. Based upon a review of the case, the prosecutor may refer the matter back to the disciplinary panel for further consideration. Service. The disciplinary panel shall serve the respondent by regular mail or hand delivery at the address the respondent maintains for purposes of licensure notice. The disciplinary panel may choose to serve the respondent personally. Opportunity to be Heard. The respondent, after service of the show cause order, has 30 days in which to respond. The respondent may show cause in writing on the following issues: Lack of conviction or plea; Whether the crime is one involving moral turpitude; Misidentity of the respondent with the defendant in the criminal matter; and Other relevant issues, if any, other than mitigation. The respondent may also, within 30 days of service of the show cause order, request an opportunity to address the disciplinary panel by a limited evidentiary hearing on the same issues. However, this argument may not be as of right, but is discretionary based on the existence of genuine issues of material fact or law as determined by the disciplinary panel. The presiding disciplinary panel member, usually the disciplinary panel chair, shall determine all procedural issues that are governed by this section, and may impose reasonable time limitations. The presiding disciplinary panel member shall make any rulings reasonably necessary to facilitate the effective and efficient operation of the hearing. Ordinarily, the respondent and the administrative prosecutor shall limit their oral presentation to 20 minutes each. The respondent shall proceed first. The presiding disciplinary panel member shall allow for consideration of documents the presiding disciplinary panel member determines relevant and material. The presiding disciplinary panel member may not admit oral testimony or witnesses. Disciplinary panel members may ask questions of any party appearing before the disciplinary panel. Representation. The respondent may appear in proper person or be represented by counsel. The administrative prosecutor shall present argument in support of the proposed sanction. Burdens of Production and Persuasion. The respondent may argue issues as set out in §E(2) of this regulation and has the burden of producing argument or evidence in response to the show cause order. The administrative prosecutor bears the burden of persuasion by a preponderance of the evidence that the respondent was convicted of or pled guilty or nolo contendere to a crime of moral turpitude. Disciplinary Panel Action. After consideration of the respondent’s answer, either in writing or at a hearing, the disciplinary panel shall deliberate and determine whether the crime is a crime involving moral turpitude, and then shall issue an appropriate order. A pending appeal of the conviction or plea does not operate as a bar to the disciplinary panel’s acting under Health Occupations Article, §14-404(b)(1), 14-5A-17(c)(1), 14-5B-14(c)(1), 14-5C-17(c), 14-5D-14(b)(1), 14-5E-16(c), 14-5F-18(c) or 15-314(b), Annotated Code of Maryland. A respondent suspended pursuant to Health Occupations Article, §14-404(b), 14-5A-17(c), 14-5B-14(c), 14-5C-17(c), 14-5D-14(b)(1), 14-5E-16(e), 14-5F-18(c) or 15-314(b), Annotated Code of Maryland, shall be reinstated immediately upon the filing of a certified docket entry that the conviction has been reversed. The reinstatement does not terminate any other disciplinary action or investigation pending against the respondent. State Government Article, §10-226(c), Annotated Code of Maryland, governs consideration of summary suspension of a license. Notice of Intent to Summarily Suspend. Based on information gathered during an investigation, the disciplinary panel may determine that there is a substantial likelihood of a risk of serious harm to the public health, safety, or welfare by the health provider, and vote an intent to summarily suspend the license of the respondent. If the disciplinary panel votes an intent to summarily suspend, the Board shall refer the matter to the administrative prosecutor for prosecutorial action. Based upon a review of the case, the prosecutor may refer the matter back to the disciplinary panel for further consideration. Notice to the respondent includes a: Proposed order for summary suspension; and Show cause notice letter providing an opportunity to the respondent to show cause why the order should not be issued. The proposed order for summary suspension includes but is not limited to: The statutory authority upon which the order is based; Notification that the respondent may request a full hearing to appeal the summary suspension, if executed by the disciplinary panel; and Statements of investigatory information which serve as a basis for the order. Service. The disciplinary panel shall serve the respondent: At least 5 calendar days before a predeprivation hearing; and By regular mail or hand delivery at the address the respondent maintains for purposes of licensure notice. The disciplinary panel may choose to serve the respondent personally. A show cause notice may not be required in extraordinary circumstances. The disciplinary panel, after consultation with the Board’s counsel, may suspend a license without prior notice and opportunity to be heard, if: The disciplinary panel determines that the health, welfare, and safety of the public or the physician imperatively requires immediate suspension; Notice and opportunity to be heard before the action is not feasible; and The respondent is provided with a postdeprivation opportunity to be heard within 15 days by the disciplinary panel, that voted to summarily suspend the license. Representation. The respondent may appear in proper person or be represented by counsel in any matter before the disciplinary panel. If represented at an evidentiary hearing, the respondent shall be represented only by an attorney admitted to the Maryland Bar or specially admitted to practice law in Maryland under Rule 14 of the Rules Governing Admission to the Bar found in the Maryland Rules. The administrative prosecutor shall appear in prosecution of the case. Predeprivation Hearing Before the Disciplinary Panel. The disciplinary panel, that voted to issue a show cause order, shall hold the predeprivation hearing on whether to summarily suspend the license. The presiding disciplinary panel member shall determine all procedural issues that are governed by this section, and may impose reasonable time limitations. The presiding disciplinary panel member may make any rulings reasonably necessary to facilitate the effective and efficient operation of the hearing, and shall limit the oral presentation by the respondent and the administrative prosecutor to 20 minutes each. The respondent shall proceed first. The presiding disciplinary panel member: Shall allow for consideration of oral presentations and documents considered by the presiding disciplinary panel member to be relevant and material to the proceeding and not unduly repetitious; and May not admit oral testimony or witnesses. The disciplinary panel members may ask any questions of any party appearing before the disciplinary panel. If the disciplinary panel proceeds under §B(7) of this regulation, the disciplinary panel shall hold a postdeprivation initial hearing. The disciplinary panel shall conduct the hearing in accordance with §D of this regulation unless the parties waive this hearing and proceed to the summary suspension appeal. Burdens of Production and Persuasion. The respondent may present argument in opposition to allegations presented in the proposed order for summary suspension. The administrative prosecutor bears the burden to show by a preponderance of the evidence that the health, welfare, and safety of the public imperatively requires the disciplinary panel to issue an order to suspend the respondent’s license. After the predeprivation hearing, the disciplinary panel shall vote to: Order a summary suspension; Deny the summary suspension; Enter any order to which the parties may agree; or Enter any interim order which the circumstances of the case warrant. After the postdeprivation hearing, the disciplinary panel shall vote to: Reaffirm the summary suspension; Rescind the summary suspension; Enter any order to which the parties may agree; or Enter any interim order which the circumstances of the case warrant. The respondent may demand a full evidentiary hearing on the merits within 10 days of the issuance of a summary suspension order, and the Office of Administrative Hearings shall set a hearing within 30 days of the demand. Evidentiary Hearing Before the Administrative Law Judge. The appeal from a summary suspension shall be an evidentiary hearing under the Administrative Procedure Act. After a full evidentiary hearing, the administrative law judge shall issue a proposed decision with findings of fact, conclusions of law and disposition. The administrative prosecutor and respondent may file exceptions in accordance with Regulation .05B of this chapter. If a party files exceptions, unless the exceptions hearing is waived, an exceptions hearing, on the record, shall be held before the disciplinary panel that had not issued the order of summary suspension. After the disciplinary panel issues its final order, the respondent may appeal this decision in accordance with Regulation .12 of this chapter. General Application of Sanctioning Guidelines. Sections A and B of this regulation and Regulation .10 of this chapter do not apply to offenses for which a mandatory sanction is set by statute or regulation. Except as provided in §B of this regulation, for violations of Health Occupations Article, §§14-404(a), 14-504 and 1-302, Annotated Code of Maryland, the disciplinary panel shall impose a sanction not less severe than the minimum listed in the sanctioning guidelines nor more severe than the maximum listed in the sanctioning guidelines for each offense. Ranking of Sanctions. For the purposes of this regulation, the severity of sanctions is ranked as follows, from the least severe to the most severe: Reprimand; Probation; Suspension; and Revocation. A stayed suspension in which the stay is conditioned on the completion of certain requirements is ranked as probation. A stayed suspension not meeting the criteria for §A(3)(b) of this regulation is ranked as a reprimand. A fine listed in the sanctioning guidelines may be imposed in addition to but not as a substitute for a sanction. The addition of a fine does not change the ranking of the severity of the sanction. The disciplinary panel may impose more than one sanction, provided that the most severe sanction neither exceeds the maximum nor is less than the minimum sanction permitted in the chart. Any sanction may be accompanied by conditions reasonably related to the offense or to the rehabilitation of the offender. The inclusion of conditions does not change the ranking of the sanction. If a licensee has violated more than one ground for discipline as set out in the sanctioning guidelines: The sanction with the highest severity ranking should be used to determine which ground will be used in developing a sanction; and The disciplinary panel may impose concurrent sanctions based on other grounds violated. Notwithstanding the sanctioning guidelines set forth in Regulation .10 of this chapter, in order to resolve a pending disciplinary action, the disciplinary panel and the licensee may agree to a surrender of license or a consent order with terms, sanction, and fine agreed to by the disciplinary panel, the administrative prosecutor, and the licensee. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the disciplinary panel may consider the aggravating and mitigating factors set out in §B(5) and (6) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines. If the disciplinary panel imposes a sanction that departs from the sanctioning guidelines set forth in Regulation .10 of this chapter, the disciplinary panel shall state its reasons for doing so in its final decision and order. Aggravating and Mitigating Factors. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the disciplinary panel may consider the aggravating and mitigating factors set out in §B(5) and (6) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines. Nothing in this regulation requires the disciplinary panel or an administrative law judge to make findings of fact with respect to any of these factors. A departure from the sanctioning guidelines set forth in Regulation .10 of this chapter is not a ground for any hearing or appeal of a disciplinary panel action. The existence of one or more of these factors does not impose on the disciplinary panel or an administrative law judge any requirement to articulate its reasoning for not exercising its discretion to impose a sanction outside of the range of sanctions set out in the sanctioning guidelines. Mitigating factors may include, but are not limited to, the following: The absence of a prior disciplinary record; The offender self-reported the incident; The offender voluntarily admitted the misconduct, made full disclosure to the disciplinary panel and was cooperative during the disciplinary panel proceedings; The offender implemented remedial measures to correct or mitigate the harm arising from the misconduct; The offender made good faith efforts to make restitution or to rectify the consequences of the misconduct; The offender has been rehabilitated or exhibits rehabilitative potential; The misconduct was not premeditated; There was no potential harm to patients or the public or other adverse impact; or The incident was isolated and is not likely to recur. Aggravating factors may include, but are not limited to, the following: The offender has a previous criminal or administrative disciplinary history; The offense was committed deliberately or with gross negligence or recklessness; The offense had the potential for or actually did cause patient harm; The offense was part of a pattern of detrimental conduct; The offender committed a combination of factually discrete offenses adjudicated in a single action; The offender pursued his or her financial gain over the patient’s welfare; The patient was especially vulnerable; The offender attempted to hide the error or misconduct from patients or others; The offender concealed, falsified or destroyed evidence, or presented false testimony or evidence; The offender did not cooperate with the investigation; or Previous attempts to rehabilitate the offender were unsuccessful. Fines for Unauthorized Practice of Medicine. The Board may impose a fine as provided in §C(3) of this regulation for: Practicing medicine without a license in violation of Health Occupations Article, §14-601, Annotated Code of Maryland; or A violation of an order of cease and desist from practicing medicine without a license. Factors in determining the amount of a fine include, but are not limited to the following: The extent to which the respondent derived any financial benefit from the improper conduct; The willfulness of the improper conduct; The extent of actual or potential public harm caused by the improper conduct; and The deterrent effect of the fine. Range of Fines Imposed. Except as specified in §C(3)(b) of this regulation, the Board may impose fines as follows: For the first violation, not less than $1,000 and not more than $30,000; For the second violation, not less than $10,000 and not more than $40,000; and For the third violation, not less than $15,000 and not more than $50,000. If the conduct resulted in harm to any patient, the Board may consider each patient seen to be a separate violation when imposing a fine listed in §C(3)(a) of this regulation. The Board shall pay all monies collected pursuant to this section into the Board’s fund. Other Fines. The disciplinary panel shall impose a fine of $100 for a violation of Health Occupations Article, §14-505, Annotated Code of Maryland, and a fine of $100 for a violation of Health Occupations Article, §14-316(f), Annotated Code of Maryland. The disciplinary panel shall pay all monies collected pursuant to §D(1) of this regulation into the Board’s fund. Offenses Related to Continuing Medical Education Credits. First Offense of Failure to Document Credits. Except as provided in §E(2) or (3) of this regulation, if a licensee has submitted an application claiming the completion of continuing medical education credits and the licensee fails to document the completion of such continuing medical education credits when audited by the Board, the disciplinary panel may impose a civil fine under Health Occupations Article, §14-316(d)(5), 14-5A-13(d)(2), 14-5B-12(d)(2), 14-5D-12(g), or 15-307(f), Annotated Code of Maryland, of up to $100 per missing continuing medical education credit in lieu of a sanction under Health Occupations Article, §14-404, 14-5A-17, 14-5B-14, 14-5D-14, or 15-314, Annotated Code of Maryland. Section E(1)(a) of this regulation does not limit the Board’s or disciplinary panel’s authority to require completion of the missing continuing medical education credits. Willful Falsification. If a licensee has willfully falsified an application with respect to continuing medical education credits, the licensee may be charged under one or more of the following, as appropriate: Health Occupations Article, §14-404(a)(3), 14-5A-17(a)(3), 14-5B-14(a)(3), 14-5C-17(a)(3), 14-5D-14(a)(3), 14-5E-16(a)(3), 14-5F-18(a)(19), or 15-314(a)(3), Annotated Code of Maryland; Health Occupations Article, §14-404(a)(11), 14-5A-17(a)(10), 14-5B-14(a)(10), 14-5C-17(a)(10), 14-5D-14(a)(10), 14-5E-16(a)(10), 14-5F-18(a)(9), or 15-314(a)(11), Annotated Code of Maryland; and Health Occupations Article, §14-404(a)(36) or 15-314(a)(36), Annotated Code of Maryland. Upon a finding of a violation, the disciplinary panel may impose any discipline authorized under Health Occupations Article, §14-404(a), 14-405.1, 14-5A-17, 14-5B-17, 14-5C-17, 14-5D-14, 14-5E-16, 14-5F-18, 15-314, or 15-316, Annotated Code of Maryland, and the sanctioning guidelines. Licensees Previously Disciplined Under §E(1) or (2) of this Regulation. If a licensee has been previously fined or otherwise disciplined under §E(1) or (2) of this regulation, the disciplinary panel may, for a subsequent offense relating to continuing medical education credits, charge a licensee under one or more of the following, as appropriate: Health Occupations Article, §14-404(a)(3), 14-5A-17(a)(3), 14-5B-14(a)(3), 14-5C-17(a)(3), 14-5D-14(a)(3), 14-5E-16(a)(3), 14-5F-18(a)(19) or 15-314(a)(3), Annotated Code of Maryland; Health Occupations Article, §14-404(a)(11), 14-5A-17(a)(10), 14-5B-14(a)(10), 14-5C-17(a)(10), 14-5D-14(a)(10), 14-5E-16(a)(10), 14-5F-18(a)(9), or 15-314(a)(11), Annotated Code of Maryland; and Health Occupations Article, §14-404(a)(36) or 15-314(a)(36), Annotated Code of Maryland. Upon a finding of a violation, the disciplinary panel may impose any discipline authorized under Health Occupations Article, §14-404(a), 14-405.1, 14-5A-17, 14-5B-17, 14-5C-17, 14-5D-14, 14-5E-16, 14-5F-18, 15-314, or 15-316, Annotated Code of Maryland, and the sanctioning guidelines for a subsequent offense. The disciplinary panel may not apply the sanction described in §E(1) of this regulation in determining a sanction for a licensee previously fined or disciplined for an offense related to continuing medical education credits. The disciplinary panel shall pay all monies collected pursuant to this section into the State’s General Fund. Payment of Fines. An individual shall pay to the disciplinary panel any fine imposed under this regulation within 15 calendar days of the date of the order, unless the order specifies otherwise. Filing an appeal under State Government Article, §10-222, Annotated Code of Maryland, does not stay payment of a fine imposed by the disciplinary panel pursuant to this regulation. If an individual fails to pay, in whole or in part, a fine imposed by the disciplinary panel pursuant to this regulation, the disciplinary panel may not restore, reinstate, or renew a license until the fine has been paid in full. In its discretion, the disciplinary panel may refer all cases of delinquent payment to the Central Collection Unit of the Department of Budget and Management to institute and maintain proceedings to ensure prompt payment. Subject to provisions of Regulation .09A and B of this chapter, the disciplinary panel may impose sanctions as outlined in §B of this regulation on physicians for violations of Health Occupations Article, §§14-404(a), 14-504, and 1-302, Annotated Code of Maryland. Range of Sanctions. This regulation applies to proceedings under Health Occupations Article, §14-205(b)(1)(iii), 14-206(e), 14-307, 14-405, 14-606(a)(4)(ii), 14-5A-17(a), 14-5A-09, 14-5A-23(b), 14-5B-09, 14-5B-14(a), 14-5B-19(b), 14-5C-09, 14-5C-17(a), 14-5C-23(b), 14-5D-08, 14-5D-14(a), 14-5D-18(b), 14-5E-09, 14-5E-16(a), 14-5E-23(b), 14-5F-11, 14-5F-18(a), 14-5F-29(b), 15-313, or 15-403, Annotated Code of Maryland. The final decision in the proceedings in this regulation is made by the full Board. Denial of Application for Initial License. When an individual files an application for a license with the Board, the applicant shall be investigated to determine whether the Board will: Issue a license; or Deny the application. The Board may vote for the issuance of an intent to deny application for an initial license to practice medicine or an allied health profession for one or any combination of the grounds for denial, including: Failing to meet the minimal qualifications or requirements of licensure; Committing an act or an omission constituting grounds for discipline under Health Occupations Article, §14-404, Annotated Code of Maryland; Failing to complete the application or failing to provide additional information requested by the Board in connection with the application; Submitting false or misleading information in connection with the application; or Failing to cooperate with the Board’s investigation of the application. If the Board votes to issue a notice of an intent to deny an application for an initial license, the notice shall be served upon the applicant by regular mail or hand delivery to an address the applicant identified on the applicant’s application. After service of the notice of intent to deny application for initial license, the applicant shall be offered an informal meeting with a panel of the Board to explore whether the matter can be resolved with a consent order. The administrative prosecutor also may attend the meeting. The panel may recommend a consent order granting a license, denying a license, or granting a license with appropriate terms and conditions including probation. If the applicant and the administrative prosecutor agree with the panel’s proposed resolution, the applicant shall sign a consent order with the proposed resolution, and the Board shall vote on whether to approve the resolution. If the applicant and the administrative prosecutor do not agree with the panel’s proposed resolution, the Board shall delegate the matter to the Office of Administrative Hearings for a contested case hearing. If the matter proceeds to a hearing before the Office of Administrative Hearings, the administrative prosecutor shall present evidence before an administrative law judge in support of the denying the initial licensure application. The applicant shall be given an opportunity to present evidence in support of granting the license. The administrative law judge shall conduct an evidentiary hearing in accordance with: The Administrative Procedure Act; COMAR 28.02.01; and COMAR 10.32.02.04C, which shall, whenever possible, be construed as supplementing and in harmony with COMAR 28.02.01. The administrative law judge shall issue a proposed decision. Within 15 days of the issuance of the proposed decision, the applicant and the administrative prosecutor may file exceptions to the proposed decision with the Board. A response to the exceptions may be filed within 15 days of the filing of the exceptions. If exceptions are filed, the Board shall hold a hearing on the exceptions. The exceptions hearing is based upon evidentiary record established before the Office of Administrative Hearings. The Board shall vote and issue a final decision and order on whether the initial license application is granted or denied. An individual whose application for initial licensure has been denied by a final decision and order by the Board may petition for judicial review of the final decision and order as provided by Health Occupations Article, §14-408(a), Annotated Code of Maryland. Unauthorized Practice and Misrepresentation as a Licensed Practitioner. The Board may vote for charges that an individual has practiced medicine or an allied health profession without authorization or that an individual has misrepresented one’s self as a practitioner of medicine or as an allied health professional. If the Board votes to charge an individual for practicing medicine or an allied health care profession without authorization or with misrepresenting one’s self as a practitioner of medicine or as an allied health professional, the notice shall be served upon the respondent by regular mail, certified mail, or hand delivery to the individual. After service of the charges, the respondent shall be offered an informal meeting with a panel of the Board to explore whether the matter can be resolved with a consent order. The administrative prosecutor may attend the meeting. The panel may recommend a consent order. If the respondent and the administrative prosecutor agree with the panel’s proposed resolution, the respondent shall sign a consent order with the proposed resolution, and the Board shall vote on whether to approve the resolution. If the applicant and the administrative prosecutor do not agree with the panel’s proposed resolution, the Board shall delegate the matter to the Office of Administrative Hearings for a contested case hearing. If the matter proceeds to a hearing before the Office of Administrative Hearings, the administrative prosecutor shall present evidence before an administrative law judge to prove the charges. The applicant shall be given an opportunity to present evidence in defense. The administrative law judge shall conduct an evidentiary hearing in accordance with: The Administrative Procedure Act; COMAR 28.02.01; and COMAR 10.32.02.04C which shall, whenever possible, be construed as supplementing and in harmony with COMAR 28.02.01. The administrative law judge shall issue a proposed decision. Within 15 days of the issuance of the proposed decision, the applicant and the administrative prosecutor may file exceptions to the proposed decision with the Board. A response to the exceptions may be filed within 15 days of the filing of the exceptions. If exceptions are filed, the Board shall hold a hearing on the exceptions. The exceptions hearing is based upon evidentiary record established before the Office of Administrative Hearings. The Board shall vote and issue a final decision and order. If the Board determines that the respondent has practiced a health care profession without authorization or misrepresented one’s self as a practitioner of medicine, the Board may fine the respondent as authorized by statute and regulation. An individual who is aggrieved by a final decision and order by the Board may petition for judicial review of the final decision and order as provided by Health Occupations Article, §14-408(a), Annotated Code of Maryland. Cease and Desist Orders An initial Board order to cease and desist issued under §14-206(e) of the Medical Practice Act from the unauthorized practice of medicine or from taking any action for which there are grounds for discipline under Health Occupations Article, §14-404, Annotated Code of Maryland, and which pose a serious risk to the health, safety, and welfare of a patient: Is a public document; and Is effective immediately unless the order states otherwise. The Board shall serve the initial order by hand delivery, certified mail, or first-class mail. Challenge. A respondent may challenge the factual or legal basis of the initial order by filing a written opposition within 30 days of its issuance, and may include a request for a hearing. The Board shall consider that opposition and shall provide a hearing if requested. After considering the written opposition and the presentation at the hearing, if any, the Board may issue a final order to rescind, modify, or affirm the cease and desist order. The Board shall serve the final order by hand delivery, certified mail, or first-class mail to the last known address of the respondent. The respondent may seek judicial review of the Board’s final order as provided in the Administrative Procedure Act. Violations of a Cease and Desist Order. The Board may impose a fine as provided in Regulation .09C of this chapter on any individual who violates a cease and desist order. Before imposition of a fine for violation of a cease and desist order, the Board shall give notice of the alleged violation, and an opportunity for a hearing. The hearing may not concern issues: That were not raised under §E(3) of this regulation; or That were raised under §E(3) of this regulation, but for which the Board did not grant the relief or modification requested. The only issues to be considered at the hearing are: Whether the individual violated the cease and desist order; and The amount of any fine to be imposed. The Board shall issue a final order stating whether a violation occurred and if so, the amount of the fine. The respondent may seek judicial review of the Board’s final order as provided in the Administrative Procedure Act. Nothing in this regulation prohibits the Board from delegating any hearing to the Office of Administrative Hearings as permitted by State Government Article, §10-205, Annotated Code of Maryland. A respondent whose license has been sanctioned by a final order of the disciplinary panel after a contested case proceeding under Health Occupations Article, §14-404, 14-5A-17.1, 14-5B-14.1, 14-5C-17(b), 14-5D-15, 14-5E-17, 14-5F-23, or 15-315(b), Annotated Code of Maryland, may seek judicial review of the disciplinary panel’s decision as provided under Health Occupations Article, §14-408(a), Annotated Code of Maryland. An individual whose application for administrative reinstatement has been denied by a final disciplinary panel order after a contested case proceeding under Health Occupations Article, §14-205(a)(1)(iii), 14-5A-17.1, 14-5B-14.1, 14-5C-17(b), 14-5D-15, 14-5E-17, 14-5F-23, or 15-315(b), Annotated Code of Maryland, may appeal the decision as provided under Health Occupations Article, §14-408(a), Annotated Code of Maryland. A Board or disciplinary panel member may not participate in an investigation or a proceeding in which the impartiality of the Board or disciplinary panel member might reasonably be questioned, including but not limited to proceedings and investigations in which the Board or disciplinary panel member has or appears to have: A personal bias or prejudice concerning a party; or Personal knowledge of disputed evidentiary facts concerning a proceeding. The recusal shall be stated on the record. In a hearing before the Board or disciplinary panel, the parties may waive the recusal. Nothing in this chapter prohibits the issuance of a charging document with a proposed order which will go into effect if the respondent fails to request a hearing. Nothing in this chapter prohibits a disciplinary panel from conducting a show cause hearing to determine if there has been: A violation of probation; A violation of a condition under which any portion of a disciplinary order was stayed; or Any other violation of a Board or disciplinary panel order. A disciplinary panel may terminate a show cause hearing if it determines that there are material facts in dispute which cannot reasonably be determined in that venue. The disciplinary panel may then convene an evidentiary hearing or delegate such a hearing to an administrative law judge. Except for formal charging documents, notices of intent to deny, or as otherwise provided by law, the proceedings of the Board and the disciplinary panels are confidential, and the confidentiality of the proceedings cannot be waived by the parties. The recommended decision by an administrative law judge is confidential, and the respondent cannot waive the confidentiality of the contested case proceedings or of the patients whose care is reflected in the record of the proceedings. To the extent possible, even after a final order is entered by the Board or a disciplinary panel, the parties shall refrain from revealing legal documents or oral statements or information that would reveal the identity of any patients referenced in the order. The Board and the disciplinary panels may consider the Principles of Ethics of the American Medical Association, but these principles are not binding on the Board or the disciplinary panels. The Board and the disciplinary panels may consider the “Guideline for Prescribing Opioids for Chronic Pain” published by the Centers for Disease Control and Prevention, but this guideline is not binding on the Board or the disciplinary panels. Administrative Expungements. The Applicant may file with the Board an application for administrative expungement to have records of an administrative action by a disciplinary panel classified as confidential, not for public release, and removed from the licensee’s public individual profile, if: The application is submitted more than 3 years after the imposition of an administrative action by the Board or after administrative reinstatement or termination of suspension of the license, whichever is later; The licensee had no incidents of a public sanction since the administrative action identified in the application occurred; and The licensee is not currently under probation or investigation by the Board. An application for administrative expungement shall only be granted for the following administrative actions: Failure to pay taxes or unemployment insurance contributions under Health Occupations Article, §1-213(b), Annotated Code of Maryland; Failure to complete continuing medical education requirements under Health Occupations Article, §14-316(d), Annotated Code of Maryland; Failure to renew a license on time under Health Occupations Article, §14-606(a)(5), Annotated Code of Maryland; or Failure to notify the Board in writing of change of name or address within the time required under Health Occupations Article, §14-316(f). An administrative expungement shall not be considered for any license denials, reprimands, probations, suspensions, and revocations issued pursuant to Health Occupations Article, §14-404, Annotated Code of Maryland. Application for Administrative Expungement. The application for administrative expungement shall be filed in writing on a form provided by the Board. The application fee shall be $450. The application fee is non-refundable. Disposition of Application. If the applicant meets the requirements specified in §§A and B of this regulation, the Board shall inform the applicant when to expect the records to be removed from the applicant’s public practitioner profile as required in Health Occupations Article, §14-411.1, Annotated Code of Maryland, and when all Board records will be classified confidential. If the applicant does not meet the requirements specified in §§A and B of this regulation, the applicant will be deemed ineligible and the Board shall notify the applicant in writing. An applicant whose application is ineligible under §C(2) of this regulation may reapply when they meet the criteria. The Board is not required to report an administrative expungement to any national database. Nothing in this regulation shall prohibit the Board from using a Board record, previous sanction, or disciplinary action for any regulatory purpose or from releasing records to law enforcement or other governmental body as permitted by law. Health Occupations Article, §§1-307, 1-402, 1-602—1-604, 1-606, 14-205, 14-317, 14-404, 14-405, 14-405.1, 14-406—14-409, 14-411, 14-505, 14-5A-03, 14-5A-13(d), 14-5A-16, 14-5A-17, 14-5A-17.1, 14-5A-19, 14-5B-03, 14-5B-12(d), 14-5B-13, 14-5B-14, 14-5B-14.1, 14-5B-16, 14-5C-03, 14-5C-14(h), 14-5C-16, 14-5C-17, 14-5C-19, 14-5D-12(d), 14-5D-12(g), 14-5D-13—14-5D-16, 14-5E-03, 14-5E-13(h), 14-5E-15, 14-5E-16, 14-5E-17, 14-5E-19, 14-5F-04, 14-5F-15(e), 14-5F-17, 14-5F-18, 14-5F-23, 14-5F-24, 14-601, 14-606, 15-205(b), 15-307(f), 15-311, 15-312, 15-314, 15-315, 15-316 and 15-403; State Government Article, §§10-206, 10-216, and 10-226; Annotated Code of Maryland Effective date: September 30, 1973 Regulations .01—.10, Hearing Procedures, repealed effective November 7, 1994 (21:22 Md. R. 1877) Regulations .01—.09, Hearing Before the Board of Physician Quality Assurance, adopted effective November 7, 1994 (21:22 Md. R. 1877) Regulation .03C amended effective March 22, 1999 (26:6 Md. R. 486) Regulation .03E amended effective January 24, 2000 (27:1 Md. R. 76); June 24, 2002 (29:12 Md. R. 927) Regulation .04 amended effective August 19, 2002 (29:16 Md. R. 1288) Regulation .10 adopted effective September 11, 1995 (22:18 Md. R. 1399) Chapter revised effective January 21, 2013 (40:1 Md. R. 20) Chapter revised effective March 2, 2015 (42:4 Md. R. 433) Regulation .02B amended effective March 17, 2025 (52:5 Md. R. 237) Regulation .03F amended effective August 7, 2023 (50:15 Md. R. 682) Regulation .10 amended effective August 7, 2023 (50:15 Md. R. 682) Regulation .17 adopted effective October 23, 2017 (44:21 Md. R. 983) Regulation .18 adopted effective March 17, 2025 (52:5 Md. R. 237) This chapter governs the practice of physician assistants and collaboration between physician assistants and one or more patient care team physicians. This chapter does not prohibit: A student from performing any of the procedures described in these regulations as part of an accredited school's clinical curriculum; An individual from practicing a health occupation that the individual is authorized to practice under Health Occupations Article, Annotated Code of Maryland; or A physician assistant employed by the federal government from performing duties incident to that employment. In this chapter, the following terms have the meanings indicated. Terms Defined. “Accredited” means accredited by the Accreditation Review Commission on Education for the Physician Assistant or its successor. “Advanced duties” means medical acts that require additional education, training, or experience that is beyond the physician assistant education program required for licensure. “Ambulatory surgical facility” means a facility: Accredited by: The American Association for Accreditation of Ambulatory Surgical Facilities; The Accreditation Association for Ambulatory Health Care; or The Joint Commission on the Accreditation of Health Care Organizations; or Certified to participate in the Medicare Program, as enacted by Title XVIII of the Social Security Act. “Applicant” means an individual who applies to the State Board of Physicians for licensure as a physician assistant. “Board” means the State Board of Physicians. “Category I hours” means hours of continuing medical education given in formally organized programs pertinent to the practice of physician assistant duties, accredited by the American Academy of Physician Assistants, the American Academy of Family Physicians, the Accreditation Council on Continuing Medical Education, the Medical and Chirurgical Faculty of Maryland, or equivalent certifying bodies. “Collaborating physician” means one or more patient care team physicians who collaborate with a physician assistant under a collaboration agreement. Collaboration. “Collaboration” means the communication and decision-making process among health care providers who are members of a patient care team related to the treatment of a patient which includes the degree of cooperation necessary to provide treatment and care to the patient. “Collaboration” includes: Communication of data and information about the treatment and care of a patient, including the exchange of clinical observations and assessments; and The development of an appropriate plan of care including decisions regarding the health care provided, accessing and assessing appropriate additional resources, expertise, referrals, testing, or studies. “Collaboration” does not require constant, physical presence of a collaborating physician on-site in the practice setting provided that the collaborating physician is accessible by electronic means. “Collaboration agreement” means a document that outlines the relationship between a physician assistant and an individual physician or a group of physicians which is maintained at the practice level and is developed between a physician assistant and collaborating physician or physicians. “Committee” means the Physician Assistant Advisory Committee. “Controlled dangerous substances” means any drug listed as such in Criminal Law Article, Annotated Code of Maryland. “Core duties” means medical acts that are included in the standard curricula of accredited physician assistant education programs. “Correctional facility” means a State or local correctional facility. “Detention center” means a State or local detention center. “Drug sample” means a unit of a prescription drug that is intended to promote the sale of the drug and is not intended for sale. “English-speaking professional school” means a school: That offers a degree after graduation from high school; That is in the United States, its territories and possessions, or the British Commonwealth; and Where all academic and clinical courses are taught in English. “Exempt facility” means: A hospital; An ambulatory surgical facility; A federally qualified health center as defined in Health-General Article, §24-1301(b), Annotated Code of Maryland; or Any other practice setting listed on a hospital delineation of privileges document. “Hospital” means: A hospital as defined under Health-General Article, §19-301(g), Annotated Code of Maryland; A comprehensive care facility that: Meets the requirements of a hospital-based skilled nursing facility under 42 U.S.C. §1395i-3; and Offers acute care in the same building; and An emergency room that is physically connected to a hospital or a freestanding medical facility that is licensed under Health-General Article, Title 19, Subtitle 3A, Annotated Code of Maryland. “Joint Commission” means the organization formerly known as the Joint Commission on Accreditation of Health Care Organizations. “NCCPA” means the National Commission on Certification of Physician Assistants, Inc. “On-site” means the physical presence of the collaborating physician on the premises of the facility where the physician assistant performs delegated medical acts. “Patient care team” means a multidisciplinary team of health care providers actively functioning as a unit with the leadership of one or more patient care team physicians for the purpose of providing and delivering health care to a patient or group of patients. “Patient care team physician” means a licensed physician who regularly practices in the State and who provides leadership in the care of patients as part of a patient care team. “Physician” means an individual who is licensed by the Board to practice medicine. “Physician assistant” means an individual who is licensed by the Board to practice as a physician assistant. “Prescriptive authority” means the authority of a physician assistant to: Prescribe and administer: Controlled dangerous substances; Prescription drugs; and Medical devices; Give verbal, written, or electronic orders for medications; and Dispense starter dosages or drug samples. “Public health facility” means a site where clinical public health services are rendered under the auspices of the Department, a local health department in a county, or the Baltimore City Health Department. “Starter dosage” means an amount of a drug sufficient to begin therapy: Of short duration of 72 hours or less; or Before obtaining a larger quantity of the drug to complete therapy. “Training” means the education or on-the-job training a physician assistant: Receives after initial licensure as a physician assistant; and Requires to perform advanced duties. Composition. The Physician Assistant Advisory Committee shall be composed as required under Health Occupations Article, §15-202, Annotated Code of Maryland. Tenure. The term of a member is 3 years. The initial terms of the members are staggered. At the end of a term, a member continues to serve until a successor is appointed. An individual may be reappointed for a second term but an individual may not serve more than two consecutive terms. Vacancy. If a vacancy occurs for a physician or physician assistant, the Board shall appoint a new member in the same category. Officers. A Committee chairperson shall be elected every 2 years by a majority vote of the membership of the Committee. Removal. Upon the recommendation of the chairman, the Board, by a majority, may vote to remove any member of the Committee for: Neglect of duty, including but not limited to: Failure to attend two successive committee meetings without adequate reason; Failure to attend Board mandated training; or Failure to complete necessary ethics filing requirements; Malfeasance; Misfeasance; Misconduct; or Incompetency. The Committee shall: Upon request, review selected applications for licensure, renewal, or reinstatement of physician assistants and make recommendations to the Board as to what action to take on the applications; Review each advanced duty which requires prior approval by the Board and, as needed, interview each physician assistant and one or more patient care team physicians to make recommendations to the Board; Make recommendations to the Board regarding regulations governing physician assistants; and Advise the Board on matters related to the practice of physician assistants. The Committee may delegate a physician member and a physician assistant member of the Committee to conduct the interview of each physician assistant and patient care team physician, as permitted under §F(2) of this regulation. Except as otherwise provided under Health Occupations Article, Title 15, Annotated Code of Maryland, an individual shall be licensed by the Board and notify the Board of an executed collaboration agreement before the individual may practice as a physician assistant or collaborate with a patient care team physician. A physician assistant's scope of practice will be limited to medical acts that are: Appropriate to the education, training, and experience of the physician assistant; Customary to the practice of a patient care team physician; and Performed in a manner consistent with the collaboration agreement. A physician assistant may delegate technical medical acts authorized under Health Occupations Article, §14-306, Annotated Code of Maryland and COMAR 10.32.12 provided the physician assistant: Has notified the Board, in a manner approved by the Board of an executed collaboration agreement; and Has completed at least 7,000 hours of clinical practice experience. Prohibitions. Regardless of the setting or other factors, a patient care team physician may not delegate, and a physician assistant may not perform general anesthesia or neuraxial anesthesia, including spinal, epidural, and image-guided interventional spine procedures. Except in hospitals, detention centers, correctional facilities, and public health facilities, a patient care team physician may not collaborate with more than eight physician assistants during the same shift. Application. Applicants shall: Complete an application on a form approved by the Board; Pay an application fee as defined in Regulation .16 of this chapter; Be at least 18 years old; Be of good moral character; and Demonstrate oral and written competency in English by one or more of the following: Graduation from a recognized English-speaking high school or undergraduate school after at least 3 years of enrollment; Graduation from a recognized English-speaking professional school; or Receiving a grade of: At least 26 on the Speaking Section of the Internet-based Test of English as a Foreign Language; and At least 79 on the Internet-based Test of English as a Foreign Language. Education. An applicant who has successfully completed an educational program for physician assistants shall: Have graduated from a physician assistant program accredited by The Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), its predecessor, or its successor; and Have passed the physician assistant national certifying examination administered by the National Commission on Certification of Physician Assistants (NCCPA) or its successor. In addition to the requirement specified in §B(1) of this regulation, an applicant who has successfully completed an educational program for physician assistants after October 1st, 2003, shall have one of the following: A bachelor’s degree; or At least 120 credit hours of education at the college or university level. Primary Source Verification. The Board may accept the Federation Credential Verification Service for primary source verification of a physician assistant's education and examination. Before a physician assistant may perform medical acts, the physician assistant shall: Execute a collaboration agreement between the physician assistant and one or more patient care team physicians; Notify the Board in a manner approved by the Board of the executed collaboration agreement; and Maintain a copy of the executed collaboration agreement on file at the physician assistant’s primary practice location. Collaboration Agreement Requirements. A collaboration agreement may only consist of one physician assistant and one or more patient care team physicians practicing at the same facility. A physician assistant shall have a separate collaboration agreement for each of the physician assistant’s employers. The physician assistant has the affirmative obligation to retain the collaboration agreement and all of the documentation pertaining to the collaboration agreement for 5 years after termination of the collaboration agreement for Board inspection. Contents. The collaboration agreement shall include, at minimum: Each patient care team physician’s name and Maryland license number; A description of each patient care team physician’s qualifications to collaborate with a physician assistant; The practice specialty of each listed patient care team physician; The physician assistant’s name and Maryland license number; The primary location and settings where the physician assistant will practice; The employer of the physician assistant; A description of the settings where the physician assistant will practice; Any delegation of prescriptive authority and, if applicable, dispensing according to Regulation .08 of this chapter; and Any other information deemed necessary by the Board to carry out the provisions of Health Occupations Article, Title 15, Annotated Code of Maryland. The collaboration agreement may include a description of any provisions established by the listed patient care team physicians that: Detail the practice of the physician assistant; Limit the physician assistant's scope of practice; or Specify office procedures. The physician assistant shall attest that: All medical acts performed by the physician assistant shall be: Appropriate to the education, training, and experience of the physician assistant; Customary to the practice of a patient care team physician listed on the collaboration agreement; and Performed in a manner consistent with the collaboration agreement; and Any performance of an advanced duty in collaboration with a patient care team physician shall be in accordance with Health Occupations Article, §15-302.1, Annotated Code of Maryland. Each collaborating physician shall document their official acknowledgment of their understanding and status as a listed patient care team physician on the collaboration agreement with the physician assistant. A physician assistant that has sufficient education, training, and experience in the performance of an advanced duty, may perform that advanced duty under a collaboration agreement without Board approval if: The physician assistant is practicing at an exempt facility in accordance with Health Occupations Article, §15–302.1, Annotated Code of Maryland and meets the conditions in §A(4) of this regulation; The physician assistant has previously received Board approval to perform the advanced duty; or The physician assistant has at least 7,000 hours of clinical practice experience as attested to by the physician assistant. For a physician assistant practicing at an exempt facility the following shall be met: The patient care team physician listed on the collaboration agreement has been credentialed by the exempt facility as a condition of employment; The physician assistant listed on the collaboration agreement has been credentialed by the exempt facility as a condition of employment; and The advanced duty to be delegated by the patient care team physician to the physician assistant is reviewed and approved in a process approved by the exempt facility before the physician assistant performs the advanced duty. Except as provided under §A of this regulation, a physician assistant shall receive Board approval to perform an advanced duty prior to performing the advanced duty. A physician assistant performing X-Ray duties in accordance with Health Occupations Article, §14–306(e), Annotated Code of Maryland, shall: Notify the Board of an executed collaboration agreement in a manner approved by the Board; Maintain a copy of the collaboration agreement on file at the practice location; Obtain Board approval for the X-Ray duty as an advanced duty if practicing at a location other than an exempt facility; Perform the X-Ray duty in the medical office of a patient care team physician; and Be limited to nonfluoroscopic X-Ray procedures of the extremities, anterior-posterior and lateral, not including the head. In addition to the requirements of §C of this regulation, a physician assistant performing the advanced duty of nonfluoroscopic X-ray procedures using a mini C-arm or similar low-level radiation machine shall be required to present the Board with evidence of completion of a course that includes: Didactic instruction of at least eight hours on the following subject matters: Principles of radiography; Image acquisition; Principles of exposure; Image evaluation; Radiation safety; Equipment overview; and Documentation; and Clinical instruction, which shall: Include anterior-posterior and lateral radiographic studies of extremities, not including the head, on at least 20 separate patients; and Be under the direct supervision of the delegating physician or radiologist. Approvals of Advanced Duties. Documentation demonstrating a physician assistant’s authority to perform an advanced duty under this section shall be maintained at the facility where the physician assistant is performing the advanced duty. The Board may audit and review collaboration agreements kept by the physician assistant at the primary place of business of the licensee at any time. If an advanced duty requires Board approval, the Committee: Shall review the collaboration agreement; May conduct a personal interview of the physician assistant and patient care team physicians; or May recommend to the Board that the collaboration agreement be modified to ensure conformance with the requirements of Health Occupations Article, §§15–302 and 15–302.1, Annotated Code of Maryland. Modification or Disapproval of Advanced Duties. The Board may modify or disapprove the performance of advanced duties under a collaboration agreement if the physician assistant does not meet the applicable education, training, and experience requirements to perform the specified advanced duties. If the Board disapproves or modifies a request to perform an advanced duties, the Board shall: Notify the delegating patient care team physician listed in the collaboration agreement and the physician assistant in writing of the particular elements of the advanced duty approval request that were the cause for the modification or denial; Set forth the specific reasons for the modification or denial; and Give the applicant an opportunity to submit an amendment to the advanced duty or request a hearing before the Board. To request a hearing regarding modification or disapproval of advanced duties, the applicant shall make a written request for a hearing within 30 days of the receipt of the notice of modification or disapproval. Physician Assistant Deemed Ineligible to Perform an Advanced Duty. A physician assistant who applies to perform an advanced duty may be deemed ineligible to perform an advanced duty if the physician assistant or patient care team physician: Fails to complete the application; Fails to provide additional information requested by the Board in connection with the application; or Submits false or misleading information to the Board in connection with the application. If a physician assistant is deemed ineligible to perform the advanced duty, the Board shall: Give written notice to the applicant; and Set forth the specific reasons for the ineligibility. A physician assistant who is deemed ineligible to perform the advanced duty shall not be authorized to perform the advanced duty except for training purposes under the direct supervision of a patient care team physician listed on the collaboration agreement. Individual members of the Board are not civilly liable for actions regarding the approval, modification, or disapproval of an advanced duty under the collaboration agreement described in this regulation. In order for a patient care team physician to delegate prescriptive authority, the [primary supervising] patient care team physician shall ensure that the collaboration agreement includes: A statement describing whether the physician intends to delegate any of the following: Prescribing of: Controlled dangerous substances; Prescription drugs; or Medical devices; Giving verbal, written, or electronic orders for medications; Dispensing starter dosages or drug samples; An attestation that all prescribing activities of the physician assistant will comply with applicable federal and State regulations; An attestation that all medical charts and records will contain a notation of any prescriptions written by a physician assistant; An attestation that all prescriptions dispensed include the physician assistant's name and the patient care team physician’s name, business address, and business telephone number legibly written or printed; An attestation that the physician assistant has: Passed the physician assistant national certification exam administered by the National Commission on the Certification of Physician Assistants, Inc. within the previous 2 years; or Completed 8 Category I hours of pharmacology education within the previous 2 years; and An attestation that the physician assistant has at least one of the following: A bachelor's degree or its equivalent; or 2 years of work experience as a physician assistant. Dispensing of Drug Samples and Starter Dosages of Drugs by Physician Assistant. A drug sample or starter dosage shall meet the following criteria before a physician assistant may dispense the drug sample or starter dosage: Package is labeled as required by Health Occupations Article, §12-505, Annotated Code of Maryland; and No charge is made for the drug sample or starter dosage. A physician assistant shall enter an appropriate note in the patient’s medical record. A physician assistant may not delegate dispensing of drug samples or starter dosages. Renewal. The Board may not renew a license until the Comptroller of Maryland has verified that the individual has paid all undisputed taxes and unemployment insurance contributions, or arranged for repayment, as required by COMAR 10.31.02. An individual who has been licensed by the Board as a physician assistant may renew the license every 2 years on the date specified by the Board by: Completing an application on a form approved by the Board; Paying the required renewal fee as defined in Regulation .16 of this chapter; Attesting to completion of continuing education activities as specified in §D of this regulation; and Meeting any additional requirements set by the Board for renewal of a license. Reinstatement. The Board shall reinstate the license of a physician assistant if the physician assistant: Completes an application on a form approved by the Board; Pays the required reinstatement fee as defined in Regulation .16 of this chapter; Submits evidence of completion of continuing education activities as specified in §D of this regulation; and Meets any additional requirements set by the Board for reinstatement of a license. Change in Name or Address. A physician assistant shall notify the Board in writing of a change in the physician assistant's name or address within 60 days after the change. If a physician assistant fails to notify the Board within the time required under §C(1) of this regulation, the physician assistant is subject to an administrative penalty of $100. Continuing Education. Except as specified in §D(2) of this regulation, in order to renew or reinstate a license under §A or B of this regulation, a physician assistant shall complete at least 50 hours of continuing education consisting of: At least 8 hours of Category 1 education on pharmacology topics earned during the 2-year period preceding: For license renewal, the expiration of the physician assistant license; or For license reinstatement, the date of the submission of the application for reinstatement; and In addition to the continuing education hours specified in §D(1)(a) of this regulation, at least 42 hours of Category I continuing education earned during the 2-year period preceding: For license renewal, the expiration of the physician assistant license; or For license reinstatement, the date of the submission of the application for reinstatement. A physician assistant who is renewing a license as a physician assistant for the first time since either initial licensure or reinstatement of a license: Shall earn at least 8 hours of Category 1 education on pharmacology topics prior to the expiration of the physician assistant license; and Is not required to complete any other hours of Category I continuing education prior to the expiration of the physician assistant license. Documentation of Continuing Education. A physician assistant shall obtain documentation of attendance at Category I continuing education and retain the documentation for 6 years. The documentation shall contain, at a minimum, the following information: Program title; Sponsor’s name; Physician assistant’s name; Inclusive date or dates and location of the program; Category I designation and the number of continuing education hours earned; and Documented verification that the physician assistant attended the program by stamp, signature, printout, or other official proof. Proof of maintenance of certification by the National Commission on Certification of Physician Assistants may be used to document compliance with the continuing education requirement. The Board may request a physician assistant to submit evidence of having met the continuing education requirements specified in this regulation. If a physician assistant cannot demonstrate completion of the required continuing education credit hours, the Board may impose a civil penalty of up to $100 per missing continuing education credit hour. A physician assistant shall: Wear an identification tag or badge which identifies that individual as a physician assistant; Identify himself or herself to all patients as a physician assistant; and Maintain a copy of the physician assistant’s license and collaboration agreement at the practice setting. An individual may not identify himself or herself as a physician assistant unless licensed by the Board. A physician assistant shall: Notify the Board in a manner approved by the Board of an executed collaboration agreement developed by the listed patient care team physician or physicians and the physician assistant; Collaborate with a patient care team physician for medical acts that: Are customary to the practice of a listed patient care team physician; and Are suitable to be performed by the physician assistant, taking into account the physician assistant’s: Education; Training; and Experience; Obtain approval for any advanced duties; and; Update the practitioner profile to report the termination of a collaboration agreement for any reason to the Board within 5 days, providing the following information: Name and license number of the patient care team physician and physician assistant; and Reason for termination, including a description of conduct or incident that resulted in the termination. Sudden Departure of the Patient Care Team Physician. In the event of the sudden departure, incapacity, or death of a patient care team physician, or in a change in licensure status that results in a patient care team physician being unable to practice medicine in the State, the collaboration agreement will remain active and valid under the supervision of any remaining listed patient care team physicians. If no remaining patient care team physicians are listed on the collaboration agreement, the physician assistant may not practice until the physician assistant has executed a new collaboration agreement and provided notification to the Board. The Board may deny a license, reprimand a physician assistant, place a physician assistant on probation, or suspend or revoke a license if the physician assistant: Fraudulently or deceptively obtains or attempts to obtain a license for the applicant or the licensee or for another; Fraudulently or deceptively uses a license; Is guilty of: Immoral conduct in the practice of medicine; or Unprofessional conduct in the practice of medicine; Is professionally, physically, or mentally incompetent; Solicits or advertises in violation of Health Occupations Article, §14-503, Annotated Code of Maryland; Abandons a patient; Is habitually intoxicated; Is addicted to, or habitually abuses, any narcotic or controlled dangerous substance as defined in Criminal Law Article, §5-101, Annotated Code of Maryland; Provides professional services: While under the influence of alcohol; or While using any narcotic or controlled dangerous substance, as defined in Criminal Law Article, §5-101, Annotated Code of Maryland, or other drug that is in excess of therapeutic amounts or without valid medical indication; Promotes the sale of drugs, devices, appliances, or goods to a patient so as to exploit the patient for financial gain; Willfully makes or files a false report or record in the practice of medicine; Willfully fails to file or record any medical report as required under law, willfully impedes or obstructs the filing or recording of the report, or induces another to fail to file or record the report; On proper request, and in accordance with the provisions of Health-General Article, Title 4, Subtitle 3, Annotated Code of Maryland, fails to provide details of a patient's medical record to the patient, another physician, or hospital; Solicits professional patronage through an agent or other person or profits from the acts of a person who is represented as an agent of the physician assistant; Pays or agrees to pay any sum to any person for bringing or referring a patient or accepts or agrees to accept any sum from any person for bringing or referring a patient; Agrees with a clinical or bioanalytical laboratory to make payments to the laboratory for a test or test series for a patient, unless the licensed physician assistant discloses on the bill to the patient or third-party payor: The name of the laboratory; The amount paid to the laboratory for the test or test series; and The amount of procurement or processing charge of the licensed physician, if any, for each specimen taken; Makes a willful misrepresentation in treatment; Practices medicine with an unauthorized person or aids an unauthorized person in the practice of medicine; Grossly over-utilizes health care services; Offers, undertakes, or agrees to cure or treat disease by a secret method, treatment, or medicine; Is disciplined by a licensing or disciplinary authority or convicted or disciplined by a court of any state or country or disciplined by any branch of the United States uniformed services or the Veterans' Administration for an act that would be grounds for disciplinary action under Health Occupations Article, §15-314, Annotated Code of Maryland; Fails to meet appropriate standards as determined by appropriate peer review for the delivery of quality medical and surgical care performed in an outpatient surgical facility, office, hospital, or any other location in this State; Willfully submits false statements to collect fees for which services are not provided; Was subject to investigation or disciplinary action by a licensing or disciplinary authority or by a court of any state or country for an act that would be grounds for disciplinary action under this regulation and the licensee: Surrendered the license issued by the state or country to the state or country; or Allowed the license issued by the state or country to expire or lapse; Knowingly fails to report suspected child abuse in violation of Family Law Article, §5-704, Annotated Code of Maryland; Fails to educate a patient being treated for breast cancer of alternative methods of treatment as required by Health-General Article, §20-113, Annotated Code of Maryland; Sells, prescribes, gives away, or administers drugs for illegal or illegitimate medical purposes; Fails to comply with the provisions of Health Occupations Article, §12-102, Annotated Code of Maryland; Refuses, withholds from, denies, or discriminates against an individual with regard to the provision of professional services for which the licensee is licensed and qualified to render because the individual is HIV positive; Except as to an association that has remained in continuous existence since July 1, 1963: Associates with a pharmacist as a partner or co-owner of a pharmacy for the purpose of operating a pharmacy; Employs a pharmacist for the purpose of operating a pharmacy; or Contracts with a pharmacist for the purpose of operating a pharmacy; Except in an emergency life-threatening situation where it is not feasible or practicable, fails to comply with the Centers for Disease Control and Prevention's guidelines on universal precautions; Fails to display the notice required under Health Occupations Article, §14-415, Annotated Code of Maryland; Fails to cooperate with a lawful investigation conducted by the Board; Is convicted of insurance fraud as defined in Insurance Article, §27-801, Annotated Code of Maryland; Is in breach of a service obligation resulting from the applicant's or licensee's receipt of State or federal funding for the licensee's medical education; Willfully makes a false representation when seeking or making application for licensure or any other application related to the practice of medicine; By corrupt means, threats, or force, intimidates or influences, or attempts to intimidate or influence, for the purpose of causing any person to withhold or change testimony in hearings or proceedings before the Board or those otherwise delegated to the Office of Administrative Hearings; By corrupt means, threats, or force, hinders, prevents, or otherwise delays any person from making information available to the Board in furtherance of any investigation of the Board; Intentionally misrepresents credentials for the purpose of testifying or rendering an expert opinion in hearings or proceedings before the Board, a disciplinary panel, or those otherwise delegated by the Office of Administrative Hearings; Fails to keep adequate medical records; Performs medical acts in a manner that is not consistent with the collaboration agreement; Performs medical acts which are outside the education, training, and experience of the physician assistant; Performs medical acts that are not customary to the practice of the patient care team physicians listed on the collaboration agreement; Practices as a physician assistant without first providing notice to the Board as required under Health Occupations Article, §15–302(A), Annotated Code of Maryland; Fails to complete a criminal history records check under Health Occupations Article, §14–308.1, Annotated Code of Maryland; Fails to comply with the requirements of the Prescription Drug Monitoring Program set forth in Health-General Article, Title 21, Subtitle 2A, Annotated Code of Maryland; or Fails to comply with any State or federal law or regulation pertaining to the practice of a physician assistant. Unprofessional conduct in the practice of medicine, Health Occupations Article, §14-404(a)(3), Annotated Code of Maryland, includes the failure of a physician to comply with the statute and regulations governing the physician's duty to supervise the physician assistant. Except as provided in §B of this regulation, a hospital, related institution, alternative health care system, and employer physician shall file with the Board a report that the hospital, related institution, alternative health system, or employer physician limited, reduced, otherwise changed, or terminated any licensee for any reason that might be grounds for disciplinary action under Regulation .13 of this chapter or Health Occupations Article, Titles 14 and 15, Annotated Code of Maryland. Exception. A hospital, related institution, alternative health system, or employer that has reason to know that a licensee has committed an action or has a condition that might be grounds for reprimand or probation of the licensee or suspension or revocation of the licensure because the licensee is alcohol impaired or drug impaired is not required to report the licensee to the Board if: The hospital, related institution, alternative health system, or employer knows that the licensee is: In an alcohol or drug treatment program that is accredited by the Joint Commission or is certified by the Maryland Department of Health; or Under the care of a health care practitioner who is competent and capable of dealing with alcoholism and drug abuse; The hospital, related institution, alternative health system, or employer is able to verify that the licensee remains in the treatment program until discharge; and The action or condition of the licensee or holder of a temporary license has not caused injury to any person while the licensee or holder of a temporary license is practicing. Notice by Licensee. If the licensee enters, or is considering entering, an alcohol or drug treatment program that is accredited by the Joint Commission or that is certified by the Maryland Department of Health, the licensee shall notify the hospital, related institution, alternative health system, employer, or patient care team physician of the licensee's or holder's decision to enter the treatment program. If the licensee fails to provide the notice required under §C(1) of this regulation, and the hospital, related institution, alternative health system, employer, or patient care team physicians learn that the licensee has entered a treatment program, the hospital, related institution, alternative health system, employer, or patient care team physician shall report to the Board that the licensee has entered a treatment program and has failed to provide the required notice. If the licensee is found to be noncompliant with the treatment program's policies and procedures while in the treatment program, the treatment program shall notify the hospital, related institution, alternative health system, employer, or patient care team physician of the licensee's noncompliance. Examination. The Board may direct a physician assistant who is an applicant or licensee to submit to an appropriate examination to determine the physician assistant’s physical, mental, or professional ability to perform delegated medical acts. A physician assistant is deemed to have consented to an examination and waived any claim to privilege as to the examination report. The unreasonable failure or refusal of an applicant or licensee to submit to an examination is: Prima facie evidence that the physician assistant cannot perform delegated medical acts; and Cause for denial of an application or suspension of a license. Entry. The executive director of the Board or other authorized representative or investigator may enter at any reasonable hour a place of business of a physician or physician assistant or into public premises: For the purpose of an audit to verify general compliance with the Maryland Physician Assistants Act; or To investigate an allegation with respect to a physician assistant. A person may not deny or interfere with an entry under §B(1) of this regulation. A person who violates any provision of §B(1) of this regulation is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $100. Audit. The Board’s representatives may require a physician, physician assistant, or facility where the physician assistant is employed or practicing to provide immediate access to any records relating to the physician assistant’s employment, credentialing, and practice and any medical records of patients seen by the physician assistant. The Board’s representative shall refer possible compliance issues to: The compliance section of the Board; or An outside agency that has jurisdiction over a facility. A physician, physician assistant, or facility who fails to comply with a Board audit in accordance with §C(1) of this regulation is subject to an administrative fine. A physician assistant who is licensed in this State or in any other state or who is an employee of the federal government is authorized to perform acts, tasks, or functions as a physician assistant during a disaster within a county in which a state of disaster has been declared by the Governor, or counties contiguous to a county in which a state of disaster has been declared, in accordance with Public Safety Article, §14-107, Annotated Code of Maryland. The physician assistant shall notify the Board in writing of their name, practice locations, and telephone numbers for the physician assistant within 30 days of the first performance of medical acts, tasks, or functions as a physician assistant during the disaster. A team of physicians and physician assistants or physician assistants practicing under this regulation may not be required to maintain on-site documentation describing collaboration agreements as otherwise required in Regulation .06 of this chapter. The following fees are applicable to physician assistants: Application fees: Initial application — $310 Endorsement application — $100 Reciprocity application — $100; and Reinstatement application — $400; Physician Assistant license fee per month until expiration of license .—. $10; Renewal fees: License renewal fee .—. $360; Maryland Health Care Commission (MHCC) fee ... As determined by MHCC under COMAR 10.25.03; and Preceptor fee — as determined in accordance with Health Occupations Article, §15–206(a)(2)(i), Annotated Code of Maryland; Written verification of licensure .—. $25; and Advanced Duty Application Fee — $100. General Application of Sanctioning Guidelines. Sections A and B of this regulation and Regulation .18A and B of this chapter do not apply to offenses for which a mandatory sanction is set by statute or regulation. Except as provided in §B of this regulation, for violations of the sections of the Physician Assistants Act listed in the sanctioning guidelines, the Board shall impose a sanction not less severe than the minimum listed in the sanctioning guidelines nor more severe than the maximum listed in the sanctioning guidelines for each offense. Ranking of Sanctions. For the purposes of this regulation, the severity of sanctions is ranked as follows, from the least severe to the most severe: Reprimand; Probation; Suspension; and Revocation. A fine listed in the sanctioning guidelines may be imposed in addition to but not as a substitute for a sanction. The addition of a fine does not change the ranking of the severity of the sanction. The Board may impose more than one sanction, provided that the most severe sanction neither exceeds the maximum nor is less than the minimum sanction permitted in the chart. Any sanction may be accompanied by conditions reasonably related to the offense or to the rehabilitation of the offender. The inclusion of conditions does not change the ranking of the sanction. If a licensee has violated more than one ground for discipline as set out in the sanctioning guidelines: The sanction with the highest severity ranking shall be used to determine which ground will be used in developing a sanction; and The Board may impose concurrent sanctions based on other grounds violated. Notwithstanding the sanctioning guidelines set forth in Regulation .18 of this chapter, in order to resolve a pending disciplinary action, the Board and the licensee may agree to a surrender of license or a consent order with terms, sanction, and fine agreed to by the Board, the administrative prosecutor, and the licensee. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the Board may consider the aggravating and mitigating factors set out in §B(4) and (5) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines. If the Board imposes a sanction that departs from the sanctioning guidelines as set forth in Regulation .18 of this chapter, the Board shall state its reasons for doing so in its final decision and order. Aggravating and Mitigating Factors. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the Board may consider the aggravating and mitigating factors set out in §B(4) and (5) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines. Nothing in this regulation requires the Board or an Administrative Law Judge to make findings of fact with respect to any of these factors. The existence of one or more of these factors does not impose on the Board or an Administrative Law Judge any requirement to articulate its reasoning for not exercising its discretion to impose a sanction outside of the range of sanctions set out in the sanctioning guidelines. Mitigating factors may include, but are not limited to, the following: The absence of a prior disciplinary record; The offender self-reported the incident; The offender voluntarily admitted the misconduct, made full disclosure to the Board, and was cooperative during the Board proceedings; The offender implemented remedial measures to correct or mitigate the harm arising from the misconduct; The offender made good faith efforts to make restitution or to rectify the consequences of the misconduct; The offender has been rehabilitated or exhibits rehabilitative potential; The misconduct was not premeditated; There was no potential harm to patients or the public or other adverse impact; or The incident was isolated and is not likely to recur. Aggravating factors may include, but are not limited to, the following: The offender has a previous criminal or administrative disciplinary history; The offense was committed deliberately or with gross negligence or recklessness; The offense had the potential for or actually did cause patient harm; The offense was part of a pattern of detrimental conduct; The offender committed a combination of factually discrete offenses adjudicated in a single action; The offender pursued his or her financial gain over the patient’s welfare; The patient was especially vulnerable; The offender attempted to hide the error or misconduct from patients or others; The offender concealed, falsified, or destroyed evidence or presented false testimony or evidence; The offender did not cooperate with the investigation; or Previous attempts to rehabilitate the offender were unsuccessful. A departure from the sanctioning guidelines set forth in Regulation .18 of this chapter is not a ground for any hearing or appeal of a Board action. Fines for Unauthorized Practice as a Physician Assistant. The Board may impose a fine not exceeding $5,000 as provided in §C(2) of this regulation for unauthorized practice as a physician assistant in violation of Health Occupations Article, §15-401, Annotated Code of Maryland. Factors in determining the amount of a fine include, but are not limited to the following: The extent to which the respondent derived any financial benefit from the improper conduct; The willfulness of the improper conduct; The extent of actual or potential public harm caused by the improper conduct; and The deterrent effect of the fine. The Board shall pay all monies collected pursuant to §C of this regulation into the Board of Physicians' fund. Employment of Unauthorized Individuals. A licensed physician, hospital, related institution, alternative health system, or employer may not employ an individual practicing as a physician assistant who does not have a license. A licensed physician may not supervise an individual practicing as a physician assistant who does not have a license. The Board may impose a fine of up to $1,000 for a violation of §D(1) or (2) of this regulation. Any funds collected under §D(3) of this regulation shall be deposited into the State's General Fund. Other Fines. The Board may impose a fine of $100 for a violation of Health Occupations Article, §15-309, Annotated Code of Maryland. The Board shall pay all monies collected pursuant to §E(1) of this regulation into the Board of Physicians' fund. Offenses Related to Continuing Medical Education Credits. First Offense of Failure to Document Credits. Except as provided in §F(2) or (3) of this regulation, if a licensee has submitted an application claiming the completion of continuing medical education credits and the licensee fails to document the completion of such continuing medical education credits when audited by the Board, the Board may impose a civil fine under Health Occupations Article, §15-307(f), Annotated Code of Maryland, of up to $100 per missing continuing medical education credit in lieu of a sanction under Health Occupations Article, §15-314, Annotated Code of Maryland. Section F(1)(a) of this regulation does not limit the Board's authority to require completion of the missing continuing medical education credits. Willful Falsification. If a licensee has willfully falsified an application with respect to continuing medical education credits, the licensee may be charged under one or more of the following, as appropriate: Health Occupations Article, §15-314(a)(3), Annotated Code of Maryland; Health Occupations Article, §15-314(a)(11), Annotated Code of Maryland; and Health Occupations Article, §15-314(a)(36), Annotated Code of Maryland. Upon a finding of a violation, the Board may impose any discipline authorized under Health Occupations Article, §15-314 or 15-316, Annotated Code of Maryland, and the sanctioning guidelines. Licensees Previously Disciplined Under §F(1) or (2) of this Regulation. If a licensee has been previously fined or otherwise disciplined under §F(1) or (2) of this regulation, the Board may, for a subsequent offense relating to continuing medical education credits, charge a licensee under one or more of the following, as appropriate: Health Occupations Article, §15-314(a)(3), Annotated Code of Maryland; Health Occupations Article, §15-314(a)(11), Annotated Code of Maryland; and Health Occupations Article, §15-314(a)(36), Annotated Code of Maryland. Upon a finding of a violation, the Board may impose any discipline authorized under Health Occupations Article, §15-314 or 15-316, Annotated Code of Maryland, and the sanctioning guidelines for a subsequent offense. The Board may not apply the sanction described in §F(1) of this regulation in determining a sanction for a licensee previously fined or disciplined for an offense related to continuing medical education credits. The Board shall pay all monies collected pursuant to §F of this regulation into the State's General Fund. Payment of Fines. An individual shall pay to the Board any fine imposed under this regulation within 15 calendar days of the date of the order, unless the order specifies otherwise. Filing an appeal under State Government Article, §10-222, Annotated Code of Maryland, does not stay payment of a fine imposed by the Board pursuant to this regulation. If an individual fails to pay, in whole or in part, a fine imposed by the Board pursuant to this regulation, the Board may not restore, reinstate, or renew a license until the fine has been paid in full. In its discretion, the Board may refer all cases of delinquent payment to the Central Collection Unit of the Department of Budget and Management to institute and maintain proceedings to ensure prompt payment. Health Occupations Article, §§1-213, 1-606, 14-205, 15-101—15-502, Annotated Code of Maryland Effective date: May 28, 1975 (2:12 Md. R. 870) Chapter revised effective October 26, 1981 (8:21 Md. R. 1708) Regulations .02 and .05F amended effective September 27, 1982 (9:19 Md. R. 1895) Regulations .05B-1 and .09A-1 adopted effective September 27, 1982 (9:19 Md. R. 1895) Regulations .01—.11 repealed effective March 18, 1991 (18:5 Md. R. 594) Regulations .01—.12 adopted effective March 18, 1991 (18:5 Md. R. 594) Regulations .02, .03, .06, .10, and .11 amended; Regulations .07—.09 and .12 repealed; and new Regulations .07—.09, .12, and .15 adopted as an emergency provision effective August 12, 1999 (26:18 Md. R. 1369); amended permanently effective January 24, 2000 (27:1 Md. R. 76) Regulations .02 and .05—.07 amended and new Regulation .06-1 adopted as an emergency provision effective November 8, 1996 (23:24 Md. R. 1676); emergency status expired October 1, 1997 Regulation .02B amended effective October 2, 1997 (24:17 Md. R. 1214); July 12, 1999 (26:14 Md. R. 1082) Regulation .04B amended effective July 12, 1999 (26:14 Md. R. 1082) Regulation .05B amended effective October 2, 1997 (24:17 Md. R. 1214) Regulation .06C amended effective November 22, 1993 (20:23 Md. R. 1804); October 2, 1997 (24:17 Md. R. 1214) Regulation .06D adopted effective October 2, 1997 (24:17 Md. R. 1214) Regulation .07A amended effective September 11, 1995 (22:18 Md. R. 1399) Regulation .07C adopted effective October 2, 1997 (24:17 Md. R. 1214) Regulation .11B amended effective April 25, 1994 (21:8 Md. R. 673) Regulation .13 adopted effective July 12, 1999 (26:14 Md. R. 1082) Regulation .14 adopted effective July 12, 1999 (26:14 Md. R. 1082) Chapter revised effective May 1, 2004 (31:7 Md. R. 584) Regulation .06D adopted as an emergency provision effective October 1, 2006 (33:24 Md. R. 1905); adopted permanently effective January 15, 2007 (34:1 Md. R. 32) Regulation .08C amended as an emergency provision effective October 1, 2006 (33:24 Md. R. 1905); amended permanently effective January 15, 2007 (34:1 Md. R. 32) Regulation .09C amended as an emergency provision effective October 1, 2006 (33:24 Md. R. 1905); amended permanently effective January 15, 2007 (34:1 Md. R. 32) Chapter revised as an emergency provision effective August 18, 2011 (38:19 Md. R. 1146); revised permanently effective October 3, 2011 (38:20 Md. R. 1202) Regulation .05C amended effective January 18, 2016 (43:1 Md. R. 14) Regulation .05F adopted effective November 7, 2016 (43:22 Md. R. 1221) Regulation .07 amended effective January 18, 2016 (43:1 Md. R. 14) Regulation .07A amended effective March 26, 2018 (45:6 Md. R. 320) Regulation .09 amended effective January 2, 2017 (43:26 Md. R. 1446) Regulation .09E adopted as an emergency provision effective January 4, 2022 (49:4 Md. R. 299); emergency status expired effective July 3, 2022 Regulation .17 adopted effective July 22, 2013 (40:14 Md. R. 1175) Regulation .18 adopted effective July 22, 2013 (40:14 Md. R. 1175) Chapter revised effective January 5, 2026 (52:26 Md. R. 1309) Annotation: COMAR 10.32.03 cited in Attorney General Opinion No. 86-008 (February 18, 1986) This chapter concerns the registration of psychiatrist's assistants before October 1, 1993, and re-registration and discipline of psychiatrist's assistants currently registered by the Board of Physicians. In this chapter, the following terms have the meanings indicated. Terms Defined. “Applicant” means the registered psychiatrist's assistant and supervisory psychiatrist who applied to the Board on or before October 1, 1993, for approval of duties and supervision. “Board” means the Board of Physicians. “Facility” means a: Hospital; Nursing home; Health maintenance organization; Community health center; Public health clinic; Similar institution; or Medical office of more than one psychiatrist. “Psychiatrist” means an individual licensed to practice medicine in Maryland who has completed the psychiatric residency requirements in a program approved by the American Board of Psychiatry and Neurology or who has received, or is eligible for, certification by the American Board of Psychiatry and Neurology. “Psychiatrist's assistant” means an individual who applied for registration on or before October 1, 1993, and was registered by the Board to perform medical duties which would normally be performed by a psychiatrist. A psychiatrist may assign duties which constitute the practice of medicine to a psychiatrist's assistant in accordance with these regulations. The psychiatrist shall personally examine, diagnose, and establish a treatment plan for each patient before assigning a patient to a psychiatrist's assistant. Adequate supervision of a psychiatrist's assistant in the performance of medical acts under these regulations requires the personal presence of the psychiatrist or the psychiatrist's participation through telephone contact, chart review, or other means as approved by the Board, or all of the above. Adequate supervision does not necessarily require on-site supervision in all cases. When in the performance of his medical duties, a psychiatrist's assistant finds a significant, new undiagnosed condition or a significant change in an existing diagnosed illness, the psychiatrist's assistant shall immediately apprise the supervising psychiatrist of the condition or change. The supervising psychiatrist shall then direct appropriate treatment and shall be available to promptly attend the patient. A psychiatrist may not employ more than two full-time psychiatrist's assistants in a non institutional practice. After October 1, 1993, the Board may not accept or approve any application for registration. An individual who has been registered by the Board as a psychiatrist's assistant pursuant to this chapter shall renew the registration every 2 years on the date specified by the Board by re-registration and payment of the appropriate fees. A registrant shall meet all the requirements of this chapter at re-registration. A psychiatrist's assistant shall notify the Board in writing of a change in the psychiatrist’s assistant name or address within 60 days after the change. Notice of the required re-registration shall be given by the Board to the psychiatrist's assistant at the address as shown on the records of the Board. The psychiatrist's assistant shall complete this re-registration by the date specified by the Board. If a psychiatrist's assistant does not receive notice of re-registration it shall be the responsibility of the psychiatrist’s assistant to contact the Board in order to complete this re-registration before the expiration of the current registration. A psychiatrist's assistant whose registration has expired for failure to renew is unregistered. A registration which has expired shall be considered permanently expired. For purposes of the re-registration, appropriate standards for continuing medical education for psychiatrist's assistants may be promulgated by the Board. When the registration expires, the approval of duties and supervision becomes invalid. When a physician or facility and a psychiatrist's assistant have agreed to the psychiatrist's assistant's employment, the two parties shall provide the Board with a written application for approval of duties and supervision before the psychiatrist's assistant begins his duties. A psychiatrist's assistant may not begin employment until a notice of approval of duties and supervision is issued by the Board to the physician or facility and the psychiatrist's assistant. Application for Approval of Duties and Supervision. The application shall be made on a form supplied by the Board and shall include: A complete list and description of the duties to be assigned to the psychiatrist's assistant. A detailed description of the supervisory relationship between the psychiatrist and the psychiatrist's assistant or the psychiatrists in a facility and the psychiatrist's assistant. The description of the supervisory relationship shall include a schedule of patient reviews. Facility employers of psychiatrist's assistants shall submit to the Board for approval: The name of a principal psychiatrist who will be responsible for the assigned duties and supervision of all psychiatrist's assistants; The total number of psychiatrist's assistants to be employed. The application shall be signed by the psychiatrist and the psychiatrist's assistant or, if a facility, by the principal psychiatrist and all supervising psychiatrists and the psychiatrist's assistant. The Board shall notify the psychiatrist's assistant and the psychiatrist or facility of its approval or disapproval of the duties and supervisory relationship within 60 days of receipt of the notice of employment. The Board may approve an application in whole or in part, based upon the applicant's education and experience. The Board shall have the authority to review the practice and supervisory relationship of a psychiatrist's assistant and psychiatrist or facility's psychiatrist at any time for conformance with these regulations. Notice shall be given to the Board by the psychiatrist or the facility and the psychiatrist's assistant within 10 days of termination of employment. A record of patient reviews with the psychiatrist's assistant shall be kept on file and shall include a summary of the psychiatrist's observations and recommendations. A psychiatrist may not assign the ultimate responsibility for diagnosis or therapy to a psychiatrist's assistant. Notwithstanding any provision contained in these regulations, a psychiatrist may not assign to a psychiatrist's assistant the duty of independently prescribing or dispensing drugs. When the Board approves a psychiatrist's assistant's duties and supervisory relationship with a psychiatrist, that approval does not relieve the psychiatrist from the primary responsibility for the care and treatment of the patient. Medical services rendered to a patient by a psychiatrist's assistant shall be, with respect to the obligation of the psychiatrist, the same as if those services had been rendered directly by the psychiatrist. The Board shall establish fees for application, registration, re-registration, late registration, and reinstatement of psychiatrist's assistants. The psychiatrist's assistant shall wear a tag or badge with lettering clearly visible to the patient, bearing his name and the title “Registered Psychiatrist's Assistant”. The use of any other degree designation either on the badge or in any other phase of practice as a psychiatrist's assistant is prohibited. A patient calling or walking in for an appointment shall be clearly notified at that time whether he will be seeing the psychiatrist or the psychiatrist's assistant. A psychiatrist's assistant may not represent himself as a psychiatrist's assistant in any employment unless an application for approval of duties and supervision has been approved by the Board. The Board shall maintain a registry of psychiatrist's assistants. If the Board disapproves an application for approval of duties and supervision, it shall give notice to the applicant and set forth the specific reasons for the denial. The applicant shall have the right to appear before the Board and be heard. If the applicant desires to be heard, he shall make a written request for a hearing within 10 days of the receipt of the notice of disapproval of his application. The hearing shall be held within 60 days after the written request has been filed. At the hearing the applicant may be represented by counsel and may present witnesses and other evidence on his behalf. The Board shall affirm, reverse, or modify its previous disapproval and give the applicant written notice of the action which it has taken within 30 days after the hearing, unless the applicant agrees to a longer period. For the commission of a prohibited act, subject to the hearing provisions of Health Occupations Article, §14-405, Annotated Code of Maryland, on the affirmative vote of a majority of its full, authorized membership, the Board may: Reprimand any psychiatrist's assistant; Place any psychiatrist's assistant on probation; or Suspend or revoke the registration of a psychiatrist's assistant. The following are prohibited acts: Fraudulently or deceptively obtaining, or attempting to obtain, a registration for the applicant or certified individual or for another; Fraudulently or deceptively using a registration; Being guilty of unprofessional or immoral conduct in the practice of psychiatry as a psychiatrist's assistant; Being professionally, physically, or mentally incompetent; Habitually being intoxicated; Being addicted to, or habitually abusing, any narcotic or controlled dangerous substance as defined in Criminal Law Article, Annotated Code of Maryland; Providing professional services while: Under the influence of alcohol, or Using any narcotic or controlled dangerous substance, as defined in Criminal Law Article, Annotated Code of Maryland, or other drug that is in excess of therapeutic amounts or without valid medical indication; Willfully making or filing a false report or record in the practice of psychiatry as a psychiatrist's assistant or aiding another individual to do so; Willfully failing to file or record any report as required under law, willfully impeding or obstructing the filing or recording of a report, or inducing another to fail to file or record a report; Making a willful misrepresentation in treatment; Practicing as a psychiatrist's assistant with an unauthorized individual or aiding an unauthorized individual in practice as a psychiatrist's assistant; Being disciplined by a licensing or disciplinary authority or being convicted or disciplined by a court of any state or country or disciplined by any branch of the United States uniformed services or the Veterans' Administration for an act that would be grounds for disciplinary action under this regulation; Failing to meet appropriate standards for the delivery of quality performance as a psychiatrist's assistant in this State; Willfully submitting false statements to collect fees for which services are not provided; Knowingly failing to report suspected child abuse in violation of Family Law Article, §5-903, Annotated Code of Maryland; Selling, prescribing, giving away, or administering medical prescription drugs, narcotics, or controlled dangerous substances, as defined in Criminal Law Article, Annotated Code of Maryland, for illegal or illegitimate medical purposes; Breaching patient confidentiality; Practicing beyond the authorized scope of practice; Performing delegated medical acts other than under the supervision of a psychiatrist approved by the Board; Refusing, withholding from, denying, or discriminating against a patient with regard to the provision of professional services for which the psychiatrist's assistant is registered and qualified to render because the patient may be HIV positive; Practicing or attempting to practice any delegated act as a psychiatrist's assistant without having received education, internship, training, or experience in the performance of that procedure; Soliciting professional patronage through an agent or other individuals or profits from the acts of an individual who is represented as an agent of the psychiatrist's assistant; Paying or agreeing to pay any sum to an individual for bringing or referring a patient or accepting or agreeing to accept any sum from an individual for bringing or referring a patient; Failing to comply with these regulations; On proper request, failing to provide, in writing, details of a patient's records to another health care provider, institution, or hospital; and Except in an emergency life-threatening situation, failing to comply with the Centers for Disease Control's guidelines on universal precautions. Crimes Involving Moral Turpitude. Subject to the Administrative Procedure Act, the Board shall order the suspension of a registration of a psychiatrist's assistant if the psychiatrist's assistant is convicted of or pleads guilty or nolo contendere with respect to a crime involving moral turpitude whether or not any appeal or other proceeding is pending to have the conviction or plea set aside. After completion of the appellate process, if the conviction has not be reversed or the plea has not been set aside with respect to a crime involving moral turpitude, the Board shall order the revocation of a psychiatrist's assistant's registration subject to the hearing provisions of Health Occupations Article, §14-405, Annotated Code of Maryland. Surrender. Unless the Board agrees to accept the surrender of a registration, a psychiatrist's assistant may not surrender the registration nor may the registration lapse by operation of law while the psychiatrist's assistant is under investigation or while charges are pending against the assistant. Unprofessional Conduct. Unprofessional conduct in the practice of medicine as defined by Health Occupations Article, §14-404(a)(3), Annotated Code of Maryland, includes the failure of a physician to comply with the statute and regulations governing supervising physicians and psychiatrist's assistants. Complaints. Individuals may refer complaints alleging prohibited conduct to the Board to be investigated according to the Board's procedures. Health Occupations Article, §§14-205, 14-302, and 14-306, Annotated Code of Maryland Effective date: May 24, 1982 (9:10 Md. R. 1022) Chapter revised effective May 8, 1995 (22:9 Md. R. 645) Regulation .01 amended effective October 10, 2016 (43:20 Md. R. 1110) Regulation .05 amended effective October 10, 2016 (43:20 Md. R. 1110) This chapter governs the practice of medicine using telehealth as an adjunct to, or replacement for, in-person patient visits. In this chapter, the following terms have the meanings indicated. Terms Defined. “Asynchronous” means not occurring in real time. “In-person” means within the physical presence of the patient. “Interpretive services” means reading and analyzing images, tracings, or specimens through telehealth or giving interpretations based on visual, auditory, thermal, or ultrasonic patterns or other patterns as may evolve with technology. “Synchronous” means occurring in real time. Telehealth. “Telehealth” means a mode of delivering health care services through the use of telecommunications technologies by a health care practitioner to a patient at a different physical location than the telehealth practitioner. “Telehealth” includes synchronous and asynchronous interactions. “Telehealth” does not include the provision of health care services solely through: Audio–only calls; E–mail messages; or Facsimile transmissions. “Telehealth practitioner” means a Maryland licensed physician or licensed allied health practitioner performing telehealth services within their respective scope of practice. Except as specified in Health Occupations Article, §14-302, Annotated Code of Maryland, a telehealth practitioner shall be licensed when providing telehealth services to a patient located in the State. Telehealth practitioners licensed in the State are subject to the jurisdiction of the State and shall abide by the telehealth requirements of this chapter if either the practitioner or patient is physically located in this State. Before performing telehealth services, a telehealth practitioner shall develop and follow a procedure to: Verify the identification of the patient receiving telehealth services within a reasonable degree of certainty through use of: Government issued photograph identification; Insurance, Medicaid, or Medicare card; or Documentation of the patient’s: Date of birth; and Home address; For an initial patient encounter, disclose the telehealth practitioner’s name, contact information, license type, and medical specialty, if any; Except for interpretive services, obtain oral or written consent from a patient or the patient’s parent or guardian if State law requires the consent of a parent or guardian including informing patients of the risks, benefits, and side effects of prescribed treatments; Securely collect and transmit a patient’s medical information, clinical data, clinical images, laboratory results, and self–reported medical history, as necessary and prevent access to data by unauthorized persons through encryption or other means; Notify patients in the event of a data breach; Ensure that the telehealth practitioner provides a secure and private telehealth connection that complies with federal and state privacy laws; and Establish safety protocols to be used in the case of an emergency. Except when providing asynchronous telehealth services, a telehealth practitioner shall: Obtain or confirm an alternative method of contacting the patient in case of a technological failure; Confirm whether the patient is in Maryland and identify the practice setting in which the patient is located; and Identify all individuals present at each location and confirm they are allowed to hear personal health information. The requirements set forth under §§A and B of this regulation may be delegated. A telehealth practitioner shall perform a synchronous or asynchronous clinical patient evaluation that is appropriate for the patient and the condition with which the patient presents before providing treatment or issuing a prescription through telehealth. A telehealth practitioner shall, if clinically appropriate for the patient, provide or refer a patient to in-person health care services or another type of telehealth service. A telehealth practitioner shall be held to the same standards of practice and documentation as those applicable in in-person health care settings. A telehealth practitioner may not treat a patient or prescribe medication based solely on a static online questionnaire. A telehealth practitioner may not prescribe an opiate described in the list of Schedule II substances under Criminal Law Article, §5-403, Annotated Code of Maryland for the treatment of pain through telehealth unless: The patient is in a health care facility as defined in Health-General Article, §19-114(d)(1), Annotated Code of Maryland; The Governor has declared a state of emergency due to a catastrophic health emergency; or There is an established bona fide practitioner-patient relationship in which the telehealth practitioner has ongoing responsibility for the assessment, care, and treatment of the patient and the telehealth practitioner, or another health care practitioner in the same group practice, as defined in Health Occupations Article, §1-301, Annotated Code of Maryland, previously conducted an in-person assessment of the patient. A telehealth practitioner shall comply with all State and federal laws and regulations related to dispensing including the prohibition on mail order dispensing. The Board shall use the same standards in evaluating and investigating a complaint about and in disciplining a licensee who practices telehealth as it would use for a licensee who does not use telehealth technology in the licensee’s practice. The failure of a telehealth practitioner to comply with Regulation .04, .05, or .06 of this chapter shall constitute unprofessional conduct. Health Occupations Article, §§1-213, 1-606, 1-1003, 1-1006, 14-205, Annotated Code of Maryland Effective date: December 28, 2009 (36:26 Md. R. 1995) Regulations .01—.07, Telemedicine, repealed and new Regulations .01—.07, Telehealth, adopted effective August 12, 2019 (46:16 Md. R. 688) Regulation .02B amended effective September 15, 2025 (52:18 Md. R. 923) Regulation .03 amended effective September 15, 2025 (52:18 Md. R. 923) Regulation .04 amended effective September 15, 2025 (52:18 Md. R. 923) Regulation .05 amended effective September 15, 2025 (52:18 Md. R. 923) Regulation .06 B, C amended effective September 15, 2025 (52:18 Md. R. 923) Regulation .06C amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .06D adopted effective September 15, 2025 (52:18 Md. R. 923) This chapter governs the practice of polysomnographic technology. Except as provided in §C or D of this regulation, on or before October 1, 2013, an individual shall be licensed by the Board before the individual may practice polysomnography. This chapter does not prohibit any polysomnographic technology student who is currently enrolled in an approved polysomnographic technology educational program from performing any of the procedures described in this chapter as part of that program's polysomnographic technology clinical curriculum. This chapter does not prohibit an individual from practicing a health occupation that the individual is authorized to practice under Health Occupations Article, Annotated Code of Maryland. This chapter does not prohibit a licensed respiratory care practitioner from practicing respiratory care within the scope of practice of the respiratory care practitioner’s license, including practicing respiratory care in a sleep laboratory. This chapter does not prohibit the practice of respiratory care by a practitioner who was licensed by the Board to practice respiratory care on or before December 31, 2012, and whose duties include practicing polysomnography. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the State Board of Physicians. “Board eligible” means a physician’s status that starts upon completion of all the requirements to take a sleep medicine certifying examination and lasts for a limited period of time, as determined by the American Board of Medical Specialties or the American Osteopathic Association. “Capnography” means measurement of the amount of CO2 being eliminated from the lungs. “Committee” means the Polysomnography Professional Standards Committee established under Health Occupations Article, §14-5C-05, Annotated Code of Maryland. “Direct supervision” means supervision by a licensed physician who is physically present on the premises while services are provided. “Electroencephalography” means a test that measures the electrical activity of the brain as recorded by electrodes placed on the scalp. “Electromyography” means a test that measures the electrical activity of the muscles. “Electrooculography” means a test that measures the movements of the eye. “Enrolled in a sleep technologist educational program” means that a student has started the Accredited Sleep Technology Program self-study online modules developed by the American Academy of Sleep Medicine but has not completed the final self-study module. “General supervision” means supervision by a licensed physician who is available to give immediately available direction, either in person, by telephone, or by electronic means. “License” means a license issued by the Board. “Licensed polysomnographic technologist” means an individual licensed by the Board to practice polysomnography under the supervision of a licensed physician. “Licensed physician” means an individual who is licensed by the Board to practice medicine. “Oximetry” means a test that measures the concentration of oxygen in the blood. “PH probe” means a device to measure the acidity of the esophagus. “Plethysmography” means a test to measure changes in blood flow or air volume in different parts of the body. “Practice polysomnography” means: Monitoring and recording physiologic data during sleep, including sleep-related respiratory disturbances, under the supervision of a licensed physician; and Using the data collected under §B(17)(a) of this regulation for the purposes of assisting a licensed physician in the diagnosis and treatment of sleep and wake disorders. “Registered polysomnographic technologist” means a polysomnographic technologist who is registered by the Board of Registered Polysomnographic Technologists. “Student” means an individual who is: Enrolled in an accredited educational program in order to qualify for a license as a polysomnographic technologist; and Performing polysomnography services within the accredited program under the supervision of a licensed physician and without compensation. “Supervision” means general supervision or direct supervision of a licensed polysomnographic technologist by a licensed physician. The Board shall appoint members of the Polysomnographic Professional Standards Committee as follows: Three polysomnographic technologists who: Before October 1, 2009, are registered polysomnographic technologists; and On or after October 1, 2009, are both registered polysomnographic technologists and licensed polysomnographic technologists; Three licensed physicians with specialty certification in sleep medicine who are specialists in the following areas: One in psychiatry or internal medicine; One in pulmonary medicine; and One in neurology; and One consumer member who is a member of the general public and who: May not be or ever has been: A polysomnographic technologist; A health care professional; In training to be a polysomnographic technologist or other health care professional; or A household member of a health care professional or an individual in training to be a health care professional; and May not: Participate, or ever have participated, in a commercial or professional field related to polysomnography; Have a household member who participates in a commercial or professional field related to polysomnography; Have had, within 2 years before appointment, a financial interest in a individual regulated by the Board; or Have had, within 2 years before appointment, a financial interest in the provision of goods or services to polysomnographic technologists or to the field of polysomnography. Tenure. The term of a member is 3 years. The terms of the members are staggered. At the end of a term, a member continues to serve until a successor is appointed. An individual may be reappointed for a second term but the individual may not serve more than two full consecutive terms. Vacancy. If a vacancy occurs, the Board shall appoint a new member to serve. The successor member shall only serve for the remainder of the term, unless reappointed. Quorum. A majority of the members then serving on the Committee is a quorum. Business may not be conducted at a Committee meeting unless there is a quorum. The Committee shall: Make recommendations to the Board regarding the practice of, and regulations governing, polysomnographic technologists; Make recommendations to the Board on the requirements for licensure as a polysomnographic technologist; Review selected applications for licensure as a polysomnographic technologist and make recommendations to the Board on the applications; At the request of the Board, review complaints against polysomnographic technologists and respond to the Board's questions; and Keep a record of the Committee's proceedings. An applicant shall: Complete an application on a form supplied by the Board; Pay the required application fee set by the Board in Regulation .09 of this chapter; Be 18 years old or older; Be of good moral character; Demonstrate spoken and written competency in English by any of the following: Documentation of graduation from a recognized English-speaking high school or undergraduate school after at least 3 years of enrollment; Documentation of graduation from a recognized English-speaking professional school; or Documentation of receiving a grade of at least: 26 on the “Speaking Section” of the Internet-based Test of English as a Foreign Language; and 79 on the Internet-based Test of English as a Foreign Language; Provide documentation of current certification as a registered polysomnographic technologist by the Board of Registered Polysomnographic Technologists or by another national certification agency approved by the Board; Provide documentation of licensure, certification, or registration from all states where the applicant has ever held a license, certificate, or registration in any health profession; and Meet the requirements of §B of this regulation. An applicant shall meet the requirements of one of the following pathways to licensure: Graduation from a polysomnographic educational program that is accredited by the Commission on Accreditation of Allied Health Education Programs; In regard to a respiratory care educational program: Graduation from a respiratory care educational program that is accredited by the Commission on Accreditation of Allied Health Education Programs; and Completion of the Committee on Accreditation for Respiratory Care’s curriculum for a polysomnography certificate that is accredited by the Commission on Accreditation of Allied Health Education Programs; In regard to an electroneurodiagnostic technology educational program: Graduation from an electroneurodiagnostic technology educational program that is accredited by the Commission on Accreditation of Allied Health Education Programs; and Completion of an add-on track in polysomnography for electroneurodiagnostic technologists that is accredited by the Commission on Accreditation of Allied Health Education Programs; or In regard to a sleep technologist educational program, completion of the requirements of §C of this regulation. An applicant who has graduated from a sleep technologist education program accredited by the American Academy of Sleep Medicine shall: Provide proof of meeting core competencies in the 3 years preceding the date of the submission of the licensure application as assessed by a sleep technologist credentialed as a Registered Polysomnographic Technologist, a sleep technologist with national certification approved by the Board, or a physician who is either board-eligible or board-certified in sleep medicine by the American Board of Sleep Medicine, American Board of Medical Specialties, or American Osteopathic Association; Provide a letter of attestation for completion of clinical hours and competencies from a physician who is either board-eligible or board-certified in sleep medicine by the American Board of Sleep Medicine, American Board of Medical Specialties, or American Osteopathic Association where the applicant practiced; and Provide proof of completion of a minimum of 546 hours of clinical experience in the 3 years preceding the date of the submission of the licensure application as either: A student enrolled in a sleep technologist educational program supervised at a sleep laboratory accredited by the American Academy of Sleep Medicine or The Joint Commission by: A sleep technologist credentialed as a Registered Polysomnographic Technologist; A sleep technologist with national certification approved by the Board; or A licensed physician who is either board-eligible or board-certified in sleep medicine by the American Board of Sleep Medicine, American Board of Medical Specialties, or American Osteopathic Association; or A sleep technologist with a current, active, unrestricted license in another state or is otherwise recognized and has practiced as a sleep technologist in another state who has: Full-time practice experience as a sleep technologist in another state at a sleep laboratory accredited by the American Academy of Sleep Medicine or The Joint Commission for a minimum of 6 months in the 3 years preceding the date of the submission of the licensure application; and Completed at least 30 hours of approved continuing education in the 3 years preceding the date of the submission of the licensure application. A licensed polysomnographic technologist may practice only under the supervision of a licensed physician. A licensed polysomnographic technologist may practice only in a hospital sleep laboratory or a stand-alone sleep center. The scope of practice of a licensed polysomnographic technologist includes and is limited to the following: Monitoring and recording physiologic data during sleep, including sleep-related respiratory disturbances; Using data collected under §C(1) of this regulation to assist a licensed physician in the diagnosis and treatment of sleep and wake disorders; Assisting with the diagnosis and treatment of individuals who suffer from sleep disorders as a result of developmental defects, the aging process, physical injury, disease, or actual or anticipated somatic dysfunction; Observing and monitoring physical signs and symptoms, general behavior, and general physical responses to polysomnographic evaluation, and determining whether initiation, modification, or discontinuation of a treatment regimen is warranted; Using evaluation techniques that include limited cardiopulmonary function assessments, the need and effectiveness of therapeutic modalities and procedures, and the assessment and evaluation of the need for extended care; and Using the following techniques, equipment, and procedures: Continuous positive airway pressure, bi-level positive airway pressure titration, or adaptive servo-ventilation on spontaneously breathing patients; Supplemental low flow oxygen therapy during polysomnogram; Capnography during polysomnogram; Cardiopulmonary resuscitation; Pulse oximetry; PH probe placement and monitoring; Esophageal pressure; Sleep staging, including surface electroencephalography, surface electrooculography, and surface submental electromyography; Surface electromyography of arms and legs; Electrocardiography; Respiratory effort, including thoracic and abdominal; Plethysmography blood flow; Snore monitoring; Audio or video monitoring; Implementation of a written or verbal order from a licensed physician that requires the practice of polysomnography; Monitoring the effects a nasal device used to treat sleep apnea has on sleep patterns provided that the device does not extend into the trachea; and Monitoring the effects an oral device used to treat sleep apnea has on sleep patterns provided that: The oral device does not extend into the trachea; A dentist has evaluated the structures of the patient's oral and maxillofacial region for purposes of fitting the oral device; A dentist made or directed the making of the oral device; and A dentist directs the use of the oral device. The scope of practice of a polysomnographic technologist does not include administering medications. A licensed polysomnographic technologist shall wear an identification tag or a badge displaying in readily visible type that the individual is a licensed polysomnographic technologist. An individual may not identify himself or herself as a polysomnographic technologist unless the individual is licensed by the Board. Change of Name or Address. A licensed polysomnographic technologist shall advise the Board in writing of any change in name or mailing address within 60 days. The Board may impose a fine of $100 for failure to notify the Board of a change in name or mailing address. Renewal. The Board may not renew a license until the Comptroller of Maryland has verified that the individual has paid all undisputed taxes and unemployment insurance contributions, or arranged for repayment. An individual who has been licensed by the Board as a polysomnographic technologist may renew the license on or before the date specified by the Board by: Submitting a renewal application on a form supplied by the Board; Paying the required renewal fee set by the Board in Regulation .09 of this chapter; Attesting to the completion of at least 20 hours of approved continuing education, earned during the 2-year period preceding the expiration of the license, as specified in Regulation .08 of this chapter; and Meeting any other requirement set by the Board. Reinstatement. The Board shall reinstate the license of a polysomnographic technologist if the polysomnographic technologist: Completes a reinstatement application on a form supplied by the Board; Pays the required reinstatement fee and any other fees specified in Regulation .09 of this chapter; Documents evidence of completion of at least 20 hours of approved continuing education in the 2-year period preceding the date of the submission of the application for reinstatement, as specified in Regulation .08 of this chapter; and Meets any additional requirements set by the Board for reinstatement of a license. Application. A licensed polysomnographic technologist is not required to obtain continuing education hours for the first renewal after initial licensure or reinstatement. Except as stated in §A(1) of this regulation, the Board may not renew or reinstate the license of a polysomnographic technologist unless the polysomnographic technologist has met the requirements for continuing education described in §B of this regulation. Requirements. A polysomnographic technologist shall earn at least 20 continuing education hours as described in §B(2) of this regulation during the 2-year period preceding: For license renewal, the expiration of the license for polysomnographic technologist; or For license reinstatement, the date of the submission of the application for reinstatement. The Board shall recognize sleep-related continuing education hours approved by one of the following organizations or any other organization recommended by the Committee and approved by the Board: American Medical Association; American Association of Sleep Technologists; American Academy of Sleep Medicine; American Society of Electroneurodiagnostic Technologists, Inc.; American Association for Respiratory Care; American Nursing Association; or Board of Registered Polysomnographic Technologists Documentation of Continuing Education Hours. A polysomnographic technologist shall obtain the required documentation of continuing education attendance and retain this documentation for the succeeding 6 years for possible inspection by the Board. The required documentation shall contain the: Program title; Sponsor's name; Polysomnographic technologist's name; Number of continuing education hours earned; Verification of successful completion by signature, stamp, or other official proof; and Date of the continuing education activity. The following fees are applicable to polysomnographic technologists: Initial licensure application fee — $200; License renewal fees: License renewal fee — $150; and Maryland Health Care Commission (MHCC) fee — As determined by MHCC in accordance with COMAR 10.25.02; Reinstatement fee — $200; and Written verification of licensure fee — $25. Fees paid to the Board are non-refundable. Subject to the hearing provisions of Health Occupations Article, §14-405, Annotated Code of Maryland, and in accordance with COMAR 10.32.02, a disciplinary panel may deny a license to any applicant, reprimand any licensee, place any licensee on probation, or suspend or revoke a license if the applicant or licensee: Fraudulently, or deceptively obtains or attempts to obtain a license for the applicant or licensee, or for another; Fraudulently or deceptively uses a license; Is guilty of unprofessional or immoral conduct in the practice of polysomnography; Is professionally, physically, or mentally incompetent; Abandons a patient; Is habitually intoxicated; Is addicted to or habitually abuses any narcotic or controlled dangerous substance as defined in Criminal Law Article, §5-101, Annotated Code of Maryland; Provides professional services while: Under the influence of alcohol; or Using any narcotic or controlled dangerous substance as defined in Criminal Law Article, §5-101, Annotated Code of Maryland, or any other drug that is in excess of therapeutic amounts or without valid medical indication; Promotes the sale of services, drugs, devices, appliances, or goods to a patient so as to exploit the patient for financial gain; Willfully makes or files a false report or record in the practice of polysomnography; Willfully fails to file or record any report as required under law, willfully impedes or obstructs the filing or recording of a report, or induces another to fail to file or record a report; Breaches patient confidentiality; Pays or agrees to pay any sum or provide any form of remuneration or material benefit to any individual for bringing or referring a patient, or accepts or agrees to accept any sum or any form of remuneration or material benefit from an individual for bringing or referring a patient; Knowingly makes a misrepresentation while practicing polysomnography; Knowingly practices polysomnography with an unauthorized individual, or aids an unauthorized individual in the practice of polysomnography; Knowingly delegates a polysomnographic duty to an unlicensed individual; Offers, undertakes, or agrees to cure or treat disease by a secret method, treatment, or medicine; Is disciplined by a licensing or disciplinary authority, is convicted or disciplined by a court of any state or country, or is disciplined by any branch of the United States uniformed services or the U.S. Department of Veterans Affairs for an act that would be grounds for disciplinary action under the Board's disciplinary statutes; Fails to meet appropriate standards for the delivery of polysomnographic services performed in a hospital sleep laboratory or a stand-alone sleep center; Knowingly submits false statements to collect fees for which services are not provided; Has been subject to investigation or disciplinary action by a licensing or disciplinary authority or by a court of any state or country for an act that would be grounds for disciplinary action under the Board's disciplinary statutes and has: Surrendered the license, if any, issued by the state or country; or Allowed the license, if any, issued by the state or country to expire or lapse; Knowingly fails to report suspected child abuse in violation of Family Law Article, §5-704, Annotated Code of Maryland; Sells, prescribes, gives away, or administers drugs for illegal or illegitimate medical purposes; Practices or attempts to practice beyond the authorized scope of practice; Is convicted of, or pleads guilty or nolo contendere to, a felony or to a crime involving moral turpitude, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside; Refuses, withholds from, denies, or discriminates against an individual with regard to the provision of professional services for which the licensee is licensed and qualified to render because the individual is HIV positive; Practices or attempts to practice a polysomnography procedure or uses or attempts to use polysomnography equipment if the applicant or licensee has not received education and training in the performance of the procedure or the use of the equipment; or Fails to cooperate with a lawful investigation conducted by the Board. Crimes of Moral Turpitude. Proceedings for crimes of moral turpitude under Health Occupations Article, §14-5C-17(c), Annotated Code of Maryland, shall be held in accordance with COMAR 10.32.02.07. On the filing of certified docket entries with the Board by the Office of the Attorney General, a disciplinary panel shall order the suspension of a license if the licensee is convicted of, or pleads guilty or nolo contendere with respect to, a crime involving moral turpitude, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside. After completion of the appellate process, if the conviction has not been reversed or the plea has not been set aside with respect to a crime involving moral turpitude, the disciplinary panel shall order the revocation of a license on the certification by the Office of the Attorney General. A reporting entity, as defined in COMAR 10.32.22.02, shall file all required reports in accordance with Health Occupations Article, §14-5C-18, Annotated Code of Maryland, and COMAR 10.32.22. An individual who violates any provision of Heath Occupations Article, Title 14, Subtitle 5C, Annotated Code of Maryland, is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000 or imprisonment not exceeding 1 year, or both. An individual who violates any provision of Health Occupations Article, Title 14, Subtitle 5C, Annotated Code of Maryland, or any regulation in this chapter, is subject to a civil fine of not more than $5,000 to be levied by the Board or a disciplinary panel. The Board shall pay any penalty collected under §A or B of this regulation into the Board of Physicians Fund. Employment of Unlicensed Polysomnography Practitioner. A person who violates Health Occupations Article, §14-5C-22.1, Annotated Code of Maryland, is subject to a civil fine of not more than $5,000 to be levied by the Board. The Board shall pay any fine collected under §D of this regulation into the State’s General Fund. The Board may impose a fine up to $1,000 for a reporting entity, as defined in COMAR 10.32.22.02, that fails to make a report to the Board required by COMAR 10.32.22. General Application of Sanctioning Guidelines. Sections F and G of this regulation and Regulation .13 of this chapter do not apply to offenses for which a mandatory sanction is set by statute or regulation. Except as provided in §G of this regulation, for violations of the sections of the Maryland Polysomnography Act listed in the sanctioning guidelines, a disciplinary panel shall impose a sanction not less severe than the minimum listed in the sanctioning guidelines nor more severe than the maximum listed in the sanctioning guidelines for each offense. Ranking of Sanctions. For the purposes of this regulation, the severity of sanctions is ranked as follows, from the least severe to the most severe: Reprimand; Probation; Suspension; and Revocation. A stayed suspension in which the stay is conditioned on the completion of certain requirements is ranked as probation. A stayed suspension not meeting the criteria for §F(3)(b) of this regulation is ranked as a reprimand. The disciplinary panel may impose more than one sanction, provided that the most severe sanction neither exceeds the maximum nor is less than the minimum sanction permitted in the chart. Any sanction may be accompanied by conditions reasonably related to the offense or to the rehabilitation of the offender. The inclusion of conditions does not change the ranking of the sanction. If a licensee has violated more than one ground for discipline as set out in the sanctioning guidelines: The sanction with the highest severity ranking shall be used to determine which ground will be used in developing a sanction; and The disciplinary panel may impose concurrent sanctions based on other grounds violated. Notwithstanding the sanctioning guidelines set forth in Regulation .13 of this chapter, in order to resolve a pending disciplinary action, the disciplinary panel and the licensee may agree to a surrender of license or a consent order with terms and sanction agreed to by the disciplinary panel, the administrative prosecutor, and the licensee. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the disciplinary panel may consider the aggravating and mitigating factors set out in §G(4) and (5) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines. If the disciplinary panel imposes a sanction that departs from the sanctioning guidelines as set forth in Regulation .13 of this chapter, the disciplinary panel shall state its reasons for doing so in its final decision and order. Aggravating and Mitigating Factors. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the disciplinary panel may consider the aggravating and mitigating factors set out in §G(4)—(5) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines. Nothing in this regulation requires the disciplinary panel or an Administrative Law Judge to make findings of fact with respect to any of these factors. The existence of one or more of these factors does not impose on the disciplinary panel or an Administrative Law Judge any requirement to articulate its reasoning for not exercising its discretion to impose a sanction outside of the range of sanctions set out in the sanctioning guidelines. Mitigating factors may include, but are not limited to, the following: The absence of a prior disciplinary record; The offender self-reported the incident; The offender voluntarily admitted the misconduct, made full disclosure to the Board, and was cooperative during the Board proceedings; The offender implemented remedial measures to correct or mitigate the harm arising from the misconduct; The offender made good faith efforts to make restitution or to rectify the consequences of the misconduct; The offender has been rehabilitated or exhibits rehabilitative potential; The misconduct was not premeditated; There was no potential harm to patients or the public or other adverse impact; or The incident was isolated and is not likely to recur. Aggravating factors may include, but are not limited to, the following: The offender has a previous criminal or administrative disciplinary history; The offense was committed deliberately or with gross negligence or recklessness; The offense had the potential for or actually did cause patient harm; The offense was part of a pattern of detrimental conduct; The offender committed a combination of factually discrete offenses adjudicated in a single action; The offender pursued his or her financial gain over the patient’s welfare; The patient was especially vulnerable; The offender attempted to hide the error or misconduct from patients or others; The offender concealed, falsified, or destroyed evidence or presented false testimony or evidence; The offender did not cooperate with the investigation; or Previous attempts to rehabilitate the offender were unsuccessful. A departure from the sanctioning guidelines set forth in Regulation .13 of this chapter is not a ground for any hearing or appeal of a disciplinary panel action. Offenses Related to Continuing Education Requirements. If a licensee has submitted an application claiming the completion of continuing education credits and the licensee fails to document the completion of such continuing education credits when audited by the Board, the licensee may be charged under one or more of the following, as appropriate: Health Occupations Article, §14-5C-17(a)(3), Annotated Code of Maryland; Health Occupations Article, §14-5C-17(a)(10), Annotated Code of Maryland; and Health Occupations Article, §14-5C-17(a)(11), Annotated Code of Maryland. Upon a finding of a violation, the disciplinary panel may impose any discipline authorized under Health Occupations Article, §14-5C-17, Annotated Code of Maryland, and the sanctioning guidelines. Payment of Fines Imposed by the Board or a Disciplinary Panel. An individual shall pay to the Board any fine imposed pursuant to this regulation within 15 calendar days of the date of the order, unless the order specifies otherwise. Filing an appeal under State Government Article, §10-222, Annotated Code of Maryland, does not stay payment of a fine imposed pursuant to this regulation. If an individual fails to pay, in whole or in part, a fine imposed pursuant to this regulation, the Board may not restore, reinstate, or renew a license until the fine has been paid in full. In its discretion, the Board may refer all cases of delinquent payment to the Central Collection Unit of the State Department of Budget and Management to institute and maintain proceedings to ensure an individual’s prompt payment. A. Subject to provisions of Regulation .12F and G of this chapter, a disciplinary panel may impose sanctions as outlined in §B of this regulation on polysomnographic technologists for violations of Health Occupations Article, §14-5C-17(a), Annotated Code of Maryland. Range of Sanctions. Health Occupations Article, §§1-213, 1-221, 1-606, 14-205, and 14-5C-01—14-5C-23, Annotated Code of Maryland Effective date: December 1, 2008 (35:24 Md. R. 2078) Regulation .01B amended as an emergency provision effective October 1, 2009 (36:17 Md. R. 1311); amended permanently effective October 5, 2009 (36:20 Md. R. 1528) Regulation .01B amended effective March 5, 2012 (39:4 Md. R. 337) Regulation .01E, F adopted effective May 11, 2015 (42:9 Md. R. 647) Regulation .02B amended effective August 15, 2016 (43:16 Md. R. 900); September 29, 2025 (52:19 Md. R. 956) Regulation .04 amended effective December 22, 2014 (41:25 Md. R. 1485); September 29, 2025 (52:19 Md. R. 956) Regulation .04A amended effective June 20, 2016 (43:12 Md. R. 667) Regulation .04C repealed effective August 15, 2016 (43:16 Md. R. 900) Regulation .04G amended as an emergency provision effective October 1, 2009 (36:17 Md. R. 1311); amended permanently effective October 5, 2009 (36:20 Md. R. 1528) Regulation .04G amended effective March 5, 2012 (39:4 Md. R. 337) Regulation .06 amended effective September 29, 2025 (52:19 Md. R. 956) Regulation .07 amended effective January 2, 2017 (43:26 Md. R. 1446) Regulation .07A amended effective September 29, 2025 (52:19 Md. R. 956) Regulation .07B, C amended effective December 22, 2014 (41:25 Md. R. 1485) Regulation .08B amended effective August 15, 2016 (43:16 Md. R. 900); January 2, 2017 (43:26 Md. R. 1446) Regulation .09 amended effective May 11, 2015 (42:9 Md. R. 647); September 29, 2025 (52:19 Md. R. 956) Regulation .10 amended effective September 29, 2025 (52:19 Md. R. 956) Regulation .10A amended effective May 11, 2015 (42:9 Md. R. 647) Regulation .11 amended effective September 29, 2025 (52:19 Md. R. 956) Regulation .12 amended effective May 11, 2015 (42:9 Md. R. 647); September 29, 2025 (52:19 Md. R. 956) Regulation .12D—H adopted effective July 22, 2013 (40:14 Md. R. 1175) Regulation .13 adopted effective July 22, 2013 (40:14 Md. R. 1175) Regulation .13 amended effective May 11, 2015 (42:9 Md. R. 647) Regulation .13A amended effective September 29, 2025 (52:19 Md. R. 956) Effective date: February 11, 1985 (12:3 Md. R. 245) Regulation .01 amended effective September 11, 1995 (22:18 Md. R. 1399) Regulation .02 amended effective September 11, 1995 (22:18 Md. R. 1399) Regulation .03 amended effective September 11, 1995 (22:18 Md. R. 1399) Regulation .04 amended effective September 11, 1995 (22:18 Md. R. 1399) Regulations .07 and .08 repealed effective September 11, 1995 (22:18 Md. R. 1399) Regulation .07 adopted effective September 11, 1995 (22:18 Md. R. 1399) Chapter repealed effective April 23, 2018 (45:8 Md. R. 422) This chapter governs the practice of athletic training including “dry needling” within the practice of athletic training. This chapter does not prohibit an athletic training student who is enrolled in an accredited athletic training educational program from performing without pay any of the procedures described in this chapter as part of that program’s athletic training clinical curriculum. This chapter does not prohibit an individual from practicing a health occupation that the individual is authorized to practice under Health Occupations Article, Annotated Code of Maryland. This chapter does not prohibit an individual employed by the federal government as an athletic trainer from practicing within the scope of that employment. This chapter does not apply to an individual employed by or under contract with an entity located in another state who represents that entity: At an athletic event in Maryland; For a period not exceeding 45 days within a calendar year; and By providing athletic training services to individuals representing the entity at the event. In this chapter, the following terms have the meanings indicated. Terms Defined. “Accredited athletic training educational program” means an athletic training educational program that: Awards either a bachelor’s or master’s degree in athletic training; and Is accredited by the Commission on Accreditation of Athletic Training Education or its successor. “Alternate supervising physician” means one or more physicians designated by the supervising physician to provide supervision of an athletic trainer: During the absence of the supervising physician; and In accordance with the evaluation and treatment protocol on file with the Board. “Athlete” means an individual who participates in an athletic activity. “Athletic activity” means an exercise, recreation, sport, competition, or game that: Requires physical strength, range of motion, flexibility, control, speed, stamina, or agility; and Is associated with a setting as defined under this section, an educational institution or a professional, amateur, or recreational sports club or athletic organization. “Athletic injury” means an injury that affects an athlete’s participation or performance in an athletic activity. “Board” means the State Board of Physicians. “Certifying board” means the Board of Certification, Inc., or its successor. “Committee” means the Athletic Trainer Advisory Committee of the Board. “Dry needling” means an intramuscular therapy that: Involves the insertion of one or more solid needles into the muscle and related tissues to effect change in the muscle and related tissues; Requires ongoing evaluation, assessment, and reevaluation of an impairment; Is used only in parts of the body with neuromuscular or musculoskeletal links to an impairment; and Is not performed for: The purpose of acupuncture as defined in Health Occupations Article, §1A-101, Annotated Code of Maryland; or Any purpose outside of the scope of practice of athletic trainers. “Evaluation and treatment protocol” means a document that is executed by a physician and an athletic trainer that meets the requirements in Regulation .06 of this chapter. “Immediately available instruction” means instruction provided by the supervising physician to the athletic trainer in person, by telephone, or by other electronic means. “Licensed athletic trainer” means an individual licensed by the Board to practice athletic training. “Licensed health care practitioner” means an individual licensed, certified, or otherwise authorized to practice a health occupation under Health Occupations Article, Annotated Code of Maryland. “Nonsupervising physician” means a physician licensed by the Board who is not the supervising physician of the athletic trainer. “Outside referral” means a request for treatment from a nonsupervising physician or licensed health care practitioner. “Physician” means an individual licensed to practice medicine in Maryland under Health Occupations Article, Title 14, Annotated Code of Maryland. Practice Athletic Training. “Practice athletic training” means application of the following principles and methods for managing athletic injuries for athletes in good overall health under the supervision of a licensed physician: Prevention; Clinical evaluation and assessment; Immediate care; and Treatment, rehabilitation, and reconditioning. “Practice athletic training” includes: Organization and administration of an athletic training program; and Instruction to coaches, athletes, parents, medical personnel, and community members regarding the care and prevention of athletic injuries. “Practice athletic training” does not include any of the following: The practice of chiropractic, including adjustments, manipulation, or high-velocity mobilizations of the spine or extremities; The practice of massage therapy; The practice of medicine; The practice of occupational therapy; The practice of physical therapy; The practice of podiatry; The reconditioning of systemic neurologic injuries, conditions, or disease; or Except for the conditioning of an athlete under the supervision of a treating physician, the treatment, rehabilitation, or reconditioning of nonathletic injuries or disease. “Setting” means a: Location where an athletic activity, as defined in §B(4) of this regulation, is being held; Health or fitness club; Clinic or hospital; Corporation; or Government agency. “Supervising physician” means a physician who has been approved by the Board to supervise one or more athletic trainers. “Supervision” means the responsibility of a physician to provide ongoing and immediately available instruction, in person, by telephone, or by other electronic means, that is adequate to ensure the safety and welfare of a patient and is appropriate to the setting. “Supervision mechanism” means continuous availability to the athletic trainer of a supervising physician by one or more of the following means: On-site supervision; Written instructions; Electronic means; Verbal orders; and Designation of an alternate supervising physician. Therapeutic Modalities. “Therapeutic modalities” means a variety of physical agents used to treat athletic injuries in an effort to decrease pain, reduce inflammation, decrease swelling, decrease muscle spasm, and provide a proper environment for the healing process to take place. “Therapeutic modalities” does not include the use of a prescription or nonprescription drug. The Board shall establish a committee composed of the following individuals: Three licensed physicians meeting the following criteria: At least one physician shall be a specialist in orthopedic or sports medicine; and At least two of the physicians shall currently be or in the past have been partnered with or directed an athletic trainer; Three athletic trainers who meet the following criteria: Have at least 5 years of clinical experience as an athletic trainer; If appointed or serving before October 1, 2011, be certified by the certifying board; and If appointed or serving on or after October 1, 2011, be licensed as an athletic trainer; One licensed chiropractor with sports medicine experience; One licensed physical therapist; One licensed occupational therapist; and Two consumers meeting the criteria specified in Health Occupations Article, §14-5D-05(c), Annotated Code of Maryland. Selection of Athletic Trainers. The Board may appoint the athletic trainer members from a list of qualified individuals submitted to the Board by the Maryland Athletic Trainers Association, Inc. Tenure. The term of a member is 3 years. The terms of the members are staggered. At the end of a term, a member continues to serve until a successor is appointed. An individual may be reappointed for a second term, but the individual may not serve more than two full, consecutive terms. Vacancy. If a vacancy occurs, the Board shall appoint a new member to serve, as provided in this chapter. The successor member shall serve only for the remainder of the term, unless reappointed. Chair. The Committee shall elect a chair from among its members. The chair shall serve for 2 years. The Committee shall: Make recommendations to the Board regarding: Regulations governing athletic trainers; Continuing education requirements for license renewal; and The practice of athletic training; Develop and recommend to the Board an evaluation and treatment protocol for use by an athletic trainer and the physician with whom the athletic trainer practices; Upon request of the Board, provide advice and recommendations to the Board on individual evaluation and treatment protocols; and Keep a record of the Committee’s proceedings. An applicant for licensure as an athletic trainer shall: Complete an application on a form supplied by the Board; Pay an application fee as specified in Regulation .08 of this chapter; and Submit all documentation which the Board requires to evaluate the application. To qualify, an applicant shall meet all of the following requirements: Be 18 years old or older; Be of good moral character; Demonstrate oral and written competency in English by any of the following: Graduation from a recognized English-speaking high school or undergraduate school after at least 3 years of enrollment; Graduation from a recognized English-speaking professional school with acceptable proof of proficiency in the oral and written communication of English; or Receiving a grade of: At least 26 on the “Speaking Section” of the Internet-based Test of English as a Foreign Language; and At least 79 on the Internet-based Test of English as a Foreign Language; Meet the following education requirements: A bachelor’s or master’s degree from an accredited athletic training educational program; or Exemption from the education requirement because the applicant: Was certified by the certifying board on or before October 1, 2012; and Is in good standing with the certifying board at the time of the application; Has passed the certification examination of the certifying board; and Has been certified and maintains current certification from the certifying board at the time of application. The scope of practice of an athletic trainer in the domain of injury prevention and wellness protection includes the following: Minimization of risk of injury of athletes through awareness and education; Monitoring of environmental conditions to facilitate individual and group safety of athletes; Maintenance or enhancement of physical conditioning of athletes; and Promotion of a healthy lifestyle of athletes using appropriate education and communication strategies to enhance wellness and minimize the risk of injury and illness. The scope of practice of an athletic trainer in the domain of clinical evaluation and assessment includes the following with respect to athletes: Obtaining athlete’s health history through observation, interview, and records review; Examining athlete’s body to assess the type and extent of the athletic injury; Formulating a clinical assessment; and Communicating information about the athletic injury to appropriate persons including the athlete. The scope of practice of an athletic trainer in the domain of immediate and emergency care includes the following with respect to athletes: Immediate and emergency procedures including: CPR; Applying ice; Splinting; Elevation; Pressure; Bandaging for bleeding; Proper immobilization of spine or other body parts; and Dry needling; and Making appropriate referrals so that the athlete will obtain appropriate follow-up. The scope of practice of an athletic trainer in the domain of treatment and rehabilitation includes the following activities, performed in an approved setting, with respect to athletes with athletic injuries: Administering therapeutic and conditioning exercises as identified by the evaluation and treatment protocols of the supervising physician; Administering therapeutic modalities as identified by the evaluation and treatment protocols of the supervising physician; Applying braces, splints, or other assistive devices as identified by the evaluation and treatment protocols of the supervising physician; Reassessing the status of injuries, illnesses, or conditions using appropriate techniques and documentation strategies to: Determine appropriate treatment, rehabilitation, or reconditioning for injuries; and Evaluate readiness to return to desired level of activity with respect to injuries, illnesses, or conditions; and Administering dry needling therapy under the direction and guidance of a supervising physician who has training and experience in dry needling. The scope of practice of an athletic trainer in the domain of organization and management includes the following activities: Maintenance of medical records with respect to all athletes who receive emergency care, assessment, or treatment; Planning and organization of an athletic training program; and Instructing others in prevention of and care for athletic injuries. The athletic trainer may accept an outside referral from a nonsupervising physician or licensed health care practitioner if: The supervising physician specifies in the evaluation and treatment protocol that the athletic trainer may accept referrals from nonsupervising physicians or other licensed health care practitioners; The nonsupervising physician or licensed health care practitioner has seen the athlete and has written an order for the care; and The duties are: Within the scope of practice of an athletic trainer; and Among the duties delegated in the evaluation and treatment protocol. Contents. The evaluation and treatment protocol shall include the following: Identification, licensure information, and signature of the: Licensed athletic trainer; and Licensed supervising physician; Information about where the athletic trainer practices, including: Addresses of the primary employer and supervising physician; and Identification of the settings where the athletic trainer may practice; Description of the supervision mechanism that applies to each setting; Description of the delegated processes and procedures that the athletic trainer may use in each of the following areas: Injury or illness prevention and wellness; Clinical evaluation and assessment; Immediate and emergency care; Treatment, rehabilitation, and reconditioning; and Organizational and professional well-being; Descriptions of tasks which the athletic trainer may not perform; Description of specialized tasks the supervising physician is delegating to the athletic trainer to perform with documentation of competencies, certification, credentials, or any other requirements established by the Board to support the delegation of the specialized tasks; A statement of whether or not the supervising physician will permit the athletic trainer to accept outside referrals meeting the requirements stated in Regulation .05F of this chapter; If applicable, the name and other relevant information about an alternate supervising physician; and An attestation that states that the supervising physician will be responsible for providing ongoing and immediately available instruction that is adequate to ensure the safety and welfare of a patient and is appropriate to the setting. Process and Approval. A licensed athletic trainer shall: Submit an evaluation and treatment protocol on a form approved by the Board; and Pay the fee as specified in Regulation .08 of this chapter. A licensed athletic trainer may practice athletic training after receiving written approval from the Committee. The Committee shall conditionally approve an evaluation and treatment protocol if: The evaluation and treatment protocol does not include specialized tasks; or The evaluation and treatment protocol includes specialized tasks that have been previously approved by the Board. If an evaluation and treatment protocol includes a specialized task that has not been previously approved by the Board, the athletic trainer may perform the specialized task only after receiving written approval from the Board. After consideration by the Committee, the Board shall either: Approve the evaluation and treatment protocol and any specialized tasks; or Disapprove the evaluation and treatment protocol or a specialized task if the Board determines that the evaluation and treatment protocol or specialized task does not meet the requirements in Health Occupations Article, §14-5D-11.3(b), Annotated Code of Maryland. If the Board disapproves an evaluation and treatment protocol or a specialized task included in an evaluation and treatment protocol, the Board shall send written notice of the disapproval to the: Primary supervising physician; and Athletic trainer. An athletic trainer who receives notice of a disapproval of an evaluation and treatment protocol from the Board shall immediately cease: Practicing under the evaluation and treatment protocol; or Performing the specialized task. An individual member of the Board is not civilly liable for any act or omission relating to the approval, modification, or disapproval of an evaluation and treatment protocol. Termination of Evaluation and Treatment Protocol. If the athletic trainer or the supervising physician terminates the evaluation and treatment protocol, the athletic trainer shall cease practicing until another evaluation and treatment protocol is approved by the Board. The supervising physician shall report the termination of an evaluation and treatment protocol for any reason to the Board within 10 days of the termination and provide the following information: Name and license number of supervising physician and athletic trainer; and Reason for termination, including a description of conduct or incident that resulted in the termination. Emergency Evaluation and Treatment Protocol. In the event of a sudden departure, incapacity, or death of a supervising physician, a designated alternate may assume the role of the supervising physician by submitting a new evaluation and treatment protocol to the Board within 15 days. Dry Needling Protocol. The practice of dry needling by a licensed athletic trainer shall require approval from the Board as a specialized task. The Board shall issue approval to perform dry needling to a licensed athletic trainer who provides proof of completion of at least 80 hours of instruction in a continuing education course approved by: The National Athletic Trainers’ Association; The Board of Certification for the Athletic Trainer; or The United States Armed Forces. Course Requirements. Of the 80 hours of instruction required under §E(2) of this regulation, at least 40 hours of instruction shall be in the following content areas: Theory and application of dry needling; Dry needling technique, including spine and extremities; Dry needling indications and contraindications; Infection control, the Occupational Safety and Health Administration’s Bloodborne Pathogen Protocol, and safe handling of needles; Emergency preparedness and response procedures related to complications associated with dry needling; and Appropriate documentation of dry needling. Of the 80 hours of instruction required under §E(2) of this regulation, at least 40 hours shall be practical, hands-on instruction in the application and technique of dry needling that is completed under the guidance of a licensed health care practitioner who: Is approved to perform dry needling; and Has practiced dry needling for at least 5 years. The instruction required under §E of this regulation shall include an assessment of the licensed athletic trainer’s competency to perform dry needling that is performed by the instructor of the approved course. Renewal. The Board may not renew a license until the Comptroller of Maryland has verified that the individual has paid all undisputed taxes and unemployment insurance contributions, or arranged for repayment, as required by COMAR 10.31.02. An individual who has been licensed by the Board as an athletic trainer may renew the license every 2 years on the date specified by the Board by: Completing a renewal application on a form supplied by the Board; Paying the required renewal fee specified in Regulation .08 of this chapter; Attesting to the completion of at least 50 hours of approved continuing education credits, earned during the 2-year period preceding the expiration of the license for athletic training, in accordance with the requirements specified in §C of this regulation; and Meeting any other requirement established by the Board. The continuing education requirement applies to all renewal applications after the first renewal. Reinstatement. The Board shall reinstate the license of an athletic trainer if the athletic trainer: Completes a reinstatement application on a form supplied by the Board; Pays the required reinstatement fee and any other fees specified in Regulation .08 of this chapter; Documents evidence of at least 50 hours of approved continuing education credits during the 2-year period preceding the date of the submission of the application for reinstatement; Meets any additional requirements set by the Board for reinstatement of a license; and Is currently registered with the certifying board. Continuing Education. The following activities are approved continuing education experiences: Programs presented by providers approved by the certifying board; Professional development activities approved by the certifying board; and Courses offered for undergraduate or graduate degree credit by colleges or universities. Documentation. An athletic trainer shall obtain documentation of completion of continuing education and retain the documentation for 4 years. The documentation for a program provided by a provider approved by the certifying board shall contain, at a minimum, the following information: Program title; Sponsor’s name; Athletic trainer’s name; Inclusive date or dates and location of the program; Number of continuing education hours earned; and Documented verification that the athletic trainer attended the program by stamp, signature, printout, or other official proof. Documentation for professional development activities shall be as specified by the certifying board. Documentation of credits earned through college or university courses shall be an official transcript from the college or university. Proof of maintenance of certification by the certifying board may be used to document compliance with the continuing education requirement. Change in Name or Address. A licensee shall notify the Board in writing of a change in name or address within 60 days after the change. Licensees who fail to notify the Board of name or address changes as required by §D(1) of this regulation are subject to an administrative penalty of $100. The following fees are applicable to athletic trainers. Initial licensure fee — $200; License renewal fees: License renewal fee — $135; and Maryland Health Care Commission (MHCC) fee — as determined by MHCC under COMAR 10.25.03; Reinstatement fee — $200; Evaluation and treatment protocol — $100; Written verification fee — $25; and Replacement of license fee — $25. Subject to the hearing provisions of Health Occupations Article, §14-405, Annotated Code of Maryland, the Board may deny a license to any applicant, reprimand any licensee, place any licensee on probation, or suspend or revoke a license if the applicant or licensee: Fraudulently or deceptively obtains or attempts to obtain a license for the applicant, for the licensee, or for another; Fraudulently or deceptively uses a license; Is guilty of unprofessional or immoral conduct in the practice of athletic training; Is professionally, physically, or mentally incompetent; Abandons a patient; Habitually is intoxicated; Is addicted to, or habitually abuses, any narcotic or controlled dangerous substance as defined in Criminal Law Article, §5-101, Annotated Code of Maryland; Provides professional services while: Under the influence of alcohol; or Using: Any narcotic or controlled dangerous substance as defined in Criminal Law Article, §5-101, Annotated Code of Maryland; or Any other drug that is in excess of therapeutic amounts or without valid medical indication; Promotes the sale of services, drugs, devices, appliances, or goods to a patient so as to exploit the patient for financial gain; Willfully makes or files a false report or record in the practice of athletic training; Willfully fails to file or record any report as required under law, willfully impedes or obstructs the filing or recording of the report, or induces another to fail to file or record the report; Breaches patient confidentiality; Pays or agrees to pay any sum or provide any form of remuneration or material benefit to any for bringing or referring a patient or accepts or agrees to accept any sum or any form of remuneration or material benefit from an individual for bringing or referring a patient; Knowingly makes a misrepresentation while practicing athletic training; Knowingly practices athletic training with an unauthorized individual or aids an unauthorized individual in the practice of athletic trainer services; Offers, undertakes, or agrees to cure or treat disease by a secret method, treatment, or medicine; Is disciplined by a licensing, certifying, or disciplinary authority or is convicted or disciplined by a court of any state or country or is disciplined by any branch of the United States uniformed services or the Veterans Administration for an act that would be grounds for disciplinary action under Health Occupations Article, §15-5D-14, Annotated Code of Maryland; Fails to meet appropriate standards for delivery of athletic training services; Knowingly submits false statements to collect fees for which services have not been provided; Has been subject to investigation or disciplinary action by a licensing or disciplinary authority or by a court of any state or country for an act that would be grounds for disciplinary action under the Board’s disciplinary statutes and the licensed individual: Surrendered the license issued by the state or country; or Allowed the license issued by the state or country to expire or lapse; Knowingly fails to report suspected child abuse in violation of Family Law Article, §5-704, Annotated Code of Maryland; Sells, prescribes, gives away, or administers drugs for illegal or illegitimate medical purposes; Practices or attempts to practice beyond the authorized scope of practice; Refuses, withholds from, denies, or discriminates against an individual with regard to the provision of professional services for which the licensee is licensed and qualified to render because the individual is HIV positive; Practices or attempts to practice an athletic training procedure or uses or attempts to use athletic training equipment if the applicant or licensee has not received education and training in the performance of the procedure or the use of the equipment; Fails to cooperate with a lawful investigation conducted by the Board; Fails to practice under the supervision of a physician or violates the approved evaluation and treatment protocol; Violates an order of the Board, including any condition of probation; or Performs dry needling without the approval of the Board issued under Regulation .06E of this chapter. Crimes of Moral Turpitude. On the filing of certified docket entries with the Board by the Office of the Attorney General, the Board shall order the suspension of a license if the licensee is convicted of or pleads guilty or nolo contendere with respect to a crime involving moral turpitude, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside. After completion of the appellate process, if the conviction has not been reversed or the plea has not been set aside with respect to a crime involving moral turpitude, the Board shall order the revocation of a license on the certification by the Office of the Attorney General. Complaints alleging prohibited conduct shall be referred to the Board to be investigated according to the Board’s procedures. A hearing on charges issued under Regulation .09A of this chapter or Health Occupations Article, §14-5D-14(a), Annotated Code of Maryland, shall be held in accordance with the hearing provisions of Health Occupations Article, §§14-405 and 14-5D-15, Annotated Code of Maryland. Proceedings for crimes of moral turpitude, under Health Occupations Article, §14-5D-14(b), Annotated Code of Maryland, or Regulation .09B of this chapter shall be held in accordance with COMAR 10.32.02.08. All other hearings shall be held in accordance with the Administrative Procedure Act. Appeals from a final Board decision shall be taken in accordance with Health Occupations Article, §14-5D-15, Annotated Code of Maryland. An individual who violates any provision of Health Occupations Article, Title 14, Subtitle 5D, Annotated Code of Maryland, is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000, or imprisonment not exceeding 1 year, or both. The Board may impose a civil fine of not more than $5,000 on an individual who violates any provision of Health Occupations Article, Title 14, Subtitle 5D, Annotated Code of Maryland. The Board shall deposit a penalty collected under §B of this regulation into the Board of Physicians fund. General Application of Sanctioning Guidelines. Sections D and E of this regulation and Regulation .12 of this chapter do not apply to offenses for which a mandatory sanction is set by statute or regulation. Except as provided in §E of this regulation, for violations of the sections of the Maryland Athletic Trainers Act listed in the sanctioning guidelines, the Board shall impose a sanction not less severe than the minimum listed in the sanctioning guidelines nor more severe than the maximum listed in the sanctioning guidelines for each offense. Ranking of Sanctions. For the purposes of this regulation, the severity of sanctions is ranked as follows, from the least severe to the most severe: Reprimand; Probation; Suspension; and Revocation. A stayed suspension in which the stay is conditioned on the completion of certain requirements is ranked as probation. A stayed suspension not meeting the criteria for §D(3)(b) of this regulation is ranked as a reprimand. A fine listed in the sanctioning guidelines may be imposed in addition to but not as a substitute for a sanction. The addition of a fine does not change the ranking of the severity of the sanction. The Board may impose more than one sanction, provided that the most severe sanction neither exceeds the maximum nor is less than the minimum sanction permitted in the chart. Any sanction may be accompanied by conditions reasonably related to the offense or to the rehabilitation of the offender. The inclusion of conditions does not change the ranking of the sanction. If a licensee has violated more than one ground for discipline as set out in the sanctioning guidelines: The sanction with the highest severity ranking should be used to determine which ground will be used in developing a sanction; and The Board may impose concurrent sanctions based on other grounds violated. Notwithstanding the sanctioning guidelines set forth in Regulation .12 of this chapter, in order to resolve a pending disciplinary action, the Board and the licensee may agree to a surrender of license or a consent order with terms, sanction, and fine agreed to by the Board, the administrative prosecutor, and the licensee. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the Board may consider the aggravating and mitigating factors set out in §E(4) and (5) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines. If the Board imposes a sanction that departs from the sanctioning guidelines as set forth in Regulation .12 of this chapter, the Board shall state its reasons for doing so in its final decision and order. Aggravating and Mitigating Factors. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the Board may consider the aggravating and mitigating factors set out in §E(4) and (5) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines. Nothing in this regulation requires the Board or an Administrative Law Judge to make findings of fact with respect to any of these factors. The existence of one or more of these factors does not impose on the Board or an Administrative Law Judge any requirement to articulate its reasoning for not exercising its discretion to impose a sanction outside of the range of sanctions set out in the sanctioning guidelines. Mitigating factors may include, but are not limited to, the following: The absence of a prior disciplinary record; The offender self-reported the incident; The offender voluntarily admitted the misconduct, made full disclosure to the Board and was cooperative during the Board proceedings; The offender implemented remedial measures to correct or mitigate the harm arising from the misconduct; The offender made good faith efforts to make restitution or to rectify the consequences of the misconduct; The offender has been rehabilitated or exhibits rehabilitative potential; The misconduct was not premeditated; There was no potential harm to patients or the public or other adverse impact; or The incident was isolated and is not likely to recur. Aggravating factors may include, but are not limited to, the following: The offender has a previous criminal or administrative disciplinary history; The offense was committed deliberately or with gross negligence or recklessness; The offense had the potential for or actually did cause patient harm; The offense was part of a pattern of detrimental conduct; The offender committed a combination of factually discrete offenses adjudicated in a single action; The offender pursued his or her financial gain over the patient’s welfare; The patient was especially vulnerable; The offender attempted to hide the error or misconduct from patients or others; The offender concealed, falsified or destroyed evidence or presented false testimony or evidence; The offender did not cooperate with the investigation; or Previous attempts to rehabilitate the offender were unsuccessful. A departure from the sanctioning guidelines set forth in Regulation .12 of this chapter is not a ground for any hearing or appeal of a Board action. Offenses Related to Continuing Medical Education Credits. First Offense of Failure to Document Credits. Except as provided in §F(2) or (3) of this regulation, if a licensee has submitted an application claiming the completion of continuing medical education credits and the licensee fails to document the completion of such continuing medical education credits when audited by the Board, the Board may impose a civil fine under Health Occupations Article, §14-5D-12, Annotated Code of Maryland, of up to $100 per missing continuing medical education credit in lieu of a sanction under Health Occupations Article, §14-5D-14, Annotated Code of Maryland. Section F(1)(a) of this regulation does not limit the Board's authority to require completion of the missing continuing medical education credits. Willful Falsification. If a licensee has willfully falsified an application with respect to continuing medical education credits, the licensee may be charged under one or more of the following, as appropriate: Health Occupations Article, §14-5D-14(a)(3), Annotated Code of Maryland; Health Occupations Article, §14-5D-14(a)(10), Annotated Code of Maryland; and Health Occupations Article, §14-5D-14(a)(11), Annotated Code of Maryland. Upon a finding of a violation, the Board may impose any discipline authorized under Health Occupations Article, §14-5D-14, Annotated Code of Maryland, and the sanctioning guidelines. Licensees Previously Disciplined Under §I(1) or (2) of this regulation. If a licensee has been previously fined or otherwise disciplined under §F(1) or (2) of this regulation, the Board may, for a subsequent offense relating to continuing medical education credits, charge a licensee under one or more of the following, as appropriate: Health Occupations Article, §14-5D-14(a)(3), Annotated Code of Maryland; Health Occupations Article, §14-5D-14(a)(10), Annotated Code of Maryland; and Health Occupations Article, §14-5D-14(a)(11), Annotated Code of Maryland. Upon a finding of a violation, the Board may impose any discipline authorized under Health Occupations Article, §14-5D-14, Annotated Code of Maryland, and the sanctioning guidelines for a subsequent offense. The Board may not apply the sanction described in §F(1) of this regulation in determining a sanction for a licensee previously fined or disciplined for an offense related to continuing medical education credits. The Board shall pay all monies collected pursuant to this section into the Board of Physicians Fund. Payment of Fines. An individual shall pay to the Board any fine imposed under this regulation within 15 calendar days of the date of the order, unless the order specifies otherwise. Filing an appeal under State Government Article, §10-222, Annotated Code of Maryland, does not stay payment of a fine imposed by the Board pursuant to this regulation. If an individual fails to pay, in whole or in part, a fine imposed by the Board pursuant to this regulation, the Board may not restore, reinstate, or renew a license until the fine has been paid in full. In its discretion, the Board may refer all cases of delinquent payment to the Central Collection Unit of the Department of Budget and Management to institute and maintain proceedings to ensure prompt payment. Subject to provisions of Regulation .11D—E of this chapter, the Board may impose sanctions as outlined in §B of this regulation on athletic trainers for violations of Health Occupations Article, §14-5D-14, Annotated Code of Maryland. Range of Sanctions. Health Occupations Article, §§1-213, 1-606, 14-205 and 14-5D-01—14-5D-20, Annotated Code of Maryland Effective date: July 22, 2013 (40:14 Md. R. 1176) Regulation .01A amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .02B amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .05C, D amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .06A amended effective August 15, 2016 (43:16 Md. R. 900) Regulation .06B amended effective July 31, 2017 (44:15 Md. R. 760) Regulation .06E adopted effective January 19, 2026 (53:1 Md. R. 21) Regulation .07 amended effective January 2, 2017 (43:26 Md. R. 1446) Regulation .09A amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .12B amended effective January 19, 2026 (53:1 Md. R. 21) This chapter governs the performance, delegation, assignment, and supervision of cosmetic medical procedures, and the use of cosmetic medical devices by a physician or under a physician's direction. This chapter does not govern use of medical procedures or medical devices for the purpose of treating a disease. This chapter does not endorse or certify the safety of any cosmetic medical device or cosmetic medical procedure. This chapter does not authorize the delegation of any duties to any person who is not licensed under Health Occupations Article, Annotated Code of Maryland. In this chapter, the following terms have the meanings indicated. Terms Defined. “ACCME” means the Accreditation Council on Continuing Medical Education. “ACGME” means the Accreditation Council for Graduate Medical Education. “AOA” means the American Osteopathic Association. Cosmetic Medical Device. “Cosmetic medical device” means a device that alters or damages living tissue. “Cosmetic medical device” includes any of the following items, when the item is used for cosmetic purposes: Laser; Device emitting light or intense pulsed light; Device emitting radio frequency, electric pulses, or sound waves; and Devices used for the injection or insertion of foreign or natural substances into the skin, fat, facial tissue, muscle, or bone. Cosmetic Medical Procedure. “Cosmetic medical procedure” means a procedure using a cosmetic medical device or medical product to improve an individual's appearance. “Cosmetic medical procedure” includes the following: Skin treatments using lasers; Skin treatments using intense pulsed light; Skin treatments using radio frequencies, microwave, or electric pulses; Chemical peels that ablate living skin tissue; Skin treatments with phototherapy; Dermabrasion; Subcutaneous, intradermal, or intramuscular injections of medical products; Treatments intended to remove or cause destruction of fat; and Any treatment using a cosmetic medical device for the purpose of improving an individual's appearance. “Delegate” means to entrust a duty to a physician assistant under Health Occupations Article, Title 15, Annotated Code of Maryland. “Delegation” means the entrusting of a duty by a physician to a physician assistant under Health Occupations Article, Title 15, Annotated Code of Maryland. “Dermabrasion” means an abrasive process to remove epidermis and superficial dermis, resulting in a smoothing of contour irregularities. “Direct supervision” means oversight exercised by a supervising physician who is: In the physical presence of a non-physician and a patient; and Instructing the non-physician in the performance of a cosmetic medical procedure, or observing the performance of a non-physician being trained in the procedure. “Immediately available supervision” means the responsibility of a licensed physician to provide necessary direction in person, by telephone, or by other electronic means. “Non-Physician” means an individual who: Meets the requirements of Regulation .04 of this chapter; and Is not licensed in Maryland as a physician. “On-site supervision” means oversight exercised by a supervising physician who is: Present at the site; and Able to respond in person during a delegated or assigned cosmetic medical procedure. “Physician assistant” means a physician assistant with a current certificate to practice in Maryland. License. A physician shall obtain a license to practice medicine in Maryland before the physician may perform, delegate, assign, or supervise cosmetic medical procedures or the use of cosmetic medical devices. Education. A physician who performs, assigns, supervises, or delegates the performance of cosmetic medical procedures by a non-physician first shall obtain training in the indications for and performance of the cosmetic medical procedures and operation of any cosmetic medical device to be used. Training programs provided by a manufacturer or vendor of cosmetic medical devices or supplies may not be a physician's only education in the cosmetic medical procedures or the operation of the cosmetic medical devices to be used. ACCME or AOA approved continuing education, or completion of an ACGME or AOA accredited postgraduate program that includes training in the cosmetic medical procedure performed satisfies this requirement. A cosmetic medical procedure may be delegated to a physician assistant or assigned to any other health care provider licensed under Health Occupations Article, Annotated Code of Maryland, whose licensing board has determined that the procedure falls within the provider's scope of practice. A physician may not permit any individual who performs cosmetic medical procedures delegated or assigned by that physician to operate a cosmetic medical device or perform a cosmetic medical procedure unless the individual has received: Training as described in Regulation .07 of this chapter; and Any training required by that individual's health occupations board. A physician shall: Develop and maintain at each site where the delegated, assigned, or supervised cosmetic medical procedures will be rendered written office protocols for each such cosmetic medical procedure; Personally perform the initial assessment of each patient; Prepare a written treatment plan for each patient, including diagnosis and planned course of treatment and specification of the device and device settings to be used; Obtain informed consent of the patient to be treated by a non-physician; Except as indicated in §B or C of this regulation, provide onsite supervision whenever a non-physician is performing cosmetic medical procedures or using cosmetic medical devices; Retain responsibility for any acts delegated to a non-physician; and Create and maintain medical records in a manner consistent with accepted medical practice and in compliance with Health-General Article, Title 4, Subtitles 3 and 4, Annotated Code of Maryland, and with Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. §1320d-2, as amended, and 45 CFR Parts 160 and 164, as amended). The Board may approve a delegation agreement for a physician assistant that permits the physician to delegate performance of cosmetic medical procedures under immediately available supervision after the physician has evaluated the patient and developed a written treatment plan. A delegation agreement for a physician assistant that includes cosmetic medical procedures and is approved by the Board before May 2009, is not affected by this chapter. Written protocols for cosmetic medical procedures and equipment shall include the following: List of all equipment, including: Manufacturer's specifications; Operating instructions; and Maintenance log; Documentation regarding initial and periodic training of all users of the equipment; Role of the physician for each procedure; Role of the non-physician for each procedure; Steps to address common complications and emergency situations; and Appropriate care and follow-up for the patient after the procedure. The physician is responsible for assuring that any individual to whom the physician delegates or assigns the performance of a cosmetic medical procedure or the operation of a cosmetic medical device is properly trained. Training shall include both theoretical instruction and clinical instruction. Theoretical instruction shall include: Cosmetic-dermatological indications and contraindications for treatment; Identification of realistic and expected outcomes of each procedure; Selection, maintenance, and utilization of equipment; Appropriate technique for each procedure, including infection control and safety precautions; Pharmacological intervention specific to the procedure; Identification of complications and adverse reactions for each procedure; Emergency procedures to be used in the event of: Complications; Adverse reactions; Equipment malfunction; or Any other interruption of a procedure; and Appropriate documentation of the procedure in the patient's chart. Clinical instruction shall include: Observation of performance of the procedure or use of the device by an individual experienced in performing the procedure; and Performing the procedure or using the device under the direct supervision of the delegating physician who is present and observing the procedure a sufficient number of times to assure that the non-physician is competent to perform the procedure without direct supervision. A physician who delegates or assigns a cosmetic medical procedure or the use of a cosmetic medical device to a non-physician or who supervises a non-physician performing these functions shall assure that the non-physician complies with this regulation. A non-physician may not use a cosmetic medical device or perform a cosmetic medical procedure unless the individual has received: The training described in Regulation .07 of this chapter; and Any training required by that individual's health occupations board. A non-physician shall: Review and follow the written protocol with respect to a cosmetic medical procedure; Verify that the physician has assessed the patient and given written treatment instructions for the procedure; Discuss the procedure with the patient to ensure that the patient: Is aware that the treatment will be provided by a non-physician; and Has given consent in writing to treatment by a non-physician; Notify the delegating physician about any adverse events or complications before the patient leaves the site; Document all relevant details of the procedure in the patient's chart, including any adverse events and complications; and Satisfy any requirements imposed by the licensing board of the non-physician. Physician. A physician may be disciplined for any of the following: Delegating, assigning, or supervising a cosmetic medical procedure performed by an individual who is not a physician assistant or another licensed health care provider whose licensing board has determined that the procedure is within the scope of practice of the individual; Delegating cosmetic medical procedures to an individual who has not had: The training specified in Regulation .07 of this chapter; and The training required by that individual's health occupations board; or Failure to adhere to any requirement of this chapter. Non-Physician. A non-physician who violates any provision of this chapter is guilty of the practice of medicine without a license and may be subject to a fine of not more than $50,000 under Health Occupations Article, §14-606, Annotated Code of Maryland. Other Individual. An individual using a cosmetic medical device or performing a cosmetic medical procedure who is not a licensed physician and is not authorized to perform the cosmetic medical procedure under this chapter, or under regulations promulgated by another licensing board established by Health Occupations Article, Annotated Code of Maryland, is guilty of the practice of medicine without a license and may be subject to a fine of not more than $50,000 under Health Occupations Article, §14-606, Annotated Code of Maryland. Health Occupations Article, §§14-205, 14-306, 14-404, 14-606, and 15-302, Annotated Code of Maryland Effective date: August 23, 2010 (37:17 Md. R. 1185) Regulation .02B amended effective March 14, 2016 (43:5 Md. R. 386); December 31, 2018 (45:26 Md. R. 1246) This chapter governs the practice of radiation therapy, radiography, nuclear medicine technology, and radiology assistance. This chapter does not prohibit: A radiation therapy, radiography, nuclear medicine technology, or radiology assistance student enrolled in an educational program from practicing radiation therapy, radiography, nuclear medicine technology, or radiology assistance in the educational program; An individual employed by the federal government as a radiation therapist, radiographer, nuclear medicine technologist, or radiologist assistant from practicing within the scope of that employment; or An individual from practicing a health occupation that the individual is authorized to practice under the Health Occupations Article. In this chapter, the following terms have the meanings indicated. Terms Defined. “ARRT” means the American Registry of Radiologic Technologists. “Board” means the Board of Physicians. “Certification” means recognition of an individual who has satisfied certain standards required by a national certifying board. “Committee” means the Radiation Therapy, Radiography, Nuclear Medicine Technology, and Radiology Assistance Advisory Committee of the Board. “Computed tomography (CT)” means the use of a machine that produces ionizing radiation to obtain cross-sectional images. Direct Supervision. “Direct supervision” means supervision by a licensed physician who is: In the physical presence of the licensee and a patient; and Observing and directing the licensee as the licensee performs a procedure. “Direct supervision” includes, for purposes of meeting the examination eligibility requirements set out in Regulation .10B of this chapter, supervision by a: Licensed nuclear medicine technologist with the post-primary computed tomography (CT) credential; Licensed radiographer with the post-primary CT credential; or Licensed radiologist or radiation oncologist. “Hybrid nuclear medicine/CT device” means a machine that combines two distinct imaging modalities. “Immediately available direction” means the responsibility of a licensed physician to provide necessary direction for a licensee in person, by telephone, or by other electronic means if the licensee needs assistance with a procedure. “JRCNMT” means the Joint Review Committee on Educational Programs in Nuclear Medicine Technology. “Licensee” means an individual who is licensed to practice radiography, radiation therapy, nuclear medicine technology, or radiology assistance in Maryland. “NMTCB” means the Nuclear Medicine Technology Certification Board. “Nuclear medicine technologist” means an individual licensed by the Board to practice nuclear medicine technology. “On-site supervision” means the responsibility of a licensed physician to provide necessary direction for a licensee when the physician is: Physically present in the facility; and Able to respond in person if the licensee needs assistance with a procedure. “Physician” means an individual who is licensed by the Board to practice medicine. “Post–primary computed tomography (CT) credential” means passing a specialty examination by the ARRT or the NMTCB to establish competency in performing computed tomography. “Practice nuclear medicine technology” means to: Prepare and administer radiopharmaceuticals to human beings; or Conduct in vivo detection and measurement of radioactivity for medical purposes to assist the physician in the diagnosis and treatment of disease or injury. “Practice radiation therapy” means to perform tumor localization radiography and apply therapeutic doses of radiation for the treatment of disease or injury. “Practice radiography” means to use ionizing radiation to: Demonstrate portions of the human body to assist the physician in the diagnosis of disease or injury; or Perform tumor localization radiography. “Practice radiology assistance” means to: Practice radiography; and Perform: Fluoroscopy and selected radiology procedures; Patient assessment; and Patient management. “Radiation therapist” means an individual licensed by the Board to practice radiation therapy. “Radiographer” means an individual who is licensed by the Board to practice radiography. “Radiologist” means a licensed physician who: Specializes in radiology; and Has current certification in radiology by one of the following organizations: American Board of Radiology; American Osteopathic Board of Radiology; British Royal College of Radiology; or Royal College of Physicians and Surgeons of Canada. “Special procedure request” means a written request to the Board to allow a licensed radiologist assistant to perform one or more procedures listed in Regulation .11E of this chapter. “Supervision” means the responsibility of the licensed physician to exercise on-site direction or immediately available direction for licensees. The Board shall establish a Committee composed of the following individuals: One physician whose approved specialty is radiology; One physician whose approved specialty is nuclear medicine; One physician whose approved specialty is radiation oncology; One physician who specializes in radiology and who supervises a radiologist assistant; One radiographer; One radiation therapist; One nuclear medicine technologist; One radiologist assistant; One consumer member; and One Board member. Selection. The physician whose specialty is radiology, the physician whose specialty is radiation oncology, and the physician who specializes in radiology and supervises a radiologist assistant may be selected by the Board from a list of nominees submitted by the American College of Radiology—Maryland Chapter. Nominees are not required to be members of the American College of Radiology. The physician whose specialty is nuclear medicine may be selected by the Board from a list of nominees submitted by the Mideastern Chapter—Society of Nuclear Medicine. Nominees are not required to be members of the Mideastern Chapter—Society of Nuclear Medicine. The radiographer and the radiation therapist may be selected by the Board from a list of nominees submitted by the Maryland Society of Radiologic Technologists. Nominees are not required to be members of the Maryland Society of Radiologic Technologists. The nuclear medicine technologist may be selected by the Board from a list of nominees submitted by the Mideastern Chapter—Society of Nuclear Medicine —Technologist Section. Nominees are not required to be members of the Mideastern Chapter—Society of Nuclear Medicine—Technologist Section. The consumer member shall: Meet the requirements in Health Occupations Article, §14-5B-05(d), Annotated Code of Maryland; and Be selected by the Board. Tenure. The term of a member is 3 years. The terms of the members are staggered. At the end of a term, a member continues to serve until a successor is appointed. An individual may be reappointed for a second term but the individual may not serve more than two full consecutive terms. Vacancy. If a vacancy occurs as to a member, the Board shall appoint a new member to serve, as provided in this regulation. The successor member shall only serve for the remainder of the term, unless reappointed. The Committee shall elect a chair from among its members once every 2 years. The Committee shall: Review selected applications for licensure of radiographers, nuclear medicine technologists, radiation therapists, and radiologist assistants, and make recommendations to the Board for approval; Make recommendations to the Board regarding regulations governing radiographers, nuclear medicine technologists, radiation therapists, and radiologist assistants; Make recommendations to the Board on the requirements for licensure of radiographers, radiation therapists, nuclear medicine technologists, and radiologist assistants; Make recommendations to the Board on a code of ethics for the practice of radiography, radiation therapy, nuclear medicine technology, and radiology assistance; Advise the Board on matters related to standards of care for the practice of radiography, nuclear medicine technology, radiation therapy, and radiology assistance; Advise the Board on matters related to the practice of radiography, nuclear medicine technology, radiation therapy, and radiology assistance; and Keep a record of the Committee's proceedings. An individual shall be licensed by the Board if the individual meets the requirements of §B of this regulation. An individual shall be licensed by the Board if the individual: Completes an application on a form supplied by the Board; Pays an application fee as specified in Regulation .18 of this chapter; Is 18 years old or older; Is of good moral character; Demonstrates oral and written competency in English by any of the following: Graduation from a recognized English-speaking high school or undergraduate school after at least 3 years of enrollment; Graduation from a recognized English-speaking professional school with acceptable proof of proficiency in the oral and written communication of English; Receiving a grade of: At least 26 on the “Speaking Section” of the Internet-based Test of English as a Foreign Language; and At least 79 on the Internet-based Test of English as a Foreign Language; Has successfully completed and graduated from a radiographer educational program that is recognized by the ARRT or its successor; Has passed the examination in radiography constructed by the ARRT or its successor; and Has been certified and maintains current registration or active certification from the ARRT or its successor, at the time of application. An individual shall be licensed by the Board if the individual meets the requirements of §B of this regulation. An individual shall be licensed by the Board if the individual: Completes an application on a form supplied by the Board; Pays an application fee as specified in Regulation .18 of this chapter; Is 18 years old or older; Is of good moral character; Demonstrates oral and written competency in English by any of the following: Graduation from a recognized English-speaking high school or undergraduate school after at least 3 years of enrollment; Graduation from a recognized English-speaking professional school with acceptable proof of proficiency in the oral and written communication of English; Receiving a grade of: At least 26 on the “Speaking Section” of the Internet-based Test of English as a Foreign Language; and At least 79 on the Internet-based Test of English as a Foreign Language; Has successfully completed and graduated from a nuclear medicine educational program that is recognized by the ARRT or its successor, or the NMTCB or its successor; Has passed the examination in nuclear medicine technology constructed by the ARRT or its successor, or the NMTCB or its successor; and Has been certified and maintains current registration or active certification from the ARRT or its successor, or the NMTCB or its successor at the time of application. An individual shall be licensed by the Board if the individual meets the requirements of §B of this regulation. An individual shall be licensed by the Board if the individual: Completes an application on a form supplied by the Board; Pays an application fee as specified in Regulation .18 of this chapter; Is 18 years old or older; Is of good moral character; Demonstrates oral and written competency in English by any of the following: Graduation from a recognized English-speaking high school or undergraduate school after at least 3 years of enrollment; Graduation from a recognized English-speaking professional school with acceptable proof of proficiency in the oral and written communication of English; Receiving a grade of: At least 26 on the “Speaking Section” of the Internet-based Test of English as a Foreign Language; and At least 79 on the Internet-based Test of English as a Foreign Language; Has successfully completed and graduated from a radiation therapy educational program that is recognized by the ARRT or its successor; Has passed the examination in radiation therapy constructed by the AART or its successor; and Has been certified and maintains current registration or active certification from the AART or its successor at the time of application. An individual shall be licensed by the Board if the individual meets the requirements of §B of this regulation. An individual shall be licensed by the Board if the individual: Completes an application on a form supplied by the Board; Pays an application fee as specified in Regulation .18 of this chapter; Is 18 years old or older; Is of good moral character; Demonstrates oral and written competency in English by any of the following: Graduation from a recognized English-speaking high school or undergraduate school after at least 3 years of enrollment; Graduation from a recognized English-speaking professional school with acceptable proof of proficiency in the oral and written communication of English; or Receiving a grade of: At least 26 on the “Speaking Section” of the Internet-based Test of English as a Foreign Language; and At least 79 on the Internet-based Test of English as a Foreign Language; Has been educated as follows: Completed a radiologist assistant educational program that is recognized by the ARRT or its successor; and Successfully completed coursework that leads to a baccalaureate degree or post-baccalaureate certificate; Has passed the examination administered by the ARRT or its successor; and Has been certified and maintains current registration or active certification from the ARRT or its successor at the time of application. In addition to the requirements specified in §B of this regulation, an applicant for a license as a radiologist assistant shall have: A current Maryland license as a radiographer; Completed a radiologist or radiation oncologist-directed clinical preceptorship as a part of the educational program required by §B(6) of this regulation; Current certification in advanced cardiac life support; and Current certification as a radiologist assistant by the ARRT or its successor. Supervision. A radiation therapist, radiographer, or a nuclear medicine technologist may practice only under the supervision of a licensed physician. A licensed radiologist assistant may practice only under the supervision of a licensed radiologist or radiation oncologist. Administration of Medications or Contrast Media. A radiation therapist, radiographer, nuclear medicine technologist, or radiologist assistant may initiate an intravenous line and administer contrast media with the following supervision: A radiologist assistant may administer contrast media under the immediately available direction of a radiologist or radiation oncologist; and A radiation therapist, radiographer, or nuclear medicine technologist may administer contrast media after consultation with a physician who is physically available on the premises. A radiation therapist, radiographer, nuclear medicine technologist, or radiologist assistant may not administer narcotic or sedating medication. Identification. A radiation therapist, radiographer, nuclear medicine technologist, or radiologist assistant, when practicing radiation therapy, radiography, nuclear medicine technology, or radiology assistance shall wear a badge which identifies the individual wearing the badge to be a licensed radiation therapist, radiographer, nuclear medicine technologist, or radiologist assistant. The practice of radiation therapy includes the following: Scope of practice for simulation procedures and for operation of external beam treatment devices, CT simulator, and fluoroscopic simulator for patient therapy which includes: Preparation of machine for patient procedure; Positioning patient for treatment or localization, or both; Adjustment of machine components and systems; Application of machine adjustments while patient is on the table; Attachment or removal of any machine device or machine accessory for patient service, or both; Manipulation of machine controls for patient exposure for localization or treatment, or both; Production of radiation for tumor or field localization on, or treatment of, a patient, or both; Documentation of technical set up used on a patient; Monitoring of patient and equipment during the simulation or treatment procedures for application of corrective actions; Oversight and application of image development standards and appropriate labeling of images regarding patient identification, date, and documentation of technical parameters; Performance of patient or image measurements, or both; Application of technical procedures in accordance with accepted radiation safety standards and regulations; Performance of dosimetric and geometric calculations related to patient treatment; and Manipulation, data entry, or other use of computer-accelerator interfaced hardware or software for patient treatment; Scope of practice for preparation of patient treatment devices which includes: Oversight of in-facility manufacture of devices or device accessories for use in patient treatment; and Approval of devices for use in patient simulation and treatment; Scope of practice for brachytherapy and radiopharmaceutical procedures which includes: Removal, return, or handling of radiation sources or medical applicators, or both, containing radioactive material; Transportation of radioactive materials; Documentation for the accountability and use of the radiation sources; Insertion and removal of sources from medical applicators; Preparation of sealed radiopharmaceuticals for therapeutic administration to patients under physician supervision; Assisting the licensed physician in the preparation and administration of sealed therapeutic radiopharmaceuticals for brachytherapy; Documentation of the therapeutic application of radiopharmaceuticals; Oversight of radiation safety practices related to the handling and administration of radiopharmaceuticals for therapy of patients; Management of transportation and handling of therapeutic radiopharmaceuticals, immediate management and appropriate notifications for any spills or other accidents involving radiopharmaceuticals; Calibration of therapeutic radiopharmaceuticals for dose accuracy; and Preparation of unsealed radiopharmaceuticals for therapeutic administration to patients under direct supervision by a licensed physician if the radiation therapist has received on-site training from an authorized user; and Performance of any other duties that the Board determines may be performed by a radiation therapist. The scope of practice of radiography includes the following: Analysis and correlation of procedure requests and clinical information provided by a physician or patient, or both, for preprocedure determination of the appropriate exam, its extent, and its scope; Evaluation of the physical and emotional status of the patient with respect to the ability to undergo the procedure requested; Selection, preparation, and operation of radiography equipment and accessories to perform procedures; Positioning patient to best demonstrate anatomy of interest, while respecting patient's physical limitations and comfort; Determination of radiographic exposure factors, setting of factors on control panel, and application of x-ray exposures; Application of radiation protection principles to minimize radiation exposure to patient, self, and others; Evaluation of images for technical quality; Performance of noninterpretive fluoroscopic procedures according to institutional policy; Oversight of image processing standards and the appropriate labeling of images; Administering contrast media after consultation with, and under the supervision of, a physician who is immediately and physically available; and Performing any other duties that the Board determines may be performed by a radiographer. The scope of practice of radiography includes the administration of intravenous medications and other patient care procedures as directed by the physician if the: Radiographer is: Registered by the ARRT in advanced qualifications in cardiac-interventional radiography, vascular-interventional radiography, or cardiovascular-interventional radiography; Working in a cardiac catheterization laboratory or interventional radiographic laboratory while cardiac catheterization or interventional procedures are ongoing; and Administering the medication or performing a patient care procedure at the direction of a physician while the physician is present in the room directing the administration and dosage of medication or performance of the patient care procedure; Supervising physician in the cardiac catheterization or interventional laboratory is responsible for the acts of the radiographer when delegating the administration of intravenous medications or performance of a patient care procedure; and Facility where the procedure is performed: Has protocols available for review by the Board; Documents the training provided to the radiographer; and Evaluates the radiographer on a regular basis for competency, documents the results of these tests, and makes the results available for inspection by the Board. The scope of practice of radiography includes the insertion and removal of peripherally inserted central catheters with or without fluoroscopic guidance if the: Radiographer is: Registered by the ARRT in advanced qualifications in cardiac-interventional radiography, vascular-interventional radiography, or cardiovascular-interventional radiography; Working in a cardiac catheterization laboratory or interventional radiographic laboratory while cardiac catheterization or interventional procedures are ongoing; and Under the onsite supervision of the supervising physician; Supervising physician in the cardiac catheterization or interventional laboratory is responsible for the acts of the radiographer with respect to insertion or removal of peripherally inserted central catheters; and Facility where the procedure is performed: Has protocols available for review by the Board; Documents the training provided to the radiographer; and Evaluates the radiographer on a regular basis for competency, documents the results of these tests, and makes the results available for inspection by the Board. The scope of practice of nuclear medicine technology includes the following: Scope of practice for diagnostic in-vivo procedures and in-vitro procedures which includes: Analysis and correlation of procedure request and clinical information provided by the referring physician or patient, or both, for determination of appropriate exam, extent, and scope; Evaluation of the physical and emotional status of the patient with respect to the ability to undergo the procedure requested; Immediate predose review of patient's identification, prescribed dose quantity and route of administration, and identification of the test agent designed to prevent dose misadministration; Preparation of the appropriate radiopharmaceutical with measurement of dose activity; Administration of appropriate diagnostic dose levels of radiopharmaceuticals; Administration of nonradioactive pharmaceuticals utilized in conjunction with a nuclear medicine imaging or in-vivo procedure, for example, cholecystokinin, furosemide, vitamin B12, in accordance with hospital or facility procedures, excluding narcotic and sedating medication; Selection of appropriate imaging or test parameters, or both; Obtaining images according to established protocols and any special views to optimize information as appropriate; Placement of patient in proper position using supportive materials and immobilizer as necessary; Assuring appropriate image labeling as to patient identification, position, and appropriate anatomic land marks for each view; Evaluation of images or data, or both, for technical quality; Recognition of unusual variances in the images or data, or both, caused by instrumentation malfunction and initiating appropriate action; Monitoring of patient and equipment during procedure for determination and application of any corrective actions necessary; Monitoring of data collection and processing and performance of technical analysis of test results; Preparation and performance of laboratory in-vivo nuclear medicine procedures, inclusive of the selection and operation of laboratory counting equipment, performance of calculations and data processing necessary for completion of lab procedures and the submission of results to the physician or licensee; Oversight and application of image development; and Performance of in-vitro testing of serum, plasma, or other body fluids using radio immunoassay, or similar ligand assay methods; Scope of practice for handling radiopharmaceuticals which includes: Preparation, by means of tagging, compounding, etc., in accordance with manufacturer's specifications; Measurement and calculation of activity of radionuclides with a dose calibrator; Application of radioactive decay calculations to determine required volume or unit form necessary to deliver the prescribed radioactive dose; and Recording of radiopharmaceutical information on a patient's permanent record; Scope of practice for radionuclide therapy which includes: Assisting licensed physician in the preparation and applications of therapeutic radionuclides; Oversight of radiation safety practices related to the handling and administration of radiopharmaceuticals for therapy of patients; Management of transportation and handling of therapeutic radiopharmaceuticals; Calibration of therapeutic radiopharmaceuticals for dose accuracy; and Radiation monitoring, decontamination, disposal, and patient follow-up as appropriate and required; Scope of practice for radiation safety which includes: Maintenance of records of radioactive material receipt, use, storage, and disposal in accordance with regulatory requirements; Oversight and enforcement of radiation safety policies, practices, and regulations regarding the possession and use of radioactive materials; and Performance of radiation safety procedures such as radiation survey and wipe testing of incoming radioactive shipments and facility fixtures; Operation of a hybrid nuclear medicine/CT device for a nondiagnostic attenuation correction CT without intravenous contrast; and Performing any other duties that the Board determines may be performed by a nuclear medicine technologist. The scope of practice of a nuclear medicine technologist includes operation of a standalone CT or hybrid nuclear medicine/CT device for a diagnostic CT with or without intravenous contrast if the nuclear medicine technologist: Has successfully passed the ARRT or NMTCB specialty exam for CT; and Administers contrast media after consultation with, and under the supervision of, a physician who is immediately and physically available. In order to meet the eligibility requirements to sit for the ARRT or the NMTCB post-primary CT examination, a licensed nuclear medicine technologist may perform all procedures involving diagnostic CT with or without intravenous contrast only under the direct supervision of a: Licensed nuclear medicine technologist with the post-primary CT credential; Licensed radiographer with the post-primary CT credential; or Licensed radiologist or radiation oncologist. The scope of practice of a radiologist assistant includes the following activities to obtain the clinical history and physical examination of the patient: Review the patient's medical record to verify the appropriateness of a specific exam or procedure; Interview the patient to obtain, verify, or update medical history; Explain procedure to the patient or significant others, including a description of risks, benefits, alternatives, and follow-up; Obtain informed consent; Determine if the patient has followed instructions in preparation for the exam such as diet and premedications; Assess risk factors that may be contraindications to the procedure such as health history, medications, pregnancy, psychological indicators, and alternative medicines; Obtain and evaluate vital signs; Perform physical examination and analysis of data such as signs and symptoms, laboratory values, and significant abnormalities, as required by the imaging procedure to be conducted; and Report findings related to Regulation .10A(1)—(5) of this chapter to the supervising radiologist or radiation oncologist. The scope of practice of a radiologist assistant includes the following general procedures: Apply ECG leads and recognize life threatening ECG abnormalities; Perform urinary catheterization; Perform venipuncture; Monitor IV for flow rate and complications; Position patient to perform required procedure, using immobilization devices and modifying technique as necessary; Assess patient's vital signs and levels of anxiety and pain and inform the radiologist or radiation oncologist when appropriate; Recognize and respond to medical emergencies, such as drug reactions, cardiac arrest, and hypoglycemia, and activate emergency response systems, including notification of the radiologist; Administer oxygen as prescribed; Operate a fixed/mobile fluoroscopic unit; Assure documentation of fluoroscopy time; Explain effects and potential side effects to the patient of the pharmaceutical required for the examination; Administer contrast agents as prescribed by the radiologist or radiation oncologist; Administer general medications, excluding radiopharmaceuticals and narcotic or sedating medications, as prescribed by the radiologist; and Monitor patient for side effects or complications of the pharmaceuticals. The scope of practice of the radiologist assistant includes performing the following examinations and procedures, including contrast media administration, placement of needle or catheter, and operation of imaging equipment, under the immediate available direction of a radiologist or radiation oncologist: Upper GI; Esophagus; Small bowel studies; Barium enema; Evaluation of percutaneous gastric and enteric tubes; Swallowing study; Cystogram and voiding cystourethrogram; and Nasoenteric and oroenteric feeding tube placement. The scope of practice of the radiologist assistant includes performing the following examinations and procedures, including contrast media administration, placement of needle or catheter, and operation of imaging equipment, under the on-site supervision of a radiologist or radiation oncologist: Joint injection and aspiration; Arthrogram, including conventional, CT, and MR; PICC placement; Paracentesis with appropriate image guidance; Thoracentesis with appropriate image guidance; Lumbar puncture under fluoroscopic guidance; Fistulogram; and Port injection. On a case-by-case basis as specified in Regulation .12 of this chapter, the Board or its designee may approve a radiologist assistant to perform one or more of the following procedures under the level of supervision by a radiologist or radiation oncologist as specified in the request letter submitted by the radiologist or radiation oncologist and radiologist assistant: Lower extremity venography; Lumbar, thoracic, or cervical myelography; Non-tunneled venous central line placement; Venous catheter placement for dialysis; Breast needle localization; Ductogram (galactogram); T-tube cholangiogram; Retrograde urethrogram; Sinogram; Loopogram; Hysterosalpingogram; and Other specific procedures approved by the Board. The scope of practice of a radiologist assistant includes the following post-imaging activities: Review of imaging procedures, making initial observations, and communicating observations only to the radiologist or radiation oncologist; Communication of radiologist's report to referring physician; Provision of radiologist-prescribed post-care instructions to patients; Performance of follow-up patient evaluation, and communication of findings to the radiologist or radiation oncologist; Documenting procedure in appropriate record, and documenting exceptions from established protocol or procedure; Writing patient discharge summary for review and co-signature by the radiologist or the radiation oncologist; Participating in quality improvement activities within radiology practice; and Assisting with data collection and review for clinical trials or other research. Eligibility. The Board may grant a radiologist assistant permission to perform one or more of the procedures specified in Regulation .11E of this chapter based on the following criteria: Evidence of satisfactory completion of an adequate number of cases for the procedure being requested; and Level of supervision of the radiologist assistant, as specified by the radiologist. Request. The radiologist or radiation oncologist and radiologist assistant shall jointly request approval to perform a special procedure by submitting a letter that includes the following information: Special procedures requested; and Documentation of satisfactory completion of an adequate number of cases of the procedure. Training and Experience. Documentation of successful completion of cases of a procedure may include: Cases submitted to ARRT for registration as a registered radiologist assistant; and Other cases performed under the supervision of a radiologist or radiation oncologist who is present and observing the procedure. Board Approval. Except as provided in §D(2) of this regulation, a licensed radiologist assistant may not perform any of the procedures specified in Regulation .11E of this chapter until the Board or its designee has approved the special procedure request submitted by the radiologist or radiation oncologist and radiologist assistant. A licensed radiologist assistant may perform a procedure for training purposes under the direct supervision of a radiologist who is: Physically present with the patient and the radiologist assistant; and Observing the performance of the procedure by the radiologist assistant. Renewal. The Board may not renew a license until the Comptroller of Maryland has verified that the individual has paid all undisputed taxes and unemployment insurance contributions, or arranged for repayment, as required by COMAR 10.31.02. An individual who has been licensed by the Board as a radiation therapist, radiographer, or nuclear medicine technologist shall renew the license every 2 years on the date specified by the Board by: Completing a renewal application on a form approved by the Board; Paying a renewal fee as specified in Regulation .18 of this chapter; and Attesting to one of the following: Completion of at least 24 hours of approved continuing education earned during the 2-year period preceding the expiration of the license for radiation therapist, radiographer, or nuclear medicine technologist, in accordance with the requirements specified in §A(5) of this regulation; Current American Registry of Radiologic Technologists (ARRT) registration; or Active certification by the Nuclear Medicine Technology Certification Board. An individual who has been licensed by the Board as a radiologist assistant shall renew the license every 2 years on the date specified by the Board by: Completing a renewal application on a form approved by the Board; Paying a renewal fee as specified in Regulation .18 of this chapter; Attesting to one of the following: Completion of at least 50 hours of approved continuing education earned during the 2-year period preceding the expiration of the license for radiologist assistant, in accordance with the requirements specified in §A(5) of this regulation; or Current American Registry of Radiologic Technologists (ARRT) registration as a radiologist assistant. Continuing education hours that are used to satisfy the continuing education requirement for renewal of a license as a radiographer may also be used to satisfy the continuing education requirement for a radiologist assistant. Approved continuing education is as follows: In-service programs at a hospital or related institution as defined in Health-General Article, §19-301, Annotated Code of Maryland, or a health maintenance organization certified by the State; or Programs relevant to the practice of a radiation therapist, radiographer, nuclear medicine technologist, or radiologist assistant approved by the: American College of Radiology or its chapters; Maryland Society of Radiologic Technologists; Mideastern Chapter—Society of Nuclear Medicine — Technologist Section; Mideastern Chapter—Society of Nuclear Medicine or the District of Columbia Chapter of the American College of Radiology; American Medical Association; MedChi, the Maryland State Medical Society; or American Society of Radiologic Technologists. The continuing education requirement applies to all renewal applications after the first renewal. Reinstatement. The Board shall reinstate the license of a radiation therapist, radiographer, nuclear medicine technologist, or radiologist assistant if the individual: Completes a reinstatement application on a form approved by the Board; Pays a reinstatement fee as defined in Regulation .18 of this chapter; and Documents evidence of: For a radiographer, radiation therapist, or nuclear medicine technologist, at least one of the following requirements: Completion of at least 24 hours of approved continuing education earned during the 2-year period preceding the date of the submission of the application for reinstatement of the license for radiation therapist, radiographer, or nuclear medicine technologist; Current ARRT registration; or Active certification by the NMTCB; or For a radiologist assistant, at least one of the following requirements: Completion of at least 50 hours of approved continuing education earned during the 2-year period preceding the date of the submission of the application for reinstatement of the license for radiologist assistant; or Current ARRT registration as a radiologist assistant. Subject to the hearing provisions of Health Occupations Article, §14-405, Annotated Code of Maryland, the Board may deny an application, may reprimand any licensed radiation therapist, licensed radiographer, licensed nuclear medicine technologist, licensed radiologist assistant, place any licensed radiation therapist, licensed radiographer, licensed nuclear medicine technologist, licensed radiologist assistant, on probation, or suspend or revoke the license of any licensed radiation therapist, licensed radiographer, licensed nuclear medicine technologist, or licensed radiologist assistant for the commission of a prohibited act. The following are prohibited acts: Fraudulently or deceptively obtaining or attempting to obtain a license for the applicant or licensed individual or for another; Fraudulently or deceptively using a license; Being guilty of unprofessional or immoral conduct in the practice of radiation therapy, radiography, nuclear medicine technology, or radiology assistance; Being professionally, physically, or mentally incompetent; Abandoning a patient; Habitually being intoxicated; Being addicted to or abusing any narcotic or controlled dangerous substance as defined in Criminal Law Article, Annotated Code of Maryland; Providing professional services while: Under the influence of alcohol; Using any narcotic or controlled dangerous substance, as defined in Criminal Law Article, Annotated Code of Maryland, or other drug that is in excess of therapeutic amounts or without valid medical indication; Promoting the sale of services, drugs, devices, appliances, or goods to a patient to exploit the patient for financial gain; Willfully making or filing a false report or record in the practice of radiation therapy, radiography, nuclear medicine technology, or radiology assistance; Willfully failing to file or record any report as required under law, willfully impeding or obstructing the filing or recording of the report, or inducing another to fail to file or record the report; Paying or agreeing to pay any sum or provide any form of remuneration or material benefit to any person for bringing or referring a patient or accepting or agreeing to accept any sum or any form of remuneration or material benefit from an individual for bringing or referring a patient; Knowingly making a misrepresentation while practicing radiation therapy, radiography, nuclear medicine technology, or radiology assistance; Knowingly practicing radiation therapy, radiography, nuclear medicine technology, or radiology assistance with an unauthorized person or aiding an unauthorized person in the practice of radiation therapy, radiography, nuclear medicine technology, or radiology assistance; Offering, undertaking, or agreeing to cure or treat disease by a secret method, treatment, or medicine; Being disciplined by a licensing or disciplinary authority, being convicted or disciplined by a court of any state or country or disciplined by any branch of the United States uniformed services or the Veterans' Administration for an act that would be grounds for disciplinary action under the Board's disciplinary statutes or this regulation; Failing to meet appropriate standards as determined by appropriate peer review for the delivery of quality radiation therapy care, radiography care, nuclear medicine technology care, or radiology assistance care performed in an outpatient surgical facility, office, hospital, or any other location in this State; Knowingly submitting false statements to collect fees for which services are not provided; Having been subject to investigation or disciplinary action by a licensing or disciplinary authority or by a court of any state or country for an act that would be grounds for disciplinary action under this regulation and the licensed individual: Surrendered the license issued by the state or country, or Allowed the license issued by the state or country to expire or lapse; Knowingly failing to report suspected child abuse in violation of Family Law Article, §5-704, Annotated Code of Maryland; Selling, prescribing, giving away, or administering drugs for illegal or illegitimate purposes; Breaching patient confidentiality; Practicing beyond the authorized scope of practice; Practicing or attempting to practice any radiation therapy, radiography, nuclear medicine technology, or radiology assistance procedure, or using radiation therapy, radiography, nuclear medicine technology, or radiology assistance equipment, if the applicant or licensed individual has not received education, training, or experience in the use of that procedure or the use of the equipment; Refusing, withholding from, denying, or discriminating against an individual with regard to the provision of professional services for which the license holder is licensed and qualified to render because the individual is HIV positive; Failing to cooperate with a lawful investigation of the Board; Failing to practice under the supervision of a physician or violating a supervisory order of a supervising physician; or Failing to comply with these regulations. Unprofessional conduct in the practice of medicine, under Health Occupations Article, §14-404(a)(3), Annotated Code of Maryland, includes the failure of a physician to comply with the statute and regulations governing the physician's duty to supervise a radiation therapist, radiographer, nuclear medicine technologist, or radiologist assistant. Crimes of Moral Turpitude. On the filing of certified docket entries with the Board by the Attorney General, the Board shall order the suspension of a license if the licensee has been convicted of, or pled guilty or nolo contendere with respect to, a crime involving moral turpitude, regardless of whether any appeal or other proceeding is pending to have the conviction or plea set aside. After completion of the appellate process, if the conviction has not been reversed or the plea has not been set aside with respect to a crime of moral turpitude, the Board shall order the revocation of the license. Complaints alleging prohibited conduct shall be referred to the Board to be investigated according to the Board's procedures. A hearing on charges issued under Regulation .14A of this chapter or Health Occupations Article, §14-5B-14(a), Annotated Code of Maryland, shall be held in accordance with the hearing provisions of Health Occupations Article, §14-405, Annotated Code of Maryland. Proceedings for crimes of moral turpitude, under Health Occupations Article, §14-5B-14(c), Annotated Code of Maryland, or Regulation .14D of this chapter shall be held in accordance with COMAR 10.32.02.04. All other hearings shall be held in accordance with the Administrative Procedure Act. Appeals from a final Board decision shall be taken in accordance with Health Occupations Article, §14-5B-14.1, Annotated Code of Maryland. The Board may impose a civil fine of not more than $5,000 on an individual who is not licensed to practice radiation therapy, radiography, nuclear medical technology, or radiology assistance in Maryland if the individual: Represents to the public in any way that the individual is authorized to practice radiation therapy, radiography, nuclear medicine technology, or radiology assistance; Practices or attempts to practice radiation therapy, radiography, nuclear medicine technology, or radiology assistance; or Violates any provision of Health Occupations Article, Title 14, Subtitle 5B, Annotated Code of Maryland, or any regulation in this chapter. The Board shall deposit a penalty collected under §A of this regulation into the Board of Physicians fund. The Board may impose a civil fine of not more than $1,000 on an individual who fails to file a report under Regulation .17 of this chapter. The Board may impose a civil fine of not more than $1,000 on a licensed physician or employer who employs or supervises an individual practicing radiation therapy, radiography, nuclear medicine technology, or radiology assistance without a license. The Board shall deposit a fine collected under §D or E of this regulation into the General Fund. General Application of Sanctioning Guidelines. Sections F and G of this regulation and Regulation .19 of this chapter do not apply to offenses for which a mandatory sanction is set by statute or regulation. Except as provided in §G of this regulation, for violations of the sections of the Maryland Radiation Therapy, Radiography, Nuclear Medicine Technology, and Radiology Assistance Act listed in the sanctioning guidelines, the Board shall impose a sanction not less severe than the minimum listed in the sanctioning guidelines nor more severe than the maximum listed in the sanctioning guidelines for each offense. Ranking of Sanctions. For the purposes of this regulation, the severity of sanctions is ranked as follows, from the least severe to the most severe: Reprimand; Probation; Suspension; and Revocation. A stayed suspension in which the stay is conditioned on the completion of certain requirements is ranked as probation. A stayed suspension not meeting the criteria for §F(3)(b) of this regulation is ranked as a reprimand. A fine listed in the sanctioning guidelines may be imposed in addition to but not as a substitute for a sanction. If a minimum fine is listed, at least the minimum fine shall be imposed in addition to the sanction listed. The addition of a fine does not change the ranking of the severity of the sanction. The Board may impose more than one sanction, provided that the most severe sanction neither exceeds the maximum nor is less than the minimum sanction permitted in the chart. Any sanction may be accompanied by conditions reasonably related to the offense or to the rehabilitation of the offender. The inclusion of conditions does not change the ranking of the sanction. If a licensee has violated more than one ground for discipline as set out in the sanctioning guidelines: The sanction with the highest severity ranking shall be used to determine which ground will be used in developing a sanction; and The Board may impose concurrent sanctions based on other grounds violated. Notwithstanding the sanctioning guidelines set forth in Regulation .19 of this chapter, in order to resolve a pending disciplinary action, the Board and the licensee may agree to a surrender of license or a consent order with terms, sanction, and fine agreed to by the Board, the administrative prosecutor, and the licensee. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the Board may consider the aggravating and mitigating factors set out in §G(4) and (5) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines. If the Board imposes a sanction that departs from the sanctioning guidelines as set forth in Regulation .19 of this chapter, the Board shall state its reasons for doing so in its final decision and order. Aggravating and Mitigating Factors. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the Board may consider the aggravating and mitigating factors set out in §G(4) and (5) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines. Nothing in this regulation requires the Board or an Administrative Law Judge to make findings of fact with respect to any of these factors. The existence of one or more of these factors does not impose on the Board or an Administrative Law Judge any requirement to articulate its reasoning for not exercising its discretion to impose a sanction outside of the range of sanctions set out in the sanctioning guidelines. Mitigating factors may include, but are not limited to, the following: The absence of a prior disciplinary record; The offender self-reported the incident; The offender voluntarily admitted the misconduct, made full disclosure to the Board, and was cooperative during the Board proceedings; The offender implemented remedial measures to correct or mitigate the harm arising from the misconduct; The offender made good faith efforts to make restitution or to rectify the consequences of the misconduct; The offender has been rehabilitated or exhibits rehabilitative potential; The misconduct was not premeditated; There was no potential harm to patients or the public or other adverse impact; or The incident was isolated and is not likely to recur. Aggravating factors may include, but are not limited to, the following: The offender has a previous criminal or administrative disciplinary history; The offense was committed deliberately or with gross negligence or recklessness; The offense had the potential for or actually did cause patient harm; The offense was part of a pattern of detrimental conduct; The offender committed a combination of factually discrete offenses adjudicated in a single action; The offender pursued his or her financial gain over the patient’s welfare; The patient was especially vulnerable; The offender attempted to hide the error or misconduct from patients or others; The offender concealed, falsified, or destroyed evidence or presented false testimony or evidence; The offender did not cooperate with the investigation; or Previous attempts to rehabilitate the offender were unsuccessful. A departure from the sanctioning guidelines set forth in Regulation .19 of this chapter is not a ground for any hearing or appeal of a Board action. The Board may impose a fine of $100 for a violation of Health Occupations Article, §14-5B-12.1, Annotated Code of Maryland. Offenses Related to Continuing Medical Education Credits. First Offense of Failure to Document Credits. Except as provided in §I(2) or (3) of this regulation, if a licensee has submitted an application claiming the completion of continuing medical education credits and the licensee fails to document the completion of such continuing medical education credits when audited by the Board, the Board may impose a civil fine under Health Occupations Article, §14-5B-12, Annotated Code of Maryland, of up to $100 per missing continuing medical education credit in lieu of a sanction under Health Occupations Article, §14-5B-14, Annotated Code of Maryland. Section I(1)(a) of this regulation does not limit the Board's authority to require completion of the missing continuing medical education credits. Willful Falsification. If a licensee has willfully falsified an application with respect to continuing medical education credits, the licensee may be charged under one or more of the following, as appropriate: Health Occupations Article, §14-5B-14(a)(3), Annotated Code of Maryland; Health Occupations Article, §14-5B-14(a)(10), Annotated Code of Maryland; and Health Occupations Article, §14-5B-14(a)(11), Annotated Code of Maryland. Upon a finding of a violation, the Board may impose any discipline authorized under Health Occupations Article, §14-5A-14, Annotated Code of Maryland, and the sanctioning guidelines. Licensees Previously Disciplined Under §I(1) or (2) of this Regulation. If a licensee has been previously fined or otherwise disciplined under §I(1) or (2) of this regulation, the Board may, for a subsequent offense relating to continuing medical education credits, charge a licensee under one or more of the following, as appropriate: Health Occupations Article, §14-5B-14(a)(3), Annotated Code of Maryland; Health Occupations Article, §14-5B-14(a)(10), Annotated Code of Maryland; and Health Occupations Article, §14-5B-14(a)(11), Annotated Code of Maryland. Upon a finding of a violation, the Board may impose any discipline authorized under Health Occupations Article, §14-5B-14, Annotated Code of Maryland, and the sanctioning guidelines for a subsequent offense. The Board may not apply the sanction described in §I(1) of this regulation in determining a sanction for a licensee previously fined or disciplined for an offense related to continuing medical education credits. The Board shall pay all monies collected pursuant to §I of this regulation into the Board of Physicians Fund. Payment of Fines. An individual shall pay to the Board any fine imposed under this regulation within 15 calendar days of the date of the order, unless the order specifies otherwise. Filing an appeal under State Government Article, §10-222, Annotated Code of Maryland, does not stay payment of a fine imposed by the Board pursuant to this regulation. If an individual fails to pay, in whole or in part, a fine imposed by the Board pursuant to this regulation, the Board may not restore, reinstate, or renew a license until the fine has been paid in full. In its discretion, the Board may refer all cases of delinquent payment to the Central Collection Unit of the Department of Budget and Management to institute and maintain proceedings to ensure prompt payment. Except as provided in §B of this regulation, an employer of a licensed radiation therapist, licensed radiographer, a licensed nuclear medical technologist, or licensed radiologist assistant shall report to the Board if the employer limits, reduces, or otherwise changes the responsibilities of or terminates a licensed therapist, licensed radiographer, licensed nuclear medical technologist, or licensed radiologist assistant for any reason that might be grounds for disciplinary action under Health Occupations Article, Title 14, Subtitle 5B, Annotated Code of Maryland, or any regulation in this chapter. If the action taken by an employer under §A relates to alcohol or drug impairment, reporting shall be in compliance with Health Occupations Article, §14-5B-15(b),(c), and (d), Annotated Code of Maryland. A licensed radiation therapist, licensed radiographer, licensed nuclear medical technologist, or licensed radiologist assistant shall notify the licensee's employer of a decision to enter an accredited alcohol or drug treatment program. An accredited alcohol or drug treatment program that is treating a licensed radiation therapist, licensed radiographer, licensed nuclear medical technologist, or licensed radiologist assistant who has given notice to his employer under §C of this regulation shall notify the employer if the licensed radiation therapist, licensed radiographer, licensed nuclear medical technologist, or licensed radiologist assistant is found to be noncompliant with the treatment program's policies and procedures. An individual is not required to make a report under this regulation that would be in violation of any federal or State law, rule, or regulation concerning the confidentiality of alcohol and drug abuse patient records. The following fees are applicable to radiation therapists, radiographers, nuclear medicine technologists, and radiologist assistants: Application for initial licensure fee — $150; Renewal Fees: Renewal of license fee — $135; and Maryland Health Care Commission (MHCC) fee — As determined by MHCC under COMAR 10.25.03; Reinstatement of license fee — $150; Written verification fee — $25; and Other Fees: Duplicate license — $25; Duplicate wall certificate — $25. Subject to provisions of Regulation .16F and G of this chapter, the Board may impose sanctions as outlined in §B of this regulation on a radiation therapist, radiographer, nuclear medicine technologist, or radiologist assistant for violations of Health Occupations Article, §14-5B-14(a), Annotated Code of Maryland. Range of Sanctions. Health Occupations Article, §§1-213, 1-606, 14-306, 14-5B-01, and 14-5B-03—14-5B-21, Annotated Code of Maryland Effective date: Regulations .01—.12 adopted as an emergency provision effective February 16, 1990 (17:6 Md. R. 735); emergency status extended at 17:17 Md. R. 2076 and 18:3 Md. R. 301; emergency status expired July 1, 1991 Regulations .01—.11 adopted as an emergency provision effective July 2, 1991 (18:14 Md. R. 1607); emergency status expired January 1, 1992 Regulations .01—.11 adopted effective January 2, 1992 (18:21 Md. R. 2308) Regulation .01 amended effective March 1, 2004 (31:4 Md. R. 316) Regulation .02B amended effective May 8, 1995 (22:9 Md. R. 645); March 1, 2004 (31:4 Md. R. 316) Regulation .03 amended effective March 1, 2004 (31:4 Md. R. 316) Regulation .04C amended effective March 1, 2004 (31:4 Md. R. 316) Regulation .05 repealed effective May 8, 1995 (22:9 Md. R. 645) Regulation .06 amended effective December 18, 1995 (22:25 Md. R. 1962); March 1, 2004 (31:4 Md. R. 316) Regulation .06 repealed and new Regulation .06 adopted as an emergency provision effective October 1, 2008 (35:21 Md. R. 1822); adopted permanently effective November 3, 2008 (35:22 Md. R. 1957) Regulation .07 amended effective May 8, 1995 (22:9 Md. R. 645) Regulation .07 repealed and new Regulation .07 adopted effective December 2, 1996 (23:24 Md. R. 1682) Regulation .07 amended effective March 1, 2004 (31:4 Md. R. 316); June 30, 2008 (35:13 Md. R. 1180) Regulation .08 amended effective March 1, 2004 (31:4 Md. R. 316) Regulation .08 repealed effective June 30, 2008 (35:13 Md. R. 1180) Regulation .09 amended effective September 11, 1995 (22:18 Md. R. 1400); May 19, 1997 (24:10 Md. R. 710) Regulation .09 amended as an emergency provision effective February 13, 2003 (30:5 Md. R. 363); amended permanently effective March 31, 2003 (30:6 Md. R. 420) Regulation .10A, B amended effective March 1, 2004 (31:4 Md. R. 316) Regulation .11 amended effective August 19, 2002 (29:16 Md. R. 1288); March 1, 2004 (31:4 Md. R. 316) Regulation .12 adopted effective August 19, 2002 (29:16 Md. R. 1288) Regulation .12A amended effective March 1, 2004 (31:4 Md. R. 316) Regulation .13 adopted effective August 19, 2002 (29:16 Md. R. 1288) Regulation .13 amended effective March 1, 2004 (31:4 Md. R. 316) Regulation .14 adopted as an emergency provision effective February 13, 2003 (30:5 Md. R. 363); adopted permanently effective March 31, 2003 (30:6 Md. R. 420) Chapter revised effective October 5, 2009 (36:20 Md. R. 1528) Regulation .01B amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .02B amended effective May 12, 2014 (41:9 Md. R. 521); December 30, 2019 (46:26 Md. R. 1165); January 19, 2026 (53:1 Md. R. 21) Regulation .04 amended effective December 27, 2010 (37:26 Md. R. 1788) Regulation .04 repealed and new Regulation .04 adopted effective December 22, 2014 (41:25 Md. R. 1485) Regulation .04B amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .05 adopted effective December 22, 2014 (41:25 Md. R. 1485) Regulation .05B amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .05-1 adopted effective December 22, 2014 (41:25 Md. R. 1485) Regulation .05-1B amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .05-2 adopted effective December 22, 2014 (41:25 Md. R. 1485) Regulation .05-2B, C amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .06 repealed effective May 12, 2014 (41:9 Md. R. 521) Regulation .07A, B amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .07C amended effective May 12, 2014 (41:9 Md. R. 521) Regulation .08C amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .09C adopted effective March 2, 2015 (42:4 Md. R. 433) Regulation .10 amended effective December 30, 2019 (46:26 Md. R. 1165) Regulation .10A amended effective August 29, 2016 (43:17 Md. R. 955) Regulation .10C amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .11 amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .12 amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .13 amended effective January 2, 2017 (43:26 Md. R. 1446) Regulation .14A, B amended effective May 12, 2014 (41:9 Md. R. 521) Regulation .16 amended effective July 22, 2013 (40:14 Md. R. 1176) Regulation .18 amended effective May 12, 2014 (41:9 Md. R. 521) Regulation .19 adopted effective July 22, 2013 (40:14 Md. R. 1176) Regulation .19B amended effective May 12, 2014 (41:9 Md. R. 521) This chapter governs the practice of respiratory care. This chapter does not prohibit any respiratory care student who is currently enrolled in an approved respiratory care educational program from performing any of the procedures described in this chapter as part of that program's respiratory care clinical curriculum. This chapter does not prohibit an individual from practicing a health occupation that the individual is authorized to practice under the Health Occupations Article, Annotated Code of Maryland. This chapter does not apply to an individual employed by the federal government as a respiratory care practitioner while the individual is practicing within the scope of that employment. This chapter does not apply to an individual practicing respiratory care who is licensed by and resides in another jurisdiction if: The individual is participating in the transportation of a patient from that individual’s jurisdiction of licensure into the State; The individual practices respiratory care only during the transportation of the patient; The individual does not practice respiratory care on another individual who is not the patient being transported into the State; and The individual does not practice respiratory care in the State for more than 14 days within a calendar year. In this chapter, the following terms have the meanings indicated. Terms Defined. “AARC” means the American Association for Respiratory Care. “Accredited respiratory care education program” means a program accredited by the Commission on Accreditation for Respiratory Care or its successor. “Applicant” means an individual who applies to the Board for licensure as a respiratory care practitioner. “Board” means the State Board of Physicians. “Clinical supervision” means the responsibility of a respiratory care practitioner to exercise on-site or immediately available direction for respiratory care departments, the provision of any respiratory care services, licensed respiratory care practitioners, or students practicing respiratory care. “Collaboration” means a respiratory care practitioner practicing in association with and under the direction of a physician to plan and implement a regimen of care. “Committee" means the Respiratory Care Professional Standards Committee of the Board. “Disciplinary panel” means a panel established under Health Occupations Article, §14-401, Annotated Code of Maryland, which: Is composed of 11 Board members; and Addresses: Complaints and disciplinary actions against licensed physicians and allied health professionals; Initial licensure decisions; and Postdisciplinary licensure reinstatements. “Licensee” means a licensed respiratory care practitioner. “Mechanical ventilation” means utilizing positive or negative pressure to provide inspiratory support by invasive or noninvasive means. “National Certifying Board” means the National Board for Respiratory Care, Inc. or its successor. “Physician” means an individual licensed to practice medicine in Maryland. “Practice of respiratory care” means the diagnostic evaluation, care and treatment, management, and rehabilitation of patients who have deficiencies and abnormalities which affect the pulmonary system and associated aspects of the cardiopulmonary and other systems. “Respiratory care practitioner” means an individual licensed by the Board to practice respiratory care. “Supervision” means the responsibility of a physician to exercise on-site or immediately available direction for a licensed respiratory care practitioner performing delegated medical acts. The American Association for Respiratory Care Clinical Practice Guidelines (1997) is incorporated by reference. The Board shall establish a Respiratory Care Professional Standards Committee composed of the following individuals: Three licensed respiratory care practitioners; One licensed physician whose specialty is thoracic surgery; One licensed physician whose specialty is pulmonary medicine; One licensed physician whose specialty is anesthesiology; and One consumer member who meets the requirements specified in Health Occupations Article, §14-5A-06(b), Annotated Code of Maryland. Chair. The Committee shall elect a chair from among its members. The chair shall serve for a term of 2 years. Tenure. The term of a member is 3 years. A member continues to serve until a successor is appointed. A member appointed after a term has begun serves only for the rest of the term and until a successor has been appointed. A member may not serve more than 2 consecutive terms. Vacancy. If a vacancy occurs on the Committee, the Board shall appoint a new member to serve, as provided in §C of this regulation. Quorum. A majority of the members then serving on the Committee constitutes a quorum. Business may not be conducted at a Committee meeting unless there is a quorum. The Committee may develop and make recommendations to the Board in any matters related to regulating the practice of respiratory care. A respiratory care practitioner shall: Practice medically acceptable methods of treatment and may not endeavor to practice beyond the competence and the authority vested in the respiratory care practitioner by the physician; Continually strive to increase and improve the knowledge and skill to render to each patient the full measure of the respiratory care practitioner's ability; Be responsible for the competent and efficient performance of assigned duties; Expose incompetence and illegal or unethical conduct of members of the profession; Hold in strict confidence all privileged information concerning the patient; Refer all inquiries to the physician in charge of the patient's medical care; Accept no gratuities for preferential consideration of the patient; Guard against conflicts of interest; Uphold the dignity and honor of the profession and abide by its ethical principles; Be familiar with existing State and federal laws governing the practice of respiratory care and comply with those laws; and Cooperate with other health care professionals and participate in activities to promote community and national efforts to meet the health needs of the public. A breach of the ethical principles stated in §A of this regulation may be considered immoral or unprofessional conduct in the practice of respiratory care. All services shall be provided with respect for the dignity of the patient, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. The Board shall license an individual if the individual meets the requirements of §§B and C of this regulation. An individual shall be licensed by the Board if the individual: Is 18 years old or older; Is of good moral character; Demonstrates spoken and written competency in English by any of the following: Graduation from a recognized English-speaking high school or undergraduate or graduate school after at least 3 years of enrollment; Graduation from a recognized English-speaking professional school; or Receipt of a grade of: At least 79 on the Internet-based Test of English as a Foreign Language; and At least 26 on the “Speaking” section of the Internet-based Test of English as a Foreign Language; Graduate from an accredited respiratory care educational program; and Have active certification by the National Certifying Board as at least one of the following: Certified respiratory therapist; or Registered respiratory therapist. An individual shall submit a completed application form, which includes the following information: A chronological history of practice-related activities as requested by the Board for: All periods of time, including each job held; and Any other activity engaged in, including all periods of unemployment; Any physical or mental condition that currently impairs the individual’s ability to practice respiratory care; Any action by a state licensing or disciplinary board or a comparable body in the armed services, denying an application for licensure, reinstatement, or renewal for a health care occupational license; Any health professional license for which the individual has applied if the application was withdrawn for reasons that would be grounds for disciplinary action; Any action taken against the individual’s license by a state licensing or disciplinary board, or a comparable body in the armed services, including but not limited to: Limitations of practice; Required education; Admonishment; Reprimand; Suspension; or Revocation; Any investigation or charges brought against the individual by a state licensing or disciplinary board or comparable body in the armed services; Copies of: State licensing or disciplinary board charges; Final orders; or Adverse or disciplinary actions; Any investigation or charge brought against the individual by: A hospital; A related institution; An alternative health care system; or Any other employer; Any limitation or loss in privileges by: A hospital; A related health care facility; An alternative health care system; or Any other employer; Copies of the complaints, pleadings, and judgments in all malpractice claims; Copies of all arrests, court orders, orders of probation, certificates or letters of completion, or both, of any mandatory program or disciplinary actions, including final orders for driving while intoxicated or driving while under the influence of a chemical substance or medication; A plea of guilty or nolo contendere, a conviction, or receipt of probation before judgment for a criminal act; and A plea of guilty or nolo contendere, a conviction, or receipt of probation before judgment for an alcohol or controlled dangerous substance offense, including but not limited to driving while under the influence of alcohol or controlled dangerous substances. An applicant shall pay the required application fee. An applicant shall submit a passport-size photograph. On forms supplied by the Board, an applicant shall agree to release to the Board all relevant information from appropriate individuals, other institutions, and government agencies including, but not limited to: The National Practitioner Data Bank; Hospitals; and Any other licensing body. An applicant for licensure shall inform the Board by certified mail, return receipt requested, within 30 days of the occurrence or notification of any of the circumstances listed in §B of this regulation. If reasonable questions regarding an applicant's physical, mental, or professional competency have been raised by the information provided on the application, the Board may request additional information regarding the applicant's competency from the chief of staff of a hospital where the applicant has practiced. If an applicant has not passed the National Certifying Board exam for credentialing as a Certified Respiratory Therapist or a Registered Respiratory Therapist within the 5 years immediately preceding the applicant’s application and has not practiced respiratory care for at least 3 of the past 5 years, the Board may require the applicant to take and pass one of those exams as part of the application process. A disciplinary panel may require an applicant for licensure or a licensee to submit to one or more physical, mental, or other examinations, by a physician or evaluation program for treatment of impaired respiratory care practitioners, or both, chosen by a disciplinary panel to determine the applicant's ability to practice respiratory care. The applicant or licensee shall pay the costs of the evaluations required in §A of this regulation. A respiratory care practitioner licensed by the Board to practice respiratory care on or before December 31, 2012, whose duties include practicing respiratory care in a sleep laboratory or practicing polysomnography, is not required to obtain an additional license to practice polysomnography. A respiratory care practitioner licensed after December 31, 2012, whose duties include practicing polysomnography shall obtain a separate license to practice polysomnography. A respiratory care practitioner may practice only under the supervision of and in collaboration with a physician. The practice of respiratory care includes the following: Direct and indirect respiratory care services that are safe, aseptic, preventive, and restorative to the patient; The practice of the principles, techniques, and theories derived from cardiopulmonary medicine; Evaluation and treatment of individuals whose cardiopulmonary functions have been threatened or impaired by developmental defects, the aging process, physical injury, disease, or actual or anticipated dysfunction of the cardiopulmonary system; Observation and monitoring of physical signs and symptoms, general behavior, and general physical response to respiratory care procedures, and determination of whether initiation, modification, or discontinuation of the treatment regimen is warranted; The transcription and implementation of a written or oral order, or both, pertaining to the practice of respiratory care; Evaluation techniques including cardiopulmonary functional assessments, gas exchange, the need and effectiveness of therapeutic modalities and procedures, and assessment and evaluation of the need for extended care and home care procedures, therapy, and equipment; Professional application of techniques, equipment, and procedures involved in the administration of respiratory care such as: Therapeutic and diagnostic gases (excluding general anesthesia); Prescribed medications for inhalation or direct tracheal instillation; The administration of prescribed analgesic agents including substances listed in Schedule IV as defined in Criminal Law Article, §5-405, Annotated Code of Maryland, by subcutaneous injection or inhalation for the performance of respiratory care procedures; Nonsurgical intubation, maintenance, and extubation of artificial airways; Advanced cardiopulmonary measures; Chest needle decompression; Cardiopulmonary rehabilitation; Mechanical ventilation or physiological life support systems; Collection of body fluids and blood samples for evaluation and analysis, including collection by intraosseous access; Insertion of diagnostic arterial access lines, including large bore intravenous access; and Collection and analysis of exhaled respiratory gases; The clinical supervision of licensed respiratory care practitioners, respiratory care departments, or the provision of any respiratory care services; and The respiratory care clinical instruction or oversight of respiratory care students, while performing respiratory care procedures as part of their clinical curriculum. A respiratory care practitioner shall wear an identification tag or a badge which identifies that individual as a respiratory care practitioner. Change in Name or Address. Within 60 days after the change, a licensee shall notify the Board in writing of a change in name or address. Licensees who fail to notify the Board of name or address changes as required by §D(1) of this regulation are subject to an administrative penalty of $100. In evaluating the standard of care for the practice of a licensed respiratory care practitioner, the Board shall utilize the AARC’s National Clinical Practice Guidelines. If a particular practice issue has not yet been addressed in the AARC guidelines, the Board may consult with the Maryland/District of Columbia Society for Respiratory Care or any licensed respiratory care practitioner to determine whether a respiratory care practitioner being investigated by the Board is practicing within the acceptable standard of care. Renewal. The term of a license issued by the Board may not exceed 3 years. The Board may not renew a license until the Comptroller of Maryland has verified that the individual has paid all undisputed taxes and unemployment insurance contributions, or arranged for repayment, as required by COMAR 10.31.02. An individual who has been licensed by the Board as a respiratory care practitioner may renew the license for an additional term on the date specified by the Board by: Completing an online renewal application on a form supplied by the Board; Paying the required renewal fee set by the Board; Attesting to the completion of at least 16 hours of approved continuing respiratory care education, earned during the 2-year period preceding the expiration of the license for respiratory care, as described in §C of this regulation; Being of good moral character; and Meeting any additional renewal requirements set by the Board. The continuing education requirement applies to all renewal applications after the first renewal. Reinstatement. Except as provided in §B(2) of this regulation, the Board shall reinstate the license of a respiratory care practitioner if the respiratory care practitioner: Completes a reinstatement application on a form supplied by the Board; Pays the required reinstatement fee and any other fees set by the Board; Documents evidence of at least 16 hours of approved continuing education in the 2-year period preceding the date of the submission of the application for reinstatement, as described in §C of this regulation; Is of good moral character; Completes a criminal history records check; and Meets any additional requirements set by the Board for reinstatement of a license. If the license has not been renewed for more than 5 years and the applicant has not been practicing in another jurisdiction or country during at least 3 of the 5 years preceding the application, the applicant shall pass an examination approved by the Board, and meet all the requirements of licensure at the time the respiratory care practitioner applies for reinstatement. Continuing Education. Approved continuing respiratory care education includes: Programs accredited by or sponsored by one of the following organizations: Maryland/District of Columbia Society for Respiratory Care; AARC’s Continuing Respiratory Care Education System; or MedChi, the Maryland State Medical Society; or Other programs: Having requirements equivalent to the programs accredited through the organizations listed in §C(1)(a) of this regulation; and Approved by the Board. Instead of completing the required continuing education, an applicant for renewal or reinstatement may substitute passing the examination for either the certified respiratory therapist or registered respiratory therapist conducted by the National Certifying Board during the 2-year period preceding: For license renewal, the expiration of the license for respiratory care; or For license reinstatement, the date of the submission of the application for reinstatement. A disciplinary panel may impose a civil penalty of up to $100 per continuing respiratory care education hour in lieu of a sanction under Health Occupations Article, §14–5A–17, Annotated Code of Maryland, for a first offense, for the failure of a licensee to obtain continuing education hours required by the Board. The following fees are applicable to respiratory care practitioners: Initial licensure fee .— $200; License renewal fees: License renewal fee .— $150; and Maryland Health Care Commission (MHCC) fee .— As determined by MHCC under COMAR 10.25.02; Reinstatement fee .—. $200; Replacement of registration card .— $25; Replacement of wall license .—. $75; and Written verification fee .—. $25. Subject to the hearing provisions of Health Occupations Article, §14-405, Annotated Code of Maryland, a disciplinary panel, on the affirmative vote of a majority of a quorum, may deny an application for licensure, renewal, or reinstatement, reprimand any licensee, place any licensee on probation, or suspend or revoke a license if the applicant or licensee: Fraudulently or deceptively obtains or attempts to obtain a license for the applicant, licensee, or for another; Fraudulently or deceptively uses a license; Is guilty of unprofessional or immoral conduct in the practice of respiratory care; Is professionally, physically, or mentally incompetent; Abandons a patient; Is habitually intoxicated; Is addicted to or habitually abuses any narcotic or controlled dangerous substance as defined in Criminal Law Article, §5-101, Annotated Code of Maryland; Provides professional services while: Under the influence of alcohol; or Using any narcotic or controlled dangerous substance as defined in Criminal Law Article, §5-101, Annotated Code of Maryland, or any other drug that is in excess of therapeutic amounts or without valid medical indication; Promotes the sale of services, drugs, devices, appliances, or goods to a patient so as to exploit the patient for financial gain; Willfully makes or files a false report or record in the practice of respiratory care; Willfully fails to file or record any report as required under law, willfully impedes or obstructs the filing or recording of a report, or induces another to fail to file or record a report; Breaches patient confidentiality; Pays or agrees to pay any sum or provide any form of remuneration or material benefit to any person for bringing or referring a patient or accepts or agrees to accept any sum or any form of remuneration or material benefit from an individual for bringing or referring a patient; Knowingly makes a misrepresentation while practicing respiratory care; Knowingly practices respiratory care with an unauthorized individual or aids an unauthorized individual in the practice of respiratory care; Offers, undertakes, or agrees to cure or treat disease by a secret method, treatment, or medicine; Is disciplined by a licensing or disciplinary authority, is convicted or disciplined by a court of any state or country, or is disciplined by any branch of the United States uniformed services or the Veterans' Administration for an act that would be grounds for disciplinary action under the Board's disciplinary statutes; Fails to meet appropriate standards for the delivery of respiratory care performed in any: Inpatient or outpatient facility; Office; Hospital or related institution; Domiciliary care facility; Patient's home; or Other location in this State; Knowingly submits false statements to collect fees for which services are not provided; Has been subject to investigation or disciplinary action by a licensing or disciplinary authority or by a court of any state or country for an act that would be grounds for disciplinary action under the Board's disciplinary statutes and the licensed individual: Surrendered the license issued by the state or country; or Allowed the license issued by the state or country to expire or lapse; Knowingly fails to report suspected child abuse in violation of Family Law Article, §5-704, Annotated Code of Maryland; Sells, prescribes, gives away, or administers drugs for illegal or illegitimate medical purposes; Practices or attempts to practice beyond the authorized scope of practice; Refuses, withholds from, denies, or discriminates against an individual with regard to the provision of professional services for which the licensee is licensed and qualified to render because the individual is HIV positive; Practices or attempts to practice a respiratory care procedure or uses or attempts to use respiratory care equipment if the applicant or licensee has not received education and training in the performance of the procedure or the use of the equipment; Fails to cooperate with a lawful investigation conducted by the Board; or Fails to practice under the supervision of a physician or violates a supervisory order of a supervising physician. Completes a criminal history records check in accordance with Health Occupations Article, §14-308.1, Annotated Code of Maryland. Hearing. Except as otherwise provided in the Administrative Procedure Act, before the Board takes any action under §A of this regulation, the Board shall give the individual against whom the action is contemplated an opportunity for a hearing before the Board in accordance with the hearing requirements of Health Occupations Article, §14-405, Annotated Code of Maryland. Crime Involving Moral Turpitude. On the filing of certified docket entries with the Board by the Office of the Attorney General, the Board shall order the suspension of a license if the licensee is convicted of or pleads guilty or nolo contendere with respect to a crime involving moral turpitude, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside. After completion of the appellate process if the conviction has not been reversed or the plea has not been set aside with respect to a crime involving moral turpitude, the Board shall order the revocation of a license on the certification by the Office of the Attorney General. Proceedings for crimes of moral turpitude, under Health Occupations Article, §14-5A-17(c), Annotated Code of Maryland, shall comply with COMAR 10.32.02.04. Except as provided in §B of this regulation, an employer of a licensed respiratory care practitioner shall report to the Board within 10 days of the action if the employer limits, reduces, or otherwise changes the responsibilities of or terminates a licensed respiratory care practitioner for any reason that might be grounds for disciplinary action under Health Occupations Article, Title 14, Subtitle 5A, Annotated Code of Maryland, or any regulation in this chapter. If the action taken by an employer under §A of this regulation relates to alcohol or drug impairment, reporting shall comply with Health Occupations Article, §14-5A-18(b), (c), and (d), Annotated Code of Maryland and COMAR 10.32.22. A licensed respiratory care practitioner shall notify the licensed respiratory care practitioner's employer of a decision to enter an accredited alcohol or drug treatment program. An accredited alcohol or drug treatment program that is treating a licensed respiratory care practitioner who has given notice to his employer under §C of this regulation shall notify the employer if the licensed respiratory care practitioner is found to be noncompliant with the treatment program's policies and procedures. An individual is not required to make a report under this regulation that would be in violation of a federal or State law, rule, or regulation concerning the confidentiality of alcohol and drug abuse patient records. An individual who violates any provision of Health Occupations Article, Title 14, Subtitle 5A, Annotated Code of Maryland, is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000, or imprisonment not exceeding 1 year, or both. A disciplinary panel may impose a civil fine of not more than $5,000 on an individual who: Is not licensed to practice respiratory care in Maryland and represents to the public in any way that the individual is authorized to practice respiratory care in Maryland; or Violates any provision of Health Occupations Article, Title 14, Subtitle 5A, Annotated Code of Maryland. The Board shall deposit a penalty collected under §B of this regulation into the Board of Physicians fund. Employment of Unauthorized Individuals. A licensed physician, hospital, related institution, alternative health system, or employer may not employ an individual practicing respiratory care without a license. A licensed physician may not supervise an individual practicing respiratory care without a license. A disciplinary panel may impose a fine of up to $1,000 for a violation of §D(1) or (2) of this regulation. Any funds collected under §D(3) of this regulation shall be deposited into the General Fund. Failure to Make a Required Report. A disciplinary panel may impose a fine up to $1,000 for a hospital, related institution, alternative health system, or employer who fails to make a report to the Board required by Regulation .14 of this chapter. The Board shall deposit any funds collected under §E(1) of this regulation into the General Fund. General Application of Sanctioning Guidelines. Sections F and G of this regulation and Regulation .16 of this chapter do not apply to offenses for which a mandatory sanction is set by statute or regulation. Except as provided in §B of this regulation, for violations of the sections of the Maryland Respiratory Care Practitioners Act listed in the sanctioning guidelines, a disciplinary panel shall impose a sanction not less severe than the minimum listed in the sanctioning guidelines nor more severe than the maximum listed in the sanctioning guidelines for each offense. Ranking of Sanctions. For the purposes of this regulation, the severity of sanctions is ranked as follows, from the least severe to the most severe: Reprimand; Probation; Suspension; and Revocation. A stayed suspension in which the stay is conditioned on the completion of certain requirements is ranked as probation. A stayed suspension not meeting the criteria for §F(3)(b) of this regulation is ranked as a reprimand. A fine listed in the sanctioning guidelines may be imposed in addition to but not as a substitute for a sanction. If a minimum fine is listed, at least the minimum fine shall be imposed in addition to the sanction listed. The addition of a fine does not change the ranking of the severity of the sanction. A disciplinary panel may impose more than one sanction, provided that the most severe sanction neither exceeds the maximum nor is less than the minimum sanction permitted in the chart. Any sanction may be accompanied by conditions reasonably related to the offense or to the rehabilitation of the offender. The inclusion of conditions does not change the ranking of the sanction. If a licensee has violated more than one ground for discipline as set out in the sanctioning guidelines: The sanction with the highest severity ranking shall be used to determine which ground will be used in developing a sanction; and A disciplinary panel may impose concurrent sanctions based on other grounds violated. Notwithstanding the sanctioning guidelines set forth in Regulation .16 of this chapter, in order to resolve a pending disciplinary action, a disciplinary panel and the licensee may agree to a surrender of license or a consent order with terms, sanction, and fine agreed to by a disciplinary panel, the administrative prosecutor, and the licensee. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the Board may consider the aggravating and mitigating factors set out in §G(4) and (5) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines. If a disciplinary panel imposes a sanction that departs from the sanctioning guidelines as set forth in Regulation .16 of this chapter, a disciplinary panel shall state its reasons for doing so in its final decision and order. Aggravating and Mitigating Factors. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the Board may consider the aggravating and mitigating factors set out in §G(4) and (5) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines. Nothing in this regulation requires the Board or an Administrative Law Judge to make findings of fact with respect to any of these factors. The existence of one or more of these factors does not impose on the Board or an Administrative Law Judge any requirement to articulate its reasoning for not exercising its discretion to impose a sanction outside of the range of sanctions set out in the sanctioning guidelines. Mitigating factors may include, but are not limited to, the following: The absence of a prior disciplinary record; The offender self-reported the incident; The offender voluntarily admitted the misconduct, made full disclosure to the Board, and was cooperative during the Board proceedings; The offender implemented remedial measures to correct or mitigate the harm arising from the misconduct; The offender made good faith efforts to make restitution or to rectify the consequences of the misconduct; The offender has been rehabilitated or exhibits rehabilitative potential; The misconduct was not premeditated; There was no potential harm to patients or the public or other adverse impact; or The incident was isolated and is not likely to recur. Aggravating factors may include, but are not limited to, the following: The offender has a previous criminal or administrative disciplinary history; The offense was committed deliberately or with gross negligence or recklessness; The offense had the potential for or actually did cause patient harm; The offense was part of a pattern of detrimental conduct; The offender committed a combination of factually discrete offenses adjudicated in a single action; The offender pursued his or her financial gain over the patient’s welfare; The patient was especially vulnerable; The offender attempted to hide the error or misconduct from patients or others; The offender concealed, falsified, or destroyed evidence or presented false testimony or evidence; The offender did not cooperate with the investigation; or Previous attempts to rehabilitate the offender were unsuccessful. A departure from the sanctioning guidelines set forth in Regulation .16 of this chapter is not a ground for any hearing or appeal of a Board action. In addition to any sanction authorized under this regulation, a disciplinary panel may require a licensee to comply with specified terms and conditions determined by a disciplinary panel. A disciplinary panel may impose a fine of $100 for a violation of Health Occupations Article, §14-5A-14, Annotated Code of Maryland. Offenses Related to Continuing Education Credits. First Offense of Failure to Document Credits. Except as provided in §I(2) or (3) of this regulation, if a licensee has submitted an application claiming the completion of continuing medical education credits and the licensee fails to document the completion of such continuing medical education credits when audited by the Board, the Board may impose a civil fine under Health Occupations Article, §14-5A-13, Annotated Code of Maryland, of up to $100 per missing continuing medical education credit in lieu of a sanction under Health Occupations Article, §14-5A-17, Annotated Code of Maryland. Section I(1)(a) of this regulation does not limit the Board's authority to require completion of the missing continuing medical education credits. Willful Falsification. If a licensee has willfully falsified an application with respect to continuing education credits, the licensee may be charged under one or more of the following, as appropriate: Health Occupations Article, §14-5A-17(a)(3), Annotated Code of Maryland; Health Occupations Article, §14-5A-17(a)(10), Annotated Code of Maryland; and Health Occupations Article, §14-5A-17(a)(11), Annotated Code of Maryland. Upon a finding of a violation, a disciplinary panel may impose any discipline authorized under Health Occupations Article, §14-5A-17, Annotated Code of Maryland, and the sanctioning guidelines. Licensees Previously Disciplined Under §I(1) or (2) of this Regulation. If a licensee has been previously fined or otherwise disciplined under §I(1) or (2) of this regulation, the Board may, for a subsequent offense relating to continuing education credits, charge a licensee under one or more of the following, as appropriate: Health Occupations Article, §14-5A-17(a)(3), Annotated Code of Maryland; Health Occupations Article, §14-5A-17(a)(10), Annotated Code of Maryland; and Health Occupations Article, §14-5A-17(a)(11), Annotated Code of Maryland. Upon a finding of a violation, a disciplinary panel may impose any discipline authorized under Health Occupations Article, §14-5A-17, Annotated Code of Maryland, and the sanctioning guidelines for a subsequent offense. The Board may not apply the sanction described in §J(1) of this regulation in determining a sanction for a licensee previously fined or disciplined for an offense related to continuing education credits. The Board shall pay all monies collected pursuant to §I of this regulation into the Board of Physicians Fund. Payment of Fines. An individual shall pay to the Board any fine imposed under this regulation within 15 calendar days of the date of the order, unless the order specifies otherwise. Filing an appeal under State Government Article, §10-222, Annotated Code of Maryland, does not stay payment of a fine imposed by the Board pursuant to this regulation. If an individual fails to pay, in whole or in part, a fine imposed by the Board pursuant to this regulation, the Board may not restore, reinstate, or renew a license until the fine has been paid in full. In its discretion, the Board may refer all cases of delinquent payment to the Central Collection Unit of the Department of Budget and Management to institute and maintain proceedings to ensure prompt payment. Subject to provisions of Regulation .15F and G of this chapter, the Board may impose sanctions as outlined in §B of this regulation on respiratory care practitioners for violations of Health Occupations Article, §14-5A-17(a), Annotated Code of Maryland. Range of Sanctions. Health Occupations Article, §§1-213, 1-606, 14-205(a), 14-5A, and 14-5C-03, Annotated Code of Maryland;Ch. 328, Acts of 2008 Effective date: Regulations .01 — .06, .08, and .09 adopted effective November 11, 1991 (18:22 Md. R. 2396) Regulation .02B amended effective April 25, 1994 (21:8 Md. R. 674) Regulation .03 amended effective August 1, 1994 (21:15 Md. R. 1306) Regulation .05-1 adopted effective April 25, 1994 (21:8 Md. R. 674) Regulation .07 adopted effective February 17, 1992 (19:3 Md. R. 305) Chapter, Certification of Respiratory Care Practitioners, repealed and new chapter, Licensing of Respiratory Care Practitioners, adopted effective August 25, 1997 (24:17 Md. R. 1215) Regulation .04 amended effective February 14, 2005 (32:3 Md. R. 290) Regulation .07 repealed as an emergency provision effective October 1, 2008 (35:21 Md. R. 1822); repealed permanently effective November 3, 2008 (35:22 Md. R. 1957) Regulation .08 repealed as an emergency provision effective October 1, 2008 (35:21 Md. R. 1822); repealed permanently effective November 3, 2008 (35:22 Md. R. 1957) Regulation .11 amended as an emergency provision effective October 1, 2008 (35:21 Md. R. 1822); amended permanently effective November 3, 2008 (35:22 Md. R. 1957) Regulation .12 repealed and new Regulation .12 adopted effective February 14, 2005 (32:3 Md. R. 290) Regulation .12 amended as an emergency provision effective October 1, 2008 (35:21 Md. R. 1822); amended permanently effective November 3, 2008 (35:22 Md. R. 1957) Regulation .13 adopted effective August 19, 2002 (29:16 Md. R. 1288) Regulation .14 adopted effective August 19, 2002 (29:16 Md. R. 1288) Regulation .15 adopted effective August 19, 2002 (29:16 Md. R. 1288) Chapter revised effective March 7, 2011 (38:5 Md. R. 317) Regulation .01E adopted effective January 19, 2026 (53:1 Md. R. 21) Regulation .02B amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .04B, C amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .04D, E adopted effective January 19, 2026 (53:1 Md. R. 21) Regulation .04F amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .06 amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .07 amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .08 adopted effective May 11, 2015 (42:9 Md. R. 647) Regulation .09 amended effective January 2, 2017 (43:26 Md. R. 1446) Regulation .10A amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .11 amended effective January 2, 2017 (43:26 Md. R. 1446); January 19, 2026 (53:1 Md. R. 21) Regulation .13A amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .14B amended effective January 19, 2026 (53:1 Md. R. 21) Regulation .15 amended effective July 22, 2013 (40:14 Md. R. 1176); January 19, 2026 (53:1 Md. R. 21) Regulation .16 adopted effective July 22, 2013 (40:14 Md. R. 1176) This chapter governs the delegation of technical acts by a licensed physician to an: Assistant not otherwise authorized under the Health Occupations Article or the Education Article, Annotated Code of Maryland; and RCIS assisting in the physician's performance of fluoroscopy during a cardiac catheterization procedure under certain circumstances as authorized under Regulation .06 of this chapter. This chapter may not be construed: As establishing the licensure, certification, or registration by the Board of assistants or registered cardiovascular invasive specialists; To apply to certified, registered, or licensed professionals, or health occupation students acting pursuant to Health Occupations Article, Annotated Code of Maryland; and To mean that this chapter overrides or is to be used in lieu of more stringent regulations, policies, and procedures established by State licensure or certification requirements or Board-recognized accrediting agencies. In this chapter, the following terms have the meanings indicated. Terms Defined. “Assistant” means an individual to whom only routine technical acts are delegated by a licensed physician and who is: Trained as defined in §B(17) of this regulation and not certified, registered, or licensed by the Board or any other State health occupation board; or Certified, registered, or licensed by the Board or any other State health occupation board and is not acting under the authority of that certification, registration, or license granted by a State health occupation board. “Board” means the State Board of Physicians. “CLIA” means the federal Clinical Laboratory Improvement Amendments of 1988 (42 U.S.C. §263a) and the regulations promulgated under them, and 42 CFR Part 493, Subparts B and M. “Delegating physician” means a physician possessing an active license to practice medicine in this State who directs an assistant or RCIS to perform technical acts. “Direct supervision” means oversight exercised by a delegating physician who is: Personally treating the patient; and In the presence of the patient and the: Assistant; or RCIS. “Fluoroscopy” means a technique for generating x-ray images and presenting them simultaneously and continuously as visible images. “Hospital” has the meaning stated in Health-General Article, §19-301, Annotated Code of Maryland. “Licensed physician” means, unless the context requires otherwise, a physician, including a doctor of osteopathy, who is licensed by the Board to practice medicine. “MDE” means the Maryland Department of the Environment. “Microdermabrasion” means the use of a minimally invasive technique to gently exfoliate the dead, outermost layer of skin and is a method for improving superficial, environmental, aging, and hereditary skin changes by superficial, mechanically powered abrasion, often combined with application of topical crystals such as vitamin C. “On-site supervision” means oversight exercised by a delegating physician who is present at the site and able to be immediately available in person during the course of the performance of a delegated act. “Perform fluoroscopy” means the energizing of a fluoroscopic x-ray system by an individual authorized in accordance with MDE regulations. “Readily retrievable” means maintained in a method by which a hospital can retrieve and produce the record for the Board upon request. “Registered cardiovascular invasive specialist (RCIS)” means an individual who is credentialed by Cardiovascular Credentialing International or another credentialing body approved by the Board to assist in cardiac catheterization procedures under the direct, in-person supervision of a licensed physician. “Site” means any facility or location including those defined in Health-General Article, §§19-114 and 19-3B-01(b), Annotated Code of Maryland, used for the delivery of health services not covered in this chapter. “Technical act” means a routine medical or surgical act which does not require medical judgment and is performed with the supervision as specified within this chapter. “Trained” means possessing the knowledge, skills, and abilities, as determined by the licensed physician, to perform delegated acts. A licensed physician who delegates shall: Evaluate the risk to the patient and the outcome of the delegated acts; Delegate only those technical acts that are customary to the practice of the licensed physician; Delegate only those technical acts for which the assistant has been trained; Be responsible for the acts of the assistant; and Supervise the assistant. The responsibility for the delegated act cannot be transferred from the delegating physician to another licensed physician without: The expressed consent of the other physician; and Informing the assistant. A licensed physician may not delegate to an assistant technical acts which are exclusively limited to any individual required to be licensed, certified, registered, or otherwise recognized pursuant to any provision of the Health Occupations Article and the Education Article, Annotated Code of Maryland. A licensed physician may delegate technical acts consistent with national standards in the medical community and the approved policies and procedures of the sites for the delivery of health services in the following categories: Surgical technical acts that the delegating physician directly orders while present, scrubbed, and personally performing the surgery in the same surgical field; and Nonsurgical technical acts while the assistant is under the licensed physician's direct supervision or on-site supervision if the assistant performs the act in accordance with procedures of the site. At sites included in Health-General Article, §§19-114 and 19-3B-01(b), Annotated Code of Maryland, or any unit of those sites, a licensed physician may delegate technical acts in compliance with State regulations and the policies, procedures, and supervisory structures of those sites. At sites not included in Health-General Article, §§19-114 and 19-3B-01(b), Annotated Code of Maryland, when providing the following specified levels of supervision, a licensed physician may delegate to an assistant technical acts which include but are not limited to: Without on-site supervision: Patient preparation for physician examination; Patient history interview; Collecting and processing specimens, such as performing phlebotomy and inoculating culture media; Preparation of specimens for selected tests including: Pregnancy tests; Dipstick and microscopic urinalysis; and Microbiology (rapid streptococcal testing and throat cultures); Laboratory tests that the licensed physician is satisfied the assistant is qualified to perform under State and CLIA regulations; Clinical tests such as: Application of tuberculin skin tests; Electrocardiography; Administering basic pulmonary function tests; and Visual field tests; Transmitting prescriptions to a pharmacy; Providing sample packets of medication, selected by a licensed physician who is physically present at the time of selection, to patients as directed by the delegating physician and in conformance with Health Occupations Article, §12-102(a), (d), and (f), Annotated Code of Maryland; Preparing and administering oral drugs; and Microdermabrasion; With on-site supervision: Preparing and administering injections limited to intradermal, subcutaneous, and intramuscular (deltoid, gluteal, vastus lateralis) to include small amounts of local anesthetics; Establishing a peripheral intravenous line; and Injecting fluorescein-like dyes for retinal angiography; and With direct supervision, injecting intravenous drugs or contrast materials. A licensed physician who possesses a dispensing permit may delegate the dispensing functions in accordance with the requirements of COMAR 10.32.23. A licensed physician may not delegate to an assistant acts which include but are not limited to: Conducting physical examinations; Administering any form of anesthetic agent or agent of conscious sedation other than topical anesthetics or small amounts of local anesthetics; Initiating independently any form of treatment, exclusive of cardiopulmonary resuscitation; Giving medical advice without the consult of a licensed physician; and Providing physical therapy. An assistant or RCIS acting beyond the scope of this chapter may be: Considered to be engaged in the unlicensed practice of medicine; and Subject to all applicable penalties and fines in accordance with Health Occupations Article, §§14-602 and 14-607, Annotated Code of Maryland, and COMAR 10.32.02. A delegating physician, through either act or omission, facilitation, or otherwise enabling or forcing an assistant or RCIS to practice beyond the scope of this chapter, may be subject to discipline for grounds within Health Occupations Article, §14-404(a), Annotated Code of Maryland, including, but not limited to, practicing medicine with an unauthorized person or aiding an unauthorized person in the practice of medicine. A delegating physician may not: Require an assistant or RCIS to perform a delegated act; or Permit an assistant or RCIS to delegate any act to another individual. A hospital that fails to comply with the requirements of Health Occupations Article, §14-306, Annotated Code of Maryland, and this chapter may be assessed a civil penalty of up to $5,000 for each instance. Scope of Regulation. This regulation governs: A licensed physician’s delegation of technical acts to an RCIS assisting in the physician’s performance of fluoroscopy provided the delegation is in accordance with the entirety of this chapter; and The responsibilities of the hospital in which the cardiac catheterization laboratory is located to verify and document the qualifications of an RCIS and to ensure that all requirements of Health Occupations Article, §14-306, Annotated Code of Maryland and this regulation are met for each procedure. This regulation does not limit a licensed physician from delegating technical acts to an RCIS who is not assisting in the physician’s performance of fluoroscopy provided the delegation is in accordance with Regulations .01—.05 of this chapter. An RCIS assisting in a delegating physician’s performance of fluoroscopy shall: Possess an active RCIS certification issued by Cardiovascular Credentialing International or another credentialing body approved by the Board; Complete 40 hours of: Accredited didactic education in fluoroscopic radiation physics and fluoroscopic patient safety; and Clinical fluoroscopic training supervised by a radiologist, radiographer, or radiologist assistant who is physically present in the room with the RCIS to instruct the clinical fluoroscopic training; In the hospital, wear an identification badge displaying in readily visible type: The name of the RCIS; and A designation by the hospital of verification of the RCIS’ credentials and completion of requirements to assist in a physician’s performance of fluoroscopy; and Comply with any additional requirements as established by: MDE; The Joint Commission; and Federal and State laws and regulations. Responsibilities. The hospital shall: Verify that the RCIS has met the requirements in §B of this regulation before permitting an RCIS to assist in a delegating physician’s performance of fluoroscopy; Issue to the RCIS an identification badge in accordance with §B(3) of this regulation; Keep on-site all documentation of the RCIS’ certification and the additional training required under this regulation; Permit the Board, at any reasonable hour, to inspect the hospital’s documentation of the RCIS’ certification and training to ensure compliance with this regulation; Regarding radiation machines and fluoroscopy services, comply with any additional requirements as established by: MDE; The Joint Commission; and Federal and State laws and regulations; and Verify that the acts delegated to the RCIS are in accordance with the scope of this chapter. The delegating physician shall: Exercise direct supervision of the RCIS when the RCIS is assisting the delegating physician in the delegating physician’s performance of fluoroscopy; Delegate only technical acts involved in the physician’s performance of fluoroscopy in accordance with Regulation .03 of this chapter; and Verbally direct each technical act performed by the RCIS. The RCIS: May not perform fluoroscopy; Shall perform technical acts to assist the delegating physician in the delegating physician’s performance of fluoroscopy only upon verbal direction from the delegating physician; May not delegate any act to another individual; and May not engage in prohibited conduct as set out in Regulation .05 of this chapter. The Board shall conduct any necessary investigation regarding the failure to comply with the requirements of Health Occupations Article, §14-306, Annotated Code of Maryland, and this chapter. Any matter regarding a hospital’s failure to comply with the requirements of Health Occupations Article, §14-306, Annotated Code of Maryland, and Regulation .06 of this chapter shall be adjudicated in accordance with COMAR 10.32.02. Health General Article, §§19-114 and 19-118; Health Occupations Article, §§14-205(a) and 14-306; Annotated Code of Maryland Effective date: June 12, 2000 (27:11 Md. R. 1078) Regulation .01 amended effective December 27, 2021 (48:26 Md. R. 1112) Regulation .02B amended effective September 2, 2002 (29:17 Md. R. 1380); March 14, 2016 (43:5 Md. R. 386); December 27, 2021 (48:26 Md. R. 1112) Regulation .03 amended effective December 27, 2021 (48:26 Md. R. 1112) Regulation .04 amended effective September 2, 2002 (29:17 Md. R. 1380); December 27, 2021 (48:26 Md. R. 1112) Regulation .04D amended effective March 14, 2016 (43:5 Md. R. 386) Regulation .04E, F amended effective March 26, 2018 (45:6 Md. R. 320) Regulation .05 amended effective December 27, 2021 (48:26 Md. R. 1112) Regulation .06 adopted effective December 27, 2021 (48:26 Md. R. 1112) Regulation .07 adopted effective December 27, 2021 (48:26 Md. R. 1112) These regulations establish the qualifications for an individual to become licensed in Maryland to practice medicine by virtue of conceded eminence and authority in the profession and to set limits on the license. In this chapter, the following terms have the meanings indicated. Terms Defined. “ABMS or other equivalent specialty board” means the American Board of Medical Specialties or equivalent boards in other countries. “Applicant” means an individual applying for initial licensure as a physician in Maryland. “Application period” means the time between the filing of an application and the issuance of a license or denial of the application. “Board” means the Board of Physicians. “Conceded eminence and authority in the profession” means significant teaching, research, and achievement in a field of medicine recognized by the Board. “First author” means the first named author of a publication such as a research article or the author who served as the principal investigator for a research project. “Index Medicus” means an international list of periodicals concerning the practice of medicine. “Last author” means the last named author of a publication such as a research article or the senior author who served as the principal investigator for a research project. “LCME” means Liaison Committee on Medical Education of the American College of Medical Education and the American Medical Association. “LMCC” means Licentiate of the Medical Council of Canada, or its successor. “Malpractice history” means a list of claims filed against a health care provider for damage due to medical injuries as described in Courts and Judicial Proceedings Article, Title 3, Subtitle 2A, Annotated Code of Maryland, or adverse action reports made to the National Practitioner Data Bank of the federal government, or both. “Medical licensing examination results” means scores or results of examinations such as the: Educational Commission for Foreign Medical Graduates (ECFMG), or its successor; Federation Licensing Examination (FLEX) designed by the Federation of State Medical Boards; National Board of Medical Examiners (NBME); United States Medical Licensing Examination (USMLE) designed by the Federation of State Medical Boards; and Special Purpose Examination prepared by the Federation of State Medical Boards (SPEX). “Postgraduate training” means, for the purpose of conceded eminence applicants, clinical and medical training for medical school graduates, including but not limited to, internships, residencies, and fellowships. “Speech impairment” means a disorder of the voice, in articulation of speech sounds, or nonfluency in the speaker's native language. “World Health Organization directory” means the World Directory of Medical Schools, an international list of recognized medical schools compiled by the World Health Organization agency of the United Nations. An applicant shall: Complete an application on a form supplied by the Board; Pay an application fee set by the Board in COMAR 10.32.01.12; Be of good moral character; and Be at least 18 years old. Recommendations. On a form supplied by the Board, the dean of a school of medicine in the State or the director of the National Institutes of Health shall recommend the applicant to the Board, by: Attesting to the fact that the applicant is to receive an appointment at the institution represented by the dean or director; Presenting the Board with detailed evidence of the physician’s qualifications and competence including: The nature of the physician's proposed responsibilities; Reasons for any limitations of the physician's practice responsibilities; and The degree of supervision under which the physician will function; and Presenting the Board with a detailed statement describing the applicant’s conceded eminence and authority in the profession. Evidence of Teaching, Research, and Achievement. An applicant shall demonstrate eminence and authority in the profession by meeting the following qualifications: Have held an appointment at a medical school approved by the LCME or at any medical school listed in the World Health Organization directory at the level of associate or full professor, or its equivalent, for at least 5 years; Have actively practiced medicine cumulatively for 10 years after completion of postgraduate training, including clinical research; Be a member in good standing of a board of the American Board of Medical Specialties or other equivalent specialty board; Possess a current, active, unrestricted license to practice medicine in another state or country, or be otherwise recognized under the laws of the other country or jurisdiction as a medical doctor in that jurisdiction; and Within 10 years before the application: Have: Published original results of clinical research, as first author or last author, in a medical journal listed in the Index Medicus or in an equivalent scholarly publication acceptable to the Board; and Submitted these articles to the Board in English or in a foreign language with verifiable, certified translations in English; or Have developed a treatment modality, surgical technique, or other verified original contribution to the field of medicine, which is attested to by the dean of a school of medicine in the State or by the director of the National Institutes of Health. Supervision. The Board shall require an applicant to submit: The name of a licensed physician who will supervise the medical services provided by the applicant for the first 6 months of practice; and A detailed description of the medical services, duties, and responsibilities that the applicant will perform. Additional Requirements for License by Conceded Eminence and Authority in the Profession. The Board may require additional information which includes, but is not limited to, the following: A letter from the chief of staff of any hospital where the applicant has practiced within the 5 years preceding the application for license under this chapter, detailing the applicant's competence to practice medicine; A detailed description of activities including, but not limited to, the following: Any action, by any state licensing or disciplinary board, or any comparable body in the armed services, denying an application for licensure, reinstatement, or renewal; Any action taken against the physician's license, by any state licensing or disciplinary board, or any comparable body in the armed services, including but not limited to limitations of practice, required education, admonishment, reprimand, suspension, or revocation for an act that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland; Any investigations or charges brought against the physician by any licensing or disciplinary body or comparable body in the armed services; Any medical or health professional licenses for which the physician has applied when the application was withdrawn for reasons that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland; Any investigations or charges brought against the physician by any hospital, related institution, or alternative health care system that might be grounds for action under Health Occupations Article, §14-404, Annotated Code of Maryland; Any limitations or loss in privileges by any hospital, related health care facility, or alternative health care system that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland; Any pleas of guilty or nolo contendere, or convictions, or receipt of probation before judgment for any criminal act; Any pleas of guilty or nolo contendere, or convictions, or receipt of probation before judgment for any alcohol or controlled dangerous substance offense including, but not limited to, driving while under the influence of alcohol or controlled dangerous substances; Any arrests which would provide a basis for investigation or charges that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland; Any illness or condition which has impaired the physician's ability to practice medicine within the 3 years before, or during the pendency of, the application; Any treatment for alcohol abuse, substance abuse, or chemical dependence; and The filing or settling of any medical malpractice actions in which the physician is, or has been, named as a defendant; Malpractice history; Driving record, including but not limited to convictions for driving while intoxicated or while under the influence of any chemical substance or medication; Medical licensing examination results; Physical or mental examinations, or both, by a physician or evaluation program for treatment of impaired physicians, or both, chosen by the Board. On forms supplied by the Board, an applicant shall: Agree to release to the Board information from other institutions and government agencies including, but not limited to, the National Practitioner Data Bank, hospitals, and other licensing bodies; and Allow the Board to release information which is not statutorily protected. An applicant for licensure under this chapter shall agree to inform the Board by certified mail, return receipt requested, within 30 days of receiving notice of any action listed in this section. English Language Competency. An applicant shall demonstrate oral and written English language competency as described in COMAR 10.32.01.04D. Claim of Speech Impairment. An applicant wishing to claim a speech impairment shall submit documentation of this impairment on forms supplied by the Board as described in COMAR 10.32.01.04E. Withdrawals. An application may not be withdrawn if the applicant is under investigation or charges for reasons that may be grounds under Health Occupations Article, §14-404, Annotated Code of Maryland, if the applicant were licensed in this State. An applicant for licensure is restricted so that the applicant shall: Practice medicine only in the limited field approved by the Board that is consistent with the applicant’s area of conceded eminence experience; For the first 6 months of practice, practice medicine only: Within the institution and program specified within the application; and Under the supervision of a licensed physician; Following the first 6 months of practice, practice medicine only: At an institution similar to that named in the original application; and After approval by the Board; and Practice medicine under any conditions which the Board may set. Nothing in these regulations entitles an individual licensed by conceded eminence in the profession to practice beyond the scope of these regulations without having qualified for an unrestricted license under Health Occupations Article, §14-307 or 14-308, Annotated Code of Maryland, and regulations promulgated under those sections. Term and Tenure. The initial license is active for a period 1 year, and, after that, may be renewed twice for a term established by the Board. After two renewals, a licensee seeking any additional renewals shall provide documentation to the Board 3 months before the expiration of the licensee’s license indicating the continued significance of the licensee’s work at the sponsoring institution that requires the license to be renewed for another term. Unless the Board has been advised and approves of an appointment at a new institution, a license issued under this regulation expires immediately when an individual leaves the appointment at the sponsoring institution. Initial Renewal. As part of the initial renewal process: The supervising physician shall submit an attestation, approved by the Board, that the licensee was supervised for a period of at least 6 consecutive months; and The licensee shall complete a renewal application form, after Board approval of the attestation. Second Renewal. A license issued under this chapter may be renewed in a second renewal: On a date set by the Board; and As specified in COMAR 10.32.01. A licensee for second renewal shall: Complete a renewal application form; Meet the requirements set out in COMAR 10.32.01.10, including completing at least 50 hours of continuing medical education units; and Pay a renewal fee set by the Board in COMAR 10.32.01.12. A licensee shall inform the Board of the institution where the licensee plans on practicing for the renewal term. Subsequent Renewal. A license issued under this chapter may be renewed in subsequent renewals: On a date set by the Board; and As specified in COMAR 10.32.01.12. A license for subsequent renewal shall: Complete a renewal application form; Meet the requirements set out in COMAR 10.32.01.10, including completing at least 50 hours of continuing medical education units; Provide documentation to the Board 3 months before the expiration of the licensee’s license indicating the continued significance of the licensee’s work at the sponsoring institution that requires the license to be renewed for another term; and Pay a renewal fee set by the Board in COMAR 10.32.01.12. A licensee shall inform the Board of the institution where the licensee plans on practicing for the renewal term. Practicing medicine beyond the scope of these regulations, including practicing without notifying the Board and without approval of the Board at any institution or place outside the institution approved by the Board, constitutes practicing without a license under Health Occupations Article, §14-404(a)(3), Annotated Code of Maryland. On termination of the licensee’s approved appointment, the conceded eminence license terminates and becomes null and void. A licensee has a duty to inform the Board of the termination of an appointment within 30 days of the termination. Failure of the licensee to inform the Board of the termination of an appointment within 30 days constitutes unprofessional conduct under Health Occupations Article, §14-404(a)(3), Annotated Code of Maryland. New Appointment. If a licensee wishes to receive a conceded eminence license with another institution, the licensee shall apply for a new appointment with another institution. The Board may approve the new appointment at the Board’s discretion. Board approval shall be obtained before the individual may begin the appointment. Health Occupations Article, §§14-205, 14-206, 14-301, 14-302, and 14-307—319, Annotated Code of Maryland; Chapter 273 (1993) Effective date: November 22, 1993 (20:23 Md. R. 1804) Regulation .02B amended effective January 1, 2018 (44:26 Md. R. 1215); October 22, 2018 (45:21 Md. R. 975); August 26, 2019 (46:17 Md. R. 727) Regulation .03 amended effective January 1, 2018 (44:26 Md. R. 1215); October 22, 2018 (45:21 Md. R. 975) Regulation .04 amended effective January 1, 2018 (44:26 Md. R. 1215) Regulation .06 amended effective January 1, 2018 (44:26 Md. R. 1215) Regulation .08 amended effective January 1, 2018 (44:26 Md. R. 1215) This chapter governs the performance of certain X-ray duties without a license to a registered Limited X-ray Machine Operator. This chapter may not be construed to: Apply to certified, registered, or licensed professionals or health occupation students acting pursuant to Health Occupations Article, Annotated Code of Maryland; and Mean that this chapter overrides or is to be used in lieu of more stringent regulations, policies, and procedures established by State licensure or certification requirements or Board-recognized accrediting agencies. In this chapter, the following terms have the meanings indicated. Terms Defined. “ARRT” means American Registry of Radiologic Technologists. “Authorized supervisor” means a Maryland licensed physician or a Maryland licensed radiologic technologist. “Board” means the State Board of Physicians. “Certified radiologic technologist” means an individual who holds an active license and is certified in radiologic technology by the ARRT. “Competency” means the successful completion of supervised clinical procedures to verify the individual’s professional knowledge, skills, and ability. “Direct supervision” means oversight exercised by an authorized supervisor who is in the physical presence of the unlicensed individual and is able to provide instruction during the performance of an X-ray procedure. “Licensed physician” means, unless the context requires otherwise, a physician, including a doctor of osteopathy, licensed by the Board to practice medicine in the State. “Licensed radiologic technologist” means, unless the context requires otherwise, an individual licensed by the Board as a radiographer in the State. Limited Scope X-ray Educational Program. “Limited scope X-ray educational program” means an educational program that meets the requirements of Health Occupations Article, §14-306, Annotated Code of Maryland. “Limited scope X-ray educational program” is not a radiography educational program. “LXMO” means a Limited X-Ray Machine Operator registered with the Board. “Immediately available supervision" means oversight exercised by an authorized supervisor who can be immediately available to provide direction in person, by telephone, or by other electronic means. “Readily retrievable” means maintained in a method by which an office can retrieve and produce the record for the Board upon request. To apply for LXMO registration, an applicant shall: Pay the fee determined by the Board established in Regulation .09 of this chapter; and Complete a form provided by the Board attesting to: Completion of at least 6 months of clinical care experience; Completion of a limited scope X-ray educational program consisting of at least 115 hours of didactic training delivered by a certified radiologic technologist providing instruction in: Radiographic anatomy, procedures, and pathology; Digital image acquisition and display; Fundamentals, ethics, and laws of health care; Human anatomy and physiology; Image production and analysis; Imaging equipment and radiation production; Medical terminology; and Patient care; Completion of at least 480 hours of clinical training performed under the direct supervision of a certified radiologic technologist; Completion of a minimum of five competencies in each body part listed in Regulation .06B(2) of this chapter performed under the direct supervision of a certified radiologic technologist; and Achievement of a passing result of 75 percent or higher on the ARRT Examination for Limited Scope of Practice in Radiography or a passing result on an alternative exam as determined by the Board. Criminal History Records Check. An applicant shall submit to a criminal history records check in accordance with Health Occupations Article, §14-308.1, Annotated Code of Maryland, by submitting to the Central Repository: Two complete sets of legible fingerprints taken on forms approved by the Central Repository and the Federal Bureau of Investigation; and All fees required by the Central Repository and the Federal Bureau of Investigation. Renewal. Before the expiration of the registration, an individual applying for renewal shall complete an application for renewal on the form supplied by the Board. LXMO registration shall be renewed every 2 years on the date set by the Board. An LXMO shall pay the renewal fee, and any additional charges set by the Board in accordance with Regulation .09 of this chapter. An LXMO shall attest to the completion of continuing education activities as specified in Regulation .04 of this chapter. The Board may request an LXMO to submit evidence of having met the continuing education requirement specified in Regulation .04 of this chapter. If an LXMO cannot demonstrate completion of the required continuing education credit hours, the Board may impose a civil penalty of up to $100 per missing continuing education hour. If an LXMO fails to renew their registration for any reason, the registration will expire. After the expiration of the registration, an individual is no longer authorized to practice as an LXMO. The Board may impose a civil penalty of up to $1,000 on the individual and a civil penalty of up to $5,000 on the employer of the individual for practicing without registration if a formerly registered individual: Fails to submit an application and pay the requisite renewal fee before the expiration of the registration; and Practices as a LXMO after the expiration of the registration. Reinstatement. The Board shall reinstate the registration of an LXMO if the individual: Completes the reinstatement application on the form approved by the Board. Pays a reinstatement fee as determined by the Board in accordance with Regulation .09 of this chapter; and Documents evidence of completion of at least 24 hours of approved continuing education earned during the 2-year period preceding the date of the submission of the application for reinstatement for the registration as an LXMO. The applicant shall submit to a criminal history records check in accordance with Health Occupations Article, §14-308.1, Annotated Code of Maryland, by submitting to the Central Repository: Two complete sets of legible fingerprints taken on forms approved by the Central Repository and the Federal Bureau of Investigation; and All fees required by the Central Repository and the Federal Bureau of Investigation. An LXMO shall complete at least 24 hours of approved continuing education credits earned during the 2 years preceding the expiration of the registration. Approved continuing education is as follows: In-service programs at a hospital or related institution as defined in Health-General Article, §19-301, Annotated Code of Maryland, or a health maintenance organization certified by the State; or Programs relevant to the practice of an LXMO approved by the: Maryland Society of Radiologic Technologists; American Medical Association; MedChi, the Maryland State Medical Society; or American Society of Radiologic Technologists. An LXMO shall obtain documentation of continuing education attendance and retain this documentation for the succeeding 6 years for possible inspection by the Board. The required documentation of attendance at a continuing education course shall contain, at a minimum: Program title; Sponsor’s name; LXMO’s name; Inclusive date or dates and location of the continuing education event; Number of designated continuing education hours; and Documented verification of a successful completion. An LXMO shall wear an identification badge while on-site that states in readily visible type: The name of the LXMO; and The title “Limited X-Ray Machine Operator.” A physician’s office employing an LXMO shall: Issue the LXMO an identification badge described in §A of this regulation; Verify all credentials of the LXMO; Keep readily retrievable, on-site documentation that the LXMO meets the requirements of Health Occupations Article, §14-306, Annotated Code of Maryland and this chapter; Permit the Board to inspect the documentation to ensure compliance with Health Occupations Article, §14-306, Annotated Code of Maryland and this chapter; and Verify all X-ray examinations performed by the LXMO are in accordance with Health Occupations Article, §14-306, Annotated Code of Maryland and this chapter. An LXMO shall perform X-ray duties in a physician’s office under the immediately available supervision of a licensed physician or licensed radiologic technologist and in accordance with §B of this regulation. An individual registered as an LXMO may perform X-ray duties without a license only if the duties: Do not include: Computerized or non-computerized tomography; Fluoroscopy; Invasive radiology; Mammography; Nuclear medicine; Radiation therapy; or Xerography; and Are limited to X-ray procedures of the: Chest; Spine, including the: Cervical spine; Lumbar spine; Sacroiliac joints; Sacrum and coccyx; and Thoracic spine; Lower extremities, including: Toes; The foot; The ankle; The calcaneus; The tibia and fibula; The knee and patella; and The femur; and Upper extremities, including: Fingers; The hand; The wrist; The forearm; The elbow; The humerus; The shoulder; The clavicle; Acromioclavicular joints; and The scapula. An LXMO acting beyond the scope of this chapter may be: Considered to be engaged in the unlicensed practice of radiography; and Subject to all applicable penalties and fines in accordance with Health Occupations Article, §§14-601, 14-602 and 14-5B-17, Annotated Code of Maryland, and COMAR 10.32.02. A supervising licensed physician or licensed radiologic technologist, through either act or omission, facilitation, or otherwise enabling or forcing an LXMO to practice beyond the scope of this chapter, may be subject to discipline for grounds within Health Occupations Article, §§14-404(a) or 14-5B-14, Annotated Code of Maryland, including, but not limited to, practicing medicine with an unauthorized person or aiding an unauthorized person in the practice of medicine. A supervising licensed physician or licensed radiologic technologist may not: Require an LXMO to perform an X-ray procedure; and Permit an LXMO to delegate to another individual. A physician’s office that employs an individual authorized to perform X-ray duties without a license is responsible for ensuring that all requirements of Health Occupations Article, §14-306, Annotated Code of Maryland, and this chapter are met for each X-ray examination performed. The Board shall conduct any necessary investigation regarding the failure to comply with the requirements of Health Occupations Article, §14-306, Annotated Code of Maryland, and this chapter. The Board may impose a civil penalty of up to $5,000 per incident on a physician’s office for failure to comply with Health Occupations Article, §14-306, Annotated Code of Maryland, and this chapter. The Board may impose a civil penalty of up to $5,000 per incident on a physician's office who employs an unregistered individual to practice as an LXMO. The Board may impose a civil penalty of up to $1,000 per incident on an individual for failure to comply with Health Occupations Article, §14-306, Annotated Code of Maryland, and this chapter. The following fees are applicable to LXMOs: Application for initial registration—$65; Renewal Fees: Renewal of registration fee—$125; and Maryland Health Care Commission (MHCC) fee—As determined by MHCC in accordance with COMAR 10.25.03; Reinstatement of registration fee—$135; Application to take the Limited Scope of Practice in Radiology examination—$10; LXMO registration fee per month until expiration of initial registration—$2; and Written verification fee—$25. Health Occupations Article, §§14-205, 14-207, 14-306, and 14-308.1, Annotated Code of Maryland Effective date: April 25, 1994 (21:8 Md. R. 674) Regulation .01 amended effective March 1, 2004 (31:4 Md. R. 316); August 18, 2025 (52:16 Md. R. 846) Regulation .02 adopted effective August 18, 2025 (52:16 Md. R. 846) Regulation .03 adopted effective August 18, 2025 (52:16 Md. R. 846) Regulation .04 adopted effective August 18, 2025 (52:16 Md. R. 846) Regulation .05 adopted effective August 18, 2025 (52:16 Md. R. 846) Regulation .06 adopted effective August 18, 2025 (52:16 Md. R. 846) Regulation .07 adopted effective August 18, 2025 (52:16 Md. R. 846) Regulation .08 adopted effective August 18, 2025 (52:16 Md. R. 846) Regulation .09 adopted effective August 18, 2025 (52:16 Md. R. 846) In this chapter, the following terms have the meanings indicated. Terms Defined. “Applicant” means a physician who has applied to the Board for registration to perform acupuncture in this State. “Board” means the State Board of Physicians. “Medical acupuncture course of study” means a sequence of study in acupuncture approved by the Board, which sequence may consist of combinations of course work from unrelated institutions completed within 5 years of the date of application, that includes at least 200 hours of instruction in general and basic aspects, specific uses and techniques of acupuncture, and indications and contraindications of acupuncture administration. “Medical acupuncture program” means a program of study in acupuncture which has been approved for Category I continuing medical education credit by an institution accredited or recognized by the Accreditation Council on Continuing Medical Education to conduct Category I continuing medical education courses. “Physician” means an individual licensed to practice medicine in Maryland. “To perform acupuncture” means to stimulate a certain point or points on or near the surface of the human body by the insertion of needles to prevent or modify the perception of pain or to normalize physiological functions, including pain control, for the treatment of ailments or conditions of the body and for maintenance of good health. To qualify for registration, a physician shall: Complete an application on a form supplied by the Board, enclosing: Required supplementary materials, which are in English, and English translations of certified, required documentation with costs borne by the applicant; Pay a registration fee of $150; Submit a current, signed passport-sized photograph; Be a licensed physician; and Submit evidence of having successfully completed 200 hours of training in a medical acupuncture program or course of study, including any required examinations. Unprofessional conduct in the practice of medicine includes the failure of a physician to: Comply with the statute and regulations governing physicians who perform acupuncture, and includes representing oneself as a registered acupuncturist without having met all the previous requirements; and Be registered by the Board, or to have met all the requirements of Health Occupations Article, §§1A-101 — 1A-502 and §14-302(4) — (5), Annotated Code of Maryland. A physician who has been registered by the Board to perform acupuncture may advertise services subject to the provisions of this regulation. An advertisement may not express statements: Containing misrepresentation of facts; That are likely to mislead or deceive because in context the statement makes only a partial disclosure of relevant facts; That intend to or are likely to create false or unjustified expectations of favorable results; Relating to fees, other than a standard consultation fee or a range of fees for specific types of services, without fully disclosing all relevant variables so that the statement would not be misunderstood or be deceptive to a layman; Conveying the impression that the physician who has been registered by the Board to perform acupuncture could improperly influence a public body, official, corporation, or an individual on behalf of a patient; or Containing representations that a physician who has been registered by the Board to perform acupuncture is: Willing to perform any procedure which is illegal under the laws or regulations of Maryland or the United States, or A licensed acupuncturist under Health Occupations Article, §1A-101 et seq., Annotated Code of Maryland, unless licensed by the State Acupuncture Board. A physician who has been registered by the Board to perform acupuncture is accountable under this regulation if the physician uses an agent, partnership, professional association, or health maintenance organization to implement actions prohibited by this regulation. Health Occupations Article, §14-504, Annotated Code of Maryland Effective date: September 11, 1995 (22:18 Md. R. 1400) In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the Board of Physicians. “Designee” means a person or committee to whom the Board has delegated responsibility for consideration of a petition. “Person” means: An individual; An agency; An association; A corporation; or Any other entity. An interested person may file with the Board a petition for a declaratory ruling with respect to the manner in which the Board would apply: A statute; A regulation; or An order which the Board enforces to a particular case based on the facts presented in the petition. The Board may delegate responsibility for consideration of the petition. The delegation may be limited to the: Study of a request; and Preparation of a proposed ruling for the Board's consideration. Petition for Declaratory Ruling. The petition for a declaratory ruling shall be filed in writing on a form provided by the Board. The petition shall contain a statement describing in detail: The interest of the petitioner in making the request; The issue involved; A statement of the facts; and A listing of documents or statements, or both, to be considered. Unless this requirement is waived in writing by the Board, the petition shall contain a sworn statement by the petitioner that the facts contained in the petition are true to the best of the person's knowledge and belief. Granting of Petition. Not later than 60 days from receipt of the petition, the Board shall inform the petitioner whether the petition will be granted. If the petition is denied, the Board shall inform the petitioner in writing of the reasons for the denial. If the petition is granted, the Board or the Board's designee shall inform the petitioner when to expect the declaratory ruling. Consideration. A petition will be granted whenever the Board or the Board's designee considers issuing a declaratory ruling advisable under the circumstances. In rendering its ruling, the Board or the Board's designee: Shall consider all materials submitted with the petition; May consider any document, data, or other relevant material; May consult individuals; May consider comments from the staff; and May require argument of the question or permit the introduction of evidence by the petitioner or, in the Board's sole discretion, by other persons. Consideration of the proposed rulings prepared by the Board's designee shall be conducted according to procedures adopted by the Board in each case. Disposition. A declaratory ruling issued shall be in writing, stating the: Issue; Conclusion; Facts on which the conclusion was based; and Sources relied upon. A declaratory ruling issued by the Board shall plainly state that it is a declaratory ruling pursuant to this chapter. A written answer from the Board or any employee or committee of the Board to an inquiry is not a declaratory ruling unless made in conformity with this chapter. Publication and Inspection. The Board shall keep a record of each declaratory ruling issued and index all declaratory rulings issued by reference to the statute or regulation involved. The Board may publish declaratory rulings of general interest subject to the mandates of State Government Article, Title 10, Subtitle 6, Part III, Annotated Code of Maryland, and allow inspection of the declaratory rulings subject to that statute. Denial. A petition may be denied if the: Request contains incomplete information on which to base an informed declaratory ruling; Board or the Board's designee concludes that a declaratory ruling cannot reasonably be given on the matter; Matter is adequately covered by a: Regulation, Declaratory ruling, Decision, or Legal opinion; Matter is the subject of a pending disciplinary proceeding; or The Board or the Board's designee concludes that a ruling would not be in the public interest. Effect. A declaratory ruling shall be binding on the Board and the petitioner on the statement of facts covered in the declaratory ruling. Application for Revision. The petitioner shall file an application for revision within 10 days after the issuance of the declaratory ruling. The Board shall determine whether to reopen the declaratory ruling. The Board may summarily deny an application for revision. An application for revision does not stay the effect of the declaratory ruling. If the Board determines to grant the application and reopen the declaratory ruling, the declaratory ruling is stayed until the Board: Issues a revised declaratory ruling; Withdraws the declaratory ruling; or Withdraws its determination to reopen. A timely filed application for revision extends the time for judicial appeal of the declaratory ruling until the Board: Denies the application; Issues a revised declaratory ruling; Withdraws the declaratory ruling; or Withdraws its determination to reopen. If the Board determines to reopen the declaratory ruling, the Board shall give the applicant notice of the determination and of any subsequent changes to the declaratory ruling. The determination to reopen a declaratory ruling does not confer any procedural rights on the applicant. The Board shall deny applications for revision which contain additional or revised facts. The Board may treat the application as a request for a new declaratory ruling. After determining to reopen a declaratory ruling, the Board may take any action which it is authorized to take with respect to original applications for declaratory rulings. The Board's determination as to whether to reopen the declaratory ruling shall be made within 60 days of the application for revision. Revision on Board's Motion. The Board may reopen a declaratory ruling on its own motion at any time 2 years or more after a declaratory ruling's issuance. The declaratory ruling may be reopened if the Board determines that there have been subsequent changes in law, technology, economic or business conditions, or environment that render the declaratory ruling inaccurate or obsolete. The Board shall give notice to the petitioner of the Board's decision to reopen a declaratory ruling. Before a declaratory ruling is finally modified under this section, the Board shall give the petitioner the opportunity to submit written and oral argument to the Board. Appeal. A declaratory ruling is subject to review as provided in State Government Article, §10-305, Annotated Code of Maryland. State Government Article, §§10-301 — 10-305, Annotated Code of Maryland Effective date: April 5, 1999 (26:7 Md. R. 543) This chapter prohibits sexual misconduct by health care practitioners. In this chapter, the following terms have the meanings indicated. Terms Defined. “Health care practitioner” means an individual licensed under Health Occupations Article, Titles 14 and 15, Annotated Code of Maryland. Key Third Party. “Key third party” means an individual who participates in the health and welfare of the patient concurrent with the physician-patient relationship. “Key third party” includes, but is not limited to the following individuals: Spouse; Partner; Family member; Guardian; Surrogate; or Proxy designated by durable power of attorney. Sexual Contact. “Sexual contact” means the knowing touching directly or through clothing, where the circumstances surrounding the touching would be construed by a reasonable person to be motivated by the health care practitioner’s own prurient interest or for sexual arousal or gratification. “Sexual contact” includes, but is not limited to: Sexual intercourse, genital to genital contact; Oral to genital contact; Oral to anal contact or genital to anal contact; Kissing in a romantic or sexual manner; or Nonclinical touching of breasts, genitals, or any other sexualized body part. “Sexual harassment” means an unwelcome sexual advance, request for sexual favor, or other verbal or physical conduct of a sexual nature. Health care practitioners may not engage in sexual misconduct. Health Occupations Article, §§14-404(a)(3), 14-5A-17(a)(3), 14-5B-14(a)(3), 14-5C-17(a)(3), 14-5D-14(a)(3), 14-5E-16(a)(3), 14-5F-18(a)(19), and 15-314(a)(3), Annotated Code of Maryland, includes, but is not limited to, sexual misconduct. Sexual misconduct includes, but is not limited to: Engaging in sexual harassment of a patient, key third party, employee, student, or coworker regardless of whether the sexual harassment occurs inside or outside of a professional setting; Failing to provide privacy for disrobing; Performing a pelvic or rectal examination without the use of gloves; Discussing the health care practitioner’s sexual problems, sexual likes or dislikes, or fantasies; Using the health care practitioner-patient relationship to initiate or solicit a dating, romantic, or sexual relationship; Engaging in a dating, romantic, or sexual relationship which violates §D of this regulation or the code of ethics of the American Medical Association, American Osteopathic Association, American Psychiatric Association, or other professional code of ethics; Participating in any form of sexual contact with a patient or key third party; Having nonconsensual sexual contact with a coworker or employee; Causing a patient or key third party to touch the health care practitioner’s breasts, genitals, or any sexualized body part; Encouraging a patient or key third party to masturbate in the presence of the health care practitioner or masturbation by the health care practitioner while a patient or key third party is present; Offering to provide practice-related services in exchange for sexual favors; and Exposing the health care practitioner’s breasts, genitals, or any sexualized body part. Sexual or Romantic Relationships. A health care practitioner may not engage in sexual behavior with: A current patient; A key third party if the key third party’s decisions directly affect the health and welfare of the patient or if the relationship could otherwise compromise the patient’s care based on the following considerations, which include, but are not limited to: The nature of the patient’s medical problem and the likely effect on patient care; The length of the professional relationship; The degree of emotional dependence on the health care practitioner; The importance of the clinical encounter to the key third party and the patient; and Whether the health care practitioner-patient relationship can be terminated in keeping with ethics guidance and what implications doing so would have for the patient; and A former patient upon consideration of the following factors: Duration of the health care practitioner-patient relationship; Nature of the health care services provided; Lapse of time since the health care practitioner-patient relationship ended; Extent to which the former patient confided personal or private information to the health care practitioner; Degree of emotional dependence that the former patient has or had on the health care practitioner; Extent to which the health care practitioner used or exploited the trust, knowledge, emotions, or influence derived from the previous health care practitioner-patient relationship; and Whether the health care practitioner-patient relationship was terminated in order to enter into a romantic or sexual relationship. Health Occupations Article, §1-212, Annotated Code of Maryland Effective date: March 6, 2000 (27:4 Md. R. 454) Regulation .01 amended effective May 20, 2019 (46:10 Md. R. 488) Regulation .02B amended effective May 20, 2019 (46:10 Md. R. 488) Regulation .03 amended effective May 20, 2019 (46:10 Md. R. 488) A custodian of the Board may find that a compelling public purpose warrants disclosure of information in a certification, licensing, or investigative file, regardless of whether there has been a request for the information, if the information concerns: Possible criminal activity, and is disclosed to a federal, state, or local law enforcement or prosecutorial official or authority; A possible violation of law, and is disclosed to a federal, state, or local authority that has jurisdiction over the individual whose conduct may be a violation or over a facility in which the individual is practicing or has practiced and the information disclosed is limited to that information relevant to the possible violation by that individual; or Conduct by an individual which the Board reasonably believes may pose a risk to the public health, safety, or welfare, and is disclosed to a law enforcement authority, administrative official, or agency that regulates the individual or regulates a facility in which the individual has practiced, or to a hospital or other health care facility where the individual has privileges. This chapter does not prevent or limit the ability of the Board to disclose general licensing information as provided in State Government Article, §10-617(h), Annotated Code of Maryland, or any information which the Board may otherwise disclose by law. Health Occupations Article, §§14-405 and 14-411; State Government Article, §10-617(h)(3); Annotated Code of Maryland Effective date: June 10, 2002 (29:11 Md. R. 889) This chapter does not alter the authority of the Secretary under of the Health Occupations Article, §1-203(a), Annotated Code of Maryland or Health-General Article, §2-106(c), Annotated Code of Maryland. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the Maryland Board of Physicians. “Department” means the Maryland Department of Health. “Record” means the proceedings, records, or files of the Board. “Secretary” means the Secretary of Health. The Board shall disclose information contained in a record to the Secretary upon receipt of a written request from the Secretary stating that the requested information is appropriate and needed for: An investigation of quality or utilization of care in an entity regulated by the Office of Health Care Quality; An investigation of quality or utilization of care in an entity regulated by the Health Services Cost Review Commission; or An investigation regarding the introduction or spread of an infectious or contagious disease or other disease that endangers the public health in the State. The Board shall disclose information contained in a record to the Office of Health Care Quality upon receipt of a written request from the Director of the Office of Health Care Quality stating that the requested information is appropriate and needed for an investigation of quality or utilization of care in an entity regulated by the Office of Health Care Quality. The Board shall disclose information contained in a record to the Health Services Cost Review Commission upon receipt of a written request from the Executive Director of the Health Services Cost Review Commission stating that the requested information is appropriate and needed for an investigation of quality or utilization of care in an entity regulated by the Health Services Cost Review Commission. The Board shall disclose information contained in a record to the Maryland Health Care Commission upon receipt of a written request from the Executive Director of the Maryland Health Care Commission stating that the requested information is appropriate and needed in an investigation of quality or utilization of care in an entity regulated by the Maryland Health Care Commission. The Board shall disclose the information required under this chapter as soon as reasonably possible, but no later than 30 days after a request made under this chapter. The information disclosed by the Board under this chapter shall be sent on paper by first-class mail or by another delivery method agreed to by the Board and the Secretary or agency requesting the information. Information disclosed by the Board under this chapter shall remain confidential and may not be redisclosed by the Secretary, the Office of Health Care Quality, the Health Services Cost Review Commission, or the Maryland Health Care Commission unless otherwise permitted by law. Health-General Article, §18-102; Health Occupations Article, §14-411; Annotated Code of Maryland Effective date: March 3, 2014 (41:4 Md. R. 301) This chapter governs the practice of perfusion. Except as provided in §C or D of this regulation, on or after October 1, 2013, an individual shall be licensed by the Board before the individual may practice perfusion. This chapter does not prohibit any student who is currently enrolled in an accredited educational program to qualify for a license as a perfusionist from performing any of the procedures described in this chapter as part of that program’s clinical curriculum on perfusion. This chapter does not prohibit an individual from practicing a health occupation that the individual is authorized to practice under Health Occupations Article, Annotated Code of Maryland. In this chapter, the following terms have the meanings indicated. Terms Defined. “Accredited educational program” means a program accredited by The Commission on Accreditation of Allied Health Education Programs (CAAHEP), or its successor accrediting agency. “Board” means the State Board of Physicians. “Certified clinical perfusionist” means an individual holding a certificate issued by the national certifying board. “Certification” means recognition of an individual who has satisfied certain standards required by the national certifying board. “Committee” means the Perfusion Advisory Committee established under Health Occupations Article, §14-5E-05, Annotated Code of Maryland. “Conversion” means changing a license from licensed perfusionist-basic to licensed perfusionist-advanced. “Disciplinary panel” means a panel established under Health Occupations Article, §14-401, Annotated Code of Maryland, which: Is composed of 11 Board members; and Addresses: Complaints and disciplinary actions against licensed physicians and allied health professionals; Initial licensure decisions; and Postdisciplinary licensure reinstatements. “Immediately available direction” means the responsibility of a licensed physician to provide necessary direction for a licensed perfusionist in person, by telephone, or by other electronic means. “Joint Commission” means the organization formerly known as the Joint Commission on the Accreditation of Health Care Organizations. “License” means a license issued by the Board to practice perfusion. “Licensed perfusionist” means a perfusionist who is licensed by the Board, in accordance with Health Occupations Article, Title 14, Subtitle 5E, Annotated Code of Maryland, to practice perfusion as a: Licensed perfusionist-advanced; or Licensed perfusionist-basic. “Licensed perfusionist-advanced” means an individual who is licensed by the Board as a perfusionist based on current certification as a certified clinical perfusionist. “Licensed perfusionist-basic” means an individual who: Is licensed by the Board as a perfusionist for a limited time based on graduation from an accredited perfusion educational program; and Has not yet passed the national certifying examinations given by the national certifying board. “Licensed physician” means a physician licensed by the Board. “National Certifying Board” means the American Board of Cardiovascular Perfusion or its successor. “National certifying examinations” means the two examinations given by the national certifying board. “On-site direction” means the responsibility of a licensed physician to provide necessary direction for a licensed perfusionist when the physician is: Physically present in the procedure room or in the facility; and Able to respond if the perfusionist needs assistance during a procedure. Practice Perfusion. “Practice perfusion” means to perform the functions necessary for the support, treatment, measurement, or supplementation of the cardiovascular, circulatory, or respiratory systems, or other organs to ensure the safe management of physiologic functions by monitoring and analyzing the parameters of the systems under an order and the supervision of a licensed physician. “Practice perfusion” includes: Cardiopulmonary bypass for adult, pediatric, and neonatal patients; Extracorporeal circulatory support for renal, neurological, hepatic, and vascular surgery; Extracorporeal resuscitation; Extracorporeal circulation for long-term support of failing respiratory or cardiac function; Extracorporeal membrane oxygenation; Extracorporeal carbon dioxide removal; Myocardial protection; Perfusion-assisted direct coronary artery bypass; Hemofiltration and hemodialysis; Anticoagulation and hemostasis monitoring, analysis, and intervention; Thermal regulation; Blood gas and blood chemistry monitoring, analysis, and intervention; Physiological monitoring, analysis, and intervention; Administration of blood components and pharmaceuticals; Administration of anesthetic agents through a heart lung machine at the direction of an anesthesiologist; Ventricular assist device and mechanical circulatory support management; Intra-aortic balloon counterpulsation; Temporary pacemaker management; Periodic flow augmentation therapy; Autotransfusion; Platelet gel production, autologous hemocyte tissue matrix production; Nondifferentiated progenitor cell harvest bone marrow aspirate concentration; Acute normovolemic hemodilution; Isolated limb or organ delivery of chemotherapeutics, progenitor cells, gene therapy vectors, and other items; Organ procurement and preservation; Thermogenic lavage; Electrophysiological analysis; Therapeutic hyperthermia; Intravascular membrane oxygenation; and Renal perfusion. “Student” means an individual who, in accordance with Health Occupations Article, §14-5E-09(c), Annotated Code of Maryland, is: Enrolled in an accredited educational program to qualify for a license; and Performing perfusion services within the accredited program under the supervision of a licensed perfusionist and without compensation. “Supervision” means the responsibility of a licensed physician to exercise on-site direction or immediately available direction for a licensed perfusionist to ensure the safety and welfare of patients during the course of perfusion. The Board shall appoint members of the Committee as follows: Three individuals who are licensed perfusionists-advanced and who: Are certified by a National Certifying Board; and Have a minimum of 2 years of perfusion experience. Three physicians, at least one of whom: Performs cardiac or cardio-thoracic surgery; or Is a cardiac or cardio-thoracic anesthesiologist; and One consumer member who: Shall be a member of the general public; and May not: Practice, or ever have practiced perfusion, or any other health care profession; Be, or ever have been, in training to practice perfusion or any other health care profession; Have a household member who is a health care professional or is in training to be a health care professional; Participate, or ever have participated, in a commercial or professional field related to perfusion; Have a household member who participates in a commercial or professional field related to perfusion; Have had, within 2 years before appointment, a financial interest in a person regulated by the Board; or Have had, within 2 years of appointment, a financial interest in the provision of goods or services to perfusionists or to the field of perfusion. Chair. The Committee shall elect a chair from among its members. The chair shall serve for 2 years. Tenure. The term of a member is 3 years. The terms of the members are staggered. At the end of a term, a member continues to serve until a successor is appointed and qualifies. An individual may be reappointed for a second 3-year term, but the individual may not serve more than two consecutive 3-year terms. The terms of the initial members of the Perfusion Advisory Committee shall expire as follows: Two members in 2013; Two members in 2014; and Three members in 2015. Vacancy. If a vacancy occurs, the Board shall appoint a new member to serve. The successor member shall only serve for the remainder of the term, unless reappointed. Quorum. A majority of the members then serving on the Committee is a quorum. Business may not be conducted at a Committee meeting unless there is a quorum. The Committee shall develop and make recommendations to the Board in any matter related to regulating the practice of perfusion in the State. The Board shall: Consider all recommendations of the Committee; and Provide the Committee with an annual report on disciplinary matters involving licensees. The ethical responsibilities of a licensed perfusionist include, but are not limited to, compliance with the principles set forth in §B of this regulation. A licensed perfusionist: Shall: Practice medically acceptable methods of treatment and may not endeavor to practice beyond the competence and the authority vested in the perfusionist by the physician; Report: Known illegal, unethical, or incompetent conduct; or In good faith, suspected illegal, unethical, or incompetent conduct; Respect the patient’s rights and dignity; Maintain patient confidentiality and protect privileged information; Place the patient’s best interest ahead of all else; Guard against conflicts of interest including avoiding those involving financial or personal gain; Uphold the dignity and honor of the profession and abide by its ethical principles; and Be familiar with existing state and federal laws governing the practice of perfusion and comply with those laws; and May not: Delegate any perfusion duty to an individual not having the appropriate training and skill to undertake such responsibility; Falsify documentation on patient records; and Falsify reports submitted to the Board. All services shall be provided with respect for the dignity of the patient, unrestricted by considerations of: Social or economic status; Personal attributes; or The nature of health problems. A breach of ethical principles may be considered immoral or unprofessional conduct in the practice of perfusion. In evaluating the standards of care for the practice of a licensed perfusionist, the Board may consider, but is not limited to, the guidelines published by the American Society of Extracorporeal Technology (AmSECT). If a particular practice issue has not yet been addressed in the AmSECT guidelines, the Board may consult with a licensed perfusionist-advanced. The Board shall license an individual if the individual meets the requirements of §§B and C of this regulation. An individual applying for a license shall: Complete an application on a form supplied by the Board; Pay the required application fee set by the Board in Regulation .13 of this chapter; Be 18 years old or older; Be of good moral character; Demonstrate spoken and written competency in English by any of the following: Documentation of graduation from a recognized English-speaking high school or undergraduate school after at least 3 years of enrollment; Documentation of graduation from a recognized English-speaking professional school; or Documentation of receiving a grade of at least: 26 on the “Speaking Section” of the Internet-based Test of English as a Foreign Language; and 79 on the total score of the Internet-based Test of English as a Foreign Language; If applicable, provide documentation of licensure, certification, or registration from all states and jurisdictions where the applicant has ever held a license, certificate, or registration in any health profession; Have no history of public disciplinary action taken, or pending, against any license currently or previously held or expired; and Complete a criminal history records check in accordance with Health Occupations Article, §14-308.1, Annotated Code of Maryland. An applicant for a license as: A perfusionist-basic shall submit satisfactory evidence of graduation from a perfusion educational program that is accredited by the Commission on Accreditation of the Allied Health Education Program, or the Commission’s predecessor or successor; A perfusionist-advanced shall submit satisfactory evidence of current national certification from the National Certifying Board. A licensed perfusionist may practice only under the supervision of a licensed physician. The scope of practice of a licensed perfusionist is performance of the functions necessary for the support, treatment, measurement, or supplementation of the cardiovascular, circulatory, or respiratory systems, or other organs to ensure the safe management of physiologic functions by monitoring and analyzing the parameters of the systems. The scope of practice of a licensed perfusionist includes the following special procedures, performed on the order of and under the supervision of a licensed physician: Cardiopulmonary bypass for adult, pediatric, and neonatal patients; Extracorporeal circulatory support for renal, neurological, hepatic, and vascular surgery; Extracorporeal resuscitation; Extracorporeal circulation for long-term support of failing respiratory or cardiac function; Extracorporeal membrane oxygenation; Extracorporeal carbon dioxide removal; Myocardial protection; Perfusion-assisted direct coronary artery bypass; Hemofiltration and hemodialysis; Anticoagulation and hemostasis monitoring, analysis, and intervention; Thermal regulation; Blood gas and blood chemistry monitoring, analysis, and intervention; Physiological monitoring, analysis, and intervention; Administration of blood components and pharmaceuticals; Administration of anesthetic agents through a heart lung machine at the direction of an anesthesiologist; Ventricular assist device and mechanical circulatory support management; Intra-aortic balloon counterpulsation; Temporary pacemaker management; Periodic flow augmentation therapy; Autotransfusion; Platelet gel production, autologous hemocyte tissue matrix production; Nondifferentiated progenitor cell harvest bone marrow aspirate concentration; Acute normovolemic hemodilution; Isolated limb or organ delivery of chemotherapeutics, progenitor cells, gene therapy vectors, and other items; Organ procurement and preservation; Thermogenic lavage; Electrophysiological analysis; Therapeutic hyperthermia; Intravascular membrane oxygenation; and Renal perfusion. A licensed perfusionist shall wear an identification tag or a badge which identifies that individual as a licensed perfusionist. License. A licensed perfusionist shall: Keep a copy of the licensee’s license in their employment file; and Make the license available for inspection upon request. If the perfusionist has multiple places of employment, copies of the license may be kept in accordance with §B(1) of this regulation. Change of Name or Address. A licensed perfusionist shall notify the Board in writing of any changes in name or mailing address within 60 days. The Board may impose a fine of $100 for failure to notify the Board of a change in name or mailing address. Term and Expiration. A perfusionist-basic license shall expire 2 years after it is issued. Except as provided in §§D and E of this regulation, a perfusionist-basic license may not be renewed or extended beyond the 2-year expiration date. An individual who previously held a perfusionist-basic license may not be granted a new perfusionist-basic license. Upon expiration of the perfusionist-basic license, an individual who does not meet the requirements for a perfusionist-advanced license is ineligible for licensure and may not practice perfusion in this State. Conversion. The holder of a perfusionist-basic license shall convert the license to a perfusionist-advanced license at any time before the expiration after meeting the requirements outlined in Regulation .06B(2) of this chapter. The individual shall ensure that the national certifying board submits evidence, satisfactory to the Board, that the individual meets the requirements of Regulation .06B(2) of this chapter. If the Board receives the notification specified in §B(2) of this regulation, the Board shall issue a perfusionist-advanced license to the individual at no additional charge. If the holder of the perfusionist-basic license fails to convert the license to a perfusionist-advanced license before the expiration date, the individual shall file a new application for a perfusionist-advanced license. Conversion-or-Expiration Notice. At least 1 month before the expiration of the perfusionist-basic license, the Board shall send notice to the licensed perfusionist-basic that states: The date on which the current perfusionist-basic license expires; The date by which notification of meeting requirements outlined in Regulation .06B(2) shall be received in order to convert to a perfusionist-advanced license before the perfusionist-basic license expires; and Notice that upon expiration of the perfusionist-basic license, if the holder does not qualify for a perfusionist-advanced license, the holder is no longer permitted to practice perfusion in this State. The Board may permit a perfusionist with a basic license to continue to practice on that license if extenuating circumstances prevented the applicant for an advanced license from taking the national certifying examination given by the American Board of Cardiovascular Perfusion. The applicant shall specify the: Extenuating circumstances; and Basis for granting the request. Petition for Extension. At the discretion of the Board, a petition for extension of a perfusionist-basic license expiration date may be considered if: The licensee: Incurs a hardship that prevents the licensee from active use of the perfusionist-basic license for a period of at least 45 consecutive calendar days; Provides a written request, with supporting documentation if applicable, stating the extenuating circumstances that will prohibit or has prohibited the licensee from active use of the perfusionist-basic license for at least 45 consecutive calendar days; and Provides an anticipated date for resuming activity on the perfusionist-basic license; and The national certifying examination has been administered during no more than three testing windows from the time the application for the perfusionist basic license was approved. A perfusionist with a basic license may not practice during the paused time frame. Practicing or attempting to practice without an active license is in violation of Regulation .15 of this chapter and is punishable under that regulation. The Board may grant a one-time extension of the perfusionist-basic license expiration date but the extension may not exceed the time period that the perfusionist with the basic license did not have active use of the license. The Board may grant an extension if the Board determines that failure to fulfill the license requirements is clearly the result of: Functional impairment; Prolonged and serious illness; Mandatory military service or deployment; A prolonged absence from the United States; An officially declared disaster; or Other exceptional circumstances beyond the control of the applicant. Failing the national certification examination is not grounds for obtaining an extension. Renewal Notice. At least 1 month before the license expires, the Board shall send a renewal notice to the licensed perfusionist-advanced that states: The date on which the current license expires; The date by which the renewal application shall be received by the Board for the renewal to be issued and mailed before the license expires; and The amount of the renewal fee set by the Board in Regulation .13 of this chapter. Renewal. The term of a license issued by the Board may not exceed 3 years. The Board may not renew a license until the Comptroller of Maryland has verified that the individual has paid all undisputed taxes and unemployment insurance contributions, or arranged for repayment, as required by COMAR 10.31.02. An individual licensed as a perfusionist-basic may not renew the license. An individual who has been licensed by the Board as a perfusionist-advanced may renew the license every 2 years on or before the date specified by the Board by: Submitting a renewal application online or on a form supplied by the Board; Paying the required renewal fee set by the Board in Regulation .13 of this chapter; Attesting to current certification by the National Certifying Board; and Being of good moral character. Reinstatement. The Board shall reinstate the license of a perfusionist-advanced who has failed to renew the license for any reason if the perfusionist-advanced: Completes a reinstatement application on a form supplied by the Board; Meets any additional requirements set by the Board for reinstatement of a license; Pays the required reinstatement fee and any other applicable fees set by the Board; Is of good moral character; and Completes a criminal history records check in accordance with Health Occupations Article, §14-308.1, Annotated Code of Maryland. Reinstatement of a Revoked License. On the application of an individual whose license has been revoked, the Board, on the affirmative vote of a majority of the quorum, may in its discretion reinstate a revoked license. When a time period is not stated in an order for revocation: The Board may not entertain an application for post-disciplinary reinstatement until at least 3 years after the date of the order; and A revocation of a license may not be for less than 1 year. The Board may not entertain an application for post-disciplinary reinstatement after an order of revocation unless: Any time period stated in the order has expired; Any condition set out in the order has been fulfilled; The applicant has filed a formal application and paid the fee set by the Board in Regulation .13 of this chapter; and The applicant meets all of the requirements for reinstatement set out in §D of this regulation. The Board shall entertain applications for reinstatement pursuant to the procedures and standards of COMAR 10.32.02.06B. The Board may not entertain applications for reinstatement if a revocation is permanent. Application. The continuing education requirements apply to all renewal applications. The Board may not renew or reinstate the license of a perfusionist-advanced unless the perfusionist-advanced has met the requirements for continuing education described in §B of this regulation. Requirements. A licensed perfusionist-advanced shall meet continuing education requirements sufficient to maintain current national certification from the National Certifying Board. Documentation of Continuing Education Credits. A current certificate from the national certifying board will serve as documentation of continuing education credits earned. Application. The clinical activity requirements apply to all renewal applications. The Board may not renew or reinstate the license of a perfusionist-advanced unless the perfusionist-advanced has met the requirements for clinical activity described in §B of this regulation. Requirements. A licensed perfusionist-advanced shall meet clinical activity requirements sufficient to maintain current national certification from the national certifying board. Documentation of Clinical Activity. A current certificate from the national certifying board will serve as documentation of clinical activities performed. The following non-refundable fees are applicable to perfusionists: Perfusionist initial license application fee: Before October 1, 2015 — $300; and After October 1, 2015 — To be determined and promulgated in regulations by the Board in accordance with Health Occupations Article, §14-205(a)(16), Annotated Code of Maryland (Supp. 2013); Perfusionist license renewal fees, after October 1, 2015: License renewal fee — To be determined and promulgated in regulations by the Board in accordance with Health Occupations Article, §14-205(a)(16), Annotated Code of Maryland (Supp. 2013); Maryland Health Care Commission (MHCC) fee — As determined by MHCC under COMAR 10.25.03; Reinstatement fee, after October 1, 2015 — To be determined and promulgated in regulations by the Board in accordance with Health Occupations Article, §14-205(a)(16), Annotated Code of Maryland (Supp. 2013); Written verification of licensure fee — $25; and Replacement of license fee — $25 Subject to the hearing provision of Health Occupations Article, §14-405, Annotated Code of Maryland, the disciplinary panel may deny a license to any applicant, reprimand any licensee, place any licensee on probation, or suspend or revoke a license if the applicant or licensee: Fraudulently or deceptively obtains or attempts to obtain a license for the applicant or licensee or for another; Fraudulently or deceptively uses a license; Is guilty of unprofessional or immoral conduct in the practice of perfusion; Is professionally, physically, or mentally incompetent; Abandons a patient; Is habitually intoxicated; Is addicted to, or habitually abuses, any narcotic or controlled dangerous substance as defined in Criminal Law Article, §5-101, Annotated Code of Maryland; Provides professional services while: Under the influence of alcohol; or Using any narcotic or controlled dangerous substance as defined in Criminal Law Article, §5-101, Annotated Code of Maryland, or any other drug that is in excess of therapeutic amounts or without valid medical indication; Promotes the sale of services, drugs, devices, appliances, or goods to a patient so as to exploit the patient for financial gain; Willfully makes or files a false report or record in the practice of perfusion; Willfully fails to file or record any report as required under law, willfully impedes or obstructs the filing or recording of a report, or induces another to fail to file or record a report; Breaches patient confidentiality; Pays or agrees to pay any sum or provide any form of remuneration or material benefit to any person for bringing or referring a patient or accepts or agrees to accept any sum or any form of remuneration or material benefit from an individual for bringing or referring a patient; Knowingly makes a misrepresentation while practicing perfusion; Knowingly practices perfusion with an unauthorized individual or aids an unauthorized individual in the practice of perfusion; Knowingly delegates a perfusion duty to an unlicensed individual; Offers, undertakes, or agrees to cure or treat disease by a secret method, treatment or medicine; Is disciplined by a licensing or disciplinary authority or is convicted or disciplined by a court of any state or country or is disciplined by any branch of the United States uniformed services or the US Department of Veterans Affairs for an act that would be grounds for disciplinary action under the Board’s disciplinary statutes; Fails to meet appropriate standards for the delivery of perfusion services; Knowingly submits false statements to collect fees for which services are not provided; Has been subject to investigation or disciplinary action by a licensing or disciplinary authority or by a court of any state or country for an act that would be grounds for disciplinary action under the Board’s disciplinary statutes; and has: Surrendered the license, if any, issued by the state or country; or Allowed the license, if any, issued by the state or country to expire or lapse; Knowingly fails to report suspected child abuse in violation of Family Law Article, §5-704, Annotated Code of Maryland; Sells, prescribes, gives away, or administers drugs for illegal or illegitimate medical purposes; Practices or attempts to practice beyond the authorized scope of practice; Is convicted of or pleads nolo contendere to a felony or to a crime involving moral turpitude, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside; Refuses, withholds from, denies, or discriminates against an individual with regard to the provision of professional services for which the licensee is licensed and qualified to render because the individual is HIV positive; Practices or attempts to practice a perfusion procedure or uses or attempts to use perfusion equipment if the applicant or licensee has not received education and training in the performance of the procedure or the use of the equipment; or Fails to cooperate with a lawful investigation of the Board. Fails to complete a criminal history records check in accordance with Health Occupations Article, §14-308.1, Annotated Code of Maryland. Crimes of Moral Turpitude. On the filing of certified docket entries with the Board by the Office of the Attorney General, the disciplinary panel shall order the suspension of a license if the licensee is convicted of, or pleads guilty or nolo contendere with respect to, a crime involving moral turpitude, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside. After completion of the appellate process, if the conviction has not been reversed or the plea has not been set aside with respect to a crime involving moral turpitude, the disciplinary panel shall order the revocation of a license on the certification by the Office of the Attorney General. Unless the disciplinary panel agrees to accept the surrender of a license, a licensed perfusionist may not surrender the license nor may the license lapse by operation of law while the licensee is under investigation or while charges are pending against the licensee. Except as otherwise provided in Health Occupations Article, §14-5E-01(g), Annotated Code of Maryland, an individual may not practice, attempt to practice, or offer to practice perfusion in this State unless licensed to practice perfusion by the Board. An individual who violates any provision of this chapter is subject to a civil fine of not more than $5,000 to be levied by the disciplinary panel. The Board shall pay any penalty collected under this regulation into the Board of Physicians Fund. A. Complaints alleging prohibited conduct shall be referred to the disciplinary panel to be investigated according to the disciplinary panel’s procedures. A hearing on charges issued under Regulation .14 of this chapter or Health Occupations Article, §14-5E-16(a), Annotated Code of Maryland, shall be held in accordance with the hearing provisions of Health Occupations Article, §14-405, Annotated Code of Maryland. Proceedings for crimes of moral turpitude under Health Occupations Article, §14-5E-16 (c), Annotated Code of Maryland, or Regulation .14B of this chapter, shall be held in accordance with COMAR 10.32.02.08. Appeals from a final Board decision shall be taken in accordance with Health Occupations Article, §14-5E-17, Annotated Code of Maryland. Except as provided in §B, C, or F of this regulation, hospitals, related institutions, alternative health systems as defined in Health Occupations Article, §1-401, Annotated Code of Maryland, and employers shall file with the Board a report that the hospital, related institution, alternative health system, or employer limited, reduced, otherwise changed, or terminated any licensed perfusionist for any reason that might be grounds for disciplinary action under Health Occupations Article, §14-5E-16, Annotated Code of Maryland, or any regulation in this chapter. If the action taken by a hospital, related institution, alternative health system, or employer under §A of this regulation relates to alcohol or drug impairment, the hospital, related institution, alternative health system or employer is not required to report the perfusionist to the Board if: The hospital, related institution, alternative health system, or employer knows that the licensed perfusionist is: In an alcohol or drug treatment program that is: Accredited by The Joint Commission or its successor; or Certified by the Maryland Department of Health; or Under the care of a health care practitioner who is competent and capable of dealing with alcoholism and drug abuse; The perfusionist takes appropriate steps to permit the hospital, related institution, alternative health system, or employer to verify that the licensed perfusionist remains in the treatment program and is compliant with the requirements of that program until discharge; and The action of condition of the licensed perfusionist has not caused injury to an individual while the perfusionist is practicing as a licensed perfusionist. If a licensed perfusionist enters or is considering entering an alcohol or drug treatment program that is accredited by The Joint Commission or its successor that is certified by the Maryland Department of Health, the licensed perfusionist shall notify the hospital, related institution, alternative health system, or employer of the licensed perfusionist’s decision to enter the treatment program. If the licensed perfusionist fails to provide the notice required under §C of this regulation, and the hospital, related institution, alternative health system, or employer learns that the licensed perfusionist has entered a treatment program, the hospital related institution, alternative health system, or employer shall report to the Board that the licensed perfusionist has: Entered a treatment program; and Failed to provide the required notice. If the perfusionist has failed to take appropriate steps or has failed to remain compliant under §B(2) of this regulation or has failed to provide the required notice under §C of this regulation, the perfusionist may not use his or her participation in the treatment program as a mitigating circumstance in any disciplinary action. Noncompliance. If the licensed perfusionist is found to be noncompliant with the treatment program’s policies and procedures while in the treatment program, the treatment program shall notify the hospital, related institution, alternative health system, or employer of the licensed perfusionist’s noncompliance. On receipt of the notification required under §C of this regulation, the hospital, related institution, alternative health system, or employer of the licensed perfusionist shall report the licensed perfusionist’s noncompliance to the Board. A person as defined in Health Occupations Article, §14-101(h), Annotated Code of Maryland, is not required under this regulation to make any report that would be in violation of any federal or state law, rule, or regulation concerning the confidentiality of alcohol and drug abuse patient records. The hospital, related institution, alternative health system, or employer shall submit a required report within 10 days of any action described in this regulation. A report made under this regulation is not subject to subpoena or discovery in a civil action other than a proceeding arising out of a hearing and decision of the Board under Health Occupations Article, Title 14, Annotated Code of Maryland. General Application of Sanctioning Guidelines. Sections A and B of this regulation and Regulation .19 of this chapter do not apply to offenses for which a mandatory sanction is set by statute or regulation. Except as provided in §B of this regulation, for violations of Health Occupations Article §14-5E-16 Annotated Code of Maryland, listed in the sanctioning guidelines, the disciplinary panel shall impose a sanction not less severe than the minimum listed in the sanctioning guidelines nor more severe than the maximum listed in the sanctioning guidelines for each offense. Ranking of Sanctions. For the purposes of this regulation, the severity of sanctions is ranked as follows, from the least severe to the most severe: Reprimand; Probation; Suspension; and Revocation. A stayed suspension in which the stay is conditioned on the completion of certain requirements is ranked as probation. A stayed suspension not meeting the criteria for §A(3)(b) of this regulation is ranked as a reprimand. A fine listed in the sanctioning guidelines may be imposed in addition to, but not as a substitute for a sanction. If a fine is listed, then at least the minimum fine will be imposed in addition to the sanction. The imposition of a fine does not affect the making of the sanction. The disciplinary panel may impose more than one sanction, provided that the most severe sanction neither exceeds the maximum nor is less than the minimum sanction permitted in the chart. Any sanction may be accompanied by conditions reasonably related to the offense or to the rehabilitation of the offender. The inclusion of conditions does not change the ranking of the sanction. If a licensee has violated more than one ground for discipline as set out in the sanctioning guidelines: The sanction with the highest severity ranking should be used to determine which ground will be used in developing a sanction; and The Board may impose concurrent sanctions based on other grounds violated. Notwithstanding the sanctioning guidelines set forth in Regulation .19 of this chapter, in order to resolve a pending disciplinary action, the Board and the licensee may agree to a surrender of license or a consent order with terms and sanction agreed to by the Board, the administrative prosecutor, and the licensee. Aggravating and Mitigating Factors. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the Board may consider the aggravating and mitigating factors set out in §B(4) and (5) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines. Nothing in this regulation requires the Board or an Administrative Law Judge to make findings of fact with respect to any of these factors. The existence of one or more of these factors does not impose on the Board or an Administrative Law Judge any requirement to articulate its reasoning for not exercising its discretion to impose a sanction outside of the range of sanctions set out in the sanctioning guidelines. Mitigating factors may include, but are not limited to, the following: The absence of a prior disciplinary record; The offender self-reported the incident; The offender voluntarily admitted the misconduct, made full disclosure to the Board and was cooperative during the Board proceedings; The offender implemented remedial measures to correct or mitigate the harm arising from the misconduct; The offender made good faith efforts to make restitution or to rectify the consequences of the misconduct; The offender has been rehabilitated or exhibits rehabilitative potential; The misconduct was not premeditated; There was no potential harm to patients or the public or other adverse impact; or The incident was isolated and is not likely to recur. Aggravating factors may include, but are not limited to, the following: The offender has a previous criminal or administrative disciplinary history; The offense was committed deliberately or with gross negligence or recklessness; The offense had the potential for or actually did cause patient harm; The offense was part of a pattern of detrimental conduct; The offender committed a combination of factually discrete offenses adjudicated in a single action; The offender pursued his or her financial gain over the patient’s welfare; The patient was especially vulnerable; The offender attempted to hide the error or misconduct from patients or others; The offender concealed, falsified, or destroyed evidence or presented false testimony or evidence; The offender did not cooperate with the investigation; or Previous attempts to rehabilitate the offender were unsuccessful. Offenses Related to Continuing Education Credits. Willful Falsification. If a licensee has willfully falsified an application with respect to continuing education credits, the licensee may be charged under one or more of the following, as appropriate: Health Occupations Article, §14-5E-16(a)(1), Annotated Code of Maryland; Health Occupations Article, §14-5E-16(a)(3), Annotated Code of Maryland; Health Occupations Article, §14-5E-16(a)(10), Annotated Code of Maryland; and Health Occupations Article, §14-5E-16(a)(11), Annotated Code of Maryland. Upon finding a violation, the Board may impose any discipline authorized under Health Occupations Article, §14-5E-16, Annotated Code of Maryland, and the sanctioning guidelines. Licensees Previously Disciplined Under §C(1) of this regulation. Upon a finding of a violation, the Board may impose any discipline authorized under Health Occupations Article, §14-5E-16, Annotated Code of Maryland, and the sanctioning guidelines for a subsequent offense. The Board may not apply the sanction described in §C(1) of this regulation in determining a sanction for a licensee previously disciplined for an offense related to continuing education credits. Offenses Related to Clinical Activity. Willful Falsification. If a licensee has willfully falsified an application with respect to clinical activities, the licensee may be charged under one or more of the following, as appropriate: Health Occupations Article, §14-5E-16(a)(1), Annotated Code of Maryland; Health Occupations Article, §14-5E-16(a)(3), Annotated Code of Maryland; Health Occupations Article, §14-5E-16(a)(10), Annotated Code of Maryland; and Health Occupations Article, §14-5E-16(a)(11), Annotated Code of Maryland. Upon a finding of a violation, the Board may impose any discipline authorized under Health Occupations Article, §14-5E-16, Annotated Code of Maryland, and the sanctioning guidelines. Licensees Previously Disciplined Under §D(1) of this regulation. Upon a finding of a violation, the Board may impose any discipline authorized under Health Occupations Article, §14-5E-16, Annotated Code of Maryland, and the sanctioning guidelines. The Board may not apply the sanction described in §D(1) of this regulation in determining as sanction for a licensee previously fined or disciplined for an offense related to criminal activities. Subject to provisions of Regulation .18A and B of this chapter, the Board may impose sanctions as outlined in §B of this regulation on perfusionists for violations of Health Occupations Article, §14-5E-16, Annotated Code of Maryland, or Regulation .14 of this chapter. Range of Sanctions. Health Occupations Article, §§1-221, 1-606, 14-205, 14-5E-01 — 14-5E-20, and 14-5E-23, Annotated Code of Maryland Effective date: September 15, 2014 (41:18 Md. R. 1010) Regulation .02B amended effective January 19, 2026 (53:1 Md. R, 21) Regulation .03 amended effective January 19, 2026 (53:1 Md. R, 21) Regulation .03A amended effective August 15, 2016 (43:16 Md. R. 900) Regulation .06 amended effective January 19, 2026 (53:1 Md. R, 21) Regulation .08B amended effective August 15, 2016 (43:16 Md. R. 900) Regulation .09A amended effective August 15, 2016 (43:16 Md. R. 900) Regulation .09D, E adopted effective August 15, 2016 (43:16 Md. R. 900) Regulation .10 amended effective August 15, 2016 (43:16 Md. R. 900); January 19, 2026 (53:1 Md. R, 21) Regulation .11B amended effective January 19, 2026 (53:1 Md. R, 21) Regulation .14 amended effective January 19, 2026 (53:1 Md. R, 21) Regulation .15 amended effective August 15, 2016 (43:16 Md. R. 900) Regulation .15B amended effective January 19, 2026 (53:1 Md. R, 21) Regulation .16A amended effective January 19, 2026 (53:1 Md. R, 21) Regulation .17B, C amended effective August 15, 2016 (43:16 Md. R. 900) Regulation .18 amended effective August 15, 2016 (43:16 Md. R. 900) Regulation .18A, C amended effective January 19, 2026 (53:1 Md. R, 21) This chapter governs how an individual becomes licensed as a naturopathic doctor and how naturopathic doctors are regulated and disciplined. In this chapter, the following terms have the meanings indicated. Terms Defined. “Approved naturopathic medical program” means a naturopathic medical education program: In the United States that: Provides the degree of Doctor of Naturopathy or Doctor of Naturopathic Medicine; Offers a 4-year graduate level full-time didactic and supervised clinical training; Is accredited or has achieved candidacy status for accreditation, by the council on naturopathic medial education or an equivalent federally and Board recognized accrediting body for naturopathic medical education programs; and Is part of an institution of higher education that is either accredited, or is a candidate for accreditation, by a regional or national institutional accrediting agency recognized by the United States Secretary of Education; In a diploma-granting, degree-equivalent college or university in Canada that: Offers graduate level, full-time didactic and supervised clinical training; and Is accredited, or has achieved candidacy status for accreditation, by the council of naturopathic medical education or an equivalent federally and Board recognized accrediting body for participation in government-funded student aid programs; or Has provincial approval for participation in government-funded student aid programs. “Articular manipulation” means manipulation of the joints up to but not including manipulation beyond the elastic limit and exclusive of low amplitude, high velocity thrusts, also known as Grade V manipulations. “Attestation” means a statement of intent. “Board” means the State Board of Physicians. “Central Repository” means the Criminal Justice Information System Central Repository of the Department of Public Safety and Correctional Services. “Collaborate” means a cooperative relationship between naturopathic doctors and licensed physicians, which does not imply or create a supervisory relationship between the licensed physician and the naturopathic doctor. “Collaboration and consultation agreement” means an agreement whereby a naturopathic doctor and physician will collaborate and consult regarding a patient’s care, but in which the: Patient does not enter the care of the consulted physician; Consultation does not create a physician-patient relationship; and Consulted physician does not direct patient care or engage directly in the care of the patient. “Committee” means the Naturopathic Medicine Advisory Committee. “Consult” or “consultation” means a process whereby a naturopathic doctor seeks the advice or opinion of a licensed or certified health care provider as needed in the treatment of a patient, which may include discussion of the: Patient’s diagnosis; Differential diagnoses and diagnostic method; Current naturopathic treatment; Patient’s response thus far to naturopathic treatment; Potential medical and other options outside the naturopathic doctors scope of practice that might benefit the patient; Patient’s potential response to diagnostic and treatment options outside the naturopathic doctor’s scope of practice; and Patient’s expected prognosis. “Corrective and orthopedic gymnastics” means therapeutic exercises, stretching, and other movement therapies intended to promote healing and rehabilitation. “Council” means the Naturopathic Doctors Formulary Council. “Criminal history records check” means the performance of both a State criminal history check by the Central Repository, and a national criminal history check by the Federal Bureau of Investigation. “Criminal history records information” means information provided by the criminal history records check regarding an applicant’s criminal arrests, charges, and convictions, and the disposition of pending criminal charges. “Diagnostic imaging” includes, but is not limited to, X-ray, ultrasound, mammogram, bone densitometry, computed tomography (CT scans), magnetic resonance imaging (MRI scans), endoscopic exam, and all other forms of nuclear imaging. “Electromagnetic energy” means electric and magnetic energy administered through the use of a therapeutic device, including, but not limited to, transcutaneous electrical nerve stimulation, microcurrent electrical muscle stimulation, diathermy, infrared, ultra-violet treatments, and other devices which utilize electrical or magnetic force for therapeutic effect. “Electrotherapy” means treatment through application of electric energy administered through the use of therapeutic devices, including, but not limited to, transcutaneous electrical nerve stimulation, microcurrent electrical neuromuscular stimulation, and other devices which utilize electrical force for therapeutic effect. Goods. “Goods” means items that can be sold. “Goods” includes, but is not limited to, natural medicines referenced in Health Occupations Article, §14-5F—14(a)(3) and (4), Annotated Code of Maryland. Hydrotherapy. “Hydrotherapy” means external and internal applications of hot and cold water, ice, and steam for therapeutic purposes. “Hydrotherapy” includes, but is not limited to, hot or cold compresses, hydrocollator packs, hot or cold baths or showers involving the full body or specific body parts. “Licensed naturopathic doctor” means a naturopathic doctor who is licensed by the Board to practice naturopathic medicine. “Mechanical sciences of healing” means techniques and therapies which attempt to promote healing via mechanical or physical applications. “Mechanotherapy” means treatment by mechanical means including the use of durable medical and therapeutic devices. “Natural medicine” means medicine derived from mineral, animal, or botanical origin. “Naturopathic doctor” means an individual who practices naturopathic medicine. Naturopathic Medicine. “Naturopathic medicine” means the prevention, diagnosis, and treatment of human health conditions, injury, and disease using only patient education and naturopathic therapies and their therapeutic substances recognized by the council of naturopathic therapies and therapeutic substances recognized by the Council of Naturopathic Medical Education. “Naturopathic medicine” includes: Counseling; The practice of the mechanical sciences of healing, including mechanotherapy, articular manipulations, corrective and orthopedic gymnastics, hydrotherapy, electrotherapy, and phototherapy; and The practice of the material sciences of healing, including nutrition, phytotherapy, treatment by natural substances, and external applications. “Naturopathic musculoskeletal mobilization” means the treatment by manual and other mechanical means of all body tissues exclusive of high-velocity thrusts at or beyond the end range of normal joint motion. “Non-bona-fide treatment” means when: A naturopathic doctor treats or examines a patient in a way that involves sexual contact when there is no medical reason for the procedure; or The procedure falls outside a naturopathic doctor’s scope of practice. “Phototherapy” means treatment through application of light, including visible light, ultraviolet light, infrared, natural sources of light, and artificial sources of light. Physiological Function Tests. “Physiological function tests” means all tests performed to assess and diagnose physiological processes in all bodily systems. “Physiological function tests” include, but are not limited to, respiratory testing, heart rate, percent body fat, body composition, and others, as consistent with naturopathic medical education. “Phytotherapy” means treatment by use of botanical medicines. “Prescription drug” means any drug defined in the federal Food, Drug, and Cosmetic Act, 21 U.S.C. §503(b), as amended, if the drug’s label is required to bear the statement “Rx only”. “Sexually exploitative relationship” means a naturopathic doctor taking advantage of an unequal relationship between the naturopathic doctor and patient, staff member, or student. “Therapeutic deception” means representation by a naturopathic doctor that sexual contact or sexual activity by or with a patient is consistent with or part of a patient’s treatment. The Committee shall consist of five members appointed by the Board as follows: Two members shall be individuals who: Practice naturopathic medicine; Are certified by the North American Board of Naturopathic Examiners; Have a minimum of 2 years’ experience in naturopathic medicine; and By March 1, 2016 or thereafter, are licensed as a naturopathic doctor; One member: Shall be a consumer member; Shall be a resident of Maryland; May not be or ever have been licensed to practice a health occupation in Maryland; and May not have a substantial personal, business, professional, or pecuniary connection with naturopathic education, business, or practice; One member shall be a practicing: Licensed physician; or Doctor of osteopathy who is a member of the Board; and One member shall be a practicing licensed physician or practicing licensed doctor of osteopathy with experience working with naturopathic doctors by having met one or more of the following criteria: Worked in the same clinical practice as a licensed naturopathic doctor; Named in an attestation submitted by a licensed naturopathic doctor; Employed by a naturopathic medicine program accredited by the Council on Naturopathic Medical Education; Worked with, or supervised, a naturopathic resident completing a naturopathic medical residency accredited by the Council on Naturopathic Medical Education; Graduated from a naturopathic medical program accredited by the Council on Naturopathic Medical Education and holding a naturopathic doctor or naturopathic physician license in any state that licenses Naturopathic Doctors or Naturopathic Medical Doctors in addition to holding a medical doctorate or doctor of osteopathy physician’s license; Was a Diplomate of the American Board of Integrative Medicine, a graduate of any fellowship program in Integrative Medicine approved by the American Board of Integrative Medicine, a graduate of any fellowship program in Integrative Medicine approved by the American Board of Medical Specialties, or a diplomate of the American Board of Integrative Holistic Medicine; or Accrued at least 20 Category 1 continuing medical education credits, in the 2 years before serving, in topics of natural, nutritional, holistic or integrative medicine delivered by a professional association whose primary mission is the advancement of one of these fields. The Committee shall: On request, review selected applications for licensure or reinstatement of naturopathic doctors and make recommendations to the Board as to what action to take on the applications; Review each written attestation; Make recommendations to the Board regarding regulations governing naturopathic doctors; Advise the Board on matters related to the practice of naturopathic medicine; Develop and recommend to the Board examination standards consistent with the statutory requirement; Develop and recommend to the Board a code of ethics for licensed naturopathic doctors; and Develop and recommend to the Board continuing education requirements for license renewal and reinstatement. The Council consists of the following members: The Deputy Secretary for Public Health Services or the Deputy Secretary’s designee; and The following members, appointed by the Board: Two individuals who: Are licensed in the State as naturopathic doctors; Practice naturopathic medicine in the State; Are certified by the North American Board of Naturopathic Examiners; and Have a minimum of 2 years experience; Two licensed physicians who practice in the State; One pharmacist who has a background in pharmacognosy and who practices in the State; and One consumer of naturopathic services. Term of Appointment—Naturopathic Doctors Formulary Council. The term of an appointed member of the Council is 4 years and is staggered. At the end of a term, an appointed member continues to serve until a successor is appointed. An individual may be reappointed for a second 4-year term but may not serve more than two consecutive 4-year terms. The terms of the initial members of the Naturopathic Doctors Formulary Council shall expire as follows: In 2025: One naturopathic doctor member; One physician member; and The consumer member; and In 2027: One naturopathic doctor member; One physician member, and The pharmacist member. A member of the Council may not receive compensation as a member of the Council, but is entitled to reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget. The Board shall designate the chair of the Council, whose term of office of the chair is 2 years. The Board shall provide staff for the Council. Council Duties. The Council shall: Develop and recommend to the Board a formulary for use by licensed naturopathic doctors; Annually review the formulary adopted by the Board under §B(2) of this regulation to determine if any changes are necessary for compliance with current prescribing standards or the practice of naturopathic medicine; Otherwise review the formulary at the direction of the Board; and Make recommendations to the Board based on the reviews conducted under this regulation. The Board shall adopt a formulary based on the Council's recommendations under this regulation. Board Duties. The Board may modify or reject any recommendation of the Council regarding the formulary. The formulary adopted by the Board shall be in accordance with Health Occupations Article, §14-5F-04.1, Annotated Code of Maryland. To qualify for a license, an applicant shall meet the following requirements: Be of good moral character; Be at least 21 years of age; Have a doctorate in naturopathic medicine from an approved naturopathic medical program; Pass a competency based national naturopathic licensing examination part I and part II administered by the North American Board of Naturopathic Examiners or its successor agency that is consistent with federal standards of education and training; Be physically and mentally capable of safely practicing naturopathic medicine with or without reasonable accommodation; and If an applicant is licensed, certified, or registered to practice naturopathic medicine or any other health occupation in another state, be in good standing with the applicable state licensing, certification, or registration authority. To apply for a license, an applicant shall: Submit an application to the Board on a form that the Board requires; Pay to the Board an initial application fee as specified in Regulation .20 of this chapter; Submit to the Board a written attestation as provided in Regulation .05 of this chapter; and If the applicant has been licensed, certified, or registered to practice naturopathic medicine in another state, submit all evidence relating to: Any disciplinary action taken or any administrative penalties assessed against the applicant by the appropriate state licensing, certification, or registration authority; and Any consent agreements into which the applicant entered that contain conditions placed on the applicant’s professional conduct and practice, including any voluntary surrender of a license. Additional Requirements. An applicant shall submit to a criminal history records check in accordance with Health Occupations Article, §14-308.1, Annotated Code of Maryland, by submitting to the Central Repository: Two complete sets of legible fingerprints taken on forms approved by the Central Repository and the Federal Bureau of Investigation; and All fees required by the Central Repository and the Federal Bureau of Investigation. The Board shall issue a license to an applicant who meets the requirements of this regulation. A collaboration and consultation agreement shall: Include the name and license number of the physician with whom the applicant has the collaboration and consultation agreement; State that the applicant will require patients to sign a consent form in plain language that: The naturopathic doctor’s practice of naturopathic medicine is limited to the scope of practice identified in Health Occupations Article, §14-5F-14, Annotated Code of Maryland; and Describes the differences in scope of practice between naturopathic doctors and physicians; State that naturopathic doctors shall refer patients to and consult with physicians and other health care providers licensed or certified under the Health Occupations Article as needed; and State that in cases where the naturopathic doctor diagnoses a patient with a life threatening condition, the naturopathic doctor shall: Counsel and discuss with the patient the potential benefits offered by other physicians or other healthcare professionals; and Attempt to make the appropriate referral. An applicant shall complete and submit to the Board a written attestation on a form supplied by the Board that states that the applicant has a collaboration and consultation agreement: With a physician that is licensed in this State under Health Occupations Article, Title 14, Annotated Code of Maryland; and That meets the requirements of §A of this regulation. An applicant shall inform the physician named as a collaborating physician in the attestation that the physician has been named. A licensee shall maintain a collaboration and consultation agreement that meets the requirements of this regulation in order to practice naturopathic medicine in the State. A licensee shall comply with the requirements of the licensee’s collaboration and consultation agreement with a physician. The applicant shall submit an application on a form supplied by the Board. A completed application shall include: Verification of naturopathic medical education; Documentation of successful completion of the examination requirements as described in Regulation .04A(4) of this chapter, including submission of all of the applicant’s scores sent directly to the Board from the examination authority or authorities; A statement from the applicant listing all disciplinary or adverse actions taken against the applicant by a: Hospital, related institution, alternative health system, or employer; Medical board; Licensing authority; Court; or Adjudicatory body; All application and licensing fees payable to the Board at the time the application is submitted to the Board; The applicant’s Social Security number, which the Board shall use only for evaluation and identification of applicants and licensees, but may not disclose in any other context; Verification of licensure from all states where the applicant has ever held a license; Verification of voluntary licensure nonrenewal or voluntary surrender of license while the applicant was in good standing and not under disciplinary charges or investigation at the time the license was surrendered from states where the applicant no longer holds a license; A passport quality photograph; Information in the National Practitioner Data Bank including, but not limited to, the following: Medical malpractice judgments against the applicant; Settlements made by the applicant in naturopathic medical malpractice actions; and Actions taken against the applicant or the applicant’s license by state disciplinary or licensing authorities; Documentation of competency in English by any of the following: Documentation of graduation from a recognized English-speaking high school or undergraduate school after at least 3 years of enrollment; Documentation of graduation from a recognized English-speaking professional school; Documentation of a passing score on the naturopathic licensing examination administered by the North American Board of Naturopathic Examiners; or Documentation of receiving: A score of at least 26 on the “Speaking Section” of the Internet-Based Test of English as a Foreign Language; or A score of Advanced or higher on the Oral Proficiency Interview; A chronological list of: All activities, beginning with the date of completion of naturopathic medical school through the date of application, listed by month and year, that account for all periods of time, and include each job held, regardless of whether the job was: Medically related or not; and Compensated or not; Any other activity engaged in, including all periods of unemployment; Any actions, by a state licensing or disciplinary board, or a comparable body in the armed services, denying an application for licensure, reinstatement, or renewal; Any actions taken against the naturopathic doctor’s license, by a state licensing or disciplinary board, or a comparable body in the armed services, including but not limited to limitations of practice, required education, admonishment, reprimand, suspension, or revocation for an act that would be grounds for disciplinary action under Health Occupations Article, §14-5F-18, Annotated Code of Maryland; Any investigation or charge brought against the naturopathic doctor by a licensing or disciplinary body or comparable body in the armed services; Any medical or health professional license for which the naturopathic doctor has applied if the application was withdrawn for reasons that would be grounds for disciplinary action under Health Occupations Article, §14-5F-18, Annotated Code of Maryland; and Any investigation or charge brought against the naturopathic doctor by a hospital, related institution, or alternative health care system that would be grounds for action under Health Occupations Article, §14-5F-18, Annotated Code of Maryland; A plea of guilty or nolo contendere, a conviction, or receipt of probation before judgment for a criminal act including: A plea of guilty or nolo contendere, a conviction, or receipt of probation before judgment for an alcohol or controlled dangerous substance offense, including but not limited to driving while under the influence of alcohol or controlled dangerous substances; and An arrest which would provide a basis for investigation or charge which would be grounds for disciplinary action under Health Occupations Article, §14-5F-18, Annotated Code of Maryland; A physical or mental condition that currently impairs the naturopathic doctor’s ability to practice medicine; The filing or settling of a medical malpractice action in which the naturopathic doctor is, or has been, named as a defendant within the past 5 years; The following additional information: Copies of the complaints, pleadings, and judgments in all malpractice claims if the applicant has had 3 or more claims in the 5 years before the filing of the application for licensure; Copies of all arrests, disciplinary actions, judgments, and final orders which occurred or were issued within the 7 years before submitting the application for licensure for driving while intoxicated, driving while under the influence of a chemical substance or medication, or any license probation, suspension, or revocation; and All naturopathic medical licensure, certification, and recertification examination results and the dates when these examinations were taken; If required by the Board and at the applicant’s expense, a physical or mental examination, or both, by a physician or evaluation program for treatment of impaired naturopathic doctors, or both, chosen by the Board to determine the applicant’s ability to practice naturopathic medicine; On forms supplied by the Board, a release granting the Board access to relevant information from appropriate individuals, other institutions, and government agencies including, but not limited to: The National Practitioner Data Bank; Hospitals; and Other licensing bodies; On forms supplied by the Board, a release of any information which is not statutorily protected; Certificates and verifications from the certifying or verifying authority sent directly from: the national licensing authority, the naturopathic educational institution, and other state’s licensing boards to the Board for applicants; The certified translation of any of the documents required under this chapter, at the applicant’s expense, for any documents required by this chapter that are in a language other than English; and The criminal history records information received from the Central Repository in accordance with Health Occupations Article, §14-308.1, Annotated Code of Maryland, and Regulation .04C(1) of this chapter. Application Processing. The Board has designated a 4-month period for acting on applications as follows: Within 60 days after receipt of an application, the Board shall determine whether an application is complete; If the Board determines that the application is not complete, the Board shall send a notice of deficiency to the applicant; On receipt of the notice, the applicant shall correct the deficiency within 60 days or any other period specified in the notice; and If the applicant fails to correct the deficiency within the required period, the application will be closed and the applicant shall be required to: Submit a new application; and Pay the required fees specified in Regulation .20 of this chapter. The Board may not issue a license until the Board has: Received and reviewed the criminal history records information; and Approved the application. Withdrawal of Application. An applicant may not withdraw an application for initial licensure, renewal of a license, or reinstatement of a license without permission of the Board, if: The applicant is currently charged in another jurisdiction with conduct which would be grounds for discipline under the Health Occupations Article, §14-5F-18, Annotated Code of Maryland, if the applicant were licensed in this State; The applicant is under investigation in another jurisdiction for an allegation concerning conduct that would be grounds for discipline under Health Occupations Article, §14-5F-18, Annotated Code of Maryland, if the applicant were licensed in this State; or The Board is investigating the applicant or application or has issued a notice of intent to deny licensure. In determining whether to allow the withdrawal of a licensure application, the Board may consider such factors as the following: Issues of competence or conduct which caused the matter to be investigated; Duty to protect the public in other jurisdictions from duplicative expenditures on investigation of licensure applications; and Truthfulness of the applicant during the application process. The following individuals do not need to be licensed in order to practice naturopathy in Maryland: An individual who is employed by the United States Government to practice naturopathic medicine while practicing within the scope of that employment; A student who is enrolled in an approved naturopathic medical program while the student is participating in a course of study under the supervision of a licensed naturopathic doctor or a licensed professional in the field of study; An individual who is licensed in another state to practice naturopathic medicine in the state for purposes of litigation may examine a patient, offer recommendations, and provide testimony; or A naturopathic doctor licensed by and residing in another jurisdiction, if the naturopathic doctor is engaged in consultation with the naturopathic doctor in the state about a particular patient and does not direct patient care. A license authorizes a licensee, consistent with naturopathic education, training, and competence demonstrated by passing the Naturopathic Physician Licensing Examination, to: Order and perform physical and laboratory examinations for diagnostic purposes consistent with the education and training of naturopathic doctors, including: Phlebotomy; Clinical laboratory tests; Orifical examinations; Electrocardiograms with over read by a cardiologist; and Physiological function tests; Order diagnostic imaging studies, interpret the diagnostic imaging reports and have access to the images from these studies. Naturopathic doctors shall not perform the imaging procedures nor directly interpret the images themselves; Dispense, order, or administer natural medicines, including, but not limited to, food, extracts of food, nutraceuticals, vitamins, amino acids, minerals, enzymes, botanicals and their extracts, and botanical medicines, homeopathic medicines and all dietary supplements and nonprescription drugs as defined by the Federal Food, Drug, and Cosmetic Act, as follows: Except for intravenous administration, the naturopathic doctor may order or dispense natural medicines that use various routes of administration, including: Oral; Nasal; Auricular; Ocular; Rectal; Vaginal; Transdermal; and Intramuscular; and The naturopathic doctor may only administer natural medicines through transdermal administration; Administer or perform hot or cold hydrotherapy, naturopathic physical medicine, electromagnetic energy and therapeutic exercise for the purpose of providing basic therapeutic care services, except that if a referral to another licensed provider is appropriate for ongoing rehabilitation or habilitation services, the naturopathic doctor shall make the referral; Provide health education and health counseling; and Perform naturopathic musculoskeletal mobilization. An individual who is solely licensed as a naturopathic doctor may not: Prescribe, dispense, or administer any prescription drug; Perform surgical procedures; Unless licensed under the Health Occupations Article, Annotated Code of Maryland, practice or claim to practice as: A medical doctor or physician; An osteopath; A dentist; A podiatrist; An optometrist; A psychologist; A nurse practitioner; A physician assistant; A chiropractor; A physical therapist; An acupuncturist; or Any other health care professional; Use general or spinal anesthetics; Administer ionizing radioactive substances for therapeutic purposes; Perform chiropractic adjustments or manipulations that include high velocity thrusts at or beyond the end range of normal joint motion unless the licensee is also a licensed chiropractor; or Perform acupuncture unless the licensee is also a licensed acupuncturist. Renewals. The Board may not renew a license until the Comptroller of Maryland has verified that the individual has paid all undisputed taxes and unemployment insurance contributions, or arranged for repayment. The term of a license renewed by the Board is 2 years from the date of renewal. A license expires at the end of its term unless the license is renewed as provided by the Board. At least 1 month before the license expires, the Board shall send to the licensee a renewal notice that states: The date on which the current license expires; The date by which the renewal application shall be received by the Board for the renewal to be issued before the license expires; and The amount of the renewal fee as specified in Regulation .20 of this chapter. The Board shall renew the license of a licensee who: Submits a renewal application on the form that the Board requires; Pays a renewal fee as specified in Regulation .20 of this chapter; Is otherwise entitled to be licensed; Meets the continuing education requirements as set forth in Regulation 11 of this chapter; Provides evidence of biennial cardiopulmonary resuscitation certification; and Attests that the licensee has a current collaboration and consultation agreement with a physician licensed in the State that meets the requirements of Regulation .05 of this chapter at the time of renewal.. The failure to receive a renewal notice does not excuse a licensee from complying with §A(3) of this regulation. Reinstatement of an Expired or Lapsed License. An individual applying for reinstatement of a license to practice naturopathic medicine who failed to renew for any reason shall: Complete a reinstatement application on a form supplied by the Board; Pay the Board the reinstatement fee set by the Board in accordance with Regulation .20 of this chapter; Complete a criminal history records check in accordance with Health Occupations Article §14-308.1, Annotated Code of Maryland; Provide documentation of completion of at least 50 hours of approved continuing education earned during the 2-year period preceding the date of the submission of the application for reinstatement; and Attest that the licensee has a current collaboration and consultation agreement with a physician licensed in the State that meets the requirements of Regulation .05 of this chapter at the time of reinstatement. Meet any additional requirements set by the Board for reinstatement of a license. Reinstatement after Revocation of a License or After a Lapse in Renewal. On the application of an individual whose license has been revoked, the disciplinary panel, on the affirmative vote of a majority of the quorum, may, in its discretion, reinstate a revoked license. When a time period is not stated in an order for revocation, the disciplinary panel may not entertain an application for post-disciplinary reinstatement until at least 3 years after the date of the order. The disciplinary panel may not entertain an application for post-disciplinary reinstatement after an order of revocation unless: Any time period stated in the order has expired; Any condition set out in the order has been fulfilled; The applicant has filed a formal application and paid the fee set by the Board in Regulation .20 of this chapter; and The applicant meets all of the requirements for reinstatement set out in §B of this regulation. The disciplinary panel shall entertain applications for reinstatement pursuant to the procedures and standards of COMAR 10.32.02.06B. A revocation of a license may not be for less than 1 year. The disciplinary panel may not entertain applications for reinstatement if a revocation is permanent. The applicant shall meet any additional requirements set by the Board for reinstatement of a license. After the expiration date of the license, the naturopathic doctor is no longer licensed to practice naturopathic medicine. Requirements. A licensed naturopathic doctor shall take at least 50 hours of continuing education credits during every 2-year renewal period: For license renewal, preceding the expiration of the license for a naturopathic doctor; or For license reinstatement, preceding the date of the submission of the application for reinstatement. The courses selected shall be approved by any of the following: The American Association of Naturopathic Physicians; The Maryland Association of Naturopathic Physicians; The Accreditation Council for Continuing Medical Education; The Accreditation Council for Pharmacy Education; The North American Naturopathic Continuing Education Accreditation Council; or A naturopathic doctor’s licensing authority or professional association of another state which meets the standards adopted by the American Association of Naturopathic Physicians. Subject to the hearing provisions Health Occupations Article, §14-405, Annotated Code of Maryland, the Board, on the affirmative vote of a majority of its members then serving as a quorum of the Board, may deny a license to any applicant, or a disciplinary panel, on the affirmative vote of a majority of a quorum of the disciplinary panel, may reprimand any licensee, place any licensee on probation, or suspend or revoke a license of any licensee if the applicant or licensee: Is habitually intoxicated, or is addicted to or habitually abuses any narcotic or controlled dangerous substance, as defined in Criminal Law Article, §5-101, Annotated Code of Maryland, or any drug without a valid prescription or indication, or provides professional services while under the influence of alcohol or using any narcotic or controlled dangerous substance, as defined in Criminal Law Article, §5-101, Annotated Code of Maryland; Has been found to be mentally incompetent by a physician if the mental incompetence impairs the ability of the applicant or licensee to undertake the practice of naturopathic medicine in a manner consistent with the safety of the public; Has entered into a consent agreement with or has been assessed an administrative penalty by a licensing authority in another state; Fraudulently or deceptively obtains, or attempts to obtain, or uses a license for the applicant, the licensee, or another; Has a license revoked or suspended, or was otherwise acted against, including the denial of licensure, by the licensing authority of another state; Uses false, deceptive, or misleading advertising; Advertises, practices, or attempts to practice under a name other than the applicant’s or licensee’s own name; Aids, assists, employs, or advises any unlicensed individual to practice naturopathic medicine; Willfully makes or files a false report or record in the practice of naturopathic medicine; Willfully or negligently fails to file a report or record as required by law, willfully impedes or obstructs the filing or recording of a report, or induces another to fail to file or record a report; Pays or receives any commission, bonus, kickback, or rebate, or engages in any split-fee arrangement in any form with a licensed physician, organization, agency, or other person, either directly or indirectly, for patients referred to health care providers; Exercises influence within a patient-doctor relationship for purposes of engaging a patient in sexual activity; Engages in sexual misconduct with a patient; Fails to keep written medical records justifying the course of treatment of a patient; Engages in an act or omission that does not meet generally accepted standards of practice of naturopathic medicine or of safe care of patients, whether or not actual injury to a patient is established; Delegates professional responsibilities to an individual when the licensee delegating the responsibilities knows or has reason to know that the individual is not qualified by training, experience, or licensure to perform the responsibilities; Promotes the sale of services, drugs, devices, appliances, or goods to a patient so as to exploit the patient for financial gain; Breaches patient confidentiality; Is guilty of unprofessional or immoral conduct in the practice of naturopathic medicine; Offers, undertakes, or agrees to cure or treat a disease by a secret method, treatment, or medicine; Knowingly fails to report suspected child abuse in violation of Family Law Article, §5-704, Annotated Code of Maryland; Sells, prescribes, gives away, or administers drugs for illegal or illegitimate purposes; Denies or discriminates against an individual with regard to the provision of professional services for which the licensee is licensed and qualified to render because the individual is HIV positive; Fails to cooperate with a lawful investigation of the Board; Abandons a patient; or Violates any provision of this title or this chapter. Subject to provisions of Regulation .09A and B of this chapter, the disciplinary panel may impose sanctions as outlined in §B of this regulation on physicians for violations of Health Occupations Article, §§1-302, 14-404(a), and 14-504, Annotated Code of Maryland. Range of Sanctions. Except as otherwise provided in State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland, before the Board or a disciplinary panel takes any action under Health Occupations Article, §14-5F-18(a), Annotated Code of Maryland, the Board shall give the individual against whom the action is contemplated an opportunity for a hearing before the Board or disciplinary panel in accordance with the hearing requirements of Health Occupations Article, §14-405, Annotated Code of Maryland. Crime Involving Moral Turpitude. On the filing of certified docket entries with the Board by the Office of the Attorney General, a disciplinary panel shall order the suspension of a license if the licensee is convicted or pleads guilty or nolo contendere with respect to a crime involving moral turpitude, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside. After completion of the appellate process, if the conviction has not been reversed or the plea has not been set aside with respect to a crime involving moral turpitude, a disciplinary panel shall order the revocation of a license on the certification by the office of the attorney general. The Board shall investigate any complaint filed with the Board that alleges that there are grounds for action under Health Occupations Article, §14-5F-18, Annotated Code of Maryland. An investigation and any reports and recommendations related to the investigation are confidential, subject to the exceptions under §E of this regulation. On the request of a person who has made a complaint to the Board, the Board shall provide the person with information on the status of the complaint. The Board shall give notice and the Board or disciplinary panel hold the hearing in accordance with the Administrative Procedure Act. The individual may be represented at the hearing by counsel. Over the signature of an officer or the administrator of the Board or disciplinary panel, the Board or disciplinary panel may issue subpoenas and administer oaths in connection with any investigation under Health Occupations Article, §14-5F-18, Annotated Code of Maryland, and any hearings or proceedings before the Board or disciplinary panel. If, without lawful excuse, a person disobeys a subpoena from the Board or an order by the Board to take an oath or to testify or answer a question, then, on petition of the Board, a court of competent jurisdiction may punish the person as for contempt of court. If, after due notice, the individual against whom the action is contemplated fails or refuses to appear, the Board or disciplinary panel may hear and determine the matter. Appeal. Any person aggrieved by a final decision of the Board or a disciplinary panel under Health Occupations Article, §14-5F-01 et seq., Annotated Code of Maryland, in a contested case, as defined in the Administrative Procedure Act, may take a direct judicial appeal. The appeal shall be made as provided for judicial review of final decisions in the Administrative Procedure Act. An order of the Board or a disciplinary panel may not be stayed pending judicial review. The Board may appeal from any decision that reverses or modifies an order of the Board or a disciplinary panel. The Board may issue a cease and desist order for: Practicing naturopathic medicine without a license or with an unauthorized person; or Supervising or aiding an unauthorized person in the practice of naturopathic medicine. If, after a hearing, a licensee is found to have violated provisions of Health Occupations Article, §14-5F-18, Annotated Code of Maryland, the Board shall impose a fee on the licensee that shall approximate the Board’s cost of bringing the proceedings against the licensee. The hearing costs may include any or all of the following expense items: Services rendered by court reporters; Transcriptions of the hearing record by court reporters; Expenses related to witnesses appearing for the State; Obtaining or reproducing documents, exhibits, or other evidentiary items; Hearing-related per diems and expenses for Board members; or Any other expenses directly related to the investigation and prosecution of the disciplinary action against the licensee. Except as otherwise provided in this chapter, an individual may not practice, attempt to practice, or offer to practice naturopathic medicine in this State without a license. An individual who violates this section: Is guilty of a felony and upon conviction is subject to a fine not exceeding $10,000 or imprisonment not exceeding 5 years or both; and Is subject to a civil fine of no more than $50,000 to be levied by the Board. Unless an individual is licensed to practice naturopathic medicine, the individual may not: Represent to the public by title, by description, of service, methods, or procedures, or otherwise, that the individual is licensed by the Board to practice naturopathic medicine; Use the title “doctor of naturopathic medicine”, “doctor of naturopathy”, naturopathic doctor”, or “naturopath”; or Use the initials “N.D.”,” ND”, “NMD”, or “N.M.D.” after the name of the individual. An individual licensed to practice naturopathic medicine in this State may not use the title “physician”. A naturopathic doctor engaged in the private practice of naturopathic medicine in the state shall: Wear an identification badge tag or badge which identifies that individual as a naturopathic doctor; and Identify himself or herself to all patients as a naturopathic doctor. An individual may not identify himself or herself as a naturopathic doctor unless licensed by the Board. A licensed naturopathic doctor, a licensed health care practitioner, a health care facility as defined in Health-General Article, §19-114, Annotated Code of Maryland, located in the State, and a State agency shall file a written report with the Board if the person has information that gives the person reason to believe that a licensed naturopathic doctor is or may be: Medically or legally incompetent; Engaged in the unauthorized practice of naturopathic medicine; Guilty of unprofessional conduct; or Mentally or physically unable to engage safely in the practice of naturopathic medicine. This report shall be filed within 30 days of an individual or entity becoming aware of this information. A health care facility shall report promptly to the Board if: A licensed naturopathic doctor voluntarily resigns from the staff of the health care facility, voluntarily limits the licensees staff privileges, or fails to reapply for hospital privileges at the health care facility; and The action of the licensee occurs while the licensee is under formal or informal investigation by the health care facility for possible medical incompetence, unprofessional conduct, or mental or physical impairment. An advertisement may not contain: A statement containing misrepresentation of facts; Statements that cannot be verified by the Board for truthfulness; Statements likely to mislead or deceive because in context the statements make only a partial disclosure of relevant facts; Statements intended to, or likely to, create false or unjustified expectations of favorable results; Statements containing representations or implications that in reasonable probability can be expected to cause an ordinary prudent person to misunderstand or be deceived; Statements containing representations that a naturopathic doctor is willing to perform any procedure which is illegal under the laws or regulations of this State or the United States; Statements that are untruthful and improbable or contain, misstatements, falsehoods, misrepresentations, distorted, or fabulous statements as to cures; Statements that misrepresents the nature, characteristics, or qualities of natural medicines or services provided by a naturopathic doctor pursuant to Health Occupations Article, §14-5F-14(a)(3), (4), (5), (6), or (7), Annotated Code of Maryland; Statements that a manifestly incurable condition can be permanently cured; Statements promoting herbal, natural, or dietary supplements as drugs contrary to the laws, rules, and regulations of the Federal Food, Drug, and Cosmetic Act as amended by the Dietary Supplement Health and Education Act of 1994; Advertising that does not comply with state or federal law, including the: Federal Trade Commission Act, Section 12 of 15 U.S.C. §52; Federal Food, Drug and Cosmetic Act, 21 U.S.C. §§301—397; Maryland Food, Drug, and Cosmetic Act, Health-General Article, §21-207, et seq., Annotated Code of Maryland; and Commercial Law Article, §14-2902, Annotated Code of Maryland; Statements recommending any modality of care that is inconsistent with the health, safety, and welfare of the public; or Statements made as defined in Health-General Article, §§21-247 and 21-248, Annotated Code of Maryland. Naturopathic doctors shall concern themselves primarily with the welfare of the patient. A naturopathic doctor who suffers from a physical, mental, or emotional impairment, including substance abuse, that impacts the individual’s ability to practice naturopathic medicine shall seek professional treatment and refrain from the practice of naturopathic medicine until the impairment no longer exists or reasonable accommodations can be made. A naturopathic doctor shall: Use professional discretion and integrity in relationships with a member of the health care community; Be professional in conduct, with honesty, integrity, self-respect, and fairness; Remain free from conflict of interest while fulfilling the objectives and maintaining the integrity of the naturopathic doctor profession; Provide accurate fee information to the patient, the individual responsible for payment for treatment, and the insurer; At all times respect the patient’s dignity, autonomy, and privacy; Practice naturopathic medicine only as defined in the scope of practice set forth in Health Occupations Article, §14-5F-14(a), Annotated Code of Maryland; Cooperate with any lawful investigation conducted by the Board, including: Furnishing information requested in a timely manner as directed by the Board; Complying with a subpoena; Responding to a complaint at the request of the Board; and Providing meaningful and timely access to relevant patient records; and Report to the Board conduct in the practice of naturopathic medicine that indicates a violation of: This chapter; Health Occupations Article, Title 14-5F, Annotated Code of Maryland; or Any other law, including, but not limited to, aiding or abetting the unauthorized practice of naturopathic medicine. A naturopathic doctor may not: Misrepresent credentials, qualifications, or affiliations and shall attempt to correct others who misrepresent the naturopathic doctor’s credentials, qualifications, or affiliations; Knowingly engage in or condone behavior that is fraudulent, dishonest, or deceitful, or involves moral turpitude; Engage in a commercial activity which conflicts with the duties of a naturopathic doctor; Perform naturopathic medicine on a patient if a contraindication against naturopathic doctor treatment exists; Discriminate against a patient or a health care provider based on race, religion, age, gender, sexual orientation, national origin, or disability; Intimidate, threaten, influence, or attempt to influence any person regarding any violation of law or regulation; or Aid or abet any individual violating or attempting to violate any provision of law or regulation. A naturopathic doctor shall: Use professional judgment in the use of evaluation and treatment procedures; Decline to administer treatment if the naturopathic doctor believes that a treatment is contraindicated or unjustified; Terminate a professional relationship with a patient in an appropriate manner, such as: Providing the patient with sufficient notice to permit the patient to obtain the services of another professional; Assisting the patient by providing referrals if appropriate; or Continuing to provide emergency treatment to the patient if treatment is required before a reasonable time has passed to allow the patient to obtain the services of another health care provider; Maintain a written record of treatment of the patient under the naturopathic doctor’s care for at least: 5 years after the termination of treatment; and 5 years after the patient becomes 18 years old, if applicable; Make the written records of treatment available to the patient upon request, in compliance with applicable laws for disclosure of medical records; Make arrangements for another professional to provide for the needs of the patient during anticipated absences when the naturopathic doctor is unavailable to the patient; Make referrals only to other qualified and duly licensed health care providers; Accurately inform the patient, other health care professionals, and the public of the limitations of the practice of naturopathic medicine; Adequately assess the patient to determine if contraindications against naturopathic medical treatment exist and refer the patient to an appropriate health care practitioner; Exercise independent professional judgment in the treatment or evaluation of the patient regardless of whether the patient was referred by another health care provider; Ensure clear and concise professional communications with patients regarding: Nature and duration of treatment; Diagnoses; Costs; Billing; and Insurance; and Administer fair and equitable fees to patients regardless of status or insurance. A naturopathic doctor may not: Accept a client for treatment, or continue unnecessary treatment, when the patient cannot be reasonably expected to benefit from the treatment; Receive remuneration from, or provide remuneration to, or split a fee, for either making or accepting a referral of the patient to or from another health care provider; Make a guarantee or promise about the efficacy of a particular treatment, the naturopathic doctor’s practice, or the result of a treatment unless supported by scientific principles accepted by the profession; or Exploit the professional relationship by: Continuing treatment unnecessarily; or Charging for a service: Not provided; or Different from those actually provided. A naturopathic doctor shall: Maintain professional boundaries, even when the patient initiates crossing the boundaries of the professional relationship; and Respect and maintain professional boundaries and respect the patient’s reasonable expectation of professional conduct. A naturopathic doctor may not: Exploit a relationship with a patient, staff member, or student for the naturopathic doctor’s personal advantage including, but not limited to, a personal, sexual, romantic, or financial relationship; Engage in a sexually intimate act with a patient; or Engage in sexual misconduct, which includes, but is not limited to: Therapeutic deception; Non-bona-fide treatment; and A sexually exploitative relationship. A naturopathic doctor may not engage in inappropriate behavior with other practice staff including sexual advances, harassment, discrimination, exploitation, retaliation, and other unprofessional conduct. A naturopathic doctor shall: Respect and maintain the privacy and confidentiality of the patient; Disclose the patient’s records or information about the patient only with the patient’s consent or as required by law; Adequately safeguard confidential patient information, including storage and disposal of records; Provide sufficient information to a patient to allow the patient to make an informed decision regarding treatment, including: The purpose and nature of an evaluation or treatment regimen; Alternatives to treatment; Side effects and benefits of a treatment regimen proposed and alternatives to that treatment; The estimated cost of treatment and alternatives to treatment; The right of the patient to: Withdraw from treatment at any time, including the risks associated with withdrawing from treatment; Decline to participate in treatment if an aspect of the treatment will be recorded, documented, photographed, observed, or otherwise used in an educational program; or Terminate any treatment contract at any time, for any or no reason, with no fee or penalty incurred; Obtain the full informed consent of a patient participating in a human research program, without communicating a direct or implied penalty for the patient’s refusal to participate in the program and with due regard for the patient’s autonomy and dignity; Comply with applicable federal and state laws for human research programs; and Promptly and efficiently respond to any patient or Board request for records. A naturopathic doctor shall: Obtain additional training, information, and supervision as needed to perform a new technique or service in a new specialty area or when employing a new treatment modality; and Be current in the qualifications to practice, including meeting continuing education requirements as set forth in Regulation 11 of this chapter. The naturopathic doctor may not perform a treatment or provide a service that the naturopathic doctor is not qualified to perform or which is beyond the scope of the naturopathic doctor’s education, training, capabilities, experience, and scope of practice. A naturopathic doctor may not construe any failure to specify a particular ethical, legal, or professional duty in this chapter as a denial of the existence of other ethical, legal, or professional duties or responsibilities that are equally as important and generally recognized in the naturopathic medicine profession. A violation in this chapter may result in the Board taking action pursuant to Health Occupations Article, §14-5F-18, Annotated Code of Maryland. The following fees are applicable to naturopathic doctors: Initial application fee — $790; Renewal Fee: Biennial license renewal fee — $486; and The Maryland Health Care Commission fee as determined by Maryland Health Care Commission under COMAR 10.25.03; License reinstatement fee—$700; and Written verification fee—$50. Requirements. An applicant for initial licensure by reciprocity shall: Have an active, unrestricted license to practice naturopathic medicine in another jurisdiction that, at the time the applicant was licensed, had licensure requirements that were equivalent to or exceeded those set forth in Regulation .04A; Be in good standing under the laws of every jurisdiction where the individual is licensed; and Submit to a State and national criminal history records check in accordance with Health Occupations Article, §14-308.1, Annotated Code of Maryland. Documentation. An applicant for initial licensure by reciprocity shall submit to the Board: An application for reciprocity on a form provided by the Board; The application fee as set by the Board; Evidence of compliance with §A of this regulation; A written attestation as provided in Regulation .05 of this chapter; Any additional documentation set forth in Regulation .06 of this chapter that is needed for the Board to evaluate an application; Any evidence relating to any disciplinary action taken or any administrative penalties assessed against the applicant by the appropriate state licensing, certification, or registration authority; and Any consent agreements into which the applicant entered that contain conditions placed on the applicant’s professional conduct and practice, including any voluntary surrender of a license. The Board may not issue a license if the criminal history records information, pursuant to §A of this regulation, has not been received and reviewed. After a license is issued, the licensee is subject to the Board’s jurisdiction and shall comply with all laws and regulations governing the practice of naturopathic medicine in the State. Health Occupations Article, §§14-5F-12.1—14-5F-32, Annotated Code of Maryland Effective date: September 12, 2016 (43:18 Md. R. 1017) Regulation .02B amended effective August 28, 2017 (44:17 Md. R. 835); January 19, 2026 (53:1 Md. R. 22) Regulation .03-1 adopted effective January 19, 2026 (53:1 Md. R. 22) Regulation .03-2 adopted effective January 19, 2026 (53:1 Md. R. 22) Regulation .04C, D amended effective August 28, 2017 (44:17 Md. R. 835) Regulation .05A, B amended effective January 19, 2026 (53:1 Md. R. 22) Regulation .05D, E adopted effective January 19, 2026 (53:1 Md. R. 22) Regulation .06B, C amended effective August 28, 2017 (44:17 Md. R. 835) Regulation .10 repealed and new Regulation .10 adopted effective August 28, 2017 (44:17 Md. R. 835); January 19, 2026 (53:1 Md. R. 22) Regulation .11A amended effective August 28, 2017 (44:17 Md. R. 835) Regulation .11B amended effective January 19, 2026 (53:1 Md. R. 22) Regulation .20 amended effective January 19, 2026 (53:1 Md. R. 22) Regulation .21 adopted effective August 28, 2017 (44:17 Md. R. 835) This chapter governs reporting requirements to the Board of Physicians concerning health care providers and naturopathic doctors by: Hospitals; Related institutions; Employers of allied health providers or naturopathic doctors; Health care facilities; State agencies; Health care practitioners; Naturopathic doctors; and Alternative health systems. In this chapter, the following terms have the meanings indicated. Terms Defined. “Abandon” means a health care provider’s withdrawal from the care and treatment of a patient during the course of treatment without giving reasonable notice to the patient or providing a competent replacement. “Acts” means Health Occupations Article, Title 14, including subtitles 5A, 5B, 5C, 5E, and 5F, and Title 15, Annotated Code of Maryland. “Administrative suspension” means an action imposed by a reporting entity restricting a health care provider’s privileges or hours or scope of employment for failure of the health care provider to comply with the bylaws, rules, policies, or procedures of the reporting entity. “Allied health provider” means an individual who is licensed by the Board under Health Occupations Article, Title 14, Subtitles 5A, 5B, 5C, or 5E, or Title 15, Annotated Code of Maryland. “Alternative health system” has the same meaning as alternative health care system as defined in Health Occupations Article, §1-401(a), Annotated Code of Maryland. “Board” means the State Board of Physicians. “Change” means any of the following actions by a reporting entity: Terminating or failing to renew a health care provider’s staff privileges or employment or contract with the reporting entity; Taking disciplinary action against a health care provider who continues to be employed, enjoy privileges, or contract with the reporting entity, including but not limited to: Suspension; Placement on probation; or Restriction or limitation of privileges or duties; Accepting an involuntary resignation as defined in this regulation; Accepting or acquiescing to an involuntary leave of absence as defined in this regulation; Accepting or acquiescing to an involuntary alteration in practice as defined in this regulation; Requesting that a health care staffing entity cease furnishing the services of a particular health care provider; In the case of a physician, denying: By a hospital or related institution, an application for staff privileges; or By an alternative health care system, an application for employment; or Terminating the delegation agreement of a physician assistant. “Failure to report” means the failure of a reporting entity to file a report with the Board as mandated by this chapter. “Focused professional practice evaluation (FPPE)” means any process used by a reporting entity to assess the competence or proficiency of a health care provider in a certain clinical skill, activity, or procedure. “Focused review” has the same meaning as “focused professional practice evaluation” as defined in this regulation. “Good standing” means the health care provider is not suspended, on probation, or subject to any pending disciplinary proceedings, an involuntary alteration in practice, or an involuntary leave of absence, as these terms are defined in this regulation. “Health care facility” has the meaning stated in Health-General Article, §19-114, Annotated Code of Maryland. “Health care provider” means a physician or an allied health provider. “Health care staffing entity” means a business entity that contracts to provide, directly or indirectly, the personal health care services of one or more health care providers to a reporting entity. “Hospital” has the meaning stated in Health-General Article, §19-301, Annotated Code of Maryland. “Involuntary alteration in practice” means a modification in the privileges, employment, or contractual duties of a health care provider, whether self-initiated by the health care provider, mutually agreed upon, or requested or suggested by the reporting entity: After the health care provider has been notified of pending discharge or termination of privileges or a contract, or pending proceedings possibly leading to discharge or termination of privileges or a contract; While the health care provider is under investigation or subject to an inquiry, a practice review, a focused review, or an FPPE; After the health care provider has been notified that an investigation or inquiry may begin; or After the health care provider has been asked to respond to a complaint made to the reporting entity. “Involuntary leave of absence” means a hiatus, however designated, during which a health care provider does not exercise staff privileges or fulfill the duties of employment or a contract, whether the hiatus was self-initiated, mutually agreed upon, or requested or imposed by the reporting entity, where the health care provider commenced the hiatus: After being notified of pending discharge or termination of privileges or a contract, or pending proceedings possibly leading to discharge or termination of privileges or a contract; While under investigation or subject to an inquiry, a practice review, a focused review, or an FPPE; After being notified that an investigation or inquiry may begin; or After being asked to respond to a complaint made to the reporting entity. “Involuntary resignation” means a health care provider’s relinquishment of privileges, employment, or a contract with a reporting entity, whether the relinquishment was self-initiated, mutually agreed upon, or had been requested by the reporting entity, and however designated by the health care provider or the reporting entity, if the health care provider resigned: After being notified that discharge or termination of privileges, employment, or a contract, or that proceedings possibly leading to discharge or termination of privileges, employment, or a contract, would occur if the health care provider would not resign; While under investigation or subject to an inquiry, a practice review, a focused review, or an FPPE; After being notified that an investigation or inquiry may begin; or After being asked to respond to a complaint made to the reporting entity. “Licensed physician” means an individual, including doctor of osteopathy, who is licensed by the Board to practice medicine. “Mandated report” means any report required under the Acts or this chapter. “Naturopathic doctor” means an individual who is licensed by the Board under Health Occupations Article, Title14, Subtitle 5F, Annotated Code of Maryland. “Privileges” means authorization granted by a reporting entity to a health care provider to provide specific care, treatment, diagnostic services, or other services to patients. “Related institution” has the meaning stated in Health-General Article, §19-301, Annotated Code of Maryland. “Reporting entity” means: A hospital, a related institution, or an alternative health system, as these terms are defined in this regulation; and An employer of an allied health provider that is not a hospital, a related institution, or an alternative health system. “Voluntary alteration in practice” means a modification in the privileges, employment, or contractual duties made with respect to a health care provider in good standing that is not an involuntary alteration in practice as defined in this regulation. “Voluntary leave of absence” means a hiatus from providing health care services taken by a health care provider in good standing that is not an involuntary leave of absence as defined in this regulation. “Voluntary resignation” means the relinquishment of privileges, employment, or a contract with a reporting entity taken by a health care provider in good standing that is not an involuntary resignation as defined in this regulation. Subject to the limitations set out in §§B, C and D of this regulation, the reporting entity shall report to the Board in writing any change made with respect to a health care provider: Whom the reporting entity employs; Who works with the reporting entity under contract; or To whom the reporting entity has granted privileges. A reporting entity shall inform the Board of any change that has been made, in whole or in part, because the reporting entity had reason to believe that the health care provider: Abandoned a patient; Provided patient care of questionable quality; Disrupted the workplace; Committed unethical or unprofessional conduct; Committed billing or coding fraud; Used the reporting entity’s employment or privileges to commit illegal or unethical business practices; Suffers from a physical, a mental, or an emotional condition or impairment that affects the health care provider’s ability to perform the individual’s medical or surgical duties; Is habitually intoxicated by alcohol or a controlled dangerous substance; Provided care while under the influence of alcohol or while abusing or misusing any controlled dangerous substance or mood-altering substance; Has not complied with the requirements of an alcohol or a drug treatment program; With respect to allied health providers, failed to notify the reporting entity of the health care provider’s decision to enter into an alcohol or a drug treatment program; Performed care beyond the scope of licensure or privileges or delegated duties, or delegated duties to an individual not authorized to perform those duties; Repeatedly failed to complete medical records; Repeatedly violated hospital bylaws, rules, policies, or procedures after warning; or Committed any other act or suffered from any other condition which the reporting entity had reason to believe may constitute a violation of the Acts. Specific Changes Not Reportable. The following changes do not require reporting by a reporting entity: Voluntary leaves of absence that: Are not involuntary leaves of absence as defined in Regulation .02 of this chapter; Are taken by a health care provider who is in good standing; and May be caused by, for example: Maternity leave; Family problems of a medical or other personal nature; Medical problems that do not implicate the health care provider’s physical, mental, or emotional ability to provide competent care; Military deployment; Sabbaticals; Extended vacations; or Absences for professional training; Voluntary resignations that: Are not involuntary resignations as defined in Regulation .02 of this chapter; Are submitted by a health care provider who is in good standing; and May be caused by, for example: A job or career change; The health care provider’s desire to relocate from Maryland; or The health care provider’s desire to retire; Voluntary alterations in practice that: Are not involuntary alterations in practice as defined in Regulation .02 of this chapter; Are submitted by a health care provider who is in good standing; and May be caused by, for example, a health care provider’s desire to: Switch from active practice to consulting; Reduce workload; or Alter a specialty or scope of practice; With respect to allied health providers, the initial denial of employment or privileges; With respect to physicians, an involuntary alteration in practice that: Results solely from an FPPE or a focused review; Does not by itself or in combination with any other involuntary alteration in practice exceed 90 days in any one calendar year; Consists solely of one or more of the following: A program of additional training or monitoring or heightened scrutiny of the individual’s practice; or A requirement that the individual successfully perform a skill, an activity, or a procedure a specific number of times, or within a specific time period; and Does not result from inappropriate sexual behavior, harassment, or any other unprofessional conduct in the workplace; With respect to physicians, the initial denial of employment or privileges due solely to the applicant’s: Inability to fulfill on-call requirements because of other time commitments; Lack of a board certification required by the reporting entity; or Lack of experience in conducting a particular medical procedure; Administrative suspensions, if the sum total does not cumulatively exceed 30 days in any one calendar year, imposed on or agreed to by the health care provider, solely for the health care provider’s failure to: Acquire mandated vaccinations or required serum titers for infections; Attend required meetings; Complete medical records; Complete required training; or Maintain or submit a certificate of professional insurance; With respect to allied health providers and subject to the requirements of §D(1) and (2) of this regulation, entrance into an alcohol or a drug treatment program: That is accredited by the Joint Commission; That is certified by the Maryland Department of Health; To which the allied health provider is referred by the Maryland Physician Health Program or the Maryland Healthcare Professionals Program; or Provided by a health care practitioner who is competent and capable of dealing with alcoholism and drug abuse; or With respect to physicians and subject to the requirements of §D(3) and (4) of this regulation, entrance into an alcohol or a drug treatment program: That is accredited by the Joint Commission; That is certified by the Maryland Department of Health; or To which the physician is referred by the Maryland Physician Health Program. Exceptions to §C(8) and (9) of This Regulation. Section C(8) of this regulation applies only where: The allied health provider notified the reporting entity at the time the allied health provider decided to enter the program; The reporting entity is able to verify that the allied health provider remains continually in the program until properly discharged; and The action or condition of the allied health provider had not caused injury to any individual during the provision of health care by the allied health provider. Section C(8) of this regulation does not apply to: Any change made by a reporting entity relating to the discharge of an allied health provider from an alcohol or a drug treatment program, when that discharge was for non-attendance or non-compliance with the program; Additional changes made by the reporting entity, other than minor scheduling changes made solely to accommodate participation in the program; or Any change made by the reporting entity based on events set out in Regulation .03B which occurred subsequent to the provider’s entrance into the alcohol or drug treatment program. Section C(9) of this regulation applies only where: The physician notified the reporting entity at the time the physician decided to enter the program; The reporting entity is able to verify that the physician remains continually in the program until properly discharged; and The action or condition of the physician had not resulted in injury to any individual during the provision of health care by the physician. Section C(9) of this regulation does not apply to: Any change made by a reporting entity relating to the discharge of a physician by an alcohol or a drug treatment program, when that discharge was for non-attendance or non-compliance with the program; Additional changes made by the reporting entity, other than minor scheduling changes made solely to accommodate participation in the program; or Any change made by the reporting entity relating to events set out in §B of this regulation which occurred subsequent to the physician’s entrance into the alcohol or drug treatment program. A licensed naturopathic doctor, other licensed health care practitioner, health care facility located in the State, or State agency shall file a written report to the Board if there is reason to believe that a licensed naturopathic doctor is or may be: Medically or legally incompetent; Engaged in the unauthorized practice of naturopathic medicine; Guilty of unprofessional conduct; or Mentally or physically unable to engage safely in the practice of naturopathic medicine. The report required under §A of this regulation shall be filed with the Board within 30 days after the individual or entity becomes aware of this information. A health care facility shall report within 10 days to the Board if a licensed naturopathic doctor voluntarily resigns from the staff of the health care facility, voluntarily limits staff privileges, or fails to reapply for hospital privileges at the health care facility while the naturopathic doctor is under formal or informal investigation by the health care facility for possible medical incompetence, unprofessional conduct, or mental or physical impairment. Physicians. A reporting entity shall file reports required under this chapter with the Board within 10 days of any change made with regard to a physician. Within 10 days, the reporting entity who has reported a change to the Board under this chapter shall report to the Board in writing any modifications made to, or subsequent developments in, that change. Allied Health Providers. Except as provided in §B(2) of this regulation, a reporting entity shall file any report required under this chapter within 10 days of any change made with respect to allied health providers. With respect to physician assistants: An employer of a physician assistant who terminates the physician assistant because of a quality of care issue shall report the termination within 5 days of the termination; A physician or an employer who terminates a delegation agreement with a physician assistant shall report that termination within 10 days; and A report submitted under §B(2)(b) of this regulation may not be used to fulfill the requirement of §B(2)(a) of this regulation. Naturopathic Doctors. Within 30 days, a licensed naturopathic doctor, other licensed health care provider, health care facility located in the State, or State agency shall file a written report with the Board upon becoming aware of information described in Regulation .04A of this chapter. Within 10 days, a health care facility shall report to the Board any information required under Regulation .04C of this chapter. The Board shall conduct any necessary investigation regarding failure of a reporting entity to file a report required under this chapter. Over the signature of an officer, the executive director, or the deputy director, the Board may issue subpoenas in connection with any investigation or proceeding to enforce this chapter. Before submission of the final investigative report to the Board, the investigator shall inform the reporting entity of the allegation of failure to report and offer the reporting entity an opportunity to submit a written response. Any written response shall be made part of the investigative report. The investigative report is confidential and may not be released to any person except as provided in §E of this regulation. The final investigative report shall be submitted to the Board. The Board, after consideration of the investigative report, shall: If it finds probable cause that the reporting entity failed to report as required by this chapter, vote to issue a notice of failure to file a report setting out the facts of the alleged failure and the recommended civil penalty as set out in §O of this regulation; or Dismiss the case. If the Board votes to issue a notice of failure to file a report, the Board shall mail by first class mail the notice of failure to file a report to the reporting entity involved. Upon this mailing, the Board shall make available to the reporting entity the investigative report, less the names of any confidential informants who will not be called as witnesses in the case. If the reporting entity does not request a hearing within 30 days of the date the notice of failure to file a report was mailed, the notice of failure to file a report shall become final and shall constitute a final disposition of the Board. A reporting entity which has timely filed a request for a hearing may choose to attend a settlement conference with a committee of the Board to attempt to resolve a case. If a settlement conference is convened: The reporting entity may be represented by counsel; Except for consideration of a proposed resolution of the case, the Board may not use any commentary, admissions, facts revealed, or positions taken at the settlement conference, unless the subject matter is available from other sources or is otherwise discovered; At the conclusion of the settlement conference, the committee shall recommend either: Dismissing the notice of failure to file a report; or Upholding the notice of failure to file a report and imposing a civil penalty as set out in §O of this regulation. If the reporting entity agrees with the recommendation of the settlement committee, the Board shall consider the recommendation and either accept or reject it. The Board’s acceptance of the settlement committee’s recommendation constitutes the Board’s final disposition of the case. If a settlement is not reached or if the settlement committee’s recommendation is not approved by the Board, the case shall proceed to a hearing before the Board. The hearing ordinarily shall be limited to oral argument before the Board. The issues at the hearing are limited to whether a reporting entity: Made a change as defined in this chapter; Had reason to believe that the change was made, in whole or in part, because of a reason listed in Regulation .03B of this chapter; Reported the change to the Board; and Reported the change within the time frames set out in this chapter. The Board chair or alternate presiding officer may reasonably limit the time for oral argument. The Board shall conduct an evidentiary hearing if the chair or alternate presiding officer finds that there is a substantial dispute concerning one or more of the material facts set out in §J of this regulation. If there is an evidentiary hearing, the Board chair or alternate presiding officer may: Administer oaths or affirmations; Issue subpoenas for relevant evidence; Make all rulings on the admission of evidence; Rule on motions; Exclude repetitive or irrelevant evidence, require the parties to narrow the factual evidence to the relevant issues, and make any other rulings in order to focus and expedite the proceeding; Require proffers of evidence in advance of the hearing and make evidentiary rulings before the commencement of the hearing; and Reasonably limit the time for presentations. It is not a defense to the allegation of a failure to report that: An employee of the reporting entity was not aware of: The change made by the reporting entity; or The obligation to report; or The reporting entity was conducting its own proceeding to further evaluate the change or the reasons for the change. If the Board finds after the hearing that the reporting entity did not fail to file any report required by this chapter, the Board shall issue a final disposition dismissing the notice of failure to file a report. If the Board finds after a hearing that a reporting entity failed to file any report required by this chapter, the Board shall issue a final disposition with findings of fact, conclusions of law, and civil penalty. In its final disposition, the Board may impose a civil penalty as follows: With respect to reports concerning physicians: $2,500 for the first occurrence in a calendar year; or $5,000 for any subsequent occurrence in a calendar year; and With respect to reports concerning allied health providers: $500 for the first occurrence in a calendar year; or $1,000 for any subsequent occurrence in a calendar year. The Board disposition is the final administrative action on the matter. A reporting entity that is dissatisfied with a final disposition of the Board may seek judicial review of the Board’s final disposition as provided in the Administrative Procedure Act. The disposition of the Board may not be stayed pending judicial review. The Board shall pay all monies collected pursuant to this chapter into the State’s General Fund. The Board may refer any uncollected civil penalties under this regulation to the Central Collection Unit of the State. The investigative and quasi-judicial procedures set out in this regulation, and the confidentiality provisions of Regulation .07 of this chapter, apply to licensed naturopathic doctors, other licensed health care providers, health care facilities located in the State, and State agencies with respect to any allegations that they failed to file a report required under Regulation .04 of this chapter. A report made to the Board under this chapter is not subject to subpoena or discovery in any civil action other than a proceeding arising out of a hearing and the final disposition of the Board or disciplinary panel. The notice of failure to file a report and any final disposition under this chapter are public documents. The notice of failure to file a report and any final disposition shall redact: The name of a patient and any other patient-identifying information; and Records of a health care provider’s or a naturopathic doctor’s physical, mental, or emotional condition, except to the extent necessary to identify the deficient practice or condition that caused an entity to make a change as defined in Regulation .02 of this chapter. Health Occupations Article, §§14-205(a)(2), 14-413, 14-414, 14-5A-18, 14-5B-15, 14-5C-18,14-5E-18, 14-5F-19, and 15-103, Annotated Code of Maryland Effective date: November 7, 2016 (43:22 Md. R. 1221) Regulation .02B amended effective January 1, 2018 (44:26 Md. R. 1215) Regulation .03 amended effective January 1, 2018 (44:26 Md. R. 1215) Regulation .05A amended effective January 1, 2018 (44:26 Md. R. 1215) This chapter defines the parameters under which a physician may obtain a permit to dispense prescription drugs to that physician’s patients, dispense prescription drugs to the patients of other prescribers under certain circumstances, and delegate parts of the dispensing process to others in accordance with Health Occupations Article, §§12-102 and 14-306, Annotated Code of Maryland. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the State Board of Physicians. “Controlled dangerous substance (CDS)” has the meaning stated in Criminal Law Article, §5-101(g), Annotated Code of Maryland. “Dispense” has the meaning stated in Health Occupations Article, §12-101, Annotated Code of Maryland. “Drug sample” has the meaning stated in 21 CFR §203.3(i). Final Check. “Final check” means the verification of the accuracy and completeness of a filled prescription order by the permit holder before the drug is dispensed to the patient. “Final check” includes the assumption of responsibility for the filled prescription, including verifying the: Appropriateness of the dose; Accurate expiration date; Accuracy of the drug dispensed; Strength of the drug dispensed; Labeling that complies with Health Occupations Article, §12-505, Annotated Code of Maryland; and Appropriateness of the container in which the drug is dispensed, including child-proof containers where applicable. “In good standing” means that an individual: Holds a license to practice medicine in this State; Is not currently suspended by any order imposed by any medical licensing board; Is not currently on probation by any order imposed by any medical licensing board; Is not currently subject to any restrictions on practice related to the abuse, misuse, or improper prescribing of drugs; Has not been within the past 5 years sanctioned by any medical licensing board for the commission of a crime of moral turpitude or for a violation of Health Occupations Article, §14-404(a)(7), (8), (9), (10), or (28), Annotated Code of Maryland, or a similar statute of another state; and Has not within the past 5 years had the CDS registration issued by the OCSA or its predecessor, the registration issued by the federal Drug Enforcement Agency, or the Board dispensing permit: Revoked; Suspended; or Voluntarily relinquished or surrendered while under investigation or after being informed that an investigation will be commenced. “In the public interest” means that a pharmacy is not conveniently available to the patient. Mechanical Act. “Mechanical act” means an act which does not require professional judgment, medical or pharmaceutical training, or discretion. “Mechanical act” does not include: Selecting a drug; Labeling; Measuring or calculating dosages; Substituting one drug for another, including substituting a generic or brand drug for the prescribed drug; Substituting one dosage form of a drug for another; Altering the route of administration; or Counseling patients. “OCSA” means the Office of Controlled Substances Administration of the Maryland Department of Health. “Permit holder” means a physician licensed in this State who holds a valid dispensing permit under this chapter. “Readily retrievable” means maintained by any method by which the permit holder can retrieve and produce the record to OCSA during the course of an unscheduled on-site inspection. “Sample unit” has the meaning stated in 21 CFR §203.3 (aa). “Supplier” means: A wholesale distributor as defined in Health Occupations Article, §12-6C-01(v), Annotated Code of Maryland; or A pharmacy, to the extent permitted by Health Occupations Article, §12-406(b), Annotated Code of Maryland. A dispensing permit is not required to: Dispense prescription drugs or devices at a health facility or center described in Health Occupations Article, §12-102(g)(1)—(3), Annotated Code of Maryland; or Dispense to a patient, free of charge: A drug sample; A sample unit; or A starter dosage of a prescription drug, not to exceed a 72-hour supply. An applicant for a dispensing permit shall: Possess a license to practice medicine in this State; Be in good standing as that term is defined in this chapter; Be of good moral character; Demonstrate a basic knowledge of the statutes and regulations governing the practice of dispensing prescription drugs; Complete the application on a form supplied by the Board; and Pay the required fee as set out in COMAR 10.32.01.12. The applicant shall: State each location at which prescription drugs will be dispensed; and Grant permission to OCSA to inspect each location at which drugs will be dispensed at any reasonable hour. An applicant for renewal of a dispensing permit shall submit, upon request, documentation of completion of at least ten continuing education credits related to the preparing and dispensing of prescription drugs offered by the Accreditation Council for Pharmacy Education or as approved by the Secretary of the Maryland Department of Health. The Board shall grant the application for a dispensing permit if: The applicant meets the requirements of Regulation .04 of this chapter; The applicant has not been sanctioned by the Board for dispensing drugs without a permit within the last 5 years; and Granting the application is in the public interest. A permit holder shall comply with all federal and State statutes and regulations regarding prescription drugs, including all requirements for: Dispensing, including labeling; Storing and securing inventory; Allowing access only to authorized individuals; Managing inventory controls; Recordkeeping; and Submitting prescription monitoring data to the Maryland Prescription Drug Monitoring Program in accordance with Health-General Article, Title 21, Subtitle 2A, Annotated Code of Maryland. A permit holder shall: Perform in person the final check of each drug dispensed; Sign or initial documentation in person that the final check was completed; Be present on the premises and available for consultation at the time the drug is dispensed; With regard to inspections by the OCSA: Personally sign at the time of the inspection the acknowledgement of receipt of the inspection report required by Health Occupations Article, §12-102(c)(2)(ii)4D, Annotated Code of Maryland; or Assure that during all normal office hours a designee is available on the premises who will sign at the time of the inspection the acknowledgement of receipt of the inspection report; Assure that the lot number of a drug obtained from a stock bottle or other larger container: Is recorded in the office records; Can be correlated with any patient’s prescription for that drug; and Is immediately available for inspection; and Except with regard to sample units, drug samples, and starter dosages in the possession and control of an authorized prescriber, assure that physical access to all prescription drugs is denied to all individuals at all times that a permit holder is not on the premises. A permit holder may not dispense medications by: Mail order; or A refill. For the purposes of this regulation, “refill” means an additional allotment of the same drug initially authorized by the original, written prescription. “Refill” does not prohibit a permit holder from dispensing the same or different drug through an additional or subsequent, written prescription. A permit holder may delegate to an unlicensed person only mechanical acts involved in dispensing a drug. Delegation to a Physician Assistant. Except as required in §B(2) of this regulation, a permit holder may delegate to a physician assistant with whom the permit holder has a delegation agreement under Health Occupations Article, §15-302, Annotated Code of Maryland, the dispensing of a drug prescribed by: The permit holder to the permit holder’s patient; or A physician assistant or certified registered nurse practitioner who meets the requirements of Regulation .08 or .09 of this chapter. The permit holder shall perform the final check. Except as required in §§B and C of this regulation, a permit holder may dispense a drug prescribed by a physician assistant with whom the permit holder has a delegation agreement under Health Occupations Article, §15-302, Annotated Code of Maryland, which authorizes the physician assistant to prescribe the drug. The permit holder shall perform the final check. The permit holder may dispense under this regulation only a drug that the permit holder is authorized to prescribe. Except as required in §§B and C of this regulation, a permit holder may dispense a drug prescribed by a certified registered nurse practitioner who is: Authorized under Health Occupations Article, Title 8, Annotated Code of Maryland, to prescribe the drug; and Working with the permit holder in the same office setting. The permit holder shall perform the final check. The permit holder may dispense under this regulation only a drug that the permit holder is authorized to prescribe. A permit holder shall keep readily retrievable at each dispensing location: A copy of the dispensing permit issued by the Board; A record of each final check; A copy of the form, signed and dated by the patient, maintained in accordance with COMAR 10.13.01.04, indicating the patient’s determination that a pharmacy is not conveniently available and demonstrating that the determination was made solely by the patient; The delegation agreement of any physician assistant for whom the permit holder dispenses prescription drugs at that location, including the name of the primary supervising physician and any alternate supervising physician; A list of the name and license number of all physician assistants for whom the permit holder dispenses drugs at that location; A list of the name, license number, and specialty of all certified registered nurse practitioners for whom the permit holder dispenses drugs at that location; The permit holder’s protocols for handling drug recalls, including the arrangements for notifying patients; The permit holder’s protocols for disposal of drugs; With respect to suppliers from whom the permit holder purchased prescription drugs: The name, address, and phone number of each supplier; and Documentation including: For any pharmacy supplier, the number and the expiration date of the pharmacy permit issued by the Maryland Board of Pharmacy and the number and expiration date of the CDS registration issued by OCSA; and For each wholesale supplier, the number and the expiration date of the distribution permit issued by the Maryland Board of Pharmacy and the number and expiration date of the CDS registration issued by OCSA; and Any other purchasing, inventory, and dispensing records required by State or federal statutes or regulations. In addition to meeting the requirements of Regulation .10A, the permit holder shall comply with any other State or federal law or regulation relating to dispensing of prescription drugs. A permit holder who dispenses CDS shall keep additional records available for inspection as required by COMAR 10.19.03.05. A permit holder may revise a permit twice during its term, without charge, to change the location at which prescriptions will be dispensed. A permit automatically lapses if the permit holder: Dies; Fails to retain a valid and active Maryland medical license; Fails without good cause to file the annual report required by Health Occupations Article, §12-102(c)(2)(ii)4L, Annotated Code of Maryland, within 15 days of the anniversary date of the date the permit was issued; or Fails without good cause to notify the Board of a change of address as required by Health Occupations Article, §14-316(f), Annotated Code of Maryland. A lapsed permit may not be reinstated. The lapse of a permit is not in itself a bar to filing an application for a new permit. A permit holder who has reported pursuant to Health Occupations Article, §12-102(c)(2)(ii)4L, Annotated Code of Maryland, that the permit holder has not personally dispensed prescription drugs during the previous year: Will not be subject to inspections by OCSA pursuant to Health Occupations Article, §12-102.1(b), Annotated Code of Maryland, unless the permit holder begins dispensing again; and May not begin to dispense prescription drugs again during the term of the dispensing permit without notifying the Board in advance in writing. Subject to the Administrative Procedure Act, and in addition to any sanction for violation of Health Occupations Article, §14-404(a)(28), Annotated Code of Maryland, the Board may revoke a dispensing permit on any of the following grounds: Violating the attestations made pursuant to COMAR 10.13.01.05C(4); Violating State or federal statutes or regulations regarding prescribing or dispensing prescription drugs; Delegating dispensing duties outside the scope of this chapter; Dispensing prescription drugs prescribed by another outside the scope of this chapter; Dispensing at a location not designated on the permit; Being absent from the premises when prescription drugs are dispensed under the permit; Failing to comply with the applicable requirements of the Prescription Drug Monitoring Program set out in Health-General Article, Title 21, Subtitle 2A, Annotated Code of Maryland; Failing to cooperate with an investigation by the Board or an inspection by OCSA; or Violating Regulations .06, .10, or .13 of this chapter. If a permit holder surrenders the permit while under investigation: The surrender does not prevent the Board from taking any appropriate disciplinary action under Health Occupations Article, §14-404(a)(28), Annotated Code of Maryland, or any other statute under which the Board has jurisdiction; and The permit holder may not apply for another permit again for a minimum of 5 years. The Board may summarily suspend a dispensing permit if it finds that the public safety, health, or welfare imperatively requires emergency action. Procedures for summary suspension shall be governed by COMAR 10.32.02.08. Subject to the Administrative Procedure Act, a licensee who fraudulently or deceptively obtains or attempts to obtain a permit is guilty of violating Health Occupations Article, §14-404(a)(1), Annotated Code of Maryland. If the Board sanctions a permit holder for violating Health Occupations Article, §14-404(a)(7), (8), (9), (10), or (28), or §14-404(b), Annotated Code of Maryland, the Board shall, in addition to any sanctions imposed on the permit holder under COMAR 10.32.02.07 or 10.32.02.10, revoke the permit. Subject to the requirement of §C of this regulation, reinstatement of a revoked permit is at the discretion of the Board. A revoked permit may not be reinstated for a minimum of 5 years from the date of revocation. Unless otherwise authorized by Health Occupations Article, §12-102, Annotated Code of Maryland, the dispensing of prescription drugs by a physician without a permit is a violation of Health Occupations Article, §14-404(a)(28), Annotated Code of Maryland, and also may be considered unprofessional conduct in the practice of medicine in violation of Health Occupations Article, §14-404(a)(3)(ii), Annotated Code of Maryland. Nothing in this chapter relieves any permit holder from meeting the requirements of State or federal law or COMAR 10.13.01. Health Occupations Article, §§12-102, 14-205, 14-306, 14-404, and 14-408; State Government Article, §§10-206 and 10-226; Annotated Code of Maryland Effective date: March 26, 2018 (45:6 Md. R. 320) This chapter governs the practice of genetic counseling. Except as provided in §§C— D of this regulation, on or after January 1, 2024, an individual shall be licensed by the Board before the individual may practice genetic counseling. This chapter does not prohibit any student who is currently enrolled in an accredited educational program to qualify for a license as a genetic counselor from performing any of the procedures described in this chapter as part of that program’s clinical curriculum on genetic counseling. This chapter does not prohibit an individual from practicing a health occupation that the individual is authorized to practice under Health Occupations Article, Annotated Code of Maryland. The National Society of Genetic Counselors Code of Ethics (1992, revised 2017) is incorporated by reference. In this chapter, the following terms have the meanings indicated. Terms Defined. “Accredited educational program” means an educational program that is accredited by the national accrediting council or an equivalent accrediting body recognized by the national certifying board. “Board” means the State Board of Physicians. “Certified genetic counselor” means an individual certified as a genetic counselor by a national certifying board. “Committee” means the Genetic Counseling Advisory Committee established under Health Occupations Article, §14-5G-05, Annotated Code of Maryland. “Disciplinary panel” means a disciplinary panel of the Board established under Health Occupations Article, §14-401, Annotated Code of Maryland. Genetic Assessment. “Genetic assessment” means the integration of genetic laboratory test results and other diagnostic studies with the medical histories of a patient and the patient’s family members to assess the risk for the patient or the patient’s family members of: A genetic or medical condition or disease; and The recurrence of a genetic or medical condition or disease. “Genetic assessment” includes taking medical and family histories for the purpose of genetic counseling. “Good standing” has the meaning stated in COMAR 10.32.22.02. “Immediately available” means a qualified supervisor is able to provide necessary direction in person, by telephone, or by other electronic means. “License” means a license issued by the Board to practice genetic counseling. “Licensed genetic counselor” means an individual who is licensed by the Board, in accordance with Health Occupations Article, Title 14, Subtitle 5G, Annotated Code of Maryland, to practice genetic counseling as a genetic counselor in the State. “Licensee” means a licensed genetic counselor or a supervised genetic counselor. “National accrediting council” means the Accreditation Council for Genetic Counseling, or its successor, that accredits education programs for genetic counselors. “National certifying board” means the American Board of Genetic Counseling, its predecessor, or its successor, that certifies genetic counselors. Practice Genetic Counseling. “Practice genetic counseling” means: Obtaining and evaluating the medical histories of a patient and the patient’s family members for purposes of a genetic assessment; Discussing the features, natural history, means of diagnosis, genetic and environmental factors, and management of risk for genetic or medical conditions or diseases. Identifying, ordering, and coordinating genetic laboratory tests and other diagnostic studies, as appropriate, for purposes of a genetic assessment; Using the medical histories obtained from the patient and the patient’s family members for purposes of a genetic assessment; Explaining the clinical implications of genetic laboratory tests and other diagnostic studies and the results of the tests and studies and communicating the risk factors for genetic or medical conditions or diseases identified by a genetic assessment; Evaluating the responses of a patient and the patient’s family members to the results of a genetic assessment and providing counseling and anticipatory guidance for a genetic or medical condition or disease; Identifying and using community resources that provide medical, educational, financial, and psychosocial support and advocacy for a genetic or medical condition or disease; and Providing written documentation of medical, genetic, and counseling information for a patient, a patient’s family members, or appropriate health care professionals. “Practice genetic counseling” does not include diagnosing or treating an illness, a disease, or a condition. “Qualified supervisor” means: A licensed genetic counselor who has practiced for a minimum of 3 years after passing the national certifying examination; or A physician who has been licensed in the State for a minimum of 5 years. “Supervised genetic counselor” means an individual who is licensed by the Board, in accordance with Health Occupations Article §14-5G-14, to practice genetic counseling under the supervision of a qualified supervisor. “Supervision” means the ongoing, direct, clinical review for the purposes of training or teaching by a qualified supervisor who monitors the performance of a supervised genetic counselor’s supervised interaction with a patient and provides consultations, chart reviews, guidance, and instructions with respect to the clinical skills and competencies of the supervised genetic counselor, as well as documented face-to-face meetings on at least a monthly basis. “Supervised interaction” means an interaction between a supervised genetic counselor and a patient where a qualified supervisor is immediately available. The Board shall appoint members of the Committee as follows: Three individuals who practice genetic counseling who: Are in good standing with the Board; Are a resident of the State with at least 1 year of active genetic counseling experience as a licensed, supervised, or certified genetic counselor within the 5-year period immediately preceding the date of the appointment; and On or after January 1, 2024, are licensed genetic counselors; Three practicing licensed physicians who: Are in good standing with the Board; and Have experience working with genetic counselors; and One consumer member who: Shall be a member of the general public; and May not: Practice, or ever have practiced genetic counseling, or any other health care profession; Be, or ever have been, in training to practice genetic counseling or any other health care profession; Have a household member who is a health care professional or is in training to be a health care professional; Participate, or ever have participated, in a commercial or professional field related to genetic counseling; Have a household member who participates in a commercial or professional field related to genetic counseling; Have had, within 2 years before appointment, a financial interest in a person regulated by the Board; or Have had, within 2 years of appointment, a financial interest in the provision of goods or services to genetic counselors or to the field of genetic counseling. Tenure. The term of a member is 3 years. The terms of the members are staggered. At the end of a term, a member continues to serve until a successor is appointed and qualifies. An individual may be reappointed for a second 3-year term, but the individual may not serve more than two consecutive 3-year terms. The terms of the initial members of the Committee shall expire as follows: Two members in 2024; Two members in 2025; and Three members in 2026. Vacancy. If a vacancy occurs, the Board shall appoint a new member to serve on the Committee. The successor member shall only serve for the remainder of the term unless reappointed. Chair. From among its members, the Committee shall elect a chair every 2 years. Quorum. A quorum of the Committee consists of five members. Business may not be conducted at a Committee meeting unless there is a quorum. In addition to the powers set forth elsewhere in this chapter, the Committee may develop and make recommendations to the Board in any matters related to the regulation of the practice of genetic counseling. A genetic counselor in the State shall follow The National Society of Genetic Counselors Code of Ethics. An applicant for a license as a licensed genetic counselor or a supervised genetic counselor shall: Complete an application on a form provided by the Board; Pay the required application fee set by the Board in accordance with Regulation .12 of this chapter; Be 18 years old or older; Be of good moral character; Demonstrate spoken and written competency in English by any of the following: Documentation of graduation from a recognized English-speaking high school or undergraduate school after at least 3 years of enrollment; Documentation of graduation from a recognized English-speaking professional school; or Documentation of receiving a grade of at least: 26 on the “Speaking Section” of the Internet-based Test of English as a Foreign Language; and 79 on the total score of the Internet-based Test of English as a Foreign Language; If applicable, provide documentation of licensure, certification, or registration from all states and jurisdictions where the applicant has ever held a license, certificate, or registration in any health profession; Have no history of public disciplinary action taken, or pending, against any license currently or previously held or expired; and Complete a criminal history records check in accordance with Health Occupations Article, §14-308.1, Annotated Code of Maryland. An applicant for a license as a licensed genetic counselor or a supervised genetic counselor shall submit satisfactory evidence of graduation from an accredited educational program. Except as provided in § D of this regulation, an applicant for a license as a licensed genetic counselor shall submit to the Board satisfactory evidence of certification by a national certifying board. If an applicant for a license as a licensed genetic counselor does not meet the requirement under §C of this regulation, the applicant may qualify for licensure as a licensed genetic counselor if the applicant: Has worked as a genetic counselor for: At least 10 years before January 1, 2024; and At least 5 consecutive years immediately preceding the date on which the applicant submits the application for licensure; Has graduated from an accredited educational program; Submits to the Board three letters of recommendation from licensed physicians who have been licensed for at least 5 years or certified genetic counselors eligible for licensure and who: Have worked with the applicant in an employment or professional setting for 3 years before the applicant submits the application for licensure; and Can attest to the applicant’s competency in providing genetic counseling services. An applicant for a license as a supervised genetic counselor shall submit to the Board satisfactory evidence that the applicant has applied for the first available national certifying examination. The Board may not issue a supervised genetic counselor license to an applicant if the applicant has failed the national certifying examination two or more times. If, while practicing genetic counseling, a licensed genetic counselor or supervised genetic counselor determines that a patient requires diagnosis, treatment, or management, the genetic counselor shall: Refer the patient to a licensed physician or another appropriate health care practitioner; and Document the referral in the patient’s medical record. The scope of practice of a licensed genetic counselor or a supervised genetic counselor includes the following: Obtaining and interpreting individual or family medical and developmental histories; Determining the mode of inheritance and risk of transmission of genetic conditions and of birth defects, including evaluating the risks from exposure to possible mutagens and teratogens; Discussing the inheritance features, natural history, means of diagnosis, and management of genetic conditions and birth defects; Identifying, ordering, coordinating, and explaining the clinical implications of genetic laboratory tests and other diagnostic studies and their results; Integrating genetic laboratory test results and other diagnostic studies with personal and family medical history to assess and communicate risk factors for genetic or medical conditions and diseases; Assessing psychosocial factors; Recognizing social, educational, and cultural issues; Evaluating the patient’s or family’s responses to the condition or risk of recurrence and providing patient-centered counseling and anticipatory guidance; and Facilitating informed decision-making about testing, management, and alternatives. Term and Expiration. A supervised genetic counselor license shall expire on the earliest of: The issuance of a genetic counselor license to the supervised genetic counselor; On notice of the second failure of the supervised genetic counselor to pass the certification examination; or 1 year after the date of issuance. A supervised genetic counselor license may not be renewed or extended beyond the 1-year expiration date. A supervised genetic counselor who has not passed the certification examination within two examination cycles may not continue practicing under the supervised genetic counselor license. Supervision. A supervised genetic counselor may practice only under the supervision of a qualified supervisor. The supervised genetic counselor and the qualified supervisor shall enter into a written supervision contract that: Specifies the manner of supervision; Specifies any alternative qualified supervisors, as appropriate; Is signed by the supervised genetic counselor and the qualified supervisor; and Is maintained by both the supervised genetic counselor and the qualified supervisor and made available upon request to the Board. Delegation of duties by a qualified supervisor beyond the scope of practice or failure to appropriately supervise a supervised genetic counselor may be considered unprofessional conduct in the practice of the qualified supervisor’s profession. At least 1 month before the license expires, the Board shall send a renewal notice to the licensed genetic counselor that states: The date on which the current license expires; The date by which the renewal application shall be received by the Board for the renewal to be issued before the license expires; and The amount of the renewal fee set by the Board in accordance with Regulation .12 of this chapter. Renewal. The Board may not renew a license until the Office of the Comptroller or the Maryland Department of Labor has verified that the individual has paid all undisputed taxes and unemployment insurance contributions, or arranged for repayment, as required by COMAR 10.31.02. An individual who has been licensed by the Board as a licensed genetic counselor may renew the license every 2 years on or before the date specified by the Board by: Submitting a renewal application on the form supplied by the Board; Paying the required renewal fee set by the Board in accordance with Regulation .12 of this chapter; and Attesting to: Current certification by the national certifying board; or Completion of at least 50 hours of continuing education credits approved by the national certifying board, earned during the 2-year period preceding the expiration of the license for genetic counseling. Documentation of Continuing Education. A genetic counselor shall obtain documentation of attendance at continuing education and retain the documentation for 6 years. The documentation shall contain, at a minimum, the following information: Program title; Sponsor’s name; Genetic counselor’s name; Inclusive date or dates and location of the program; The number of continuing education hours earned; and Documented verification that the genetic counselor attended the program by stamp, signature, print-out, or other official proof. Proof of maintenance of certification by the national certifying board may be used to document compliance with the continuing education requirements specified in this regulation. The Board may request a genetic counselor to submit evidence of having met the continuing education requirements specified in this regulation. If a genetic counselor cannot demonstrate completion of the required continuing education credit hours, the Board may impose a civil penalty of up to $100 per missing continuing education credit hour. Reinstatement. The Board shall reinstate the license of a licensed genetic counselor who has failed to renew the license for any reason if the genetic counselor: Applies for reinstatement after the date the license expires; Provides documentation of current certification by the national certifying board; Completes a criminal history records check in accordance with Health Occupations Article, §14-308.1, Annotated Code of Maryland; and Pays to the Board the reinstatement fee set by the Board in accordance with Regulation .12 of this chapter. Reinstatement of a Revoked or Surrendered License. On the application of an individual whose license has been revoked or surrendered, a disciplinary panel, on the affirmative vote of a majority of the quorum, may in its discretion reinstate a revoked or surrendered license. When a time period is not stated in an order for revocation or letter of surrender, the disciplinary panel may not entertain an application for post-disciplinary reinstatement until at least 3 years after the date of the order or letter of surrender. A revocation of a license may not be for less than 1 year. A disciplinary panel may not entertain an application for post-disciplinary reinstatement after an order of revocation unless: Any time period stated in the order has expired; Any condition set out in the order has been fulfilled; The applicant has filed a formal application and paid the fee set by the Board in accordance with Regulation .12 of this chapter; and The applicant: Applies for reinstatement after the date the license expires; Provides documentation of current certification by the national certifying board; Completes a criminal history records check in accordance with Health Occupations Article, §14-308.1, Annotated Code of Maryland; A disciplinary panel shall entertain applications for reinstatement pursuant to the procedures and standards of COMAR 10.32.02.06B. A disciplinary panel may not entertain applications for reinstatement if a revocation or surrender is permanent. A licensed genetic counselor or supervised genetic counselor shall notify the Board in writing of a change of name or address within 60 days after the change. If a licensed genetic counselor or supervised genetic counselor fails to notify the Board within the time required under §A of this regulation, the licensed genetic counselor or supervised genetic counselor may be subject to an administrative penalty of $100. The following fees are applicable to licensed genetic counselors and supervised genetic counselors: Initial licensed genetic counselor licensure fee—$300; Supervised genetic counselor licensure fee—$100; License renewal fees: License renewal fee—$250; and Maryland Health Care Commission fee—as determined by the Maryland Health Care Commission in accordance with COMAR 10.25.03; Reinstatement fee—$300; Written verification of license fee—$25; and Replacement of license fee—$25. Subject to the hearing provisions set forth in Health Occupations Article, §14-405, Annotated Code of Maryland, a disciplinary panel may deny a license to any applicant, reprimand any licensee, place any licensee on probation, or suspend or revoke a license if the applicant or licensee: Fraudulently or deceptively obtains or attempts to obtain a license for the applicant or licensee or for another; Fraudulently or deceptively uses a license; Is guilty of unprofessional or immoral conduct while practicing genetic counseling; Is professionally, physically, or mentally incompetent; Abandons a patient; Is habitually intoxicated; Is addicted to or habitually abuses any narcotic or controlled dangerous substance as defined in Criminal Law Article, §5-101, Annotated Code of Maryland; Provides professional services while: Under the influence of alcohol; or Using any narcotic or controlled dangerous substance as defined in Criminal Law Article, §5-101, Annotated Code of Maryland, or any other drug that is in excess of therapeutic amounts without valid medical indication; Promotes the sale of services, drugs, devices, appliances, or goods to a patient so as to exploit the patient for financial gain; Willfully makes or files a false report or record in the practice of genetic counseling; Willfully fails to file or record any report as required under law, willfully impedes or obstructs the filing or recording of a report, or induces another to fail to file or record a report; Breaches patient confidentiality; Pays or agrees to pay any sum or provide any form of remuneration or material benefit to any person for bringing or referring a patient or accepts or agrees to accept any sum or any form of remuneration or material benefit from an individual for bringing or referring a patient; Knowingly makes a misrepresentation while practicing genetic counseling; Knowingly practices genetic counseling with an unauthorized individual or aids an unauthorized individual in practicing genetic counseling; Knowingly delegates a genetic counseling duty to an unlicensed individual; Grossly overutilizes health care services; Offers, undertakes, or agrees to cure or treat disease by a secret method, treatment, or medicine; Is disciplined by a licensing or disciplinary authority or is convicted or disciplined by a court of any state or country or is disciplined by any branch of the United States uniformed services or the U.S. Department of Veterans Affairs for an act that would be grounds for disciplinary action under the Board’s disciplinary statutes; Fails to meet appropriate standards for the delivery of genetic counseling services; Knowingly submits false statements to collect fees for which services are not provided; Has been subject to an investigation or disciplinary action by a licensing or disciplinary authority or by a court of any state or country for an act that would be grounds for disciplinary action under the Board’s disciplinary statutes and has: Surrendered the license, if any, issued by the state or country; or Allowed the license, if any, issued by the state or country to expire or lapse; Knowingly fails to report suspected child abuse in violation of Family Law Article, §5-704, Annotated Code of Maryland; Practices or attempts to practice beyond their authorized scope of practice; Refuses, withholds from, denies, or discriminates against an individual with regard to the provision of professional services for which the licensee is licensed and qualified to render because the individual is HIV positive; Practices or attempts to practice genetic counseling procedures or uses or attempts to use genetic assessments if the applicant or licensee has not received education and training in the performance of the procedure or the use of the genetic assessment; Fails to cooperate with a lawful investigation of the Board or a disciplinary panel; Fails to complete a criminal history records check under Health Occupations Article, §14-308.1, Annotated Code of Maryland; or Violates any provision of this title or any rule or regulation pertaining to genetic counseling that is adopted by the Board, the State, or the federal government. Crimes of Moral Turpitude. Proceedings for crimes of moral turpitude under Health Occupations Article, §14-5G-18(c), Annotated Code of Maryland, shall be held in accordance with COMAR 10.32.02.07. On the filing of certified docket entries with the Board by the Office of the Attorney General, the Board shall order the suspension of a license if the licensee is convicted of, or pleads guilty or nolo contendere with respect to, a crime involving moral turpitude, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside. After completion of the appellate process, if the conviction has not been reversed or the plea has not been set aside with respect to a crime involving moral turpitude, the Board shall order the revocation of a license on the certification by the Office of the Attorney General. Except as provided in §B, C, or F of this regulation, hospitals, related institutions, alternative health systems as defined in Health Occupations Article, §1-401, Annotated Code of Maryland, and employers shall file with the Board a report that the hospital, related institution, alternative health system, or employer limited, reduced, otherwise changed, or terminated any licensed genetic counselor or supervised genetic counselor for any reason that might be grounds for disciplinary action under Health Occupations Article, §14-5G-18, Annotated Code of Maryland, or any regulation in this chapter. If the action taken by a hospital, related institution, alternative health system, or employer under §A of this regulation relates to alcohol or drug impairment, the hospital, related institution, alternative health system, or employer is not required to report the licensed genetic counselor or supervised genetic counselor to the Board if: The hospital, related institution, alternative health system, or employer knows that the licensed genetic counselor or supervised genetic counselor is: In an alcohol or drug treatment program that is accredited by the Joint Commission or is certified by the Maryland Department of Health; or Under the care of a health care practitioner who is competent and capable of dealing with alcoholism and drug abuse; The hospital, related institution, alternative health system, or employer is able to verify that the licensed genetic counselor or supervised genetic counselor remains in the treatment program until discharge; and The action or condition of the licensed genetic counselor or supervised genetic counselor has not caused injury to an individual while the genetic counselor is practicing genetic counseling. If a licensed genetic counselor or supervised genetic counselor enters, or is considering entering, an alcohol or drug treatment program that is accredited by the Joint Commission or that is certified by the Maryland Department of Health, the licensed genetic counselor or supervised genetic counselor shall notify the hospital, related institution, alternative health system, or employer of the licensed genetic counselor or supervised genetic counselor’s decision to enter the treatment program. If the licensed genetic counselor or supervised genetic counselor fails to provide the notice required under §C of this regulation, and the hospital, related institution, alternative health system, or employer learns that the licensed genetic counselor or supervised genetic counselor has entered a treatment program, the hospital, related institution, alternative health system, or employer shall report to the Board that the licensed genetic counselor or supervised genetic counselor has entered a treatment program and has failed to provide the required notice. Noncompliance. If the licensed genetic counselor or supervised genetic counselor is found to be noncompliant with the treatment program’s policies and procedures while in the treatment program, the treatment program shall notify the hospital, related institution, alternative health system, or employer of the licensed genetic counselor or supervised genetic counselor’s noncompliance. On receipt of the notification required under §E(1) of this regulation, the hospital, related institution, alternative health system, or employer of the licensed genetic counselor or supervised genetic counselor shall report the licensed genetic counselor or supervised genetic counselor’s noncompliance to the Board. An individual is not required under this regulation to make any report that would be in violation of any federal or State law, rule, or regulation concerning the confidentiality of alcohol and drug abuse patient records. The hospital, related institution, alternative health system, or employer shall submit a required report within 10 days of any action described in this regulation. A report made under this regulation is not subject to subpoena or discovery in a civil action other than a proceeding arising out of a hearing and decision of the Board under Health Occupations Article, Title 14, Annotated Code of Maryland. An individual who violates any provision of Health Occupations Article, Title 14, Subtitle 5G, Annotated Code of Maryland, is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000 or imprisonment not exceeding 1 year, or both. An individual who violates any provision of Health Occupations Article, Title 14, Subtitle 5G, Annotated Code of Maryland, or any regulation in this chapter, is subject to a civil fine of not more than $5,000 to be levied by a disciplinary panel. The Board shall pay any penalty collected under §A or B of this regulation into the Board of Physicians Fund. Failure to Make a Required Report. A disciplinary panel may impose a fine up to $1,000 for a hospital, related institution, alternative health system, or employer who fails to make a report to the Board required by Regulation .14 of this chapter. The Board shall deposit any funds collected under §D(1) of this regulation into the State’s General Fund. General Application of Sanctioning Guidelines. §§ E and F of this regulation and Regulation .16 of this chapter do not apply to offenses for which a mandatory sanction is set by statute or regulation. Except as provided in §F of this regulation, for violations of the sections of the Maryland Genetic Counseling Act listed in the sanctioning guidelines, a disciplinary panel may not impose a sanction less severe than the minimum listed in the sanctioning guidelines or more severe than the maximum listed in the sanctioning guidelines for each offense. Ranking of Sanctions. For the purposes of this regulation, the severity of sanctions is ranked as follows, from the least severe to the most severe: Reprimand; Probation; Suspension; and Revocation. A stayed suspension in which the stay is conditioned on the completion of certain requirements is ranked as probation. A stayed suspension which does not meet the criteria for § E(3)(b) of this regulation is ranked as a reprimand. A disciplinary panel may impose more than one sanction, provided that the most severe sanction neither exceeds the maximum nor is less than the minimum sanction permitted in the sanctioning guidelines. Any sanction may be accompanied by conditions reasonably related to the offense or to the rehabilitation of the offender. The inclusion of conditions does not change the ranking of the sanction. If a licensee has violated more than one ground for discipline as set out in the sanctioning guidelines: The sanction with the highest severity ranking shall be used to determine which ground will be used in developing a sanction; and A disciplinary panel may impose concurrent sanctions based on other grounds violated. Notwithstanding the sanctioning guidelines set forth in Regulation .16 of this chapter, in order to resolve a pending disciplinary action, a disciplinary panel and the licensee may agree to a surrender of license or a consent order with terms and sanction agreed to by a disciplinary panel, the administrative prosecutor, and the licensee. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, a disciplinary panel may consider the aggravating and mitigating factors set forth in § F(4) and (5) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines. If a disciplinary panel imposes a sanction that departs from the sanctioning guidelines as set forth in Regulation .16 of this chapter, the disciplinary panel shall state the reasons for doing so in its final decision and order. Aggravating and Mitigating Factors. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, a disciplinary panel may consider the aggravating and mitigating factors set out in § F(4) and (5) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines. Nothing in this regulation requires a disciplinary panel or an Administrative Law Judge to make findings of fact with respect to any of these factors. The existence of one or more of these factors does not impose on a disciplinary panel or an Administrative Law Judge any requirement to articulate its reasoning for not exercising its discretion to impose a sanction outside of the range of sanctions set out in the sanctioning guidelines. Mitigating factors may include, but are not limited to, the following: The absence of a prior disciplinary record; The offender self-reported the incident; The offender voluntarily admitted the misconduct, made full disclosure to the Board, and was cooperative during the Board proceedings; The offender implemented remedial measures to correct or mitigate the harm arising from the misconduct; The offender made good faith efforts to make restitution or to rectify the consequences of the misconduct; The offender has been rehabilitated or exhibits rehabilitative potential; The misconduct was not premeditated; There was no potential harm to patients or the public or other adverse impact; or The incident was isolated and is not likely to recur. Aggravating factors may include, but are not limited to, the following: The offender has a previous criminal or administrative disciplinary history; The offense was committed deliberately or with gross negligence or recklessness; The offense had the potential for or actually did cause patient harm; The offense was part of a pattern of detrimental conduct; The offender committed a combination of factually discrete offenses adjudicated in a single action; The offender pursued his or her financial gain over the patient’s welfare; The patient was especially vulnerable; The offender attempted to hide the error or misconduct from patients or others; The offender concealed, falsified, or destroyed evidence or presented false testimony or evidence; The offender did not cooperate with the investigation; or Previous attempts to rehabilitate the offender were unsuccessful. A departure from the sanctioning guidelines set forth in Regulation .16 of this chapter is not a ground for any hearing or appeal of a Board action. Offenses Related to Continuing Medical Education Credits. If a licensee has submitted an application claiming the completion of continuing medical education credits and the licensee fails to document the completion of such continuing medical education credits when audited by the Board, the licensee may be charged under one or more of the following, as appropriate: Health Occupations Article, §14-5G-18(a)(3), Annotated Code of Maryland; Health Occupations Article, §14-5G-18(a)(10), Annotated Code of Maryland; and Health Occupations Article, §14-5G-18(a)(11), Annotated Code of Maryland. Upon finding a violation, a disciplinary panel may impose any discipline authorized under Health Occupations Article, §14-5G-18, Annotated Code of Maryland, and the sanctioning guidelines. Payment of Fines. An individual shall pay to the Board any fine imposed under this regulation within 15 calendar days of the date of the order, unless the order specifies otherwise. Filing an appeal under State Government Article, § 10-222, Annotated Code of Maryland, does not stay payment of a fine imposed by the Board pursuant to this regulation. If an individual fails to pay, in whole or in part, a fine imposed by the Board pursuant to this regulation, the Board may not restore, reinstate, or renew a license until the fine has been paid in full. In its discretion, the Board may refer all cases of delinquent payment to the Central Collection Unit of the Department of Budget and Management to institute and maintain proceedings to ensure prompt payment. Subject to provisions of Regulation .14E and F of this chapter, a disciplinary panel may impose sanctions as outlined in §B of this regulation on genetic counselors and supervised genetic counselors for violations of Health Occupations Article, §14-5G-18, Annotated Code of Maryland. Range of Sanctions. Health Occupations Article, §§1-606, 14-205, and 14-5G-01—14-5G-29, Annotated Code of Maryland Effective date: September 01, 2025 (52:17 Md. R. 874) This chapter governs the delegation of duties by a delegating physician to a supervised medical graduate in accordance with Regulations .04 and .05 of this chapter. This chapter may not be construed: As establishing licensure, certification, or registration by the Board for supervised medical graduates; To apply to certified, registered, or licensed professionals or health occupation students acting in accordance with Health Occupations Article, Annotated Code of Maryland; and To mean that this chapter overrides or is to be used in lieu of more stringent regulations, policies, and procedures established by State licensure or certification requirements or Board-recognized accrediting agencies. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the State Board of Physicians. “Delegated duty” means a routine medical or surgical act that does not require medical judgment and is performed under the supervision of a delegating physician. “Delegating physician” means a physician possessing an active license to practice medicine in the State who directs a supervised medical graduate to perform delegated duties. “Direct supervision” means oversight exercised by a delegating physician who is: Personally treating the patient; In the same medical office as the patient and the supervised medical graduate; and Immediately available to provide assistance and guidance to the supervised medical graduate for the duration of the delegated duty. “ECFMG” means the Educational Commission for Foreign Medical Graduates or its successor. “LCME” means the Liaison Committee on Medical Education, an organization which accredits programs in medical education leading to the doctor of medicine degree in the United States and its territories and, in cooperation with the Committee on Accreditation of Canadian Medical Schools, in Canada. Medical Office. “Medical office” means any facility or location used for the delivery of health services. “Medical office” includes but is not limited to: A health care facility as defined in Health-General Article, §19-114, Annotated Code of Maryland; and An ambulatory surgical facility as defined in Health-General Article, §19-3B-01(b), Annotated Code of Maryland. “Supervised medical graduate” means an individual who meets the requirements of Regulations .03 and .04 of this chapter and is delegated duties by a delegating physician in accordance with Regulation .05 of this chapter. A supervised medical graduate shall: Have a degree of: Doctor of Medicine from a school of medicine accredited by the LCME or its successor at the time of graduation; Doctor of Osteopathy from a school of osteopathy in the United States, its territories or possessions, Puerto Rico, or Canada that has standards for graduation equivalent to those established by the American Osteopathic Association; or Have a doctor of medicine degree from any other medical school and have successfully completed the requirements for and obtained ECFMG certification; and Receive a passing score in Part 1 and Part 2 of the United States Medical Licensing Examination. An individual may not practice as a supervised medical graduate for a period of more than 2 years. A supervised medical graduate may only be delegated duties by a delegating physician while under the direct supervision of the physician. A supervised medical graduate shall wear an identification badge while on the premises of the medical office that states in readily visible type: The name of the supervised medical graduate; and The title “Supervised Medical Graduate”. A supervised medical graduate shall comply with all additional requirements established by: Maryland Department of the Environment; The Joint Commission; and Any federal or State agency, including any federal or State laws or regulations. A medical office employing a supervised medical graduate shall: Issue the supervised medical graduate an identification badge in accordance with §C of this regulation; Verify all credentials of the supervised medical graduate; Maintain documentation that the supervised medical graduate meets the requirements of this chapter on the premises of the medical office; Permit the Board to inspect the maintained documentation to ensure compliance with this chapter; and Verify all duties delegated to and performed by the supervised medical graduate are in accordance with Health Occupations Article, §14-306, Annotated Code of Maryland, and this chapter. A delegating physician may delegate duties consistent with national standards in the medical community and the approved policies and procedures of the medical office. A delegating physician is not required to be in the presence of a supervised medical graduate and the patient during the duration of the performance of delegated duties. A delegating physician may delegate duties to a supervised medical graduate only while physically on the premises of the same medical office as the supervised medical graduate. A supervised medical graduate acting beyond the scope of this chapter may be: Considered to be engaged in the unlicensed practice of medicine; and Subject to all applicable penalties and fines in accordance with Health Occupations Article, §§14-601,14-602, 14-606 Annotated Code of Maryland and COMAR 10.32.02. A delegating physician, through either act or omission, facilitation, or otherwise enabling or forcing a supervised medical graduate to practice beyond the scope of this chapter, may be subject to discipline for grounds within Health Occupations Article, §14-404(a), Annotated Code of Maryland including, but not limited to, practicing medicine with an unauthorized person or aiding an unauthorized person in the practice of medicine. A delegating physician may not: Require a supervised medical graduate to perform delegated duties; or Permit a supervised medical graduate to delegate duties to another individual. The Board shall conduct any necessary investigation regarding the failure to comply with the requirements of Health Occupations Article, §14-306, Annotated Code of Maryland and this chapter. Health Occupations Article, §14-306, Annotated Code of Maryland Effective date: September 01, 2025 (52:17 Md. R. 874)