<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 10.32.09.05" title_num="10" subtitle_num="32" chapter_num="09" heading="Physician Responsibilities.">
  <paragraph num="A.">
    <text>A physician shall:</text>
    <paragraph num="(1)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Personally perform the initial assessment of each patient;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Obtain informed consent of the patient to be treated by a non-physician;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Retain responsibility for any acts delegated to a non-physician; and</text>
    </paragraph>
    <paragraph num="(7)">
      <text>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).</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>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.</text>
  </paragraph>
  <paragraph num="C.">
    <text>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.</text>
  </paragraph>
</regulation>