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<regulation prefix="Regulation" num=".04" citation="COMAR 10.32.12.04" title_num="10" subtitle_num="32" chapter_num="12" heading="Scope of Delegation to an Assistant.">
  <paragraph num="A.">
    <text>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.</text>
  </paragraph>
  <paragraph num="B.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>Surgical technical acts that the delegating physician directly orders while present, scrubbed, and personally performing the surgery in the same surgical field; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>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.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>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.</text>
  </paragraph>
  <paragraph num="D.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>Without on-site supervision:</text>
      <paragraph num="(a)">
        <text>Patient preparation for physician examination;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Patient history interview;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Collecting and processing specimens, such as performing phlebotomy and inoculating culture media;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Preparation of specimens for selected tests including:</text>
        <paragraph num="(i)">
          <text>Pregnancy tests;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Dipstick and microscopic urinalysis; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Microbiology (rapid streptococcal testing and throat cultures);</text>
        </paragraph>
      </paragraph>
      <paragraph num="(e)">
        <text>Laboratory tests that the licensed physician is satisfied the assistant is qualified to perform under State and CLIA regulations;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Clinical tests such as:</text>
        <paragraph num="(i)">
          <text>Application of tuberculin skin tests;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Electrocardiography;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Administering basic pulmonary function tests; and</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Visual field tests;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(g)">
        <text>Transmitting prescriptions to a pharmacy;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>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;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Preparing and administering oral drugs; and</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Microdermabrasion;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>With on-site supervision:</text>
      <paragraph num="(a)">
        <text>Preparing and administering injections limited to intradermal, subcutaneous, and intramuscular (deltoid, gluteal, vastus lateralis) to include small amounts of local anesthetics;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Establishing a peripheral intravenous line; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Injecting fluorescein-like dyes for retinal angiography; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>With direct supervision, injecting intravenous drugs or contrast materials.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>A licensed physician who possesses a dispensing permit may delegate the dispensing functions in accordance with the requirements of COMAR 10.32.23.</text>
  </paragraph>
  <paragraph num="F.">
    <text>A licensed physician may not delegate to an assistant acts which include but are not limited to:</text>
    <paragraph num="(1)">
      <text>Conducting physical examinations;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Administering any form of anesthetic agent or agent of conscious sedation other than topical anesthetics or small amounts of local anesthetics;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Initiating independently any form of treatment, exclusive of cardiopulmonary resuscitation;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Giving medical advice without the consult of a licensed physician; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Providing physical therapy.</text>
    </paragraph>
  </paragraph>
</regulation>