All proceedings of the Board in regular session shall be governed by Robert's Rules of Order. The Board shall, as the appointing authority, direct the operation of the staff through the executive director. Board members may not have monetary, pecuniary, or other interest in the affairs of any: Staff member; or Organization engaged in business with the Board, including: Businesses; Enterprises; or Other for-profit organizations. A Board member or Board staff may not serve for compensation as an instructor in a continuing education course or program under Board cognizance over which that Board member or staff member serves in an approval capacity. Preliminary educational qualifications credits acceptable to the Board are: Certificates or diplomas issued by public and private high schools accredited by the National Council of Secondary Educational Institutions or as recognized by the state or city issuing them. Certificates issued by the department of education of the states and possessions of the United States to applicants having 15 or more units to their credit. Applicants presenting foreign credits of preliminary education shall have them certified by the consul or the embassy of the country in which they were acquired. Bachelor's degree accredited by the State. The Board shall accept examination results only from the National Board of Chiropractic Examiners for applicants for a chiropractic license, including applicants seeking to practice chiropractic with physical therapy privileges. The Board shall set the minimum passing score for each section of the National Board of Chiropractic Examiners' examination. The Board shall administer a jurisprudence examination at least twice a year at times and places to be announced by the Board. An applicant for the jurisprudence examination shall: Have first successfully completed all required parts of the National Board of Chiropractic examination to the satisfaction of the Board; and Submit all documentation and fees at least 45 days before the examination date as determined by postmark. The examination shall begin promptly at a time announced by the Board and shall be proctored by a Board member or Board staff member. The applicant shall present a letter of admission and at least one form of personal, valid, current, U.S. government or state issued photo identification. There is no excuse, waiver, or exception for this requirement. The application shall be executed, verified, and submitted to the Board at least 45 days before the date of examination. The applicant shall follow all directions of the examination proctor. The examination paper shall be retained by the Board as follows: Passing examination papers shall be retained for 30 days; Failing examination papers shall be retained for 90 days; All examination papers shall be destroyed after the expiration of the time periods established under §I(1) and (2) of this regulation; and Retained examination papers may not be reviewed by the applicant following the completion of the applicant's examination. The Board shall administer the jurisprudence examination in the English language with no provisions made by the Board to accommodate the examination in any foreign language. An applicant who fails the jurisprudence examination three times may not retake the examination until the Board has reviewed the applicant's file and approved a retake. Temporary Licenses. The Board may not issue any temporary license to practice chiropractic in Maryland. An individual practicing chiropractic without a license shall be prosecuted and subject to penalties as prescribed in Health Occupations Article, Title 3, Subtitle 5, Annotated Code of Maryland. The Board shall issue a license only upon an applicant's successful completion of the: National Board of Chiropractic Examiners' examination, Parts I, II, III, and IV; Jurisprudence examination; and National Board of Chiropractic Examiners' Physiotherapy examination, if applicable. The Board may waive educational or examination requirements for any licensed chiropractor applying to practice exclusively with a visiting organization for not more than 30 days per calendar year if the: Chiropractor practices in a Board-approved, recognized jurisdiction with an active license in good standing; Practice is limited exclusively to members of the visiting organization; and Chiropractor submits a timely request by application in accordance with Board procedures. Display of License in Office. A license holder shall display conspicuously at all times at the license holders' place of business the license granted by the Board. The license holder shall notify the Board of any change in the name or address of the license holder, in writing, within 60 days after the change occurs. Licensure by Credential. An application for licensure by credential shall be based on a written SPEC examination administered by the National Board of Chiropractic Examiners, a jurisprudence examination administered by the Board, and the education and professional qualifications of the applicant. At the Board's discretion, an applicant for licensure by credential shall appear before the Board in person before the license is granted. Renewals. A license holder failing to renew a license shall: Be notified by the Board by certified mail of the delinquency; and Have the license lapse into non-renewed status if the license holder does not renew by September 30th of the renewal year. Continuing Education. Upon renewal, when audited by the Board, a license holder shall submit written evidence of the successful completion of the number of continuing education hours and cardiopulmonary resuscitation (CPR) certification required by the Board for renewal. The license holder shall have completed the required credit hours by the time of renewal. This evidence may include a photocopy of the official transcript or a report of the completion of the course. Only a course program approved by the Board may be used to meet the continuing education requirement of §H(2) of this regulation. The requirement may be waived by the Board upon proof of unusual and extreme hardship or disability, and upon application to the Board at least 60 days before September 1. Reinstatements. An applicant for reinstatement of a license that has lapsed for a period of more than 2 years shall be admitted only after satisfying the Board as to the applicant's efficiency by examination and the payment of fees due. Types of Licenses. The Board shall issue two types of licenses: A license covering the practice of chiropractic and physical therapy, as defined in Health Occupations Article, §3-101(f) and (g), Annotated Code of Maryland; and A license permitting the holder to practice chiropractic as defined in Health Occupations Article, §3-101(f) and (g), Annotated Code of Maryland. An individual holding the chiropractic license and wishing to qualify for the license to practice physical therapy in conjunction with a practice of chiropractic may do so by passing the National Board of Chiropractic Examiners Physiotherapy examination with a minimum score of 75 percent. The Board may find that a compelling public purpose warrants disclosure of information in an application, certification, licensing, or investigative file, regardless of whether there has been a request for the information, if: The information concerns possible criminal activity and the disclosure is to a federal, state, or local law enforcement or prosecutorial official or authority; The information concerns a possible violation of law and the disclosure is to a federal, state, or local authority that has jurisdiction over the individual whose conduct may be a violation, and the information disclosed is limited to information relevant to the possible violation by that individual; or The information concerns conduct by an individual that the Board reasonably believes may pose a risk to the public health, safety, or welfare, and the disclosure is to a law enforcement authority, administrative official, or agency that regulates the individual, or to a hospital or other health care facility where the individual has privileges. Other Disclosures. This regulation does not prohibit or limit the Board's ability to disclose general licensing information as provided in General Provisions Article, §4-333, Annotated Code of Maryland, or any information that the Board may otherwise disclose by law. Health Occupations Article, Title 3, Annotated Code of Maryland Effective date: February 1, 1969 Regulation .02-1 adopted as an emergency provision effective November 25, 1985 (12:25 Md. R. 2469); emergency status expired May 24, 1986 (Emergency provisions are temporary and not printed in COMAR) Regulation .06 amended effective January 21, 1991 (18:1 Md. R. 30) Regulation .06E amended effective April 27, 1977 (4:9 Md. R. 719) Regulation .08 repealed effective October 24, 1983 (10:21 Md. R. 1902) Chapter revised effective August 6, 2001 (28:15 Md. R. 1398) Regulation .02 amended effective June 9, 2003 (30:11 Md. R. 735) Regulation .02A amended effective June 13, 2011 (38:12 Md. R. 705) Regulation .04D amended effective June 13, 2011 (38:12 Md. R. 705); January 6, 2014 (40:26 Md. R. 2164) Regulation .04G amended effective June 13, 2011 (38:12 Md. R. 705) Regulation .04F amended effective October 22, 2007 (34:21 Md. R. 1915) Regulation .05 amended effective October 22, 2007 (34:21 Md. R. 1915); January 6, 2014 (40:26 Md. R. 2164) Regulation .05F amended effective April 13, 2015 (42:7 Md. R. 570) Subtitle and Chapter name amended to be, Board of Chiropractic Examiners, General Regulations, effective January 2, 2017 (43:26 Md. R. 1446) This chapter applies to all contested case hearings before the Board of Chiropractic Examiners or before the Office of Administrative Hearings. It does not apply to conferences or other informal investigations or proceedings. Written notice of a hearing shall be sent by the Board to all interested parties at least 30 days before the hearing. The notice shall state the date, time, and place of the hearing. It shall also state the issues or charges involved in the proceeding, provided, however, that if by reason of the nature of the proceeding, the issues cannot be fully stated in advance of the hearing, or if subsequent amendment of the issues is necessary, they shall be fully stated as soon as practicable. Service upon a party shall be by delivery of the charging document and a copy of the complaint to the party in person. Instead of personal service, the Board may serve the charging document and a copy of the complaint by registered or certified mail, restricted delivery, return receipt requested. Every party appearing at formal hearings has the right to appear in proper person, or by or with counsel. Pre-hearing Conferences. The Board may set a pre-hearing conference as it deems appropriate. Oaths and Subpoenas. The Board may administer oaths and compel the attendance of witnesses and the production of physical evidence before it from witnesses upon whom process is served anywhere within the State as in civil cases in the circuit court of the county or of Baltimore City, by subpoena issued over the signature of the President or Secretary and the seal of the Board. Upon a request by a party and statement under oath that the testimony or evidence is necessary to their defense, the Board shall issue a subpoena on their behalf. All motions filed by a party with the Board or the Office of Administrative Hearings, as appropriate, shall be accompanied by a memorandum of points and authorities and shall be filed at least 15 days before the hearing. A copy shall be served on the opposing party. Any response shall be filed with the Board or the Office of Administrative Hearings, as appropriate, at least 7 days before the hearing and a copy shall be served on the opposing party. Discovery on Request. By written request served on the other party and filed with the Board or the Office of Administrative Hearings, as appropriate, a party may require another party to produce, within 15 days, the following: A list of witnesses to be called; Copies of documents intended to be produced at the hearing; or Both §A(1) and (2) of this regulation. Mandatory Discovery. Each party shall provide to the other party not later than 15 days before the prehearing conference, if scheduled, or 45 days before the scheduled hearing date, whichever is earlier: The name and curriculum vitae of any expert witness who will testify at the hearing; and A detailed written report summarizing the expert's testimony, which includes the opinion offered and the factual basis and reasons underlying the opinion. If the Board or the Office of Administrative Hearings, as appropriate, finds that the report is not sufficiently specific, or otherwise fails to comply with the requirements of this section, the Board or the Office of Administrative Hearings, as appropriate, shall exclude from the hearing the testimony and any report of the expert. The Board or the Office of Administrative Hearings, as appropriate, shall consider and decide arguments regarding the sufficiency of the report. At the prehearing conference, if scheduled; or Immediately before the scheduled hearing. If an expert adopts a sufficiently specific charging document as the expert's report, that adoption satisfies the requirements set forth in this section. Parties are not entitled to discovery of items other than as listed in §§D and E 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: After the prehearing conference, if scheduled; or Later than 15 days before the hearing, if no prehearing conference is scheduled. The prohibition against adding witnesses does not apply to witnesses or documents to be used for impeachment or rebuttal purposes. Construction. In hearings conducted by an administrative law judge of the Office of Administrative Hearings, this regulation shall, whenever possible, be construed as supplementing and in harmony with COMAR 28.02.01. In the event of a conflict between this regulation and COMAR 28.02.01, this regulation applies. Duties of Presiding Officer. The Board shall conduct hearings before a quorum of the Board. For purposes of a hearing under this chapter, four Board members present and entitled to vote shall constitute a quorum. Board action shall be by majority vote of all the members then serving. The President, or the President's designee, shall be the presiding officer, and shall have complete charge of the hearing, permit the examination of witnesses, admit evidence, rule on the admissibility of evidence, and adjourn or recess the hearing from time to time. The presiding officer may set reasonable time limits in arguments and presentation of evidence. The presiding officer shall be responsible for decorum in hearings and can suspend the proceedings as necessary to maintain decorum. Legal Advisor and Counsel for the Board. The presiding officer may request the Office of the Attorney General to participate in any hearing to present the case on behalf of the Board, and, upon such a request, this counsel has all the rights with regard to the: Submission of evidence, examination and cross-examination of witnesses; Presentation of summation and argument; and Filing of objections, exceptions, and motions as counsel for any party. The presiding officer may also request a representative of the Office of the Attorney General to act as legal advisor to the Board as to questions of evidence and law. Order of Procedure. The State shall present its case first. Then the respondent shall present his case. After this the State may present rebuttal. Examination of Witnesses and Introduction of Evidence. The rules of evidence in all hearings under these regulations shall be as set forth in State Government Article, §§10-208 and 10-209, Annotated Code of Maryland. Every party has the right on every genuine issue to: Call witnesses and present evidence; Cross-examine every witness called by the agency, or other party; Submit rebuttal evidence, present summation and argument; and File objections, exceptions, and motions, except that when a party is represented by counsel, all the submissions of evidence, examination and cross-examination of witnesses, and filing of objections, exceptions, and motions shall be done and presented solely by this counsel. The presiding officer, or the presiding officer's designee, may examine: A witness called by a party; and An individual in attendance at the hearing. A member of the Board may examine a witness called by a party. The Board may submit evidence from an investigative file to other administrative and criminal investigative offices to assist in the investigation and prosecution of a case. The Board shall prepare an official record, which shall include all pleadings, testimony, exhibits, and other memoranda or material filed in the proceeding. A stenographic record of the proceedings shall be made at the expense of the Board. This record need not be transcribed, however, unless requested by a party, or by the Board. The cost of any typewritten transcripts of any proceeding, or part of it, shall be paid by the party requesting the transcript. Every decision and order rendered by the Board shall be in writing and shall be accompanied by findings of fact and conclusions of law. A copy of the decision and order and accompanying findings and conclusions shall be delivered or mailed promptly to each party or attorney of record. Any party aggrieved by the decision and order rendered may apply for rehearing within 10 days after service on him of the decision and order. Action on an application shall lie in the discretion of the Board. Unless otherwise ordered, neither the rehearing nor the application for it shall stay the enforcement of the order, or excuse the person affected by it for failure to comply with its terms. The Board may consider facts not presented in the original hearing, including facts arising after the date of the original hearing, and may by new order abrogate, change, or modify its original order. Any person whose license has been revoked or suspended by the Board, or any person placed on probation or reprimand under the regulations in this chapter, may appeal the Board's decision as provided by law. Health Occupations Article, §3-205(a)(1); State Government Article, §10-206; Annotated Code of Maryland Effective date: November 7, 1983 (10:22 Md. R. 1966) Regulation .01 amended effective May 29, 2000 (27:10 Md. R. 966) Regulation .04 amended effective May 29, 2000 (27:10 Md. R. 966); January 6, 2014 (40:26 Md. R. 2164) Regulation .05 amended effective August 6, 2001 (28:15 Md. R. 1398) Subtitle amended to be, Board of Chiropractic Examiners, Rules of Procedure for Board Hearings, effective January 2, 2017 (43:26 Md. R. 1446) A chiropractor may advertise chiropractic services subject to the provisions of this chapter. In an advertisement, a chiropractor shall include at least the chiropractor's: Name; Office address; Telephone number; and Educational degree. In an advertisement, a chiropractor may state the name of the chiropractor's specialty only if that specialty is approved by the Board. An advertisement may not contain statements that: Contain a misrepresentation of facts or do not reasonably identify the practice as chiropractic; Are likely to mislead or deceive because in context the statement makes only a partial disclosure of relevant facts; Intend to, or are likely to, create false or unjustified expectations of favorable results; Relate to fees, other than a standard consultation fee or a range of fees for specific types of services, without fully disclosing all variables and other relevant factors; Convey the impression that the chiropractor could influence improperly any public body, official, corporation, or any person on behalf of a patient; Contain representations or implications that in reasonable probability can be expected to cause an ordinary prudent person to misunderstand or to be deceived; Contain representations that the chiropractor is willing to perform any procedure which is illegal under the laws or regulations of Maryland or the United States; Contain representations regarding the use of any equipment, treatment, or procedure not within the accepted, prudent practice of chiropractic; or Promise payment, compensation, prizes, or remuneration of any intrinsic value. A chiropractor may not engage in solicitation, including but not limited to, in-person, telephone, or direct mail solicitation which: Amounts to fraud, undue influence, intimidation, or overreaching; Contains statements which would be improper under Regulation .03 of this chapter. A chiropractor shall also be accountable under this regulation if the chiropractor uses an agent, partnership, professional association, or health maintenance organization to implement actions prohibited by this regulation. Health Occupations Article, §3-401, Annotated Code of Maryland Effective date: October 24, 1983 (10:21 Md. R. 1902) Chapter revised effective August 6, 2001 (28:15 Md. R. 1398) Regulation .02C adopted effective January 6, 2014 (40:26 Md. R. 2164) Regulation .03 amended effective October 22, 2007 (34:21 Md. R. 1915) Regulation .03J adopted effective June 13, 2011 (38:12 Md. R. 705) Subtitle and Chapter name amended to be, Board of Chiropractic Examiners, Advertising, effective January 2, 2017 (43:26 Md. R. 1446) Regulation .01 amended effective January 2, 2017 (43:26 Md. R. 1446) Regulation .02C repealed effective January 2, 2017 (43:26 Md. R. 1446) Regulation .03J repealed effective January 2, 2017 (43:26 Md. R. 1446) Preface. The Board of Chiropractic Examiners has established guidelines for licensure by credentials. This method of licensure is a special privilege granted by present statute, and is secured for those candidates who possess the necessary credentials required to practice chiropractic in the State. The requirements for licensure are stringent in order to insure the public is adequately protected and that licensure may be granted only to those who qualify by virtue of clinical competency and professional expertise. Scope. This chapter applies to all chiropractors seeking licensure by credentials in Maryland. Since licensure by credentials is a privilege, the Board reserves the right to accept or deny this method of licensure based on Regulation .02 of this chapter. A chiropractor is eligible for licensure by credentials if the applicant has graduated and received the degree Doctor of Chiropractic (D.C.) from a chiropractic college accredited by the Council on Chiropractic Education (C.C.E.) or its successor. The applicant shall: Be of good moral character and have submitted to the Board three letters of recommendation, one of which shall be sent by the state licensing board in which the applicant is currently licensed; Meet all the qualifications set forth in the Health Occupations Article, §3-302, Annotated Code of Maryland; Be currently licensed in another state by virtue of passing an examination that is similar to the examination for which the applicant is seeking licensure by credentials; Have been in active clinical practice in the state for which the applicant was licensed by examination for the 5 years preceding application or has had full-time faculty status at a chiropractic college accredited by the Council on Chiropractic Education or its successor for at least 5 years before application; and Take and pass the Maryland jurisprudence and the National Board of Chiropractic Examiners (NBCE) Special Purposes Examination for Chiropractic (SPEC) examinations with minimum scores of 75 percent. A SPEC exam is not required for an applicant who has passed parts I through IV of the NBCE Examination with a minimum score of 75 percent. An applicant shall submit the necessary information as set forth in the Health Occupations Article, §3-303, Annotated Code Maryland. The Board may investigate the applicant to insure compliance with all provisions of this chapter. An applicant shall submit to the Board satisfactory evidence of having completed a State and national criminal history records check in accordance with Health Occupations Article, §3–302.1, Annotated Code of Maryland. The Board may not issue a license or registration if the criminal history records information required under §C of this regulation has not been received. At the Board's discretion, an applicant shall appear before the Board and demonstrate clinical competency in a manner and time to be determined by the Board. The fee for licensure by credentials shall be the same as that for licensure by examination. Additional fees may be assessed by the Board for investigatory purposes. The application fee is non-refundable. Health Occupations Article, §§3-302.1 and 3-305, Annotated Code of Maryland Effective date: December 17, 1984 (11:25 Md. R. 2134) Regulation .01 amended effective June 13, 2011 (38:12 Md. R. 705) Regulation .02A amended effective October 22, 2007 (34:21 Md. R. 1915) Regulation .02B amended effective August 6, 2001 (28:15 Md. R. 1398); January 6, 2014 (40:26 Md. R. 2164) Regulation .02C adopted effective January 6, 2014 (40:26 Md. R. 2164) Regulation .03B amended effective October 22, 2007 (34:21 Md. R. 1915) Regulation .03C, D adopted effective April 13, 2015 (42:7 Md. R. 570) Regulation .04 amended effective August 6, 2001 (28:15 Md. R. 1398) Subtitle name amended to be, Board of Chiropractic Examiners, effective January 2, 2017 (43:26 Md. R. 1446) Regulation .01A amended effective January 2, 2017 (43:26 Md. R. 1446) These regulations apply to all: Chiropractic externs, chiropractic extern applicants, and licensed chiropractors who are extension faculty members of a chiropractic college accredited by the Council on Chiropractic Education or its successor; and Licensed chiropractors approved by the Board to provide an externship. In this chapter, the following terms have the meanings indicated. Terms Defined. “Accredited Board-approved educational institution” means a chiropractic school, college, or university accredited by the Council on Chiropractic Education or its successor. “Approved program” means a program that has been approved by the Board and the Council on Chiropractic Education or its successor. “Board” means the Maryland Board of Chiropractic Examiners. “Chiropractic extern program” means: A 2-semester clinical program: In which a chiropractic student, that has completed all requirements to graduate, participates under the direct supervision of a licensed chiropractor who has been approved by the Board to serve as a preceptor; and That operates in a facility where chiropractic services have been approved by the Board; or A 6-month clinical program in which an individual has: Begun the process of applying for licensure, but has not met certain requirements set forth under COMAR 10.43.04; Graduated from an accredited Board-approved educational institution; Taken and passed the examination of the National Board of Chiropractic Examiners (NBCE); Been approved for an extern license by the Board; and Agreed to practice under the direct supervision of a preceptor who is a Board-approved licensed chiropractor while the extern license is in effect. “Direct supervision” means a licensed chiropractor: Remains on the premises at all times; Directly supervises and continuously monitors the extern’s performance within the practice; and Is immediately available to offer assistance. “Extern” means: An individual who has: Enrolled in an accredited Board-approved educational institution and has completed all requirements for the Doctor of Chiropractic program except for the final clinical phase of the program; or Graduated from an accredited Board-approved educational institution and is in the process of applying to the Board for a license to practice chiropractic, but has yet to meet certain requirements set forth under COMAR 10.43.04 to qualify for a license; or A chiropractor licensed in another state who is in the process of applying to the Board for a license to practice chiropractic, but has yet to meet certain requirements set forth under COMAR 10.43.04 to qualify for a license. “Extern applicant” means an individual who applies to the Board to be approved for the chiropractic externship program. “Licensed chiropractor” means a chiropractor who is licensed by the Board to practice chiropractic or to practice chiropractic with the right to practice physical therapy, and whose license is in good standing. “Preceptor or extension faculty member” means a licensed chiropractor actively practicing in the State in good standing who has been appointed to the extension faculty of an accredited Board-approved educational institution. “Preceptor sponsor” means a licensed chiropractor approved by the Board to supervise the following who are in the process of applying for licensure: A recent graduate that has completed a preceptorship program; or A chiropractor licensed in another state, whose license is in good standing. An extern applicant is eligible for approval in the chiropractic extern program if the applicant is: Currently enrolled in an approved program that is recognized by the Board as: Requiring adequate clinical training; and Maintaining an acceptable course of chiropractic instruction; A recent graduate that has completed a preceptorship program; or A chiropractor licensed in another state, whose license is in good standing. An extern applicant shall: Meet all the qualifications as set forth in Health Occupations Article, §§3-302 and 3-303, Annotated Code of Maryland; Be in good standing: At the accredited Board-approved educational institution; or In the state currently licensed; Submit the completed application forms as required by the Board; Pay the application fee as set forth in COMAR 10.43.06; Submit to a criminal background check; Have three letters of recommendation sent directly to the Board: From clinical science professors at the extern’s accredited Board-approved educational institution attesting to the applicant’s good moral character and clinical abilities; or Two of which shall be from chiropractors attesting to the applicant’s good moral character and one letter from the licensing board of the state in which the applicant is currently licensed attesting that the license is in good standing; and Be withdrawn from the program if the applicant has not obtained a license to practice chiropractic within 6 months from the date the externship is approved. A preceptor who is a Board-approved licensed chiropractor or an extension faculty member may delegate duties within the scope of one’s license, which constitute the practice of chiropractic, to an extern in accordance with COMAR 10.43. A preceptor may permit an extern to perform chiropractic duties as part of a clinical program, subject to the following conditions: The preceptor shall maintain direct supervision of the extern; The clinical training program shall be governed by a written agreement between the extern’s accredited Board-approved educational institution and the preceptor that: Has been approved by the Board; Describes the specific program; Enumerates the functions the extern may perform; and Indicates the legal responsibilities assumed by the extern’s accredited Board-approved educational institution; The accredited Board-approved educational institution shall submit to the Board the names of those doctors selected as extension faculty members. The Board shall notify the educational institution of those approved for the program; A licensed chiropractor may not supervise more than one extern during the same period; A licensed chiropractor may delegate or permit only duties and functions which are established as part of the clinical training program; The extern may not supervise chiropractic assistants or trainees; and An extern applicant that is a licensed chiropractor in another state shall have a preceptor sponsor. A preceptor may permit a licensed extern to perform chiropractic duties as part of the chiropractic practice providing the preceptor: Maintains direct supervision of the extern; and Ensures the compliance of the extern to the conditions set forth under Regulation .03B(7) of this chapter. A preceptor with a license to practice chiropractic with physical therapy privileges may supervise an applicant applying for a license to practice chiropractic: With physical therapy privileges; and Without physical therapy privileges. A preceptor with a license to practice chiropractic without physical therapy privileges may only supervise an extern applying for a license to practice chiropractic without physical therapy privileges. Malpractice insurance in an amount defined by the Council on Chiropractic Education shall be obtained: Before the clinical program begins, by the extern’s: Accredited Board-approved educational institution; and Extension faculty member participating in the clinical program; or By the preceptor sponsor of an extern applicant. A licensed chiropractor seeking preceptor status shall: Submit a completed written application to the Board; Pay the fee as set forth in COMAR 10.43.06; Provide written evidence of malpractice insurance as requested by the Board; and Agree to an administrative inspection of the chiropractic office spaces, equipment, and records as directed by the Board. Health Occupations Article, §§3-205 and 3-301, Annotated Code of Maryland Effective date: June 17, 1985 (12:12 Md. R. 1165) Regulation .02 amended effective June 13, 2011 (38:12 Md. R. 705) Regulation .02B amended effective August 6, 2001 (28:15 Md. R. 1398); October 22, 2007 (34:21 Md. R. 1915) Regulation .03A amended effective June 13, 2011 (38:12 Md. R. 705) Regulation .03B amended effective August 6, 2001 (28:15 Md. R. 1398) Regulation .04B amended effective October 22, 2007 (34:21 Md. R. 1915); June 13, 2011 (38:12 Md. R. 705) Regulation .04D adopted effective August 6, 2001 (28:15 Md. R. 1398) Subtitle name amended to be, Board of Chiropractic Examiners, Chiropractic Externship Program, effective January 2, 2017 (43:26 Md. R. 1446) Regulation .01 amended effective May 20, 2019 (46:10 Md. R. 490) Regulation .02B amended effective January 2, 2017 (43:26 Md. R. 1446); May 20, 2019 (46:10 Md. R. 490) Regulation .03 amended effective May 20, 2019 (46:10 Md. R. 490) Regulation .03A amended effective January 2, 2017 (43:26 Md. R. 1446) Regulation .04 amended effective May 20, 2019 (46:10 Md. R. 490) This chapter governs those who are licensed and registered or who are applying for licensure or registration by the Board. The following fees are established by the Board: Application fee . . . $200; Examination fee . . . $300; Licensure fee . . . $200; Reexamination fee . . . $400; Renewal fee to be paid on or before August 31 of the renewal year . . . $700; Late renewal fee to be paid, in addition to the renewal fee, for renewal submitted within 30 days after August 31 . . . $500; Reinstatement fee, in addition to the renewal fee and late fee in §§E and F of this regulation, for each renewal period that the license was expired after September 30 . . . $300; Duplicate license fee . . . $50; Duplicate license ordered at renewal . . . $25; Inactive status fee . . . $350; Reactivation fee charged to move licensure status from inactive to active status . . . $200; Preceptorship application fee . . . $300; Extern application fee . . . $50; Licensure by credentials application . . . $750; Penalty for returned checks . . . $50; Verification of licensure . . . $35; Chiropractic assistant examination fee . . . $300; Chiropractic assistant renewal fee . . . $250; Penalty for failure to maintain correct address with the Board . . . $200; Late renewal fee for chiropractic assistants . . . $200; Supervising chiropractor application fee . . . $300; Continuing Education Course processing review fee per submission . . . $25; Mailing labels or roster . . . $200; Chiropractic assistant registration fee . . . $100; Paper copy of laws and regulations . . . $25. Fees are nonrefundable with the exception of the examination fee. The examination fee may be refunded at the discretion of the Board if the applicant's written request is received by registered mail at least 14 days before the examination. The applicant shall pay at the time of license renewal a fee for health care professionals, assessed by the Maryland Health Care Commission (MHCC), as specified in COMAR 10.25.02. Health Occupations Article, §§3-205 and 3-206, Annotated Code of Maryland Effective date: March 30, 1992 (19:6 Md. R. 674) Regulation .02 amended as an emergency provision effective June 23, 1993 (20:14 Md. R. 1166); emergency status expired December 31, 1993 Regulation .02 amended effective February 14, 1994 (21:3 Md. R. 194) Chapter revised as an emergency provision effective August 23, 1999 (26:20 Md. R. 1543); revised permanently effective December 13, 1999 (26:25 Md. R. 1899) Regulation .01 amended effective January 6, 2014 (40:26 Md. R. 2164) Regulation .02 amended effective October 22, 2007 (34:21 Md. R. 1915) Regulation .02 amended as an emergency provision effective August 6, 2008 (35:18 Md. R. 1599); amended permanently effective October 6, 2008 (35:20 Md. R. 1776) Regulation .02N, V amended effective January 6, 2014 (40:26 Md. R. 2164) Regulation .02P—S adopted effective August 6, 2001 (28:15 Md. R. 1398) Regulation .02T adopted effective June 9, 2003 (30:11 Md. R. 735) Regulation .03 amended effective October 22, 2007 (34:21 Md. R. 1915) Regulation .03 amended as an emergency provision effective August 6, 2008 (35:18 Md. R. 1599); amended permanently effective October 6, 2008 (35:20 Md. R. 1776) Regulation .03 amended effective June 13, 2011 (38:12 Md. R. 705); January 6, 2014 (40:26 Md. R. 2164) Regulation .03K amended and .03N adopted effective August 6, 2001 (28:15 Md. R. 1398) Regulation .05 adopted effective August 6, 2001 (28:15 Md. R. 1398) Subtitle and Chapter name amended to be, Board of Chiropractic Examiners, Fees, effective January 2, 2017 (43:26 Md. R. 1446) Chapter revised effective January 2, 2017 (43:26 Md. R. 1446) In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the Maryland Board of Chiropractic Examiners. “Chiropractic assistant” means an individual who is registered by the Board to perform the duties authorized under this chapter. “Chiropractic assistant program” means a structured 1-year program of clinical chiropractic training under a Board-licensed supervising chiropractor in order to qualify and apply for a registration as a Maryland chiropractic assistant. “Chiropractic assistant trainee” means a person who is: Undergoing training to become a chiropractic assistant; or Applying to the Board for registration as a chiropractic assistant. “Direct supervision” means supervision provided by a supervising chiropractor who is personally present and immediately available in the area where the procedures are performed to give aid, direction, and instruction when certain procedures or activities are performed by a chiropractic assistant or a chiropractic assistant trainee. “Established patient” means an individual who has received professional services from a practicing supervising chiropractor who belongs to the same group practice in the past 3 years. “Inactive status” means the period of time that a registration is on hold. “Indirect supervision” means supervision by a supervising chiropractor that is provided by a phone call or text to give aid, direction, and instructions when certain activities, as set forth under Regulation .10 of this chapter, are performed by a chiropractic assistant. “Practice day” means the hours of physical practice with a patient, excluding the office’s designated lunch or exclusive administrative time. “Supervising chiropractor” means a chiropractor licensed by the Board in chiropractic with the right to practice physical therapy as set forth in Health Occupations Article, §3-301(c), Annotated Code of Maryland, and approved as a supervising chiropractor by the Board. At the time of application on the Request to Employ form for training, an applicant shall: Be 18 years old or older; Be of good moral character; Be a U.S. Citizen or hold federal documentation authorizing employment; Be proficient in the English language sufficiently to allow for clear interaction with patients; Be enrolled in a Board-approved Cardiopulmonary Resuscitation (CPR) class within 4 months of the commencement of the chiropractic assistant training or be currently CPR certified; Be a graduate of a high school or hold a GED; and Have any foreign transcripts professionally interpreted and certified An applicant who otherwise qualifies for being employed within the 1-year chiropractic assistant training program shall: Complete the profile portion of the application; Provide the supervising chiropractor with: The requested documentation; A diploma or transcripts; A valid State picture identification; and An authorization to work in the U.S. for the application documentation, if applicable; and Submit satisfactory evidence of having completed a State and national criminal history records check in accordance with Health Occupations Article, §3-302.1, Annotated Code of Maryland. The supervising chiropractor shall complete and submit to the Board a legible application and documentation proving that the applicant meets the qualifications listed in §A of this regulation. An applicant may not commence work or training until the supervising chiropractor receives an authorization letter from the Board. Within 120 days of the date of hire, the applicant shall: Satisfactorily complete the required CPR class; Enroll in a Board-approved chiropractic assistant 103-hour course of instruction; and Submit proof of completion of both requirements in a timely manner on the form provided by the Board. Within 1 calendar year of the date of hire, the applicant shall satisfactorily complete: A minimum of 520 in-service training hours, of which: The initial 20 hours shall consist of observation procedures as listed in Regulation .09 of this chapter and performed by the supervising chiropractor or registered chiropractic assistant; and The remaining 500 hours shall consist of direct supervision by a supervising chiropractor in the treatment area; and A 103 hour course of instruction from a Board-approved provider with a minimum of: 24 hours in anatomy and terminology; 3 hours in jurisprudence and risk management; and 76 hours in physical therapy modalities and indications. No waivers, extensions, or exceptions shall be granted except by majority vote of the Board . Failure to meet the requirements of §§E and F of this regulation shall result in immediate suspension from the applicant training program. A chiropractic assistant trainee who otherwise qualifies for registration is entitled to be examined as provided in this regulation. The chiropractic assistant trainee shall pass a Board proficiency and jurisprudence examination. The chiropractic assistant trainee shall: Pay to the Board as set forth in COMAR 10.43.06: A nonrefundable application fee; and An examination fee; and Submit all fees, transcripts, and application documentation postmarked no later than 30 days before the examination date. The Board shall: Give examinations to chiropractic assistant trainees at least twice a year, at the times and places that the Board determines; Notify each qualified chiropractic assistant trainee of the time and place of examinations; and Determine the subject scope, form, and passing score for examination. Reexaminations. If the chiropractic assistant trainee fails the examination twice, the chiropractic assistant trainee may retake the examination only if the chiropractic assistant trainee: Pays the reexamination fee; and Completes additional minimum 10 hour refresher classroom training courses as approved by the Board in areas of deficiency. A chiropractic assistant trainee who fails the examination twice may not perform in-service training duties in direct patient care or treatment under Regulation .03 of this chapter. A chiropractic assistant shall notify the Board of any change in the name or electronic or physical address of the chiropractic assistant, in writing, within 60 days after the change occurs. A chiropractic assistant shall display the registration and any current renewal registration conspicuously in the space where the registration holder is engaged in practice, including in any temporary space, or in any exhibit location. Only a supervising chiropractor may work with or train a chiropractic assistant or applicant. Only an active, licensed chiropractor who holds physical therapy privileges and has no outstanding disciplinary orders may qualify for supervising chiropractor status. An applicant for supervising chiropractor status shall: Submit to the Board the required application and fee; Successfully pass the Board supervising chiropractor examination and interview; and Satisfactorily follow Board regulations and statutes. The Board may deny, suspend, or revoke supervising chiropractor status for violation of the Board’s statutes and regulations by the supervising chiropractor. The supervising chiropractor shall: Submit: The required Board Request to Employ form before undertaking any hands on training or coursework with any chiropractic assistant applicant; and All other Board-required reports and forms in a timely manner as determined by the Board. Notify the Board and course instructor or instructors of any change in status of any chiropractic applicant or assistant within 10 days of the change, including: Reasons for the change in status; Training received by the applicant or assistant; Hours completed by the applicant or assistant; and The applicant's or assistant's forwarding address; Maintain accurate, legible, and comprehensive records of all clinical training provided to the chiropractic applicant or assistant, including, but not limited to: Dates and times and duration of training as described in Regulation .02 of this chapter; Modalities; Equipment used; and Any other information as directed by the Board; Follow indirect supervision procedures set forth under Regulation .10 of this chapter; Immediately produce the records described in §C of this regulation and Regulation .10D(1) of this chapter upon request or audit by the Board; Promptly: Report a chiropractic applicant or assistant not making satisfactory training progress; and Report before the Board as directed regarding the details of the training program issue; Maintain competency in knowledge of applicable laws and regulations and successfully complete any jurisprudence requirements that may be directed by the Board; Ensure that all patient records accurately and legibly reflect the extent and degree of the involvement or assistance of the chiropractic applicant or assistant; Submit the in-service training hours and verification of chiropractic applicant or assistant competency on a form provided by the Board within 30 days of completion of training or transfer of the chiropractic applicant or assistant to another supervising chiropractor; Be fully responsible for the safe and competent performance of the chiropractic applicant or assistant at all times; and Provide direct supervision to not more than five chiropractic assistants or applicants. The supervising chiropractor may not: Delegate responsibilities in any manner to anyone not holding supervising chiropractor status; Leave the treatment area: When treating a patient; When a chiropractic applicant is treating a patient; or During a chiropractic applicant’s 20-hour observation period; Permit a chiropractic applicant to treat a patient without the presence of the supervising chiropractor in the treatment area; or Be unavailable by phone call or text when a chiropractic assistant is treating an established patient with an established treatment program as set forth under Regulation .10B of this chapter. The license of a licensee who violates this regulation shall be subject to the penalties set forth in COMAR 10.43.10. A chiropractic applicant or assistant may perform the following activities without the direct supervision of a supervising chiropractor: Taking the height, the weight, and vital signs of a patient and recording them in the patient record; Assisting in the dressing, undressing, and draping of a patient; Removing and applying assistive and supportive devices; Observing treatments and modalities as authorized by the supervising chiropractor; Providing preprinted non-patient specific health and chiropractic concepts and information that has been approved and reviewed by the supervising chiropractor; and Taking patient histories. A chiropractic assistant or a chiropractic assistant trainee may perform the following activities under the direct supervision of a supervising chiropractor who is in the treatment area: Functional activities of daily living and hygiene; Gait practice and ambulation; Demonstration, administration, and observation of therapeutic exercises as prescribed by a supervising chiropractor; Assist in moving a patient within the treatment area; Contrast baths; Hot and cold packs; Hubbard tank; Infrared, ultraviolet irradiation, non-laser light therapy, and non-ablative therapeutic laser; Muscle stimulation; Electrotherapy; Paraffin baths; Traction therapy; Ultrasound; Whirlpool; Diathermy; Therapeutic massage, if licensed under Health Occupations Article, Title 6, Annotated Code of Maryland; and Mechanical or computerized examination procedures for the sole purpose of collecting data subject to the following conditions: All data will later be used and interpreted by the chiropractor to form a diagnosis and treatment plan; and No test may be performed that requires diagnosis or interpretation as part of the data collecting or testing procedure. A chiropractic applicant or assistant may not engage in any of the following activities: Communicate an evaluation or diagnosis to a patient; Perform an act requiring the professional skill or judgment of a licensed chiropractor; Perform orthopedic or neurological tests; Engage in dietary or nutritional advice or counseling; or Other acts not within the chiropractic applicant or assistant's specified scope. Indirect supervision may only be provided by a supervising chiropractor to a chiropractic assistant who is treating an established patient. A chiropractic assistant may perform the following activities under the indirect supervision of a supervising chiropractor to an established patient with an established treatment program for not more than 10 percent of the treatment time in a given 30 days, without exceeding 3 consecutive days in a given week: Functional activities of daily living and hygiene; Gait practice, ambulation, administration, and observation of therapeutic exercises as prescribed by a supervising chiropractor; Assist in moving a patient within the treatment area; Contrast baths; Hot and cold packs; Hubbard tank; Infrared, ultraviolet irradiation, nonlaser light therapy, and nonablative therapeutic laser; Muscle stimulation; Electrotherapy; Paraffin baths; Traction therapy; Ultrasound; Whirlpool; Diathermy; Therapeutic massage, if licensed under Health Occupations Article, Title 6, Annotated Code of Maryland; and Mechanical or computerized examination procedures for the sole purpose of collecting data subject to the following conditions: All data will later be used and interpreted by the chiropractor to form a diagnosis and treatment plan; and No test may be performed that requires diagnosis or interpretation as part of the data collecting or testing procedure. A chiropractic assistant who participates in indirect supervision shall be: In good standing with the Board; and Trained and proficient in the office’s indirect supervision protocol, which includes: Informed consent to the patient; and Immediate access to the supervising chiropractor. The supervising chiropractor shall: Prior to the implementation of indirect supervision, establish and make readily available an: Emergency procedures protocol; and Indirect supervision protocol; Maintain a log of indirect supervision treatment, which includes: Patient’s name or identification information; and Treatment: Date; Time initiated; Duration; and Procedure or activity provided; and Review or update, or both, indirect supervision orders every 30 days. An indirect supervision protocol shall be listed on the office’s: Consent to treatment form signed by the patient; or Informed consent protocol. A chiropractic assistant may perform the duties of a chiropractic assistant with X-ray privileges only as directed by a supervising chiropractor. A chiropractic assistant, with or without X-ray privileges, may not: Provide oral or written diagnosis; or Work independently. A chiropractic assistant may perform X-rays only after the completion of: 60 hours of didactic training in a Board-approved course of instruction that includes: Radiation physics; Radiation biology; Radiation protection; Imaging principles in radiation exposure; Patient preparation and positioning; Human anatomy and physiology; and Emergency procedures; and 46 X-ray studies under the direct supervision of a supervising chiropractor that include: 10 cervical series which include at least one of each of the following views: Anterior to posterior; Lateral; Anterior to posterior open mouth; Flexion; Extension; and Oblique; 6 thoracic series which include at least one of each of the following views: Anterior to posterior; Lateral; Flexion; and Extension; 10 lumbar series which include at least one of each of the following views: Anterior to posterior; Lateral; Flexion; Extension; and Oblique; and 20 extremity views which include at least one of each of the following: Shoulder; Elbow; Wrist; Hand; Ribs; Hip; Knee; Ankle; and Foot. A registration expires every 2 years, unless the registration is renewed for a 2-year term. Before a registration expires, the registrant periodically may renew it for another term if the registrant: Otherwise is entitled to be registered; Pays a renewal fee as set forth in COMAR 10.43.06; Submits to the Board a renewal application on the form that the Board requires; and Submits to the Board verification of at least 10 hours of continuing education in courses approved by the Board. The Board shall place a registration holder on inactive status if the registration holder submits to the Board the: Completed application for inactive status on the form provided by the Board; and Biennial fee for inactive status as specified in COMAR 10.43.06. The registration holder on inactive status: Is not entitled to practice chiropractic until the registration is reactivated; and May reactivate the registration at any time if the: Application for reactivation is completed; and Reactivation fee is paid as set forth in COMAR 10.43.06. The Board shall place a registration holder in a nonrenewed status if the registration holder fails to complete an application for: Registration renewal during the biennial cycle; or Inactive status during the renewal cycle. The registration holder may reinstate a nonrenewed status for registration within 5 years of the expiration date of the last active registration. If the expired registration holder is on nonrenewed status for more than 5 years, the holder shall: Reapply; and Meet all of the requirements set forth in this chapter. Except as otherwise provided in this chapter, a person may not practice, attempt to practice, or offer to practice as a chiropractic assistant in this State unless registered by the Board. A person may not serve as a chiropractic applicant or assistant unless approved by the Board. Violations of these regulations may result in disciplinary action against the supervising chiropractor as set forth in Health Occupations Article, §3-313, Annotated Code of Maryland. A person practicing as a chiropractic assistant without being registered, except as provided in these regulations, is guilty of a misdemeanor, and may be fined $5,000 or imprisoned for 1 year, or both. A chiropractic assistant and an applicant for registration is subject to the Board's disciplinary authority under Health Occupations Article, §3-313, Annotated Code of Maryland. A chiropractic assistant shall display the registration and any current renewal registration conspicuously in the space where the license holder is engaged in practice, including in any temporary space, or in any exhibit location. A registered chiropractic assistant shall notify the Board of any change in the name or address of the chiropractic assistant, in writing, within 60 days after the change occurs. Health Occupations Article, §§3-205, 3-302.1, and 3-404, Annotated Code of Maryland Effective date: May 9, 1994 (21:9 Md. R. 751) Regulation .01B amended effective June 9, 2003 (30:11 Md. R. 735) Regulation .02 amended effective June 9, 2003 (30:11 Md. R. 735) Regulation .03B, C amended effective June 9, 2003 (30:11 Md. R. 735) Regulation .03C amended effective August 6, 2001 (28:15 Md. R. 1398) Regulation .04C amended effective August 6, 2001 (28:15 Md. R. 1398) Regulation .04E amended effective June 9, 2003 (30:11 Md. R. 735) Regulation .05B amended effective August 6, 2001 (28:15 Md. R. 1398) Regulation .06 amended effective June 9, 2003 (30:11 Md. R. 735) Regulation .07A, C amended effective June 9, 2003 (30:11 Md. R. 735) Regulation .07C amended effective August 6, 2001 (28:15 Md. R. 1398) Regulation .08 amended effective August 6, 2001 (28:15 Md. R. 1398) Regulation .11 amended effective August 6, 2001 (28:15 Md. R. 1398) Regulation .12 adopted effective June 9, 2003 (30:11 Md. R. 735) Chapter revised effective October 22, 2007 (34:21 Md. R. 1915) Regulation .01B amended effective June 13, 2011 (38:12 Md. R. 705) Regulation .02C amended effective January 6, 2014 (40:26 Md. R. 2164) Regulation .02D adopted effective January 6, 2014 (40:26 Md. R. 2164) Regulation .03A amended effective January 6, 2014 (40:26 Md. R. 2164) Regulation .03 amended effective June 13, 2011 (38:12 Md. R. 705) Regulation .05 repealed and new Regulation .05 adopted effective January 6, 2014 (40:26 Md. R. 2164) Regulation .07 amended effective April 13, 2015 (42:7 Md. R. 570) Regulation .07C amended effective January 6, 2014 (40:26 Md. R. 2164) Regulation .08 amended effective June 13, 2011 (38:12 Md. R. 705); January 6, 2014 (40:26 Md. R. 2164) Regulation .09 amended effective June 13, 2011 (38:12 Md. R. 705) Regulation .09C amended effective January 6, 2014 (40:26 Md. R. 2164) Regulation .09H amended effective April 13, 2015 (42:7 Md. R. 570) Regulation .10 amended effective June 13, 2011 (38:12 Md. R. 705); January 6, 2014 (40:26 Md. R. 2164) Regulation .14 adopted effective April 13, 2015 (42:7 Md. R. 570) Subtitle name amended to be, Board of Chiropractic Examiners, Chiropractic Assistants, effective January 2, 2017 (43:26 Md. R. 1446) Regulation .01B amended effective January 2, 2017 (43:26 Md. R. 1446) Regulation .05E amended effective July 2, 2018 (45:13 Md. R. 668) Regulation .09P amended effective January 2, 2017 (43:26 Md. R. 1446) Chapter revised effective December 30, 2019 (46:26 Md. R. 1165) Regulation .01B amended effective April 4, 2022 (49:7 Md. R. 467) Regulation .03 amended effective April 4, 2022 (49:7 Md. R. 467) Regulation .08 amended effective April 4, 2022 (49:7 Md. R. 467) Regulation .10 amended effective April 4, 2022 (49:7 Md. R. 467) Regulation .11 amended effective April 4, 2022 (49:7 Md. R. 467) These regulations establish the procedures to be followed by examination applicants who have special needs because of a handicap or religious convictions. An applicant with a disability may request modifications in examination materials or procedures by making a written request to the Board that includes: The applicant's name; The date of the examination to be modified; A letter from the appropriate medical professional that: Confirms the disability; and Provides information describing the accommodations required; and A letter from the applicant's education program, indicating what modifications, if any, were granted by the program. The applicant shall send the request for modification and supporting documentation to the Board by the application deadline. The Board reserves the right to review each special needs application and evaluate each on its individual merit. The applicant may be required to bear the cost of special arrangements or procedures to accommodate the applicant's special needs. Health Occupations Article, §§3-205 and 3-304, Annotated Code of Maryland Effective date: October 26, 1992 (19:21 Md. R. 1892) Regulation .01 amended effective January 24, 2000 (27:1 Md. R. 77) Regulation .02 amended effective August 6, 2001 (28:15 Md. R. 1398) Regulation .02A amended effective January 24, 2000 (27:1 Md. R. 77) Subtitle and Chapter name amended to be, Board of Chiropractic Examiners, Licensure and Registration Examination — Special Needs Applicants, effective January 2, 2017 (43:26 Md. R. 1446) This chapter establishes standards for the imposition of penalties not exceeding $5,000 against any chiropractor in the State if, after a hearing, the Board finds that there are grounds under Health Occupations Article, §3-313, Annotated Code of Maryland, to suspend or revoke a license. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the State Board of Chiropractic Examiners. “License” means a license issued by the Board to practice chiropractic or to practice chiropractic with the right to practice physical therapy. “Licensee” means a chiropractor who is licensed by the Board to practice chiropractic or to practice chiropractic with the right to practice physical therapy. “Penalty” means monetary penalty. Imposition of a Penalty After a Hearing. If, after a hearing under Health Occupations Article, §3-315, Annotated Code of Maryland, the Board finds that there are grounds under Health Occupations Article, §3-313, to suspend or revoke a license, the Board may impose a penalty of not more than $5,000: Instead of, or in addition to, suspending the license; or In addition to revoking the license. Imposition of a Penalty Without a Hearing. If, after disciplinary procedures have been brought against a licensee, the licensee waives the right to a hearing required under this subtitle, and if the Board finds that there are grounds under Health Occupations Article, §3-313, Annotated Code of Maryland, to reprimand the licensee, place the licensee on probation, or suspend or revoke a license, the Board may impose a penalty not exceeding $5,000 for each violation in addition to reprimanding, placing the licensee on probation, or suspending or revoking the license. The Board may impose a penalty of not less than $100 or more than $2,000 on a chiropractor found guilty of any of the following, if the chiropractor: Willfully fails to file or record a report as required by law; or 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. The Board may impose a penalty of not less than $300 or more than $3,500 on a chiropractor found guilty of any of the following, if the chiropractor: Practices chiropractic under a false name or trade name; Provides professional services while: Under the influence of alcohol; or Using any narcotic or controlled dangerous substance as defined in Criminal Law Article, Title 5, Subtitle 4, Annotated Code of Maryland, or other drug that is in excess of therapeutic amounts, or without valid medical indication; Solicits or advertises in a false or misleading manner, or in any other manner not approved by the Board; Abandons a patient; Misrepresents the effectiveness of any treatment, drugs, devices, appliances, or goods to a patient so as to exploit the patient for financial gain; Willfully impedes or obstructs the filing or recording of a report, or induces another to fail to file or record the report; Pays or agrees to pay a sum to an individual for bringing or referring a patient; or Violates any rule or regulation adopted by the Board. The Board may impose a penalty of not less than $500 or more than $5,000 on a chiropractor found guilty of any of the following: Fraudulently or deceptively obtaining or attempting to obtain a license for the applicant or licensee, or for another; Fraudulently or deceptively using a license; Impersonating another practitioner; Having been convicted of or pleading guilty or nolo contendere to a felony or to a crime involving moral turpitude, whether any appeal or other proceeding is pending to have the conviction or plea set aside; Unethically conducting the practice of chiropractic; Being professionally, physically, or mentally incompetent; Grossly and willfully: Overcharging for professional services; or Submitting false statements to collect fees for which services are not provided; Having been disciplined by a licensing or disciplinary authority of any other state or country or convicted by a court of any state or country for an act that would be grounds for disciplinary action under Health Occupations Article, §3-313, Annotated Code of Maryland; Practicing chiropractic with an unauthorized individual or supervising or aiding an unauthorized individual in the practice of chiropractic; Behaving immorally in the practice of chiropractic; or Committing an act of unprofessional conduct in the practice of chiropractic. In those cases in which the Board determines that the imposition of a penalty is appropriate, the Board shall take into consideration the following factors, without limitations, in determining the amount of penalty: The extent to which the chiropractor derived any financial benefit from unprofessional or improper conduct; The willfulness of the unprofessional or improper conduct; The extent of actual or potential public harm caused by the unprofessional or improper conduct; and The cost of investigating and prosecuting the case against the chiropractor. A chiropractor shall pay to the Board a penalty imposed under these regulations as of the date the Board's order is issued, unless the Board's order specifies otherwise. Filing an appeal under State Government Article, §10-215, Annotated Code of Maryland, or Health Occupations Article, §3-316, Annotated Code of Maryland, does not automatically stay payment of a penalty imposed by the Board pursuant to these regulations. If a chiropractor fails to pay, in whole or in part, a penalty imposed by the Board pursuant to these regulations, the Board may not restore, reinstate, or renew a license until the penalty 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 Fiscal Planning to institute and maintain proceedings to ensure prompt payment. The Board shall pay all monies collected pursuant to these regulations into the State's General Fund. Health Occupations Article, §3-314, Annotated Code of Maryland Effective date: Chapter and Subtitle renamed and recodified from COMAR 10.43.10 to COMAR 10.43.09, Board of Chiropractic Examiners, Monetary Penalties, effective January 2, 2017 (43:26 Md. R. 1446) Regulation .02 amended effective January 2, 2017 (43:26 Md. R. 1446) This chapter governs continuing education for all individuals licensed to practice chiropractic or registered to practice as a chiropractic assistant in Maryland. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the Maryland Board of Chiropractic Examiners. “Credit hour” means 1 course or program hour. “Licensee” means a chiropractor licensed by the Board. “Pre-approved provider” means: The State Chiropractic Association; The American Chiropractic Association; The International Chiropractors Association; Schools or colleges accredited by the Council on Chiropractic Education (CCE), the Federation of Chiropractic Licensing Boards Providers of Approved Continuing Education (FCLB PACE), and the National Board of Chiropractic Examiners (NBCE); Agencies approved by the Board of Physicians; or Schools and organizations approved by the Board. “Provider” means an individual or group who designs and develops continuing education courses or programs. “Registrant” means a chiropractic assistant who is registered by the Board to perform duties authorized under COMAR 10.43.07. License Renewal. A licensee shall satisfactorily complete 48 hours of continuing education in the 2-year period before each renewal and provide verification to the Board if requested. The licensee shall: Obtain a minimum of: 3 hours in approved communicable-disease education, which includes AIDS/HIV, and sanitary procedures; 1 hour in diversity or cultural competency education; 3 hours in risk management; and 1 hour in professional ethics or jurisprudence; Pay a renewal fee as set forth in COMAR 10.43.06; and Submit to the Board a renewal application accompanied by a continuing education form that the Board requires. Registration Renewal. A registrant shall satisfactorily complete 10 hours of continuing education in the 2-year period before each renewal and provide verification to the Board, if requested. The registrant shall: Pay a renewal fee as set forth in COMAR 10.43.06; and Submit to the Board a renewal application accompanied by a continuing education form that the Board requires. Hours may be in-person, home study, or online format. Exemptions, Waivers, and Extensions. Individuals issued initial licensure or registration within 12 months of the renewal date are exempt from the continuing education (CEU) requirements under this chapter for the first renewal cycle. Licensees and registrants with documented hardships seeking an exemption, waiver, or extension from CEU requirements under this chapter shall petition the Board in writing at least 90 days before the renewal date. The Board shall review the petition for an exemption, waiver, or extension, and respond in writing to the licensee or registrant within 30 days of the Board’s decision. The Board may deny the license or registration renewal of any chiropractor or chiropractic assistant who fails to comply with this chapter. The Board shall conduct an audit of licensees and registrants before or during the renewal period to ensure compliance with this chapter. Continuing education hours may not be carried over from one renewal period to the next. The Board shall: Base accreditation and approval of continuing education courses and programs on their content and instructor qualifications; and Ensure that continuing education courses and programs are directed toward improvement, advancement, and extension of professional skill and knowledge related to chiropractic. Pre-Approved Providers. Pre-approved providers shall submit continuing education courses or programs to the Board within 30 days before commencement of the course or program date. A course or program conducted by a pre-approved provider is considered approved without further review, provided that the course or program meets the subject-matter requirements of §D of this regulation. The Board shall post the list of pre-approved providers on the Board's website for public view. Non-Pre-Approved Providers. Non-pre-approved providers shall submit continuing education courses or programs to the Board 60 days prior to commencement of course or program date for review. The Board shall formally respond to submittals in a timely manner. The process for submission for approval shall be published on the Board’s website. The Board shall post the list of approved courses or programs from non-pre-approved providers on the Board's website for public view. For license renewal credit, the Board may approve a course or program consisting of one of the following subjects or a combination of these subjects: Chiropractic principles and adjusting techniques; Chiropractic ethics and jurisprudence; X-ray quality assurance program; Diagnostic imaging; Physical diagnosis; Clinical laboratory diagnosis; Orthopedic diagnosis; Neurological diagnosis; Rehabilitative procedures; Nutritional diagnosis; Physical therapy; Risk management; Cultural competency or diversity awareness; or A subject with clinical application approved by the Board. Term of Approval. The Board shall approve a course or program for a period of 5 years. At the expiration of the 5-year approval period, the provider: May resubmit the course or program; and Shall meet the approval requirements of this regulation. A licensee may: Submit a request for review of continuing education from the Board if the: Continuing education is not already approved or disapproved by the Board; and Licensee submits a request to the Board at least 60 days prior to the commencement of the course or program containing, but not exclusive to, information set forth in this chapter; and Achieve up to 12 hours for verified participation as an instructor, volunteer, or mentor under structured, sponsored courses or programs reviewed and approved by the Board. A continuing education processing review fee shall be paid in accordance with COMAR 10.43.06.02. A continuing education course may not exceed 12 hours during any renewal period. In addition to the required hours of continuing education set forth in this chapter, a licensee or registrant shall maintain a current CPR certification at the healthcare provider level from a Board-approved CPR provider for each renewal period. Approved credits are not transferable and are acceptable toward fulfillment of the continuing education requirement only in the renewal period in which the approved credits are earned. The licensee or registrant shall keep accurate records of attendance at approved continuing education courses or programs and be able to substantiate those records upon request. The Board shall conduct a random audit before or during the license or registration renewal period to ensure compliance with this chapter. The Board shall disallow the continuing education credits for a licensee or registrant who is unable to substantiate the credits and may deny the license or registration renewal if credits are disallowed. The Board may require additional verification for any information received regarding content and certification of, and attendance at, a continuing education course or program. The Board may grant an extension of time for the licensee or registrant to obtain required continuing education credits if the licensee or registrant presents evidence satisfactory to the Board that failure to comply was due to circumstances beyond the licensee's or registrant’s control. The Board may not accept continuing education credits from a previous renewal period. The Board shall renew a license or registration for the first renewal period following the issuance of the original license or registration without requiring continuing education credits if the original license or registration was issued 1 year or less before the expiration date of the license or registration. A licensee or registrant shall maintain complete and accurate records of the licensee's or registrant’s continuing education credits for the preceding 4 years and present them to the Board upon request. Upon licensee or registrant petition, the Board may waive the continuing education requirements when it determines that the licensee or registrant was unable to comply due to hardship. The Board may institute disciplinary action, pursuant to Health Occupations Article, §3-313, Annotated Code of Maryland, against a chiropractor or chiropractic assistant who submits fraudulent information to the Board. Failure to substantiate continuing education hours if requested by the Board shall result in denial of: License or registration renewal; or Reinstatement of a license or registration. A licensee shall satisfactorily complete a minimum of 48 continuing education hours as set forth under Regulation .03A(2)(a) of this chapter in the 2-year period immediately preceding reinstatement. A registrant shall satisfactorily complete a minimum of 10 continuing education hours as set forth under Regulation .03B of this chapter in the 2-year period immediately preceding reinstatement. Health Occupations Article, §§3-308 and 3-313, Annotated Code of Maryland Effective date: March 9, 1998 (25:5 Md. R. 370) Regulation .02B amended effective June 9, 2003 (30:11 Md. R. 735); June 13, 2011 (38:12 Md. R. 705); January 6, 2014 (40:26 Md. R. 2164) Regulation .03B amended effective August 6, 2001 (28:15 Md. R. 1398); June 9, 2003 (30:11 Md. R. 735); October 22, 2007 (34:21 Md. R. 1915); June 13, 2011 (38:12 Md. R. 705) Regulation .03D amended effective October 22, 2007 (34:21 Md. R. 1915) Regulation .03E adopted effective January 6, 2014 (40:26 Md. R. 2164) Regulation .04 amended effective October 22, 2007 (34:21 Md. R. 1915) Regulation .04B amended effective August 6, 2001 (28:15 Md. R. 1398); June 9, 2003 (30:11 Md. R. 735) Regulation .04G amended effective June 13, 2011 (38:12 Md. R. 705) Regulation .04 repealed and new Regulation .04 adopted effective January 6, 2014 (40:26 Md. R. 2164) Regulation .05 amended effective June 13, 2011 (38:12 Md. R. 705) Regulation .05I amended effective January 6, 2014 (40:26 Md. R. 2164) Chapter and Subtitle renamed and recodified from COMAR 10.43.11 to COMAR 10.43.10, Board of Chiropractic Examiners, Continuing Education Requirements, effective January 2, 2017 (43:26 Md. R. 1446) Regulation .01 amended effective January 8, 2024 (50:26 Md. R. 1132) Regulation .02B amended effective January 2, 2017 (43:26 Md. R. 1446); January 8, 2024 (50:26 Md. R. 1132) Regulation .03 amended effective January 8, 2024 (50:26 Md. R. 1132) Regulation .04 amended effective January 8, 2024 (50:26 Md. R. 1132) Regulation .05 amended effective January 8, 2024 (50:26 Md. R. 1132) Regulation .06 adopted effective January 8, 2024 (50:26 Md. R. 1132) This chapter establishes the requirements for licensure by examination for all applicants, except applicants who qualify for licensure under Health Occupations Article, §3-305, Annotated Code of Maryland. In this chapter, the following terms have the meanings indicated. Terms Defined. “Accredited college” means a chiropractic school approved by the Council on Chiropractic Education, or its successor, and approved by the Board. “Board” means the State Board of Chiropractic Examiners. “Letter of admission” means a document sent by the Board to the applicant approving the applicant's request to take the licensure examination. “Maryland Board examination” means the jurisprudence examination administered by the Board to measure competency under Health Occupations Article, Title 3, Annotated Code of Maryland, and COMAR 10.43.01 — .19. “National Board examination” means the written tests administered by the National Board of Chiropractic Examiners to measure competency in chiropractic. An individual is eligible to take the Maryland Board examination for licensure if the individual submits documentation, postmarked at least 45 days before the examination, verifying that the individual has: Been awarded a bachelor's degree from a Board-recognized, accredited college; Graduated from a college of chiropractic approved by the Board, pursuant to Health Occupations Article, §3-402, Annotated Code of Maryland; Successfully completed parts one and two of the National Board examination with a passing score established by the National Board of Chiropractic Examiners, and all other parts with a passing score of at least 75 percent; Obtained certification in CPR at the Health Care Provider level; Provided two letters of reference attesting to the applicant's good moral character; Certified or affirmed that the individual has not practiced chiropractic without a license in the State; Filed an application and paid the required application fee as specified in COMAR 10.43.06; Paid the required examination fee as specified in COMAR 10.43.06; and Completed a State and national criminal history records check in accordance with Health Occupations Article, §3–302.1, Annotated Code of Maryland. The Board may not refund an application fee. The Board shall refund the examination fee to an applicant whom the Board determines is not qualified to take the examination. The Board shall send to an approved applicant a letter of admission to the examination. The Board may refund examination fees to an applicant unable to be present for the examination if the applicant submits verification of hardship and a written request for a refund. The Board may not issue a license or registration if the criminal history records information required under §A(9) of this regulation has not been received. An applicant seeking physical therapy privileges shall have obtained: Clinical and didactic education in PT modalities from an accredited institution of higher education; and A minimum score of 75 percent on the National Board Physiotherapy Examination. After a hearing, the Board may permanently deny licensure to an applicant found to have cheated on or subverted an examination taken to qualify for Maryland licensure. Health Occupations Article, §§3-202, 3-205, and 3-301—3-304, Annotated Code of Maryland Effective date: March 9, 1998 (25:5 Md. R. 370) Regulation .02B amended effective June 9, 2003 (30:11 Md. R. 735); June 13, 2011 (38:12 Md. R. 705); January 6, 2014 (40:26 Md. R. 2164) Regulation .03B amended effective August 6, 2001 (28:15 Md. R. 1398); June 9, 2003 (30:11 Md. R. 735); October 22, 2007 (34:21 Md. R. 1915); June 13, 2011 (38:12 Md. R. 705) Regulation .03D amended effective October 22, 2007 (34:21 Md. R. 1915) Regulation .03E adopted effective January 6, 2014 (40:26 Md. R. 2164) Regulation .04 amended effective October 22, 2007 (34:21 Md. R. 1915) Regulation .04B amended effective August 6, 2001 (28:15 Md. R. 1398); June 9, 2003 (30:11 Md. R. 735) Regulation .04G amended effective June 13, 2011 (38:12 Md. R. 705) Regulation .04 repealed and new Regulation .04 adopted effective January 6, 2014 (40:26 Md. R. 2164) Regulation .05 amended effective June 13, 2011 (38:12 Md. R. 705) Regulation .05I amended effective January 6, 2014 (40:26 Md. R. 2164) Chapter and Subtitle renamed and recodified from COMAR 10.43.12 to COMAR 10.43.11, Board of Chiropractic Examiners, Licensure Examination, effective January 2, 2017 (43:26 Md. R. 1446) Regulation .02B amended effective January 2, 2017 (43:26 Md. R. 1446) This chapter governs all chiropractic clinical demonstrations in public places by licensed chiropractors in Maryland. In this chapter, the following terms have the meanings indicated. Terms Defined. “Chiropractic display facility” means an area where chiropractic procedures are demonstrated. “Chiropractic procedure” means examinations, mensurations, analyses, evaluations, screenings, or clinical determinations related to the practice of chiropractic in a public place. “Cursory postural screening” means a visualization, by a licensed chiropractor, of an individual's posture to detect possible structural deviations. “Demonstration” means performing chiropractic procedures in public places. When performing chiropractic procedures in a public place, the chiropractor shall: Prominently display the chiropractor's current license; Provide adequate facilities for patients to disrobe in privacy; Ensure that the patient is properly draped for examination; and Maintain the privacy of the patient at all times. The chiropractor may perform a cursory postural screening while the patient is fully clothed. For procedures that require partial or complete disrobing of the patient, the chiropractor shall ensure that the chiropractic display facility provides sufficient patient privacy. An unlicensed individual may not perform chiropractic procedures in public places. This chapter does not preclude a salesperson from demonstrating chiropractic equipment during a convention or educational seminar. The Board may initiate disciplinary proceedings, pursuant to Health Occupations Article, §3-313, Annotated Code of Maryland, against a chiropractor found in violation of this chapter. Health Occupations Article, §3-205, Annotated Code of Maryland Effective date: November 4, 1996 (23:22 Md. R. 1497) Regulation .03A amended effective January 6, 2014 (40:26 Md. R. 2164) Regulation .04 amended effective January 6, 2014 (40:26 Md. R. 2164) Chapter and Subtitle renamed and recodified from COMAR 10.43.13 to COMAR 10.43.12, Board of Chiropractic Examiners, Procedures for Clinical Demonstrations in Public Places, effective January 2, 2017 (43:26 Md. R. 1446) This chapter applies to licensed chiropractors and registered chiropractic assistants. In this chapter, the following terms have the meanings indicated. Terms Defined. “Chiropractic assistant” means an individual who is registered by the Board to perform the duties authorized under COMAR 10.43.07. “Chiropractor” means an individual licensed by the Board: To practice chiropractic; or To practice chiropractic with the right to practice physical therapy. “Non-bona-fide treatment” means when a chiropractor or chiropractic assistant treats or examines a patient in a way that involves sexual contact, but there is no medical reason for the procedure, or the procedure falls outside the scope of reasonable chiropractic practices. “Sexually exploitative relationship” means when sexual contact occurs in an existing therapeutic relationship or within a period of time after formal termination of the relationship when the patient may still be vulnerable to the power imbalance that exists in the practitioner-patient relationship, even if the relationship may appear to be or is mutually consensual. “Therapeutic deception” means when a chiropractor or chiropractic assistant misrepresents sexual conduct as a legitimate form of treatment. A chiropractor and chiropractic assistant shall concern themselves primarily with the welfare of the patient. A chiropractor or chiropractic assistant who suffers from a physical, mental, or emotional impairment, including chemical abuse, that impacts the individual's ability to practice chiropractic or provide chiropractic assistance shall seek professional treatment and refrain from the practice of chiropractic or the practice of chiropractic assistance until the impairment no longer exists or reasonable accommodations can be made. A chiropractor and chiropractic assistant 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 chiropractic 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 chiropractic only as defined in the scope of practice set forth in Health Occupations Article, §3-101(f) and (g), Annotated Code of Maryland; Provide chiropractic assistance only within the parameters set forth in Health Occupations Article, §3-404, Annotated Code of Maryland, and COMAR 10.43.07; 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, or other appropriate authority, conduct in the practice of chiropractic that indicates a violation of: This chapter; Health Occupations Article, Title 3, Annotated Code of Maryland; or Any other law, including but not limited to aiding or abetting the unauthorized practice of chiropractic. A chiropractor or chiropractic assistant may not: Misrepresent credentials, qualifications, or affiliations and shall attempt to correct others who misrepresent the chiropractor's or the chiropractic assistant'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 chiropractor and chiropractic assistant; Perform chiropractic on a patient if a contraindication against chiropractic 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 chiropractor shall: Use professional judgment in the use of evaluation and treatment procedures; Decline to administer treatment if the chiropractor 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 chiropractor'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 chiropractor 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 chiropractic; Adequately assess the patient to determine if contraindications against chiropractic 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 chiropractor 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 chiropractor'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 chiropractor and chiropractic assistant 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 chiropractor and chiropractic assistant may not: Exploit a relationship with a patient, staff member, or student for the chiropractor's or chiropractic assistant'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 chiropractor and chiropractic assistant may not engage in inappropriate behavior with other practice staff including sexual advances, harassment, discrimination, exploitation, retaliation, and other unprofessional conduct. A chiropractor shall: Respect and maintain the privacy and confidentiality of the patient; Disclose the patient’s records or information about the patient only: In accordance with the consent to treatment form signed by the: Patient; or Parent or guardian of a minor patient or incompetent patient; 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 chiropractor or chiropractic assistant 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 established by the Board. The chiropractor or chiropractic assistant may not perform a treatment or provide a service that the chiropractor or chiropractic assistant is not qualified to perform or which is beyond the scope of the chiropractor's or chiropractic assistant’s education, training, capabilities, experience, and scope of practice. A chiropractor may advertise services subject to COMAR 10.43.03. A chiropractor is accountable under this regulation if the chiropractor uses an agent, partnership, professional association, or health maintenance organization to implement an action prohibited by COMAR 10.43.03.05. A chiropractor and chiropractic assistant 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 chiropractic profession. Violation of a regulation in this chapter may result in the Board taking action pursuant to Health Occupations Article, §3-313, Annotated Code of Maryland. Health Occupations Article, §§1-212, 3-205, and 3-313, Annotated Code of Maryland Effective date: January 9, 2000 (26:27 Md. R. 2015) Regulation .03B, D amended effective October 22, 2007 (34:21 Md. R. 1915) Regulation .03C amended effective January 6, 2014 (40:26 Md. R. 2164) Regulation .03D amended effective October 22, 2007 (34:21 Md. R. 1915); June 13, 2011 (38:12 Md. R. 705) Regulation .04A amended effective October 22, 2007 (34:21 Md. R. 1915) Regulation .05B amended effective January 6, 2014 (40:26 Md. R. 2164) Regulation .05C adopted effective January 6, 2014 (40:26 Md. R. 2164) Regulation .06D amended effective January 6, 2014 (40:26 Md. R. 2164) Regulation .06G adopted effective October 22, 2007 (34:21 Md. R. 1915) Regulation .07 amended effective June 13, 2011 (38:12 Md. R. 705) Chapter and Subtitle renamed and recodified from COMAR 10.43.14 to COMAR 10.43.13, Board of Chiropractic Examiners, Code of Ethics, effective January 2, 2017 (43:26 Md. R. 1446) Regulation .06B amended effective December 30, 2019 (46:26 Md. R. 1165) This chapter establishes the minimum standards for the documentation of patient care by the chiropractor. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the Maryland Board of Chiropractic Examiners. “Diagnosis” means the determination by the chiropractor of the nature and cause of a disease or injury through evaluation of patient history, examination, and review of any laboratory and radiological data. “Examination” means varied procedures such as analysis, assessment, and evaluation performed by the chiropractor to determine a diagnosis. "History" means the patient's account of past, present, and familial health. “Subjective, objective, assessment, and plan (SOAP) notes” means the written record maintained by the chiropractor of: The patient's qualitative or quantitative description of the patient's condition; Findings pertaining to the patient's condition based on examination and tests; The chiropractor's clinical opinion of the condition; and Instructions given to the patient, orthopedic appliances provided to the patient with instructions for usage, and recommendations for treatment, including modalities used and areas treated. The chiropractor shall maintain accurate, detailed, legible, and organized records, documenting all data collected pertaining to the patient's health status. The chiropractor may not erase, alter, or conceal patient records but shall initial and date any changes made in the corresponding margin. The Patient Record. The chiropractor shall create a record for each patient. The chiropractor shall state the patient's name or identification number on each document contained in the patient record. The chiropractor shall include the following information in the patient record: Chiropractor and clinic name identification; Patient history; Examination findings; Diagnoses; Treatment plan; SOAP notes; Financial records; Records of telephone conversations; Copies of correspondence and reports sent to other health care providers, diagnostic facilities, and legal representatives; Records and reports provided by other health care providers and diagnostic facilities; and The signed consent to treatment form of the: Patient; or Parent or guardian of a minor patient or incompetent patient. Correspondence. The chiropractor shall identify the name of the attending chiropractor, clinic name, address, and telephone number on patient records and reports sent to another health care provider. Maintenance and Release of Patient Records. The chiropractor shall keep confidential all information contained in the patient file, in accordance with Health-General Article, Title 4, Subtitle 3, Annotated Code of Maryland. The chiropractor shall release patient records when release is: Authorized by the patient in writing; or Compelled by law. The chiropractor may assess fees for duplicating patient records for the patient or for another health care provider in accordance with Health-General Article, §4-304, Annotated Code of Maryland. The chiropractor shall maintain records in accordance with Health-General Article, §4-403, Annotated Code of Maryland. The chiropractor is responsible for record keeping, consent to treatment forms, billing, and other patient-related documentation handled, maintained, or managed by the chiropractor’s staff. The chiropractor shall ensure that employees involved in the preparation, organization, and filing of records adhere to the regulations of this chapter. The chiropractor shall include the following in the patient history: Personal data, including: Name, Address, Telephone number, Date of birth, Race, Sex, and Current occupation; Complaint or complaints, including: Description of the complaint or complaints, Quality and character of the complaint or complaints, Intensity, Frequency, Location, Radiation, Onset, Duration, Palliative and provocative factors, and History of present complaint or complaints; Family health history; Past health history, including: General state of health, Previous illnesses, Surgical history, Previous injuries, Hospitalizations, Previous treatment and diagnostic testing, Prescribed and nonprescribed medications and supplements, Allergies, and Mental illness; Systems review, including: Musculoskeletal, Cardiovascular, Respiratory, Gastrointestinal, Neurological, Ophthalmological, Otolaryngological, Endocrine, Peripheral vascular, and Psychiatric; and Personal history, including: Occupational, Activities, Exercise, and Health habits. Violation of this chapter may result in disciplinary action against the chiropractor, as set forth in Health Occupations Article, §3-313, Annotated Code of Maryland. Health Occupations Article, §3-205, Annotated Code of Maryland Effective date: February 23, 1998 (25:4 Md. R. 244) Regulation .02B amended effective June 13, 2011 (38:12 Md. R. 705) Regulation .03B amended effective October 22, 2007 (34:21 Md. R. 1915) Chapter and Subtitle renamed and recodified from COMAR 10.43.15 to COMAR 10.43.14, Board of Chiropractic Examiners, Record Keeping, effective January 2, 2017 (43:26 Md. R. 1446) Regulation .03C amended effective December 30, 2019 (46:26 Md. R. 1165) Regulation .04A amended effective December 30, 2019 (46:26 Md. R. 1165) This chapter shall be used by the Board and the Maryland Office of Administrative Hearings as a framework for imposing discipline. The Board and the Maryland Office of Administrative Hearings shall take into consideration a range of activity within certain types of conduct rather than assigning particular sanctions to each specific violation. The Board shall complete a worksheet for each complaint considered by the Board that is not initially closed. The Board is aware that there may be conduct by a licensee that does not fall squarely within a particular guideline contained in Regulation .06 of this chapter. In that event the Board will so indicate on the worksheet and use its best judgment to determine the appropriate sanction. The Board and the Maryland Office of Administrative Hearings shall make determinations that maximize the protection of the public’s health while maintaining the rights of licensees. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the Maryland State Board of Chiropractic Examiners. “Conditions” means requirements in a public or nonpublic order that a licensee is required to satisfy which include but are not limited to: Treatment and counseling for an emotional or physical illness; Submission to drug and alcohol testing; Abstinence from specified drugs; Abstinence from alcohol; Remedial training; Inspection; Monitoring; Evaluation; Supervision; Testing of clinical skills; Submission of written reports; A demonstration of knowledge or competency; Limitation of practice; Limitation on the administration of specified drugs to patients; The provision of pro bono chiropractic to the poor, elderly, or disabled; Obeyance of Maryland Chiropractic Act, federal, state, and local laws; and The payment of a civil penalty. “Conduct” means behavior or action or a failure to behave or act that results in a violation of the Maryland Chiropractic Act or the regulations adopted by the Board. This chapter shall be used by the Board as a guide for sanctioning licensees in formal and informal actions and proceedings. Except as provided in Regulation .05 of this chapter, the Board shall impose a sanction not less severe than the minimum listed in Regulation .06 of this chapter, nor more severe than the maximum listed in Regulation .06 of this chapter. When conduct results in multiple violations of the Maryland Chiropractic Act and the regulations adopted by the Board, the Board shall consider sanctions that are greater than those imposed for a single violation. This chapter does not apply to disciplinary matters reviewed by the Board that are initially closed. Unless otherwise indicated, the period of a suspension may be stayed in whole or in part. A respondent placed on suspension or probation shall have conditions attached to the suspension or probation which focus on the conduct and steps needed to assure public protection. Consent orders shall: Include an acknowledgement of the violation or violations; and Indicate that the respondent accepts personal responsibility for the respondent's behavior. If the conduct is not described in Regulation .06 of this chapter, the Board shall use its judgment to determine appropriate sanctions and shall so state in the sanctions worksheet. A departure from the sanctioning guidelines alone may not be grounds for any hearing or appeal of any Board action before the Board or the Maryland Office of Administrative Hearings. The sanctioning guidelines are not applicable to: Individuals seeking an initial license; or The summary suspension of a license under State Government Article, §10-226, Annotated Code of Maryland. Notwithstanding the sanctioning guidelines, a respondent may surrender a license. The Board shall complete a sanctions worksheet after considering each disciplinary matter. The sanctions worksheet shall, at a minimum: Briefly summarize the conduct that constituted the violation or violations meriting action; Identify the severity of the conduct; Describe other factors that the Board considered in determining the recommended sanctions imposed including but not limited to: Aggravating factors as outlined in Regulation .05 of this chapter; Mitigating factors as outlined in Regulation .05 of this chapter; and Prior disciplinary history; and Identify the recommended sanctions. The Board’s summary of the conduct that constituted the violation or violations need not: Be exhaustive; or Include every violation meriting action by the Board. The existence of one or more aggravating or mitigating factors contained in Regulation .05 of this chapter does not impose on the Board any requirement to make findings of fact or to articulate its reasoning for not exercising its discretion to impose a sanction outside the range of sanctions. A copy of the sanctions worksheet may be obtained by the respondent or the respondent's legal representative. Sanctions in a particular case may fall outside the range of the sanctioning guidelines established by the Board. If the sanctions imposed by the Board fall outside the range of the sanctioning guidelines the Board shall state its reasons on its worksheet. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the Board may consider the following aggravating and mitigating factors in determining whether the sanction in a particular case should fall outside the range of the sanctioning guidelines: Aggravating Factors: Previous criminal or administrative discipline history; Whether the offense was committed deliberately or with gross negligence or recklessness; Whether the offense has the potential for, or caused, serious patient harm; Whether the offense was part of a pattern of detrimental conduct; Whether the respondent pursued the respondent's financial gain over the patient’s welfare; Whether the patient was especially vulnerable; Whether the respondent attempted to hide error or misconduct from patients or others; Whether the respondent: Concealed, falsified, or destroyed evidence; or Presented false testimony or evidence; Whether the respondent willfully and without legal justification failed to cooperate with a lawful investigation conducted by the Board; and Whether previous attempts to rehabilitate the respondent were unsuccessful; and Mitigating Factors: Absence of a prior disciplinary record; The passage of time since any prior offenses; Whether the respondent self-reported to the Board; Cooperation with the Board’s investigation; Full disclosure to the Board; Implementation of remedial measures to correct or mitigate harm arising from the misconduct; Timely good-faith efforts to make restitution or to rectify consequences of misconduct; Evidence of rehabilitation or rehabilitative potential; Absence of premeditation to commit the offense; Absence of potential harm to the public; Absence of adverse impact; Whether the offense was an isolated incident and not likely to recur; How and when the respondent has been involved in community service and the value of the community service to the community; and Voluntary admissions of misconduct. The following guidelines shall be used by the Board as a guide for sanctioning licensees in formal and informal actions and proceedings: Abuse — Physical and Emotional. Criminal Convictions or Plea of Nolo Contendere. Disciplined by Another Licensing or Disciplinary Authority. Diversion of Controlled Substances or Prescription Drugs. Failure to Renew a License When the Licensee Has Continued to Practice. Noncompliance with Board Orders. Incompetent Practice Or Misconduct. Sexual Misconduct. Substance Abuse. Unauthorized Practice. Unethical Conduct. Health Occupations Article, §§1-606, 3-313, and 3-315, Annotated Code of Maryland Effective date: April 16, 2012 (39:7 Md. R. 494) Subtitle amended and recodified from COMAR 10.43.16 to COMAR 10.43.15, Board of Chiropractic Examiners, Sanctioning Guidelines, effective January 2, 2017 (43:26 Md. R. 1446) This chapter establishes standards for the provision of dry needling as an intervention performed by chiropractors. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the State Board of Chiropractic Examiners. “Dry needling” means a chiropractic intervention, also known as intramuscular manual therapy, that: Is performed only by chiropractors with physical therapy privileges; Involves the insertion of one or more solid needles, a mechanical device, into the muscle and related tissues to affect change in muscle and related tissues; Requires ongoing evaluation, assessment, and re-evaluation of the impairments; Is only utilized in parts of the body with neuromuscular or musculoskeletal links to the impairments; and Is not performed for: The purposes of acupuncture as defined in Health Occupations Article, §1A-101, Annotated Code of Maryland; or Any purpose outside the scope of chiropractic. A chiropractor registered to perform dry needling shall: Fully explain dry needling to the patient in advance of treatment; Obtain informed written consent specific to dry needling, which shall be included in the patient’s medical record; Perform dry needling in a competent manner consistent with patient health and safety; and Document the provision and the specific location of the dry needling service in accordance with the requirements of COMAR 10.43.14.03. A chiropractor who performs dry needling in a manner inconsistent with the standards of practice enumerated in this regulation may be subject to discipline pursuant to COMAR 10.43.15.06. Dry needling is not within the scope of practice for: A registered chiropractic assistant; A chiropractic assistant trainee; A preceptor; or An extern. A chiropractor with physical therapy privileges shall be in good standing before registering to perform dry needling. The Board shall accept a dry needling course completed before May 18, 2020, if: The same course, in substantially similar form, is sponsored by a continuing education provider approved by the Board; and The chiropractor seeking to perform dry needling provides the Board with a certificate of completion of 3 hours of a recertification course in dry needling. In order to perform dry needling, a chiropractor with physical therapy privileges shall complete a minimum of 80 hours of total instruction in the following content areas, including: 60 hours of: Academic coursework obtained through completion of a college program accredited by the Council of Chiropractic Education, as part of the Doctor of Chiropractic program, including the following minimum requirements: Foundations; Basic sciences; Clinical sciences; and Professional practice; or Coursework required to sit for Part I, Part II, Part III, Physiotherapy, and Part IV of the examination administered by the National Board of Chiropractic Examiners; and Board-approved coursework consisting of 20 hours to be done in a hands-on classroom setting, including but not limited to the following learning topics: Philosophy and historical perspective of dry needling; Indications, contra-indications, and qualifications for treatment; Protocols, doctor and patient safety, usage of dry needling, and dry needling as a diagnostic tool; Case management and jurisprudence; and Direct, hands-on implementation and testing for competency in dry needling of: Cervical, thoracic, lumbar, and pelvic regions; Anterior and posterior thoracic and ribs; The upper and lower extremity; The face and head; Technique; and Needle size and gauge appropriateness. The Board shall register a chiropractor with physical therapy privileges as qualified to perform dry needling in the State, provided the chiropractor submits to the Board: Evidence of completion of the education and training requirements outlined in Regulation .04 of this chapter; and An application for registration on a form provided by the Board. A chiropractor with physical therapy privileges may not perform dry needling without registering with the Board. Health Occupations Article, §§3-101, 3-205(a), 3-307, 3-403, and 13-101, Annotated Code of Maryland Effective date: May 18, 2020 (47:10 Md. R. 519) Regulation .03A, C amended effective April 4, 2022 (49:7 Md. R. 467) Regulation .04 amended effective April 4, 2022 (49:7 Md. R. 467) Regulation .05A amended effective April 4, 2022 (49:7 Md. R. 467) This chapter governs the practice of chiropractic using telehealth as an adjunct to, or replacement for, in-person patient visits. Nothing in the chapter restricts or limits reimbursement requirements pursuant to the Health-General Article and Insurance Article, Annotated Code of Maryland. In this chapter, the following terms have the meanings indicated. Terms Defined. “Asynchronous” means not occurring in real time. “Board” means the Maryland Board of Chiropractic Examiners. “In-person” means within the physical presence of the patient. “Synchronous” means occurring in real time. “Telehealth” has the meaning stated in Health Occupations Article, §1-1001, Annotated Code of Maryland. “Telehealth practitioner” means a Maryland licensed chiropractor performing telehealth services within their respective scope of practice. Subject to the provisions of Health Occupations Article, Title 3, Annotated Code of Maryland, a telehealth practitioner shall be licensed in Maryland when providing telehealth services to a patient located in the State. Before performing telehealth services, a telehealth practitioner shall develop and follow a procedure to: Verify the identification of the patient receiving telehealth services through use of: A government-issued photograph identification; An insurance, Medicaid, or Medicare card; or Documentation of the patient’s: Date of birth; and Home address; For an initial patient-telehealth practitioner encounter, disclose the telehealth practitioner’s: Name; Maryland license number; and Contact information; Obtain oral or written consent from a patient or 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 the recommended treatment plan; Securely collect and transmit a patient’s medical health information, clinical data, clinical images, laboratory results, and self-reported medical health and clinical 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 communication modality that complies with federal and state privacy laws; and Establish safety protocols to be used in the case of an emergency, including contact information for emergency services at the patient’s location. 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 specific practice setting in which the patient is located; and Identify all individuals present at each location and confirm they are allowed to hear the patient’s health information. A telehealth practitioner shall be held to the same standards of practice and documentation as those applicable for in-person chiropractic practice appointments. 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 a treatment plan through telehealth; and If clinically appropriate for the patient, provide or refer a patient to: In-person treatment; or Another type of telehealth service. A telehealth practitioner may not treat a patient based solely on an online questionnaire. The Board shall use the same standards of evaluating and investigating a complaint about and in disciplining a telehealth practitioner 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 this chapter shall constitute unprofessional conduct and may be subject to disciplinary action by the Board. Health Occupations Article, §§1-1001—1-1006 and 3-205,, Annotated Code of Maryland Effective date: September 18, 2023 (50:18 Md. R. 797) Effective date: October 16, 2000 (27:20 Md. R. 1839) Chapter revised effective June 13, 2011 (38:12 Md. R. 705) Regulation .02B amended effective January 6, 2014 (40:26 Md. R. 2164); April 13, 2015 (42:7 Md. R. 570) Regulation .03 amended effective April 13, 2015 (42:7 Md. R. 570) Regulation .04A amended effective April 13, 2015 (42:7 Md. R. 570) Regulation .05 amended effective January 6, 2014 (40:26 Md. R. 2164) Regulation .07A amended effective April 13, 2015 (42:7 Md. R. 570) Chapter recodified from COMAR 10.43.18 to COMAR 10.65.03 under new Subtitle, Board of Massage Therapy Examiners, Code of Ethics, effective January 2, 2017 (43:26 Md. R. 1446) Effective date: May 29, 2000 (27:10 Md. R. 966) Chapter revised effective June 13, 2011 (38:12 Md. R. 705) Regulation .02B amended effective April 13, 2015 (42:7 Md. R. 570) Regulation .03G amended effective April 13, 2015 (42:7 Md. R. 570) Chapter recodified from COMAR 10.43.19 to COMAR 10.65.04 under new Subtitle, Board of Massage Therapy Examiners, Advertising, effective January 2, 2017 (43:26 Md. R. 1446) Effective date: June 24, 2002 (29:12 Md. R. 928) Regulation .01 amended effective January 6, 2014 (40:26 Md. R. 2164) Regulation .02 repealed and new Regulation .02 adopted effective January 6, 2014 (40:26 Md. R. 2164) Regulation .03 amended effective January 6, 2014 (40:26 Md. R. 2164) Regulation .04A amended effective August 18, 2003 (30:16 Md. R. 1075); April 13, 2015 (42:7 Md. R. 570) Chapter recodified from COMAR 10.43.20 to COMAR 10.65.05 under new Subtitle, Board of Massage Therapy Examiners, Continuing Education Requirements, effective January 2, 2017 (43:26 Md. R. 1446) Effective date: January 6, 2014 (40:26 Md. R. 2164) Subtitle recodified from COMAR 10.43.21 to COMAR 10.65.06, Board of Massage Therapy Examiners, Record Keeping, effective January 2, 2017 (43:26 Md. R. 1446)