# COMAR Title 10 — Maryland Department of Health

## Subtitle 43 — Board of Chiropractic Examiners

### Chapter 13 — Code of Ethics

#### Regulation .04 Relationship with Patient.

*COMAR 10.43.13.04*

A. A chiropractor shall:

  (1) Use professional judgment in the use of evaluation and treatment procedures;

  (2) Decline to administer treatment if the chiropractor believes that a treatment is contraindicated or unjustified;

  (3) Terminate a professional relationship with a patient in an appropriate manner, such as:

    (a) Providing the patient with sufficient notice to permit the patient to obtain the services of another professional;

    (b) Assisting the patient by providing referrals if appropriate; or

    (c) 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;

  (4) Maintain a written record of treatment of the patient under the chiropractor's care for at least:

    (a) 5 years after the termination of treatment; and

    (b) 5 years after the patient becomes 18 years old, if applicable;

  (5) Make the written records of treatment available to the patient upon request, in compliance with applicable laws for disclosure of medical records;

  (6) Make arrangements for another professional to provide for the needs of the patient during anticipated absences when the chiropractor is unavailable to the patient;

  (7) Make referrals only to other qualified and duly licensed health care providers;

  (8) Accurately inform the patient, other health care professionals, and the public of the limitations of the practice of chiropractic;

  (9) Adequately assess the patient to determine if contraindications against chiropractic treatment exist and refer the patient to an appropriate health care practitioner;

  (10) Exercise independent professional judgment in the treatment or evaluation of the patient regardless of whether the patient was referred by another health care provider;

  (11) Ensure clear and concise professional communications with patients regarding:

    (a) Nature and duration of treatment;

    (b) Diagnoses;

    (c) Costs;

    (d) Billing; and

    (e) Insurance; and

  (12) Administer fair and equitable fees to patients regardless of status or insurance.

B. A chiropractor may not:

  (1) Accept a client for treatment, or continue unnecessary treatment, when the patient cannot be reasonably expected to benefit from the treatment;

  (2) 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;

  (3) 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

  (4) Exploit the professional relationship by:

    (a) Continuing treatment unnecessarily; or

    (b) Charging for a service:

      (i) Not provided; or

      (ii) Different from those actually provided.