<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.43.13.04" title_num="10" subtitle_num="43" chapter_num="13" heading="Relationship with Patient.">
  <paragraph num="A.">
    <text>A chiropractor shall:</text>
    <paragraph num="(1)">
      <text>Use professional judgment in the use of evaluation and treatment procedures;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Decline to administer treatment if the chiropractor believes that a treatment is contraindicated or unjustified;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Terminate a professional relationship with a patient in an appropriate manner, such as:</text>
      <paragraph num="(a)">
        <text>Providing the patient with sufficient notice to permit the patient to obtain the services of another professional;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Assisting the patient by providing referrals if appropriate; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>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;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Maintain a written record of treatment of the patient under the chiropractor's care for at least:</text>
      <paragraph num="(a)">
        <text>5 years after the termination of treatment; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>5 years after the patient becomes 18 years old, if applicable;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Make the written records of treatment available to the patient upon request, in compliance with applicable laws for disclosure of medical records;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Make arrangements for another professional to provide for the needs of the patient during anticipated absences when the chiropractor is unavailable to the patient;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Make referrals only to other qualified and duly licensed health care providers;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Accurately inform the patient, other health care professionals, and the public of the limitations of the practice of chiropractic;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Adequately assess the patient to determine if contraindications against chiropractic treatment exist and refer the patient to an appropriate health care practitioner;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Exercise independent professional judgment in the treatment or evaluation of the patient regardless of whether the patient was referred by another health care provider;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Ensure clear and concise professional communications with patients regarding:</text>
      <paragraph num="(a)">
        <text>Nature and duration of treatment;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Diagnoses;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Costs;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Billing; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Insurance; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(12)">
      <text>Administer fair and equitable fees to patients regardless of status or insurance.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>A chiropractor may not:</text>
    <paragraph num="(1)">
      <text>Accept a client for treatment, or continue unnecessary treatment, when the patient cannot be reasonably expected to benefit from the treatment;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>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</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Exploit the professional relationship by:</text>
      <paragraph num="(a)">
        <text>Continuing treatment unnecessarily; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Charging for a service:</text>
        <paragraph num="(i)">
          <text>Not provided; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Different from those actually provided.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>