<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.69.02.04" title_num="10" subtitle_num="69" chapter_num="02" heading="Scope of Delegation to an Assistant.">
  <paragraph num="A.">
    <text>A licensed certified midwife may not delegate technical tasks to an assistant which shall, by law or regulation, be performed only by an individual that is required to be licensed, certified, registered, or otherwise recognized pursuant to any State laws.</text>
  </paragraph>
  <paragraph num="B.">
    <text>A licensed certified midwife may delegate technical tasks, consistent with the approved policies and procedures of the site, in the following categories:</text>
    <paragraph num="(1)">
      <text>Surgical technical tasks that the delegating licensed certified midwife directly orders while present and personally performing the surgery in the same surgical field; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Nonsurgical technical tasks while the assistant is under the delegating licensed certified midwife’s direct supervision or on-site supervision.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Except as provided in §§B(1) and D of this regulation, a licensed certified midwife shall provide a minimum of on-site supervision when delegating technical tasks to an assistant, including, but not limited to, the following:</text>
    <paragraph num="(1)">
      <text>Client preparation for physical examination;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Client history interview;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Collecting and processing specimens, such as performing phlebotomy, inoculating culture media, pregnancy tests; dipstick and microscopic urinalysis, and microbiology including rapid streptococcal testing and throat cultures;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Preparing and performing laboratory tests under State and Clinical Laboratory Improvement Amendments regulations;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Clinical tests;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Transmitting prescriptions to a pharmacy;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Preparing and administering oral drugs;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Establishing a peripheral intravenous line; and</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Preparing and administering injections including small amounts of local anesthetics if provided either:</text>
      <paragraph num="(a)">
        <text>Intradermal;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Subcutaneous; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Intramuscular in the deltoid, gluteal, or vastus lateralis.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>When delegating injecting intravenous drugs or contrast materials to an assistant, a licensed certified midwife shall provide direct supervision.</text>
  </paragraph>
  <paragraph num="E.">
    <text>A licensed certified midwife who is dispensing prescription medication under Health Occupations Article, Title 8, Annotated Code of Maryland may delegate only mechanical acts involved in dispensing a drug.</text>
  </paragraph>
  <paragraph num="F.">
    <text>A licensed certified midwife may not delegate to an assistant any act that requires the exercise of clinical judgment by a licensed certified midwife, including, but not limited to:</text>
    <paragraph num="(1)">
      <text>Conducting physical examinations;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Administering any form of anesthetic agent or agent of conscious sedation other than topical anesthetics or small amounts of local anesthetics;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Initiating independently any form of treatment, except for cardiopulmonary resuscitation, or other forms of emergency treatment authorized to be performed by non-clinicians under State law;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Establishing a diagnosis or giving clinical advice; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Providing physical therapy.</text>
    </paragraph>
  </paragraph>
</regulation>