A licensed commercial ambulance service may not provide specialty care transport unless: Licensed as a specialty care transport ambulance service; or No more than ten times a year, if a licensed specialty care transport ambulance service is not available within a clinically reasonable time as determined by the referring physician: The sending facility provides health care personnel authorized by law to provide the level of care required by the patient during transport, which may include a nurse meeting the requirements of COMAR 10.27.09.04C(2); Required specialty equipment is available; The ambulance used is licensed as at least an ALS ambulance; Notice is made to SOCALR within 24 hours of the transport; and A report, reviewed and signed by the medical director, is submitted to SOCALR within 7 days of the transport, documenting the patient’s condition, the care rendered, crew configuration and efforts made by the referring physician, and the service to secure appropriate SCT resources.