Duty to Hold Confidential and Duty to Disclose a Medical Record

22. Medical Records Act--Duty to Hold Confidential and Duty to Disclose a

Medical Record

HEALTH-GENERAL ARTICLE § § 4-301--4-309, 8-601

§ 4-301. Definitions

(a) In general. -- In this subtitle the following words have the meanings indicated.

(b) Directory information. --

(1) "Directory information" means information concerning the presence and general health

condition of a patient who has been admitted to a health care facility or who is currently

receiving emergency health care in a health care facility.

(2) "Directory information" does not include health care information developed primarily in

connection with mental health services.

communication of information in a medical record, including an acknowledgment that a medical

record on a particular patient or recipient exists.

(d) Emergency. -- "Emergency" means a situation when, in the professional opinion of the health

care provider, a clear and significant risk of death or imminent serious injury or harm to a patient

or recipient exists.

(e) General health condition. -- "General health condition" means the health status of a patient

described in terms of "critical", "poor", "fair", "good", "excellent", or terms denoting similar

conditions.

(f) Health care. -- "Health care" means any care, treatment, or procedure by a health care

provider:

(1) To diagnose, evaluate, rehabilitate, manage, treat, or maintain the physical or mental

condition of a patient or recipient; or

(2) That affects the structure or any function of the human body.

(g) Health care provider. --

(1) "Health care provider" means:

(i) A person who is licensed, certified, or otherwise authorized under the Health Occupations

Article or § 13-516 of the Education Article to provide health care in the ordinary course of

business or practice of a profession or in an approved education or training program; or

(ii) A facility where health care is provided to patients or recipients, including a facility as

defined in § 10-101(e) of this article, a hospital as defined in § 19-301 of this article, a related

institution as defined in § 19-301 of this article, a health maintenance organization as defined in

§ 19-701(g) of this article, an outpatient clinic, and a medical laboratory.

(2) "Health care provider" includes the agents, employees, officers, and directors of a facility

and the agents and employees of a health care provider.

(h) Medical record. --

(1) "Medical record" means any oral, written, or other transmission in any form or medium of

information that:

(i) Is entered in the record of a patient or recipient;

(ii) Identifies or can readily be associated with the identity of a patient or recipient; and

(iii) Relates to the health care of the patient or recipient.

(2) "Medical record" includes any:

(i) Documentation of disclosures of a medical record to any person who is not an employee,

agent, or consultant of the health care provider;

(ii) File or record maintained under § 12-403(b)(13) of the Health Occupations Article by a

pharmacy of a prescription order for drugs, medicines, or devices that identifies or may be

readily associated with the identity of a patient;

(iii) Documentation of an examination of a patient regardless of who:

1. Requested the examination; or

2. Is making payment for the examination; and

(iv) File or record received from another health care provider that:

1. Relates to the health care of a patient or recipient received from that health care provider;

and

2. Identifies or can readily be associated with the identity of the patient or recipient.

(i) Mental health services. --

(1) "Mental health services" means health care rendered to a recipient primarily in connection

with the diagnosis, evaluation, treatment, case management, or rehabilitation of any mental

disorder.

(2) For acute general hospital services, mental health services are considered to be the

primarily rendered service only if service is provided pursuant to Title 10, Subtitle 6 or Title 12

of this article.

(j) Patient. -- "Patient" means a person who receives health care and on whom a medical record

is maintained.

(k) Person in interest. -- "Person in interest" means:

(1) An adult on whom a health care provider maintains a medical record;

(2) A person authorized to consent to health care for an adult consistent with the authority

granted;

(3) A duly appointed personal representative of a deceased person;

(4) (i) A minor, if the medical record concerns treatment to which the minor has the right to

consent and has consented under Title 20, Subtitle 1 of this article; or

(ii) A parent, guardian, custodian, or a representative of the minor designated by a court, in

the discretion of the attending physician who provided the treatment to the minor, as provided in

§ 20-102 or § 20-104 of this article;

(5) If item (4) of this subsection does not apply to a minor:

(i) A parent of the minor, except if the parent's authority to consent to health care for the

minor has been specifically limited by a court order or a valid separation agreement entered into

by the parents of the minor; or

(ii) A person authorized to consent to health care for the minor consistent with the authority

granted; or

(6) An attorney appointed in writing by a person listed in item (1), (2), (3), (4), or (5) of this

subsection.

(l) Primary provider of mental health services. -- "Primary provider of mental health services"

means the designated mental health services provider who:

(1) Has primary responsibility for the development of the mental health treatment plan for the

recipient; and

(2) Is actively involved in providing that treatment.

(m) Recipient. -- "Recipient" means a person who has applied for, for whom an application has

been submitted, or who has received mental health services.

§ 4-302. Confidentiality and disclosure generally

(a) In general. -- A health care provider shall:

(1) Keep the medical record of a patient or recipient confidential; and

(2) Disclose the medical record only:

(i) As provided by this subtitle; or

(ii) As otherwise provided by law.

(b) Applicability of subtitle. -- The provisions of this subtitle do not apply to information:

(1) Not kept in the medical record of a patient or recipient that is related to the administration

of a health care facility, including:

(i) Risk management;

(ii) Quality assurance; and

(iii) Any activities of a medical or dental review committee that are confidential under the

provisions of Title 4, Subtitle 5 and Title 14, Subtitle 5 of the Health Occupations Article and

any activities of a pharmacy review committee;

(2) Governed by the federal confidentiality of alcohol and drug abuse patient records

regulations, 42 C.F.R. Part 2 and the provisions of § 8-601(c) of this article; or

(3) Governed by the developmental disability confidentiality provisions in §§ 7-1008 through

7-1011 of this article.

patient without the authorization of a person in interest, except if the patient has instructed the

health care provider in writing not to disclose directory information.

(d) Redisclosure. -- A person to whom a medical record is disclosed may not redisclose the

medical record to any other person unless the redisclosure is:

(1) Authorized by the person in interest;

(2) Otherwise permitted by this subtitle;

(3) Permitted under § 1-202(b) or (c) of the Human Services Article; or

(4) Directory information.

(e) Transfer of records relating to transfer of ownership of health care practice or facility. --

(1) Except as provided in paragraph (2) of this subsection, a person may not disclose by sale,

rental, or barter any medical record.

(2) This subsection shall not prohibit the transfers of medical records relating to the transfer of

ownership of a health care practice or facility if the transfer is in accord with the ethical

guidelines of the applicable health care profession or professions.

(f) Construction of subtitle. -- The provisions of this subtitle may not be construed to constitute

an exception to the reporting requirements of Title 5, Subtitle 7 and Title 14, Subtitle 3 of the

Family Law Article.

§ 4-302.1. Medical care electronic claims clearinghouses

(a) Limitations on payors' acceptance of claims. -- Payors that accept claims originating in this

State from medical care electronic claims clearinghouses shall accept claims only from medical

care electronic claims clearinghouses that are:

(1) Accredited by the Electronic Healthcare Network Accreditation Commission; or

(2) Certified by the Maryland Health Care Commission.

(b) Regulations. -- The Maryland Health Care Commission shall adopt regulations to carry out

this section.

§ 4-303. Disclosure upon authorization of a person in interest

(a) In general. -- A health care provider shall disclose a medical record on the authorization of

a person in interest in accordance with this section.

(b) Form, terms and conditions of authorization. -- Except as otherwise provided in subsections

(1) Be in writing, dated, and signed by the person in interest;

(2) State the name of the health care provider;

(3) Identify to whom the information is to be disclosed;

(4) State the period of time that the authorization is valid, which may not exceed 1 year,

except:

(i) In cases of criminal justice referrals, in which case the authorization shall be valid until 30

days following final disposition; or

(ii) In cases where the patient on whom the medical record is kept is a resident of a nursing

home, in which case the authorization shall be valid until revoked, or for any time period

specified in the authorization; and

(5) Apply only to a medical record developed by the health care provider unless in writing:

(i) The authorization specifies disclosure of a medical record that the health care provider has

received from another provider; and

(ii) The other provider has not prohibited redisclosure.

receipt of a preauthorized form that is part of an application for insurance.

(d) Authorization for release related to workers' compensation claims. -- A health care provider

shall disclose a medical record on receipt of an authorization for the release of relevant medical

information that is included with the claim application form filed with the Workers'

Compensation Commission in accordance with § 9-709(a), § 9-710(b), or § 9-711(a) of the

Labor and Employment Article.

(e) Revocation of authorization. --

(1) Except in cases of criminal justice referrals, a person in interest may revoke an

authorization in writing.

(2) A revocation of an authorization becomes effective on the date of receipt by the health care

provider.

(3) A disclosure made before the effective date of a revocation is not affected by the

revocation.

(f) Entries in records. -- A copy of the following shall be entered in the medical record of a

patient or recipient:

(1) A written authorization;

(2) Any action taken in response to an authorization; and

(3) Any revocation of an authorization.

§ 4-304. Copies of records; changes in records

(a) Requests for copies. --

(1) Except as otherwise provided in this subtitle, a health care provider shall comply within a

reasonable time after a person in interest requests in writing:

(i) To receive a copy of a medical record; or

(ii) To see and copy the medical record.

(2) If a medical record relates to a psychiatric or psychological problem and the attending

health care provider, with any available and feasible input from a primary provider of mental

health services, believes disclosure of any portion of the medical record to be injurious to the

health of a patient or recipient, the health care provider may refuse to disclose that portion of the

medical record to the patient, recipient, or person in interest but, on written request, shall:

(i) Make a summary of the undisclosed portion of the medical record available to the patient,

recipient, or person in interest;

(ii) Insert a copy of the summary in the medical record of the patient or recipient;

(iii) Permit examination and copying of the medical record by another health care provider

who is authorized to treat the patient or recipient for the same condition as the health care

provider denying the request; and

(iv) Inform the patient or recipient of the patient's or recipient's right to select another health

care provider under this subsection.

(b) Changes in records. --

(1) A health care provider shall establish procedures for a person in interest to request an

addition to or correction of a medical record.

(2) A person in interest may not have any information deleted from a medical record.

(3) Within a reasonable time after a person in interest requests a change in a medical record,

the health care provider shall:

(i) Make the requested change; or

(ii) Provide written notice of a refusal to make the change to the person in interest.

(4) A notice of refusal shall contain:

(i) Each reason for the refusal; and

(ii) The procedures, if any, that the health care provider has established for review of the

refusal.

(5) If the final determination of the health care provider is a refusal to change the medical

record, the provider:

(i) Shall permit a person in interest to insert in the medical record a concise statement of the

reason that the person in interest disagrees with the record; and

(ii) May insert in the medical record a statement of the reasons for the refusal.

(6) A health care provider shall give a notice of a change in a medical record or a copy of a

statement of disagreement:

(i) To any individual the person in interest has designated to receive the notice or statement;

and

(ii) To whom the health care provider has disclosed an inaccurate, an incomplete, or a

disputed medical record within the previous 6 months.

(7) If a health care provider discloses a medical record after an addition, correction, or

statement of disagreement has been made, the provider shall include with the medical record a

copy of each addition, correction, or statement of disagreement.

(1) (i) In this subsection, "medical record" includes a copy of a medical bill that has been

requested by an individual.

(ii) The provisions of this subsection do not apply to x-rays.

(2) A health care provider may require a person in interest or any other authorized person who

requests a copy of a medical record to pay the cost of copying:

(i) For State facilities regulated by the Department of Health and Mental Hygiene, as

provided in § 10-621 of the State Government Article; or

(ii) For all other health care providers, the reasonable cost of providing the information

requested.

(3) (i) Subject to the provisions of paragraph (4) of this subsection, for a copy of a medical

record requested by a person in interest or any other authorized person under paragraph (2)(ii) of

this subsection, a health care provider may charge a fee for copying and mailing not exceeding

50 cents for each page of the medical record.

(ii) In addition to the fee charged under subparagraph (i) of this paragraph, a hospital or a

health care provider may charge:

1. A preparation fee not to exceed $ 15 for medical record retrieval and preparation; and

2. The actual cost for postage and handling of the medical record.

(4) On or after July 1, 1995, the fees charged under paragraph (3) of this subsection may be

adjusted annually for inflation in accordance with the Consumer Price Index.

(5) (i) Except as provided in subparagraph (ii) of this paragraph, a health care provider may

charge a fee, as authorized under paragraphs (3) and (4) of this subsection, for the retrieval,

copying, preparation, mailing, and actual cost of postage and handling of a medical record

disclosed under § 4-306 of this subtitle.

(ii) If a government unit or agency makes a request for the disclosure of a medical record

under § 4-306 of this subtitle, a health care provider may not charge the government unit or

agency a fee for the retrieval, copying, preparation, mailing, and actual cost of postage and

handling of the medical record.

(6) Notwithstanding any other provision of law, any person or entity who is not subject to the

provisions of this subsection and who obtains a medical record from a health care provider or the

provider's agent may not charge a fee for any subsequent copies of that medical record that

exceeds the fee authorized under paragraph (3)(i) of this subsection.

(d) Nonpayment of copying costs. -- Except for an emergency request from a unit of State or

local government concerning a child protective services case or adult protective services case, a

health care provider may withhold copying until the fee for copying is paid.

§ 4-305. Disclosures without authorization of person in interest -- In general

(a) Construction of section. -- This section may not be construed to impose an obligation on a

health care provider to disclose a medical record.

(b) Permitted disclosure. -- A health care provider may disclose a medical record without the

authorization of a person in interest:

(1) (i) To the provider's authorized employees, agents, medical staff, medical students, or

consultants for the sole purpose of offering, providing, evaluating, or seeking payment for health

care to patients or recipients by the provider;

(ii) To the provider's legal counsel regarding only the information in the medical record that

relates to the subject matter of the representation; or

(iii) To any provider's insurer or legal counsel, or the authorized employees or agents of a

provider's insurer or legal counsel, for the sole purpose of handling a potential or actual claim

against any provider if the medical record is maintained on the claimant and relates to the subject

matter of the claim;

(2) If the person given access to the medical record signs an acknowledgment of the duty under

this Act not to redisclose any patient identifying information, to a person for:

(i) Educational or research purposes, subject to the applicable requirements of an institutional

review board;

(ii) Evaluation and management of health care delivery systems; or

(iii) Accreditation of a facility by professional standard setting entities;

(3) Subject to the additional limitations for a medical record developed primarily in connection

with the provision of mental health services in § 4-307 of this subtitle, to a government agency

performing its lawful duties as authorized by an act of the Maryland General Assembly or the

United States Congress;

(4) Subject to the additional limitations for a medical record developed primarily in connection

with the provision of mental health services in § 4-307 of this subtitle, to another health care

provider for the sole purpose of treating the patient or recipient on whom the medical record is

kept;

(5) If a claim has been or may be filed by, or with the authorization of a patient or recipient on

behalf of the patient or recipient, for covered insureds, covered beneficiaries, or enrolled

recipients only, to third party payors and their agents, if the payors or agents have met the

applicable provisions of §§ 15-10B-01 to 15-10B-18 of the Insurance Article, including

nonprofit health service plans, health maintenance organizations, fiscal intermediaries and

carriers, the Department of Health and Mental Hygiene and its agents, the United States

Department of Health and Human Services and its agents, or any other person obligated by

contract or law to pay for the health care rendered for the sole purposes of:

(i) Submitting a bill to the third party payor;

(ii) Reasonable prospective, concurrent, or retrospective utilization review or

predetermination of benefit coverage;

(iii) Review, audit, and investigation of a specific claim for payment of benefits; or

(iv) Coordinating benefit payments in accordance with the provisions of the Insurance Article

under more than 1 sickness and accident, dental, or hospital and medical insurance policy;

(6) If a health care provider makes a professional determination that an immediate disclosure is

necessary, to provide for the emergency health care needs of a patient or recipient;

(7) Except if the patient has instructed the health care provider not to make the disclosure, or if

the record has been developed primarily in connection with the provision of mental health

services, to immediate family members of the patient or any other individual with whom the

patient is known to have a close personal relationship, if made in accordance with good medical

or other professional practice;

(8) To an appropriate organ, tissue, or eye recovery agency under the restrictions of § 5-408 of

this article for a patient whose organs and tissues may be donated for the purpose of evaluating

the patient for possible organ and tissue donation;

(9) To the Department of Health and Mental Hygiene or an organ, tissue, or eye recovery

agency designated by the Department for the purpose of conducting death record reviews under §

19-310 of this article; or

(10) Subject to subsection (c) of this section, if the purpose of the medical record disclosure is

for the coordination of services and record retention within the Montgomery County Department

of Health and Human Services.

Department of Health and Human Services. --

(1) The disclosure of medical records under subsection (b)(10) of this section to a person that is

not employed by or under contract with the Montgomery County Department of Health and

Human Services shall be conducted in accordance with this subtitle.

(2) Under provisions of State law regarding confidentiality, the Montgomery County

Department of Health and Human Services shall be considered to be one agency.

§ 4-306. Disclosures without authorization of person in interest -- Investigations

(a) Compulsory process. -- In this section, "compulsory process" includes a subpoena,

summons, warrant, or court order that appears on its face to have been issued on lawful

authority.

(b) Permitted disclosures. -- A health care provider shall disclose a medical record without the

authorization of a person in interest:

(1) To a unit of State or local government, or to a member of a multidisciplinary team assisting

the unit, for purposes of investigation or treatment in a case of suspected abuse or neglect of a

child or an adult, subject to the following conditions:

(i) The health care provider shall disclose only the medical record of a person who is being

assessed in an investigation or to whom services are being provided in accordance with Title 5,

Subtitle 7 or Title 14, Subtitle 3 of the Family Law Article;

(ii) The health care provider shall disclose only the information in the medical record that

will, in the professional judgment of the provider, contribute to the:

1. Assessment of risk;

2. Development of a service plan;

3. Implementation of a safety plan; or

4. Investigation of the suspected case of abuse or neglect; and

(iii) The medical record may be redisclosed as provided in §§ 1-201, 1-202, 1-204, and 1-205

of the Human Services Article;

(2) Subject to the additional limitations for a medical record developed primarily in connection

with the provision of mental health services in § 4-307 of this subtitle, to health professional

licensing and disciplinary boards, in accordance with a subpoena for medical records for the sole

purpose of an investigation regarding:

(i) Licensure, certification, or discipline of a health professional; or

(ii) The improper practice of a health profession;

(3) To a health care provider or the provider's insurer or legal counsel, all information in a

medical record relating to a patient or recipient's health, health care, or treatment which forms

the basis for the issues of a claim in a civil action initiated by the patient, recipient, or person in

interest;

(4) Notwithstanding any privilege in law, as needed, to a medical review committee as defined

in § 1-401 of the Health Occupations Article or a dental review committee as defined in § 4-501

of the Health Occupations Article;

(5) To another health care provider as provided in § 19-308.2 or § 10-807 of this article;

(6) Subject to the additional limitations for a medical record developed primarily in connection

with the provision of mental health services in § 4-307 of this subtitle and except as otherwise

provided in items (2), (7), and (8) of this subsection, in accordance with compulsory process, if

the health care provider receives:

(i) 1. A written assurance from the party or the attorney representing the party seeking the

medical records that:

A. In a Child in Need of Assistance proceeding pursuant to Title 3, Subtitle 8 of the

Courts and Judicial Proceedings Article, a person in interest has not objected to the disclosure of

the designated medical records and 15 days have elapsed since the notice was sent;

B. In all other proceedings, a person in interest has not objected to the disclosure of the

designated medical records within 30 days after the notice was sent; or

C. The objections of a person in interest have been resolved and the request for disclosure

is in accordance with the resolution;

2. Proof that service of the subpoena, summons, warrant, or court order has been waived by

the court for good cause; or

3. A copy of an order entered by a court expressly authorizing disclosure of the designated

medical records; and

(ii) For disclosures made under item (i)1A of this paragraph, copies of the following items

that were mailed by certified mail to the person in interest by the person requesting the disclosure

at least 15 days before the records are to be disclosed:

1. The subpoena, summons, warrant, or court order seeking the disclosure or production of

the records;

2. This section; and

3. A notice in the following form or a substantially similar form:

____________________________ In the

Plaintiffs ______________________________________

v. For

_______________________________________

Defendants

____________________________ Case No.: _______________________________

NOTICE TO (Patient Name)

IN COMPLIANCE WITH § 4-306 OF THE HEALTH - GENERAL ARTICLE,

ANNOTATED CODE OF MARYLAND

TAKE NOTE that medical records regarding (Patient Name), have been

subpoenaed from the (Name and address of Health Care Provider) pursuant to the

attached subpoena and § 4-306 of the Health - General Article, Annotated Code

of Maryland. This subpoena _______does _____ does not (mark one) seek production of

mental health records.

Please examine these papers carefully. IF YOU HAVE ANY OBJECTION TO THE

PRODUCTION OF THESE DOCUMENTS, YOU MUST FILE A MOTION FOR A

PROTECTIVE ORDER OR A MOTION TO QUASH THE SUBPOENA ISSUED FOR THESE

DOCUMENTS UNDER MARYLAND RULES 2-403 AND 2-510 NO LATER THAN

FIFTEEN (15) DAYS FROM THE DATE THIS

NOTICE IS MAILED. For example, a protective order may be granted if the

records are not relevant to the issues in this case, the request unduly

invades your privacy, or causes you specific harm.

Also attached to this form is a copy of the subpoena duces tecum issued for

these records.

If you believe you need further legal advice about this matter, you should

consult your attorney.

_________________________

Attorney

(Firm Name

Attorney address

Attorney phone number)

Attorneys for (Name of Party

Represented)

Certificate of Service

I hereby certify that a copy of the foregoing notice was mailed,

first-class postage prepaid, this______day of______ , 20__ to

_________________________________

Patient

_________________________________

Each Counsel in Case

_________________________________

Attorney

(iii) For disclosures made under item (i)1B of this paragraph, copies of the following items that

were mailed by certified mail to the person in interest by the person requesting the disclosure at

least 30 days before the records are to be disclosed:

1. The subpoena, summons, warrant, or court order seeking the disclosure or production of

the records;

2. This section; and

3. A notice in the following form or a substantially similar form:

_________________________

Plaintiffs In the

_________________________________

For

v. _________________________________

_____________________________

Defendants

Case No.: ____________________

NOTICE TO (Patient Name)

IN COMPLIANCE WITH § 4-306 OF THE HEALTH - GENERAL ARTICLE,

ANNOTATED CODE OF MARYLAND

TAKE NOTE that medical records regarding (Patient Name), have been

subpoenaed from the (Name and address of Health Care Provider) pursuant to the

attached subpoena and § 4-306 of the Health - General Article, Annotated Code

of Maryland. This subpoena____does____does not (mark one) seek production of

mental health records.

Please examine these papers carefully. IF YOU HAVE ANY OBJECTION TO THE

PRODUCTION OF THESE DOCUMENTS, YOU MUST FILE A MOTION FOR A

PROTECTIVE ORDER OR A MOTION TO QUASH THE SUBPOENA ISSUED FOR THESE

DOCUMENTS UNDER MARYLAND RULES 2-403 AND 2-510 NO LATER THAN

THIRTY (30) DAYS FROM THE DATE THIS NOTICE IS MAILED. For example, a

protective order may be granted if the records are not relevant to the issues in this case, the

request unduly invades your privacy, or causes you specific harm.

Also attached to this form is a copy of the subpoena duces tecum issued for

these records.

If you believe you need further legal advice about this matter, you should

consult your attorney.

__________________________

Attorney

(Firm Name

Attorney address

Attorney phone number)

Attorneys for (Name of Party

Represented)

Certificate of Service

I hereby certify that a copy of the foregoing notice was mailed,

first-class postage prepaid, this day of , 200 to

____________________________

Patient

_____________________________

Each Counsel in Case

______________________________

Attorney

(7) Subject to the additional limitations for a medical record developed primarily in

connection with the provision of mental health services in § 4-307 of this subtitle, to grand juries,

prosecution agencies, law enforcement agencies or their agents or employees to further an

investigation or prosecution, pursuant to a subpoena, warrant, or court order for the sole purposes

of investigating and prosecuting criminal activity, provided that the prosecution agencies and law

enforcement agencies have written procedures to protect the confidentiality of the records;

(8) To the Maryland Insurance Administration when conducting an investigation or

examination pursuant to Title 2, Subtitle 2 of the Insurance Article, provided that the Insurance

Administration has written procedures to maintain the confidentiality of the records;

(9) To a State or local child fatality review team established under Title 5, Subtitle 7 of this

article as necessary to carry out its official functions; or

(10) To a local domestic violence fatality review team established under Title 4, Subtitle 7 of

the Family Law Article as necessary to carry out its official functions.

(1) A written request for disclosure or written confirmation by the health care provider of an

oral request that justifies the need for disclosure shall be inserted in the medical record of the

patient or recipient; and

(2) Documentation of the disclosure shall be inserted in the medical record of the patient or

recipient.

§ 4-307. Disclosure of mental health records

(a) Definitions. --

(1) In this section the following words have the meanings indicated.

(2) "Case management" means an individualized recipient centered service designed to assist a

recipient in obtaining effective mental health services through the assessing, planning,

coordinating, and monitoring of services on behalf of the recipient.

(3) "Core service agency" means an organization approved by the Mental Hygiene

Administration to manage mental health resources and services in a designated area or to a

designated target population.

(4) "Director" means the Director of the Mental Hygiene Administration or the designee of the

Director.

(5) "Mental health director" means the health care professional who performs the functions of a

clinical director or the designee of that person in a health care, detention, or correctional facility.

(6) (i) "Personal note" means information that is:

1. The work product and personal property of a mental health provider; and

2. Except as provided in subsection (d)(3) of this section, not discoverable or admissible as

evidence in any criminal, civil, or administrative action.

(ii) Except as provided in subsection (d)(2) of this section, a medical record does not include

a personal note of a mental health care provider, if the mental health care provider:

1. Keeps the personal note in the mental health care provider's sole possession for the

provider's own personal use;

2. Maintains the personal note separate from the recipient's medical records; and

3. Does not disclose the personal note to any other person except:

A. The mental health provider's supervising health care provider that maintains the

confidentiality of the personal note;

B. A consulting health care provider that maintains the confidentiality of the personal

note; or

C. An attorney of the health care provider that maintains the confidentiality of the

personal note.

(iii) "Personal note" does not include information concerning the patient's diagnosis,

treatment plan, symptoms, prognosis, or progress notes.

(b) Governing provisions. -- The disclosure of a medical record developed in connection with the

provision of mental health services shall be governed by the provisions of this section in addition

to the other provisions of this subtitle.

provision of mental health services is disclosed without the authorization of a person in interest,

only the information in the record relevant to the purpose for which disclosure is sought may be

released.

(d) Personal notes. --

(1) To the extent a mental health care provider determines it necessary and appropriate, the

mental health care provider may maintain a personal note regarding a recipient.

(2) A personal note shall be considered part of a recipient's medical records if, at any time, a

mental health care provider discloses a personal note to a person other than:

(i) The provider's supervising health care provider;

(ii) A consulting health care provider;

(iii) An attorney of the health care provider; or

(iv) A recipient under paragraph (3) of this subsection.

(3) The provisions of this subsection do not prohibit the disclosure, discovery, or admissibility

of a personal note regarding a recipient who has initiated an action for malpractice, an intentional

tort, or professional negligence against the health care provider.

(e) Disclosure relating to psychological tests. --

(1) Except as otherwise provided in paragraphs (3), (4), and (5) of this subsection, if the

disclosure of a portion of a medical record relating to a psychological test would compromise the

objectivity or fairness of the test or the testing process, a mental health care provider may not

disclose that portion of the medical record to any person, including a subject of the test.

(2) The raw test data relating to a psychological test is only discoverable or admissible as

evidence in a criminal, civil, or administrative action on the determination by the court or

administrative hearing officer that the expert witness for the party seeking the raw test data is

qualified by the appropriate training, education, or experience to interpret the results of that

portion of the raw test data relating to the psychological test.

(3) (i) A recipient who has been the subject of a psychological test may designate a

psychologist licensed under Title 18 of the Health Occupations Article or a psychiatrist licensed

under Title 14 of the Health Occupations Article to whom a health care provider may disclose

the medical record.

(ii) The recipient shall:

1. Request the disclosure authorized under this paragraph in writing; and

2. Comply with the provisions of § 4-304 of this subtitle.

(4) A health care provider may disclose a medical record relating to a psychological test as

provided under § 4-305(b)(2)(i) of this subtitle.

(5) The provisions of this subsection may not restrict access to or affect the disclosure of a

medical record which is also an education record under the federal Individuals with Disabilities

Education Act, the federal Family Educational Rights and Privacy Act, or any federal and State

regulations that have been adopted to implement those laws.

(f) Disclosure relating to obtaining or continuing employment. -- Notwithstanding any other

provision of this subtitle, a person in interest shall have the right to obtain a medical record of a

recipient that is developed in conjunction with a mental health evaluation relating to obtaining or

continuing employment, if the evaluation has been performed at the request of or on behalf of an

employer or prospective employer:

(1) In connection with a civil action or U.S. Equal Employment Opportunity Commission

complaint initiated by the person in interest; or

(2) On a written authorization of the employer or prospective employer.

(g) Records relating to groups or families. -- A health care provider may disclose a medical

record that relates to and identifies more than one recipient in group or family therapy only:

(1) On the authorization of a person in interest for each recipient;

(2) As provided in this subtitle; or

(3) As otherwise provided by law.

(h) Participants in plans of care service agencies. -- This section may not be construed to prevent

the disclosure of a medical record that relates to the provision of mental health services between

or among the health care providers that participate in the approved plan of a core service agency

for the delivery of mental health services, if a recipient:

(1) Has received a current list of the participating providers; and

(2) Has signed a written agreement with the core service agency to participate in the client

information system developed by the agency.

(i) Rate reviews, audits, health planning, licensures, approvals or accreditations of facilities. -- If

an individual given access to a medical record that relates to the provision of mental health

services signs an acknowledgment of the duty under this Act not to redisclose personal

identifying information about a recipient, this section may not be construed to prevent the

disclosure of the medical record for rate review, auditing, health planning, licensure, approval, or

accreditation of a facility by governmental or professional standard setting entities.

(j) Health, safety, and protection of recipient or others. --

(1) A health care provider may disclose a medical record without the authorization of a person

in interest:

(i) To the medical or mental health director of a juvenile or adult detention or correctional

facility if:

1. The recipient has been involuntarily committed under State law or a court order to the

detention or correctional facility requesting the medical record; and

2. After a review of the medical record, the health care provider who is the custodian of the

record is satisfied that disclosure is necessary for the proper care and treatment of the recipient;

(ii) As provided in § 5-609 of the Courts and Judicial Proceedings Article;

(iii) 1. If a health care provider is a facility as defined in § 10-101 of this article, to a law

enforcement agency concerning a recipient who:

A. Has been admitted involuntarily or by court order to the facility; and

B. Is on an unauthorized absence or has otherwise left the facility without being

discharged or released;

2. The facility director may disclose to the law enforcement agency identifying information

and only such further information that the director believes is necessary to aid the law

enforcement agency in locating and apprehending the recipient for the purpose of:

A. Safely returning the recipient to custody; or

B. Fulfilling the provisions of subparagraph (ii) of this paragraph;

(iv) If a health care provider is a facility as defined in § 10-101 of this article, the facility

director may confirm or deny the presence in the facility of a recipient to a parent, guardian, next

of kin, or any individual who has a significant interest in the status of the recipient if that

individual has filed a missing persons report regarding the recipient; and

(v) To allow for the service of process or a court order in a facility when appropriate

arrangements have been made with the facility director so as to minimize loss of confidentiality.

(2) When a disclosure is made under this subsection, documentation of the disclosure shall be

inserted in the medical record of the recipient.

(k) Transfer of recipient; protection and advocacy system; commitment proceedings; court

orders, subpoenas, etc.; death of recipient. --

(1) A health care provider shall disclose a medical record without the authorization of a person

in interest:

(i) To the medical or mental health director of a juvenile or adult detention or correctional

facility or to another inpatient provider of mental health services in connection with the transfer

of a recipient from an inpatient provider, if:

1. The health care provider with the records has determined that disclosure is necessary for

the continuing provision of mental health services; and

2. The recipient is transferred:

A. As an involuntary commitment or by court order to the provider;

B. Under State law to a juvenile or adult detention or correctional facility; or

C. To a provider that is required by law or regulation to admit the recipient;

(ii) To the State designated protection and advocacy system for mentally ill individuals under

the federal Protection and Advocacy for Mentally Ill Individuals Act of 1986, as amended, if:

1. The State designated protection and advocacy system has received a complaint regarding

the recipient or the director of the system has certified in writing to the chief administrative

officer of the health care provider that there is probable cause to believe that the recipient has

been subject to abuse or neglect;

2. The recipient by reason of mental or physical condition is unable to authorize disclosure;

and

3. A. The recipient does not have a legal guardian or other legal representative who has the

authority to consent to the release of health care information; or

B. The legal guardian of the recipient is a representative of a State agency;

(iii) To another health care provider or legal counsel to the other health care provider prior to

and in connection with or for use in a commitment proceeding in accordance with Title 10,

Subtitle 6 or Title 12 of this article;

(iv) In accordance with a court order, other than compulsory process compelling disclosure,

as permitted under § 9-109(d), § 9-109.1(d), or § 9-121(d) of the Courts and Judicial Proceedings

Article, or as otherwise provided by law, to:

1. A court;

2. An administrative law judge;

3. A health claims arbitrator; or

4. A party to a court, administrative, or arbitration proceeding;

(v) In accordance with a subpoena for medical records on specific recipients:

1. To health professional licensing and disciplinary boards for the sole purpose of an

investigation regarding licensure, certification, or discipline of a health professional or the

improper practice of a health profession; and

2. To grand juries, prosecution agencies, and law enforcement agencies under the

supervision of prosecution agencies for the sole purposes of investigation and prosecution of a

provider for theft and fraud, related offenses, obstruction of justice, perjury, unlawful distribution

of controlled substances, and of any criminal assault, neglect, patient abuse or sexual offense

committed by the provider against a recipient, provided that the prosecution or law enforcement

agency shall:

A. Have written procedures which shall be developed in consultation with the Director to

maintain the medical records in a secure manner so as to protect the confidentiality of the

records; and

B. In a criminal proceeding against a provider, to the maximum extent possible, remove

and protect recipient identifying information from the medical records used in the proceeding; or

(vi) In the event of the death of a recipient, to the office of the medical examiner as

authorized under § 5-309 or § 10-713 of this article.

(2) If a recipient believes that a medical record has been inappropriately obtained, maintained,

or disclosed under paragraph (1)(vi) of this subsection, the recipient may petition the State

prosecutor for an investigation of the allegation.

(3) Except in a proceeding relating to payment for the health care of a recipient, the medical

record of a recipient and any information obtained as a result of disclosure under paragraph

(1)(vi) of this subsection is disclosable, notwithstanding any privilege in law, but may not be

used in any proceeding against the recipient.

(4) A written request for disclosure or written confirmation of an oral request in an emergency

that justifies the need for disclosure shall be inserted in the medical record of the recipient.

(5) Documentation of the disclosure shall be inserted in the medical record of the recipient.

(6) This subsection may not preclude a health care provider, a recipient, or person in interest

from asserting in a motion to quash or a motion for a protective order any constitutional right or

other legal authority in opposition to disclosure.

§ 4-308. Liability for good faith actions

A health care provider, who in good faith discloses or does not disclose a medical record, is not

liable in any cause of action arising from the disclosure or nondisclosure of the medical record.

§ 4-309. Refusal to disclose records; violations of subtitle; penalties

(a) Refusal to disclose records. -- If a health care provider knowingly refuses to disclose a

medical record within a reasonable time but no more than 21 working days after the date a

person in interest requests the disclosure, the health care provider is liable for actual damages.

(b) Refusal to disclose because payment is owed. -- A health care provider may not refuse to

disclose a medical record on the request of a person in interest because of the failure of the

person in interest to pay for health care rendered by the health care provider.

subtitle if the health care provider or any other person:

(1) Requests or obtains a medical record under false pretenses or through deception; or

(2) Discloses a medical record in violation of this subtitle.

(d) Criminal penalties. -- Except as otherwise provided in subsection (e) of this section, a health

care provider or any other person, including an officer or employee of a governmental unit, who

knowingly and willfully violates any provision of this subtitle is guilty of a misdemeanor and on

conviction is subject to a fine not exceeding $ 1,000 for the first offense and not exceeding $

5,000 for each subsequent conviction for a violation of any provision of this subtitle.

(e) Fraudulent obtaining of records; wrongful disclosure of records. --

(1) A health care provider or any other person, including an officer or employee of a

governmental unit, who knowingly and willfully requests or obtains a medical record under false

pretenses or through deception or knowingly and willfully discloses a medical record in violation

of this subtitle is guilty of a misdemeanor and on conviction is subject to the following penalties:

(i) A fine not exceeding $ 50,000, imprisonment for not more than 1 year, or both;

(ii) If the offense is committed under false pretenses, a fine not exceeding $ 100,000,

imprisonment for not more than 5 years, or both; and

(iii) If the offense is committed with intent to sell, transfer, or use individually identifiable

health information for commercial advantage, personal gain, or malicious harm, a fine not

exceeding $ 250,000, imprisonment for not more than 10 years, or both.

(2) This subsection does not apply to an officer or employee of a governmental unit that is

conducting a criminal investigation.

(f) Civil penalties. -- A health care provider or any other person who knowingly violates any

provision of this subtitle is liable for actual damages.

§ 8-601. Privileged information

(a) Statements of abuser; observations and conclusions of counselor; results of examination. --

If any individual seeks counseling, treatment, or therapy, for any form of drug or alcohol abuse,

from a health professional licensed under the Health Occupations Article treating patients within

the scope of the professional's practice, or hospital, or a person who is certified by the

Administration for counseling or treating drug or alcohol abuse, the oral or written statements

that the individual makes and the observations and conclusions that the health professional,

hospital, or other person derives or the results of an examination to determine the existence of an

illegal or prohibited drug in the body of an individual are not admissible in any proceeding

against the individual, other than and subject to the federal regulations concerning the

confidentiality of alcohol and drug abuse patient records:

(1) A proceeding that relates to parole or probation or conditional release from a not criminally

responsible finding, if the examination had been ordered as a condition of parole or probation or

the conditional release from a not criminally responsible finding; or

(2) A proceeding under Subtitle 5 of this title, if the examination had been ordered for that

proceeding.

(b) Evidence and results of proceeding. -- The results of a proceeding under Subtitle 5 of this title

and evidence in the proceeding may not be used against that individual in any other proceeding.

by alcohol abuse and drug abuse treatment programs shall be governed by the federal regulations

on the confidentiality of alcohol and drug abuse patient records, 42 C.F.R. Part 2.