Section 4-304 - Copies of records; changes in records(a)(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)(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.(c)(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 for the cost of copying: (i) For State facilities regulated by the Maryland Department of Health, as provided in § 4-206 of the General Provisions Article; or(ii) For all other health care providers, a reasonable cost-based fee for providing the information requested.(3)(i) Except as provided in subparagraph (iii) of this paragraph, 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 76 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. Subject to the fee limitations that apply to persons in interest under 45 C.F.R. 164.524 and any guidance on those limitations issued by the U.S. Department of Health and Human Services, a preparation fee not to exceed $22.88 for medical record retrieval and preparation; and2. The actual cost for postage and handling of the medical record.(iii) Subject to the fee limitations that apply to persons in interest under 45 C.F.R. 164.524 and any guidance on those limitations issued by the U.S. Department of Health and Human Services, a hospital or a health care provider that uses or maintains the requested medical records in an electronic format may charge for an electronic copy of a medical record in an electronic format requested by a person in interest or any other authorized person:1. A preparation fee not to exceed $22.88 for electronic format medical records retrieval and preparation;2. A per-page fee of 75% of the per-page fee charged by a health care provider under subparagraph (i) of this paragraph that may not exceed $80; and3. The actual cost for postage and handling of the electronic format medical records.(4)(i) Except as provided in subparagraph (ii) of this paragraph, the fees charged under paragraph (3) of this subsection may be adjusted annually for inflation in accordance with the Consumer Price Index.(ii) The preparation fee charged for medical record retrieval and preparation under paragraph (3)(ii)1 of this subsection and for retrieval and preparation of a medical record in an electronic format under paragraph (3)(iii)1 of this subsection may not be adjusted annually for inflation in accordance with the Consumer Price Index.(5) A health care provider or a representative of the health care provider may not charge a fee for providing copies of a medical record: (i) Requested by:2. The patient's personal representative; 3. An employee or other representative of a nonprofit legal services entity or other volunteer or nonprofit program representing the patient; or4. An attorney representing the patient; and(ii) That will be used for the purpose of filing a claim regarding or appealing a denial of Social Security disability income or Social Security benefits under Title II or Title XVI of the Social Security Act.(6)(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 or court-appointed guardian ad litem in a criminal or juvenile delinquency court proceeding 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 or court-appointed guardian ad litem a fee for the retrieval, copying, preparation, mailing, and actual cost of postage and handling of the medical record.(7) Notwithstanding any other provision of law, a health care provider may not charge a person in interest, except for an attorney appointed in writing by a person in interest, who requests a copy of a medical record of an individual enrolled in the Maryland Medical Assistance Program a fee that exceeds $20, adjusted annually for inflation in accordance with the Consumer Price Index, for each 100 pages or portion of 100 pages copied.(8) 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) 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.Amended by 2024 Md. Laws, Ch. 837,Sec. 1, eff. 10/1/2024.Amended by 2021 Md. Laws, Ch. 157, Sec. 1, eff. 10/1/2021.Amended by 2017 Md. Laws, Ch. 166, Sec. 1, eff. 10/1/2017.Amended by 2017 Md. Laws, Ch. 165, Sec. 1, eff. 10/1/2017.Amended by 2016 Md. Laws, Ch. 724, Sec. 1, eff. 10/1/2016.Amended by 2014 Md. Laws, Ch. 398, Sec. 1, eff. 10/1/2014.Amended by 2014 Md. Laws, Ch. 104, Sec. 2, eff. 10/1/2014.