1. A. 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.

2. B. A licensed certified midwife may delegate technical tasks, consistent with the approved policies and procedures of the site, in the following categories:

   1. (1) Surgical technical tasks that the delegating licensed certified midwife directly orders while present and personally performing the surgery in the same surgical field; and
   2. (2) Nonsurgical technical tasks while the assistant is under the delegating licensed certified midwife’s direct supervision or on-site supervision.

3. C. 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:

   1. (1) Client preparation for physical examination;
   2. (2) Client history interview;
   3. (3) 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;
   4. (4) Preparing and performing laboratory tests under State and Clinical Laboratory Improvement Amendments regulations;
   5. (5) Clinical tests;
   6. (6) Transmitting prescriptions to a pharmacy;
   7. (7) Preparing and administering oral drugs;
   8. (8) Establishing a peripheral intravenous line; and

   9. (9) Preparing and administering injections including small amounts of local anesthetics if provided either:

      1. (a) Intradermal;
      2. (b) Subcutaneous; or
      3. (c) Intramuscular in the deltoid, gluteal, or vastus lateralis.
4. D. When delegating injecting intravenous drugs or contrast materials to an assistant, a licensed certified midwife shall provide direct supervision.
5. E. 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.

6. F. 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:

   1. (1) Conducting physical examinations;
   2. (2) Administering any form of anesthetic agent or agent of conscious sedation other than topical anesthetics or small amounts of local anesthetics;
   3. (3) 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;
   4. (4) Establishing a diagnosis or giving clinical advice; and
   5. (5) Providing physical therapy.

Authority: Health Occupations Article, §§ 8-101, 8-205, 8-208, 8-508, 8-601, 8-6A-02, 8-6D-01 through 8-6D-15, 8-701, 8-708, and 8-710, Annotated Code of Maryland

Effective date: February 22, 2026 (52:17 Md. R. 875)