DEPARTMENT OF HEALTH & MENTAL HYGIENE

PUBLIC HEALTH SERVICES

Herbert R. O'Conor State Office Building, 201 West Preston St., Baltimore, Maryland, March 2004. Photo by Diane F. Evartt.

To ensure that basic public health services are provided in all parts of Maryland, the Deputy Secretary for Public Health Services oversees the local health departments in each county and Baltimore City. Under direction of a local health officer, each local health department provides these services and administers and enforces State and local health laws and regulations in its jurisdiction. Programs meet the public health needs of the community and provide services not offered by the private sector. The local health officer is appointed jointly by the Secretary of Health and Mental Hygiene and the local governing body.

CHIEF OF STAFF

HEALTH & HUMAN SERVICES REFERRAL BOARD
In October 2004, the Health and Human Services Referral Board was organized under Public Health Services (Chapter 390, Acts of 2004). Initially, the Board oversaw establishment of a single-source information and referral phone number for health and human services statewide, beginning with four pilot programs.

The Board was reorganized in October 2010 (Chapter 311, Acts of 2010). Since then, the Board additionally has overseen the 211 Maryland Call Centers and the operation of a statewide system.

The Board consists of sixteen members. Five are appointed by the Governor to four-year terms, and the Senate President and House Speaker each appoint one member. One member is appointed by the Board of Directors, 2-1-1 Maryland, and each call center in the State appoints a member. Four members serve ex officio (Code Health-General Article, secs. 24-1101 through 24-1105).

Authorized in 1945, Deer's Head Center was established in 1950 (Chapter 994, Acts of 1945). The Center joined the Community and Public Health Administration in January 1997, and transferred to the Family Health Administration in July 2001 (Code Health-General Article, sec. 19-502). In July 2012, the Center moved to the Health Systems and Infrastructure Administration.

The Center is a regional facility for the chronically ill and elderly adults in need of medical and rehabilitation services or general medical care for chronic disease or terminal illness. It also operates a kidney dialysis facility for area residents.

In FY2010, the Center was licensed for 66 hospital beds, providing the services of a chronic disease hospital (including a small hospice service) and 80 long-term nursing home care beds, as well as outpatient and end-stage kidney dialysis, and outpatient rehabilitation therapy. Also in FY2010, the Center provided 14,786 dialysis treatments to 158 patients.

CITIZENS ADVISORY BOARD
Upon recommendation of the Secretary of Health and Mental Hygiene, the Governor appoints the Board's seven members to four-year terms.

WESTERN MARYLAND CENTER
1500 Pennsylvania Ave., Hagerstown, MD 21740

Western Maryland Center began as Western Maryland State Hospital. Authorized in 1952, the Hospital opened in 1957 (Chapter 53, Acts of 1952). The Center was made part of the Community and Public Health Administration in January 1997, and moved to the Family Health Administration in July 2001. In July 2012, it became part of the Health Systems and Infrastructure Administration.

The Center provides chronic or rehabilitation hospital care, and comprehensive or nursing home care. The Center also offers adult day care; end-stage kidney dialysis services; and physical, occupational and speech rehabilitation to outpatients. It has 60 licensed hospital beds and 63 licensed comprehensive care beds (Code Health-General Article, sec. 19-502).

CITIZENS ADVISORY BOARD
The Board's seven members are appointed to four-year terms by the Governor upon recommendation of the Secretary of Health and Mental Hygiene.

LOCAL PUBLIC HEALTH FUNDING
By law, the Department of Health and Mental Hygiene annually provides matching funds to Maryland's twenty-four local health departments for certain health services. These cover administration and communication; adult health promotion; child health; communicable disease services; environment; family planning; geriatric services; maternal health; and wellness. Funding for these core public health services transferred from the Family Health Administration to the Health Systems and Infrastructure Administration in July 2012.

Core Public Health Services Funding Program. This program provides matching State funds to local health departments for vital programs, such as communicable disease control, maternal and child health services, and environmental health.

OFFICE OF CONTROLLED SUBSTANCES ADMINISTRATION

In 1951, the Office of Controlled Substances Administration originated as the Division of Drug Control within the Bureau of Environmental Hygiene. Later transferred to the Office of Licensing and Certification, the Division of Drug Control reorganized in 1987 as the Office of Drug Control and joined the Community Health Surveillance and Laboratories Administration. The Office became part of the Laboratories Administration in 1997 and resumed its original name in November 2004. In November 2015, the Division moved directly under the Deputy Secretary for Public Health Services, and in July 2016, restructured under its present name.

The Office enforces the Controlled Dangerous Substance Act, and ensures the availability of drugs for legitimate medical and scientific purposes while working to prevent drug abuse (Code Criminal Law Article, secs. 5-101 through 5-505). Office programs focus on physicians, dentists, veterinarians, pharmacists, manufacturers, distributors, pharmacies, and nonpharmacy establishments.

OFFICE OF HEALTH CARE QUALITY

The Office of Health Care Quality started in 1971 as the Division of Licensing and Certification under the Office of General Administration and reorganized in 1986 as the Office of Licensing and Certification Programs. In 1987, it was renamed the Licensing and Certification Administration. As the Office of Quality Assurance, it transferred from Health Care Policy, Finance, and Regulation and was placed under the Office of Secretary in March 1999. The Office received its present name in September 1999, then moved under Regulatory Programs in August 2005, and under the Office of Secretary in November 2009. It again moved in August 2015 to Regulatory Programs, and in January 2016 to Public Health Services.

All hospitals and health-related institutions in Maryland must be licensed by the Office. The quality of care and compliance with both State and federal regulations in 8,000 health-care facilities and health-related services and programs is monitored by the Office. These include: adult daycare centers; ambulatory surgical facilities; assisted-living programs; birthing centers; developmental disabilities programs; dialysis centers; group homes; health maintenance organizations (HMOs); home health agencies; hospice programs, hospitals; independent physical therapists; major medical equipment; medical laboratories; mental health programs; nursing homes and rehabilitation centers; prison hospitals; residential service agencies; residential treatment centers; substance abuse programs; and other miscellaneous programs. To regulate these institutions and programs, the Office conducts more than 10,000 inspections yearly.

For all health facilities participating in the Medical Assistance Program (Medicaid) and Medicare, the Office is responsible for inspection and certification recommendations. Administrative actions against facilities that violate State rules and regulations are initiated by the Office.

The Office consists of Policy and Administration, and two divisions: Federal Programs, and State Programs.

POLICY & ADMINISTRATION
For the Office of Health Care Quality, Policy and Administration develops policy, operational procedures, regulations, budgets, and legislation. Policy and Administration also oversees the Health Maintenance Organization (HMO) and Hospital Licensure Program.

HMO & HOSPITAL LICENSURE PROGRAM
The HMO and Hospital Licensure Program evaluates all hospitals, and investigates and responds to consumer complaints. The Program licenses and certifies hospitals that participate in Medicare.

QUALITY ASSURANCE UNIT
Established in 1999, the Quality Assurance Unit investigates quality-of-care complaints referred by the Maryland Insurance Commissioner, and enforces statutory and regulatory requirements relating to the quality of care provided by health maintenance organizations (Chapter 697, Acts of 1999).

NURSING HOME TECHNICAL ASSISTANCE UNIT
The Nursing Home Technical Assistance Unit within the Office of Health Care Quality was authorized in October 2000 (Chapter 217, Acts of 2000). The Unit was placed under the HMO and Hospital Licensure Program in August 2015.

The Unit supports compliance with quality assurance for nursing home care. The Unit also is to establish a list of approved medical automated systems (Code Health-General Article, sec. 19-1412).

FEDERAL PROGRAMS DIVISION
The Federal Programs Division originated as the Long-Term Care Program within the Licensing and Certification Administration before it reformed in 1992 as Long-Term Care, Community Mental Health and Substance Abuse Programs. In 1995, it became the Long-Term Care Program, which evaluated and surveyed nursing homes, adult day-care centers, and licensed and registered domiciliary-care homes. In 2001, it reorganized as the Federal Programs Division.

This division is responsible for licensure of adult medical daycare, ambulatory care facilities, laboratories, and nursing homes.

Ambulatory Care Program. This program started as the Hospitals and Ambulatory Care Program. It reorganized in 1995 as the Developmental Disabilities and Ambulatory Care Program, and adopted its present name in 1997.

The Program reviews State and federal programs involving home health agencies, hospices, health maintenance organizations, major medical equipment, ambulatory care facilities, residential service agencies, and dialysis centers.

Laboratory Program. Formerly under the Office of Health Care Quality, the Laboratory Program later transferred to the Federal Programs Division.

The Laboratory Program evaluates and surveys some 2,000 laboratories, including physician office laboratories, to determine compliance with State and federal laws and regulations. The Program also coordinates and manages the State and federal Cytology Proficiency Testing Program for individuals who interpret pap smears.

STATE PROGRAMS DIVISION
Functions of the State Programs Division began in 1992 as the Long-Term Care Program, the Community Mental Health Program, and the Substance Abuse Program. The work of these units was reorganized in 1995 into two units, and thereafter the Substance Abuse and Community Mental Health Program formed. In 1995, the Developmental Disabilities and Ambulatory Care Program also was created. Its ambulatory care functions were reassigned in 1997. That program reorganized as the Developmental Disabilities, Substance Abuse and Community Mental Health Program in 1997, and became the State Programs Division in 2001.

The State Programs Division oversees licensure of assisted-living facilities, developmental disabilities facilities, and mental health programs. The Division also certifies substance abuse programs, and evaluates community residential and day programs for the developmentally disabled.

All residential and nonresidential health-related services and programs for the mentally impaired and the alcohol and drug addicted are evaluated by the Division. The Division also manages the licensure of private review agents doing business in Maryland. Private review agents are third parties (often employed by insurance companies) who (in advance) approve or disapprove medical procedures to be covered by insurance.

OFFICE OF POPULATION HEALTH IMPROVEMENT

LABORATORIES ADMINISTRATION

The Laboratories Administration was made part of the Department of Health and Mental Hygiene as the Community Health Surveillance and Laboratories Administration in 1987 and received its present name in January 1997.

Broad responsibilities for laboratory testing to help physicians and health officials prevent, diagnose, and control human diseases are assigned to the Laboratories Administration. It also performs examinations in connection with the enforcement of State health laws, and the chemical, microbiological, and radiological surveillance of the environment related to foods, waters, sewage, air, pharmaceuticals, and hazardous wastes. Laboratory tests are conducted to support State occupational safety and health regulations and to enforce pure food and drug laws.

To ensure the quality of laboratory services, the Administration develops standards and regulations for medical laboratories, tissue banks, and physician office laboratories. Moreover, it certifies and periodically inspects laboratories that examine water and dairy products for shipment out of Maryland.

In April 2015, the Administration moved from the Herbert R. O'Conor State Office Building, 201 West Preston St., Baltimore, to its present location.

In addition to a central laboratory in Baltimore and two regional laboratories, the Laboratories Administration oversees the Office of Laboratory Emergency Preparedness and Response, as well as Administrative and Support Services, and Scientific Programs. The Administration is assisted by the Laboratory Advisory Committee.

LABORATORY ADVISORY COMMITTEE
Authorized in 1989, the Laboratory Advisory Committee advises the Secretary of Health and Mental Hygiene on matters relating to medical laboratories (Chapter 330, Acts of 1989; Health-General Article, sec. 17-217).

The Secretary of Health and Mental Hygiene appoints Committee members to two-year terms and names the chair.

OFFICE OF LABORATORY EMERGENCY PREPAREDNESS & RESPONSE
In July 2002, the Office of Laboratory Emergency Preparedness and Response was organized within the Laboratories Administration as the Laboratory Bioterrorism Office. It was reorganized under its present name in November 2004. The Office develops procedures, trains staff, and coordinates State efforts to prepare for and respond to a bioterrorism attack. The Office also oversees the Biological Agents Registry.

BIOLOGICAL AGENTS REGISTRY
Since October 2002, the Biological Agents Registry has been authorized to monitor persons in Maryland who possess, maintain, or transfer certain biological agents. These biological agents could include microorganisms, fungi, and other toxins.

The Registry is in charge of a system of safeguards requiring individuals who possess, maintain, or transfer biological agents to comply with the federal regulations on transferring these agents. The Registry also alerts proper authorities of unauthorized possession, or attempted possession of biological agents. In addition, during investigations, the Registry is maintained for the use of federal law enforcement agencies, and the Centers for Disease Control and Prevention (Chapter 361, Acts of 2002; Code Health-General Article, secs. 17-601 through 17-605).

ADMINISTRATIVE & SUPPORT SERVICES

Today, Administrative and Support Services oversees four offices: Information Management Services; Laboratory Support Services; Quality Systems and Maintenance; and Safety and Training.

SCIENTIFIC PROGRAMS

ENVIRONMENTAL CHEMISTRY DIVISION
To help monitor and enforce environmental and consumer product safety laws, the Environmental Chemistry Division tests air, beverages, drugs, drinking water, foods, pharmaceuticals, sediments, sludges, soils, wastewater, and local flora and fauna. Tests are conducted to detect potentially toxic pollutants, such as pesticides, radioactivity, metals, and organic and inorganic compounds. For consumer safety, products are tested for tampering, characterization, and nutritional labeling.

ENVIRONMENTAL MICROBIOLOGY DIVISION
The Environmental Microbiology Division tests for disease-causing microorganisms in drinking water, swimming water, sewage treatment water, foods, shellfish and shellfish waters, and dairy products. Also, the Division certifies laboratories to test water, shellfish, and dairy products.

MOLECULAR BIOLOGY DIVISION
In the Molecular Biology Division, testing is carried out for HIV, rabies, West Nile virus, and other pathogens.

Five sections perform the Division's work: Molecular Diagnostics; Molecular Epidemiology; Molecular Imaging and Analysis; DNA Sequencing; and Rabies Zoonosis.

NEWBORN & CHILDHOOD SCREENING DIVISION
For every baby born in Maryland, the Newborn and Childhood Screening Division offers testing for numerous hereditary disorders. These include biotinidase deficiency; congenital adrenal hyperplasis; galactosemia; homocystinuria; maple syrup urine disease (MSUD); neonatal hypothyroidism; phenylketonuria (PKU); sickle cell anemia and other hemoglobinopathies; and tyrosinemia. As part of the State's Lead Poisoning Prevention Program, the Division also tests children's blood for elevated lead levels and environmental samples for lead contamination.

PUBLIC HEALTH MICROBIOLOGY DIVISION
The Public Health Microbiology Division began as the Division of Diagnostic and Public Health Microbiology and assumed its current name in November 2004. The Division provides diagnostic services, including processing patient specimens, recovering and identifying infectious agents, and assisting physicians in delivering proper antimicrobial therapy. For Maryland health care providers and institutions, the Division indentifies and confirms microbial agents: enteric and diarrheal; foodborne, fungal; gonococcal; parasitic; pertussis; and tuberculosis. These agents cause various diseases.

Four sections comprise the Division: Bacteriology; Mycobacteriology; Mycology; and Parisitology.

VIROLOGY & IMMUNOLOGY DIVISION
To detect viral and certain bacterial agents that cause diseases in humans, the Virology and Immunology Division conducts serological assays to determine the effectiveness of vaccines for hepatitis, measles, mumps, polio, rubella, and varicella. The Division conducts surveillance testing for sexually transmitted diseases; does cell culture isolations for epidemiological studies of respiratory virus outbreaks; and analyzes animal-borne agents, such as Hantaviruses, Lyme disease, rabies, and arboviruses, including encephalitis.

PREVENTION & HEALTH PROMOTION ADMINISTRATION

The Prevention and Health Promotion Administration was formed from the merger in July 2012 of the Infectious Disease and Environmental Health Administration, and the Family Health Administration.

Infectious Disease & Environmental Health Administration. The Infectious Disease & Environmental Health Administration started in July 2009 with the merger of the AIDS Administration and the Community Health Administration. It was responsible for environmental health programs, food control services, HIV care services, infectious disease prevention and reporting, outbreak response, and regulatory programs.

500 North Calvert St., Baltimore, Maryland, February 2004. Photo by Diane F. Evartt.

The other component that helped to make the Infectious Disease and Environmental Health Administration was the Community Health Administration. It originated in 1969 as the Local Health Services Administration. By 1973, it reorganized as the Local Health and Professional Support Services Administration and, by 1977, as the Local Health Administration. The Local Health Administration and the Family Health Administration merged in 1989 to form the Local and Family Health Administration. In January 1997, the Administration reformed as the Community and Public Health Administration. That administration divided into the Community Health Administration and the Family Health Administration in July 2001. Functions of the Community Health Administration transferred in July 2009 to the Infectious Disease and Environmental Health Administration.

Family Health Administration. The other forerunner of the Prevention and Health Promotion Administration was the Family Health Administration. The Family Health Administration worked to prevent and control chronic diseases; prevent injuries; provides public health information; and promotes healthy behaviors in Marylanders. Further, it strove to ensure that quality health care services are available, especially for at-risk and vulnerable people. The Administration also oversaw programs for maternal and child health; family planning and reproductive health; cancer control; oral health; and tobacco use prevention.

The Family Health Administration also was responsible for the Center for Cancer Surveillance and Control; the Center for Health Promotion and Tobacco Use Prevention and Cessation; and the Center for Maternal and Child Health. In addition, the Administration oversees five offices: Chronic Disease Prevention; Genetics and Children with Special Health Care Needs; Health Policy and Planning; Oral Health; and Women, Infants and Children Food Program. In July 2010, the Administration restructured into two deputy directorates: Family Health Services, and Prevention and Disease Control.

Prevention & Health Promotion Administration. Initially, the Prevention and Health Promotion Administration was organized under four bureaus: Cancer and Chronic Disease; Environmental Health; Infectious Disease; and Maternal and Child Health. In April 2015, it restructured with five bureaus: Environmental Health; Infectious Disease Epidemiology and Outbreak Response; Infectious Disease Prevention and Care Services; Maternal and Child Health; and Primary Care and Community Health.

PRIMARY CARE & COMMUNITY HEALTH BUREAU

The Bureau is responsible for the Office of Oral Health, the Office of Primary Care Access, and three centers: Cancer Prevention and Control; Chronic Disease Prevention and Control; and Tobacco Prevention and Control.

CENTER FOR CANCER PREVENTION & CONTROL
The Center for Cancer Prevention and Control began as the Center for Cancer Surveillance and Control, which formed under the Community and Public Health Administration in January 2000. The Center for Cancer Surveillance and Control joined the Family Health Administration in July 2001. At that time, it assumed functions of the former Division of Cancer Control from the Office of Chronic Disease Prevention, as well as oversight of the Maryland Cancer Registry. In July 2012, the Center reorganized under its present name as part of the Cancer and Chronic Disease Bureau. In April 2015, it became part of the Primary Care and Community Health Bureau.

The Center plans, develops, and implements initiatives to reduce deaths and disabilities due to cancer.

MARYLAND CANCER REGISTRY
The Maryland Cancer Registry was initiated in July 1982. Formerly under the Department of the Environment, the Registry transferred to the Department of Health and Mental Hygiene in 1991.

The Registry is an incidence-based electronic database containing demographic, diagnostic and treatment data on Maryland residents and those nonresidents who are diagnosed or treated in Maryland (Code Health-General Article, sec. 18-204). Under contractual agreement with the Department of Health and Mental Hygiene, the Registry is operated by Tri-Analytics, Inc., of Bel Air, Maryland.

MARYLAND CANCER REGISTRY ADVISORY COMMITTEE
Following the establishment of the Maryland Cancer Registry in July 1982, the Maryland Cancer Registry Advisory Committee was created. The Committee advises the State Council on Cancer Control on the operation of the Registry.

CENTER FOR CHRONIC DISEASE PREVENTION & CONTROL
Herbert R. O'Conor State Office Building, 201 West Preston St., Room 300, Baltimore, MD 21201

The Center for Chronic Disease Prevention and Control organized in the 1960s as the Regional Medical Program and later became the Adult Health Program. When the Local and Family Health Administration formed in 1989, the Program reformed under it as the Office of Chronic Disease Prevention. The Office transferred to the Community and Public Health Administration in 1997, and became the Office of Chronic Disease Prevention and Public Health Residency Program under the Family Health Administration in 2001. It combined with the Office of Injury and Disability Prevention to form the Center for Preventive Health Services in May 2003. In June 2008, the Center was renamed again as the Office of Chronic Disease Prevention. In July 2012, the Office reorganized under its present name as part of the Cancer and Chronic Disease Bureau of the Prevention and Health Promotion Administration. In April 2015, it moved under the Primary Care and Community Health Bureau.

STATE ADVISORY COUNCIL ON ARTHRITIS & RELATED DISEASES
The State Advisory Council on Arthritis and Related Diseases started as the State Commission on Arthritis and Related Diseases in 1985 (Chapter 250, Acts of 1985). The Council received its present name and was placed under the Local and Family Health Administration in 1992 (Chapter 71, Acts of 1992). In 1997, the Administration became the Community and Public Health Administration. In July 2001, the Council joined the Family Health Administration, and in July 2012, the Prevention and Health Promotion Administration.

The Council advises the Department on implementation of the Arthritis Prevention and Control Program, which was created in October 2002 (Chapter 215, Acts of 2002). In establishing the Program, the General Assembly considered the fact that arthritis is the leading cause of disability in the United States, affecting nearly one out of every six people. Through the Program, the Council trains teachers, and health-care professionals and providers about how to prevent and control arthritis. The Council also educates consumers about the importance of early diagnosis of arthritis, its causes and prevention.

To improve the quality of life for arthritic individuals and their families, the Council coordinates the activities of public and private agencies, medical schools, and related professional groups. The Council recommends ways to limit costs associated with arthritis prevention and treatment, and vocational training, as well as to improve services. The Council also develops and coordinates programs for vocational rehabilitation and industry to help arthritic individuals remain productive in the workforce.

Through studies and proposals, the Council devises a State program of education and applied research in gerontology and geriatrics. The development of a strategic plan of patient education throughout Maryland is coordinated by the Council. The plan involves State and local health departments, private agencies, pharmaceutical companies, medical schools, and professional organizations.

The Council's fifteen members are appointed by the Governor, who names the chair. Members serve four-year terms (Code Health-General Article, secs. 13-505 through 13-509).

STATE ADVISORY COUNCIL ON HEART DISEASE & STROKE
The State Advisory Council on Heart Disease and Stroke originated as the Commission on High Blood Pressure in 1976 (Chapter 792, Acts of 1976). It became the State Commission on High Blood Pressure and Related Cardiovascular Risk Factors in 1986 (Chapter 486, Acts of 1986). In 1992, it reorganized as the State Advisory Council on High Blood Pressure and Related Cardiovascular Risk Factors and was placed under the Local and Family Health Administration (Chapter 71, Acts of 1992). The Administration became the Community and Public Health Administration in 1997. The Council reorganized as the State Advisory Council on Heart Disease and Stroke in July 2001 when it became part of the Family Health Administration (Chapter 238, Acts of 2001). In July 2012, the Council joined the Prevention and Health Promotion Administration.

Guidelines to manage and treat heart disease and stroke are established by the Council. To detect, prevent, and treat these conditions, the Council also develops and promotes educational programs targeted for those at high-risk and for geographic areas with high incidences of heart disease and stroke.

Educational programs on the prevention, early detection, and treatment of heart disease and stroke in Maryland are developed and promoted by the Council.

The Council's twenty-four members are appointed by the Governor to four-year terms (Code Health-General Article, secs. 13-201 through 13-206).

STATE ADVISORY COUNCIL ON PHYSICAL FITNESS
In 1963, the State Advisory Council on Physical Fitness began as the State Commission on Physical Fitness (Chapter 606, Acts of 1963). The Commission reorganized in 1992 by its present name under the Local and Family Health Administration (Chapter 71, Acts of 1992). The Administration became the Community and Public Health Administration in 1997. When that Administration split in July 2001, the Council joined the Family Health Administration. In July 2012, the Council moved to the Prevention and Health Promotion Administration.

The Council works to protect and improve the physical fitness of Marylanders. It disseminates information about physical fitness, and collects and assembles information from State agencies. To further its work, the Council maintains liaison with the State Department of Education, local boards of education, private and parochial schools, and local physical fitness commissions.

With the advice of the Secretary of Health and Mental Hygiene, the Governor appoints the Council's twenty-five members. Members serve four-year terms. The Governor names the chair. The Secretary of Health and Mental Hygiene appoints the executive director.

In each county and Baltimore City, the Governor may appoint a local advisory council of from fifteen to twenty-five members. The Secretary of Health and Mental Hygiene names each local council chair (Code Health-General Article, secs. 13-401 through 13-412).

STATE BOARD OF SPINAL CORD INJURY RESEARCH
In July 2000, the State Board of Spinal Cord Injury Research was authorized (Chapter 512, Acts of 2000; Code Health-General Article, secs. 13-1401 through 13-1407).

Due to lack of funding, the Board did not meet from October 2004 until July 2006. It resumed its work of reviewing grant applications for spinal cord research in July 2006.

CENTER FOR TOBACCO PREVENTION & CONTROL
300 West Preston St., Baltimore, MD 21201

300 West Preston St., Baltimore, Maryland, December 2000. Photo by Diane F. Evartt.

The Center is responsible for six programs: Health in Pregnancy, a smoking cessation program; the Maryland Arthritis Project; Maryland Kids in Safety Seats (Maryland KISS); Planned Approach to Community Health (PATCH); Rape and Sexual Assault Prevention Program; and Tobacco Use Prevention. Initiatives of the Office enable individuals and institutions to change behaviors in health-enhancing ways.

Maryland Arthritis Project. With funding from the federal Centers for Disease Control and Prevention, this Project began in September 1999. It is setting up a surveillance system to collect epidemiological data on arthritis and related rheumatic conditions; formulating the Maryland State Arthritis Plan; and working to expand the role of the State Advisory Council on Arthritis and Related Diseases.

Maryland Kids in Safety Seats Program. To ensure children's safety as passengers in vehicles, this program began in 1980. It educates the public about what State law requires for child safety seats and restraints, and how to properly install and use them. A newsletter containing product information on child safety seats, product recalls, safety tips, instructions on proper installation, and related issues is published by the Program. To offer low-income families access to child safety seats, the Program also coordinates loaner programs statewide.

Tobacco Use Prevention Program. This program funds local school districts and health departments in their tobacco use prevention and cessation efforts. It support media campaigns on clean indoor air and smoke-free environments and other community programs that educate the public about tobacco use.

OFFICE OF ORAL HEALTH
Herbert R. O'Conor State Office Building, 201 West Preston St., Baltimore, MD 21201

The Office of Oral Health focuses on improving the oral health of Marylanders, preventing oral diseases and injuries, and increasing their access to oral health care. The Office develops educational materials, including brochures on oral cancer, brushing and flossing techniques, healthy eating habits, and a children's guide to healthy oral habits. The Office also grants local health departments funds to develop oral health education and prevention programs and for community water fluoridation.

To increase the number of dentists serving in Dental Health Professional Shortage Areas, the Office works with the University of Maryland Dental School.

Under the Office is the Maryland Dental-Care Loan Assistance Repayment Program.

OFFICE OF PRIMARY CARE ACCESS
In April 2015, the Office of Primary Care Access moved from the Health Systems and Infrastructure Administration to the Primary Care and Community Health Bureau.

ENVIRONMENTAL HEALTH BUREAU

The Bureau oversees the Office of Food Protection and four centers: Environmental and Occupational Epidemiology; Healthy Homes and Community Services; Injury and Sexual Assault Prevention; and Injury Epidemiology.

CENTER FOR ENVIRONMENTAL & OCCUPATIONAL EPIDEMIOLOGY

CENTER FOR HEALTHY HOMES & COMMUNITY SERVICES

CENTER FOR INJURY & SEXUAL ASSAULT PREVENTION

CENTER FOR INJURY EPIDEMIOLOGY

The Office of Food Protection started as the Office of Food and Product Health. It was renamed the Office of Food Protection and Consumer Health Services in 1988 under the Community Health Surveillance and Laboratories Administration. In 1997, it reorganized as Consumer Health and Facility Services under the Community and Public Health Administration, joined the Community Health Administration in July 2001, and the Infectious Disease and Environmental Health Administration in July 2009. In July 2012, it reorganized under its present name within the Environmental Health Bureau of the Prevention and Health Promotion Administration.

Cow & workers, Milking Parlor, Cow Palace, Maryland State Fair, Timonium, Maryland, September 2015. Photo by Sarah A. Hanks.

The Office is responsible for four centers: Facility and Process Review; Food Defense and Emergency Response; Food Processing; and Milk and Dairy Product Safety. The Youth Camp Safety Advisory Council assists the Office.

YOUTH CAMP SAFETY ADVISORY COUNCIL
c/o Office of Food Protection & Consumer Health Services
3431 Benson Ave., Baltimore, MD 21227

In 1986, the Youth Camp Safety Advisory Council was authorized (Chapter 116, Acts of 1986). The Council helps the Department of Health and Mental Hygiene develop and review regulations for certifying youth camps. These regulations cover fire and safety standards; medical services; personnel screening procedures; refuse collection and disposal; safety; sanitation; sewage disposal; and water supplies; and reporting systems for fatalities, serious illnesses, or accidents. All youth camps in Maryland must comply with these regulations.

The Council's eleven members are appointed to three-year terms by the Governor with the advice of the Secretary of Health and Mental Hygiene and Senate advice and consent (Code Health-General Article, secs. 14-401 through 14-411).

CENTER FOR FACILITY & PROCESS REVIEW


CENTER FOR FOOD DEFENSE & EMERGENCY RESPONSE


CENTER FOR FOOD PROCESSING
To ensure the safety of food in Maryland, the Center for Food Processing licenses and inspects wholesale food manufacturing plants, warehouses, canneries, crabmeat and shellfish plants, soda and bottled-water facilities, and vehicles for commercial food transportation.

CENTER FOR MILK & DAIRY PRODUCT SAFETY
The Center for Milk and Dairy Product Safety began as the Division of Milk Control and was restructured as the Center for Milk Control in August 2009. It reorganized under its present name in July 2012.

To ensure that Marylanders have a safe supply of milk and dairy products, the Center licenses and inspects dairy farms, milk processing plants, frozen dessert manufacturers, bulk milk receiving and transfer stations, and wholesale distribution facilities that handle Grade A milk products. Further, the Center licenses and certifies dairy farm inspectors; licenses and evaluates bulk milk haulers and samplers; and licenses milk transportation companies operating in Maryland. For dairy products produced in Maryland, the Center issues certificates for exports. The Center also investigates all complaints and enforces all laws relating to production and shipment of milk and dairy products (Code Health-General Article, secs. 21-401 through 21-436).

INFECTIOUS DISEASE EPIDEMIOLOGY & OUTBREAK RESPONSE BUREAU

The Infectious Disease Epidemiology and Outbreak Response Bureau assumed the duties of the Office of Infectious Disease Epidemiology and Outbreak Response. That Office was initiated as the Office of Epidemiology and Disease Control, which began under the Community Health Surveillance and Laboratories Administration. That administration became the Community and Public Health Administration in 1997, and the Community Health Administration in July 2001. After the latter reformed as the Infectious Disease and Environmental Health Administration in July 2009, the Office of Epidemiology and Disease Control was renamed the Office of Infectious Disease Epidemiology and Outbreak Response in August 2009. In July 2012, the Office became part of the Infectious Disease Bureau of the Prevention and Health Promotion Administration.

The Bureau works to control all communicable diseases affecting people in Maryland. The Bureau strives to contain hard-to-control diseases, such as hepatitis, influenza, sexually-transmitted diseases, and rabies. It also works to control acute communicable diseases, tuberculosis, nosocomial infections, and animal-borne diseases transmittable to humans. In addition, the Bureau supervises health programs for refugees and migrants.

Currently under the Bureau are the Emerging Infections Program, the Office of Immigrant Health, and five centers: HIV Surveillance Epidemiology and Evaluation; Immunization; Surveillance, Infection Prevention, and Outbreak Response; Tuberculosis Prevention and Control; and Zoonotic and Vector-Borne Disease.

CENTER FOR HIV SURVEILLANCE & EPIDEMIOLOGY
With local health care providers, health departments, and the federal government, the Center for HIV Surveillance and Epidemiology collects and analyzes data on HIV and AIDS in Maryland. This information is vital for tracking, preventing, and planning to control the diseases.

CENTER FOR IMMUNIZATION
To prevent diseases, the Center for Immunization provides free vaccines to health providers and local health departments through the Vaccines for Children Program. The Center also educations the public on vaccine requirements for entering child care or school and college, as well as traveling abroad. Further, the Center monitors outbreaks of diseases.

CENTER FOR SURVEILLANCE, INFECTION PREVENTION, & OUTBREAK RESPONSE


CENTER FOR TUBERCULOSIS PREVENTION & CONTROL


CENTER FOR ZOONOTIC & VECTOR-BORNE DISEASE
The Center for Zoonotic and Vector-Borne Diseases works with local health departments, the general public, government agencies, health care providers, and veterinarians to prevent and control certain communicable diseases in Maryland. These diseases fall into two categories: zoonotic diseases, and vector-borne diseases. Zoonotic diseases are those which naturally are transmitted between animals and humans, such as rabies, avian influenza, and salmonellosis. Vector-borne diseases are transmitted to humans through a vector, such as a mosquito or tick, and include Lyme disease and the West Nile virus.

OFFICE OF IMMIGRANT HEALTH

INFECTIOUS DISEASE PREVENTION & CARE SERVICES BUREAU

The Bureau is responsible for the Office of Faith-Based and Community Partnerships, the Maryland AIDS Drug Assistance Program, and the Center for Sexually Transmitted Infection Prevention.

CENTER FOR HIV CARE SERVICES
In 1989, the Division of AIDS Services, Planning, and Development formed within the AIDS Administration. The Division became the Center for AIDS Services, Planning, and Development in 1994. It reorganized in 1997 as the Center for HIV Patient Services, and became the Center for HIV Health Services in 2001. Also in 2001, the Center for HIV Client Services was formed to operate programs to fund medication for eligible persons. In December 2006, that Center combined with the Center for HIV Client Services to form the Center for HIV Care Services. It joined the Infectious Disease and Environmental Health Administration in July 2009.

Clinical activities for the diagnosis and evaluation of patients with AIDS are funded by the Administration. The Administration also directly operates drug assistance and insurance assistance programs for those living with HIV/AIDS. The Administration consults and coordinates its work with twenty-four local health departments. Each local health department has counseling and testing sites that offer free tests and consultations.

The Center administers the federal Ryan White CARE Act Program. Through this and other federal and State programs, the Center assures that Marylanders living with or affected by HIV/AIDS have access to primary medical care, case management and dental care, as well as to other support services. Funds are awarded to local health departments, other government agencies, community and hospital-based health care facilities, and community organizations to provide these services. For housing assistance and related supportive services for individuals with HIV/AIDS, the Center also administers funds from the Housing Opportunities for Persons with AIDS (HOPWA) Program of the U.S. Department of Housing and Urban Development.

MARYLAND AIDS DRUG ASSISTANCE PROGRAM
Through the Maryland AIDS Drug Assistance Program, specified medications in the treatment of HIV and AIDS patients are funded throughout Maryland. Two other health insurance programs: Maryland AIDS Drug Assistance Program-Plus (MADAP-Plus), and the Maryland AIDS Insurance Assistance Program (MAIAP) also are administered.

CENTER FOR HIV PREVENTION
The Center for HIV Prevention began in 1991 as the Division of Professional Education and Health Services. The Division formed within the AIDS Administration by merging functions of the Division of Provider Education and Training with the Division of Patient Care Services. In 1994, the Division of Professional Education and Health Services reorganized as the Center for Professional Education and Patient Services, and in 1997 as the Center for Education and Training. In February 2005, the Center for Education and Training merged with the Center for Prevention Planning, Development and Evaluation to form the Center for HIV Prevention, which transferred to the Infectious Disease and Environmental Health Administration in July 2009.

The Center for HIV Prevention educates health-care professionals about HIV and treats persons who are HIV infected. HIV diagnostic evaluation units where a person with HIV disease can be assessed by health-care professionals are funded by the Center. Staff consult with the patient's health-care provider to help that provider meet the patient's complex medical needs.

In 1997, when the Center for Quality Assessment and Improvement was abolished, most of its functions were assigned to the Center for Education and Training. Among these functions that continue with the Center for HIV Prevention today are the evaluation of the results of preventive care, early intervention, and treatment provided by the AIDS Administration; and the setting of high standards of clinical performance for State and federally funded HIV and AIDS services.

Under the Center are three divisions: Capacity Building and Training; Health Communications, Public Information, and Prevention for HIV Positive Persons (PHIPP); and Local Prevention and Provider Education.

DIVISION OF LOCAL PREVENTION & PROVIDER EDUCATION
The Division of Local Prevention and Provider Education first organized as the Division of HIV Counseling and Testing Services within the AIDS Administration. Renamed Division of Local Prevention Services, it was placed under the Center for AIDS Education (later the Center for Prevention Programs). The Division transferred in 1997 to the Center for Education and Training, and reorganized as the Division of Local Prevention and Provider Education. In July 2004, the Center reformed as the Center for Prevention, Education, and Training and, in July 2009, the Division was made part of the Infectious Disease and Environmental Health Administration.

At no charge, the Division provides HIV health education and counseling, as well as voluntary HIV antibody testing to any Marylander. Efforts are made selectively to test, counsel, and refer for treatment and other services those individuals who practice behaviors that put them at risk for HIV infection.

Services are provided by funding local health departments to operate 54 sites throughout Maryland for HIV counseling and testing services. All local health departments also provide programs for sexually transmitted disease. These programs offer HIV-risk assessment, counseling, and testing to their clients.

The Maternal and Child Health Bureau formed as the Center for Maternal and Child Health in January 2000 with the merger of the Office of Children's Health and the Office of Maternal Health and Family Planning. From July 2010 to July 2012, the Center was under Family Health Services. In July 2012, it moved to the Prevention and Health Promotion Administration under its present name.

The Office of Children's Health had been known as the Office of Child Health Services since 1989 when it was made part of the Local and Family Health Administration. In 1993, the Office reformed as the Office of Child Health. In 1994, the Office of Child Health and the Office of Children's Medical Services merged to form the Office of Child Health and Children's Medical Services. Renamed the Office of Children's Health in 1995, it became part of the Community and Public Health Administration in 1997 and joined the Family Health Administration in July 2001.

In 1922, the Office of Maternal Health and Family Planning originated as the Bureau of Maternal and Child Health and Services to Crippled Children. The Bureau had become the Division of Maternal and Child Health under the Bureau of Preventive Medicine by 1951, under the Bureau of Preventive Medical Services by 1967, and under the Preventive Medicine Administration in 1969. The Division was renamed the Office of Maternal Health, Family Planning, and Hereditary Disorders by 1985. As the Office of Maternal and Child Health it was placed under the Family Health Administration in 1987. The Office joined the Local and Family Health Administration in 1989 and was renamed the Office of Maternal Health and Family Planning in 1990. As part of the Community and Public Health Administration since 1997, it transferred to the Family Health Administration in July 2001.

Since the merger of the Office of Children's Health with the Office of Maternal Health and Family Planning, the Center for Maternal and Child Health has worked to improve the health of women of childbearing age and their babies. With federal and State funds, the Center directs prenatal care and family planning services offered by local health departments and others. The Center also administers special grants to improve the reproductive health of adolescents and introduce new contraceptive techniques into the public health system.

For basic preventive services to safeguard the health of children, the Center administers State and federal funding to the local health department in each county and Baltimore City. These services include immunizations; screening for lead poisoning, vision, hearing and scoliosis; and counseling in basic nutrition. The Center also administers special grants, such as the grant to the University System of Maryland relating to sudden infant death syndrome (SIDS), or grants to Eastern Shore counties for preventive dental care for children. In addition, the Center offers training, consultation, and technical assistance to local health departments and the private sector.

For children whose chronic illnesses or disabling conditions interfere with normal growth and development, the Center helps families plan and obtain specialized medical and rehabilitative care. These conditions include cerebral palsy, orofacial anomalies, speech and language problems, spina bifida, heart disease and defects, hearing impairment, cystic fibrosis, chronic otitis media, chronic renal disease, and epilepsy. Many other diagnoses qualify a child to receive services if financial eligibility requirements also are met (Code of Maryland Regulations - COMAR 10.22.08.05B).

A joint federal, State and local program called Children's Medical Services, formerly Crippled Children's Services, is administered by the Center. While State funding for services to crippled children dates to at least 1922, the program has operated in Maryland since 1937 (Code Health-General Article, sec. 15-125).

Under the Bureau are four offices; Family Planning and Home Visiting; Genetics and People with Special Health Care Needs; Surveillance and Quality Initiatives; and Maryland Women, Infants, and Children Food Program.

MARYLAND STATE SCHOOL HEALTH COUNCIL
c/o Baltimore County Health Department
One Investment Place, 11th floor, Towson, MD 21204 - 4125

In 1946, the Maryland State School Health Council was created by the State Department of Health and the State Department of Education. Reorganized in 1966, the Council advises the Department of Health and Mental Hygiene and the State Department of Education on the school health program. The Council helps develop and maintain programs to provide a healthful school environment, health and safety instruction, and school health services. It also serves as a forum for the two State departments, their local counterparts, and other groups concerned with the health of school-age children.

The Council includes two representatives appointed by each of the twenty-four local health and education departments. The Executive Board consists of five members elected by the Council and representatives of health and education agencies; State and local associations; and education organizations.

OFFICE FOR GENETICS & PEOPLE WITH SPECIAL HEALTH CARE NEEDS
Herbert R. O'Conor State Office Building, 201 West Preston St., Baltimore, MD 21201 - 2399

In 1964, the first programs of the Office for Genetics and People with Special Health Care Needs were initiated. These programs were assigned to the Division of Hereditary Disorders in 1973. Reorganized as the Office of Hereditary Disorders in 1990, the Office was placed under Family Health Services and Primary Care in 1997, and became the Office for Genetics and Children with Special Health Care Needs in March 2000. The Office functioned under the Family Health Administration from July 2001 to July 2012, when it received its present name and moved to the Maternal and Child Health Bureau of the Prevention and Health Promotion Administration.

The Office works to improve the early identification of children with special health care needs through newborn screening for metabolic diseases, sicle cell disease, chronic diseases, birth defects, hearing loss, and developmental problems. The Office coordinates alpha-fetoprotein (AFP) testing to pregnant women; screens nearly every newborn baby in Maryland for birth defects; treats genetic metabolic diseases and hemoglobin disorders, including sickle cell disease; and provides clinical services for other genetic disorders.

The Birth Defects Reporting and Information System (BDRIS) is maintained by the Office. The System collects data and provides information to parents of children with disorders and defects. Educational programs on genetics and genetic services are offered by the Office to health professionals, educators, and the general public. The Office also ensures that children receive timely specialized medical care and family support services.

STATE ADVISORY COUNCIL ON HEREDITARY & CONGENITAL DISORDERS
In 1973, the State Advisory Council on Hereditary and Congenital Disorders formed as the Commission on Hereditary Disorders (Chapter 695, Acts of 1973). It became the State Commission on Hereditary and Congenital Disorders in 1986 (Chapter 740, Acts of 1986). Renamed the State Advisory Council on Hereditary and Congenital Disorders, it was placed under the Local and Family Health Administration in 1992 (Chapter 71, Acts of 1992). In 1997, the Administration reformed as the Community and Public Health Administration, and in July 2001 as the Family Health Administration. In July 2010, the Council moved under the Laboratories Administration. In July 2012, the Council moved to the Office for Genetics and People with Special Health Care needs in the Prevention and Health Promotion Administration.

Information on the treatment of hereditary and congenital disorders in Maryland is gathered and disseminated by the Council. It also establishes and promulgates rules, regulations, and standards for the detection and management of these disorders. On a continuous basis, it evaluates the need for and efficiency of relevant State programs. For the public and providers of health services, the Council also institutes and supervises educational programs and counseling on hereditary and congenital disorders, their treatment and prevention.

In July 2011, the Council was charged with studying the implementation of critical congenital heart disease screening of infants (Chapters 553, Acts of 2011).

The Council is composed of eleven voting members and five nonvoting members. Those voting serve four-year terms. They include nine members appointed by the Governor, one senator named by the Senate President, and one delegate chosen by the House Speaker. The nonvoting members are appointed by the Secretary of Health and Mental Hygiene (Code Health-General Article, secs. 13-103 through 13-109).

EARLY HEARING DETECTION & INTERVENTION PROGRAM
The Early Hearing Detection and Intervention Program was established as the Program to Identify Hearing-Impaired Infants under the Developmental Disabilities Administration in 1985 (Chapter 402, Acts of 1985). In 1990, the Program transferred to the Office of Children's Medical Services and, in 1992, to the Office of Children's Health within the Local and Family Health Administration. In 1995, the Program became part of the Office of Child Health, which moved under the Community and Public Health Services Administration in 1997. The Program was placed under the Office of Hereditary Disorders in 1998. Reformed as the Universal Newborn-Hearing Screening Program in 1999, it moved under the Office for Genetics and Children with Special Health Care Needs in 2000 (Code Health-General Article, sec. 13-602; Chapter 127, Acts of 1999). The Program became part of the Family Health Administration in July 2001 and the Prevention and Health Promotion Administration in July 2012. The Program assumed its present name in July 2014 (Chapter 30, Acts of 2014).

The Program provides early identification and follow-up of hearing-impaired infants and infants who are at risk of developing a hearing impairment. Since 1999, the Program has been required to help develop protocols for the universal screening of newborns' hearing (Chapter 127, Acts of 1999).

EARLY HEARING DETECTION & INTERVENTION ADVISORY COUNCIL
In 1985, the Early Hearing Detection and Intervention Advisory Council began as the Advisory Council for Program to Identify Hearing-Impaired Infants (Chapter 402, Acts of 1985). It was renamed the Advisory Council on Universal Newborn-Hearing Screening Program in 1999 (Chapter 127, Acts of 1999), and received its present name in July 2014 (Chapter 30, Acts of 2014).

The Council advises the Department of Health and Mental Hygiene on implementing the Early Hearing Detection and Intervention Program and on educational programs for families, professionals, and the public. The Council also reviews Program materials distributed by the Department.

Appointed by the Secretary of Health and Mental Hygiene to three-year terms, the Council consists of twelve members (Code Health-General Article, secs. 13-601 through 13-605).

OFFICE OF MARYLAND WOMEN, INFANTS & CHILDREN FOOD PROGRAM
Herbert R. O'Conor State Office Building, 201 West Preston St., Baltimore, MD 21201 - 2399

Created by the Department in 1985, the Office of Maryland Women, Infants and Children Food Program joined the Family Health Administration in 1987. That administration was renamed the Local and Family Health Administration in 1989, the Community and Public Health Administration in 1997, and again the Family Health Administration in July 2001. The Office became part of the Prevention and Health Promotion Administration in July 2012.

Maryland Special Supplemental Food Program for Women, Infants, and Children (WIC). The Program offers health and nutrition services, including supplemental foods, to pregnant, postpartum and breast-feeding women; infants up to one year of age; and children until their fifth birthday. To be eligible, an individual also must meet income requirements and be at nutritional risk.

Funded by the U.S. Department of Agriculture, the Program is administered by the Office of Maryland Women, Infants and Children Food Program through grants to eighteen local agencies that serve the entire State. Each local agency determines recipient eligibility, prescribes individualized food packages, provides nutrition education, prepares required records and reports, and issues food instruments (negotiable checks used in exchange for approved foods). The Office ensures that Maryland's program accords with federal requirements (P.L. 95-627).

The Office is assisted by the Maryland Women, Infants and Children Advisory Council.

MARYLAND WOMEN, INFANTS & CHILDREN ADVISORY COUNCIL

VITAL STATISTICS ADMINISTRATION

In November 1998, the Vital Statistics Administration started from divisions formerly under the General Services Administration. At that time, the Division of Health Statistics and the Division of Vital Records were placed under the Administration. Formerly under Operations, the Vital Statistics Administration moved to Public Health Services in February 2011.

The Administration registers all births, deaths, and fetal deaths that occur in Maryland. It issues certified copies of birth, death and marriage certificates, and provides verification of divorces. Further, the Administration compiles and analyzes vital statistics data; prepares annual population estimates by age, race, sex, and geographical subdivisions; compiles reports on vital statistics and population; and makes its data available to government agencies and the public.

The work of the Administration is performed by two divisions: Health Statistics, and Vital Records.

DIVISION OF HEALTH STATISTICS

Functions of the Division of Health Statistics began in 1951 as part of the Division of Vital Records and Statistics under the Department of Health. By 1959, the work of vital statistics was placed under the Division of Research and Planning. By 1961, it was found under the Office of Planning and Research and, by 1963, was part of the Division of Statistical Research and Records. In 1967, it formed separately as the Division of Biostatistics under the Bureau of Analysis and Records. In 1969, the Division became the Center for Health Statistics and, by 1973, was placed under the Office of General Administration. The Center reorganized as a division in 1988.

Annually, the Division of Health Statistics publishes vital statistics and population estimates for the State. To highlight significant trends and findings, the Division analyzes and reports annually on the health status of Maryland residents. It provides statistical analysis and advice to programs on studies and systems development. The Division publishes annual and special reports on these topics.

DIVISION OF VITAL RECORDS

The Division of Vital Records organized in 1910 as the Bureau of Vital Statistics under the State Department of Health (Chapter 560, Acts of 1910). In 1951, it reformed as the Division of Vital Records and Statistics and, in 1967, as the Division of Vital Records under the Bureau of Analysis and Records. In 1969, the Division was placed under the Center for Health Statistics. In 1988, the Division was separated from Health Statistics.

Copies of certified birth, death, and marriage certificates and divorce verification are issued by the Division. All births, deaths, marriages, and divorces that occur in the State also are registered with the Division. Copies of birth and death records are issued to authorized persons for a fee of $10 for the first certified copy (checks to be made payable to Department of Health and Mental Hygiene). Application for certified copies may be made in person, by mail or online. Verification of identity is required to ensure the applicant is authorized to receive a certificate. Commemorative birth certificates also may be ordered from the Division for a fee of $50.

Birth and Death Records. The Division has birth and death records for Baltimore City from January 1, 1875, and for the twenty-three counties of Maryland from August 1898. The information also is available from the State Archives.

Marriage and Divorce Records. State marriage registration began on June 1, 1951, and divorce registration began in June 1961. Copies of marriage records prior to January 1, 1990 may be obtained from the Circuit Court clerk in the county where the marriage occurred, or from the State Archives. For a fee of $12, the Division issues certified copies of marriage certificates for marriages occurring after January 1, 1990, and official verification of divorces and annulments occurring after January 1, 1992.

OFFICE OF CHIEF MEDICAL EXAMINER

The Office of Chief Medical Examiner oversees a network of local deputy medical examiners and forensic investigators who investigate violent and suspicious deaths, and deaths unattended by physicians. These duties had been the responsibility first of local sheriffs, and then of local coroners from 1666 to the end of the nineteenth century. Then, they were assumed by justices of the peace. In 1939, these functions were assigned to deputy medical examiners (Chapter 369, Acts of 1939).

Any death that occurs by violence, suicide, casualty, or in any suspicious or unusual manner, or a sudden death in which the deceased was in good health or unattended by a physician is required by law to be investigated (Code Health-General Article, sec. 5-309). In the event of such a death, the local police or sheriff will notify the appropriate State's Attorney and a local medical examiner or forensic investigator authorized by the Office of Chief Medical Examiner to investigate deaths in that jurisdiction. The investigator proceeds to the scene of death to take charge of the body; investigates the medical cause of death; takes possession of any property found on the body; collects the names and addresses of witnesses; obtains photographs; preserves any evidence; and writes a detailed report to be submitted to the Office.

With the State Postmortem Examiners Commission, the Chief Medical Examiner may appoint physicians as deputy medical examiners and forensic investigators in each county. The deputy medical examiners file with the Office of Chief Medical Examiner reports of all deaths investigated. Records of the Office are open for inspection to the family of the deceased and are acceptable in court as evidence of the facts contained.

The Chief Medical Examiner performs autopsies and provides the local state's attorney with copies of records concerning any death which requires further investigation. Appointed by the State Postmortem Examiners Commission, the Chief Medical Examiner oversees Administration, Autopsy Services, Statewide Services, Toxicology, and the Center for the Study of Health Effects of Fire.

STATE POSTMORTEM EXAMINERS COMMISSION
Created in 1939, the Department of Postmortem Examiners replaced a decentralized system of local coroners (Chapter 69, Acts of 1939). In 1982, the Department was subsumed into the State Postmortem Examiners Commission (Chapter 21, Acts of 1982).

The State Postmortem Examiners Commission is composed of four ex officio members and a representative of the Department of Health and Mental Hygiene selected by the Secretary of Health and Mental Hygiene. The Commission appoints all professional personnel (Code Health-General Article, secs. 5-301 through 5-312).

CENTER FOR THE STUDY OF HEALTH EFFECTS OF FIRE
Forensic Medical Center, 900 West Baltimore St., Baltimore, MD 21202

The Center for the Study of the Health Effects of Fire was created in 1988 (Chapter 185, Acts of 1988). The Center studies the health effects of exposure to fire; gathers and analyzes data on fire-related injury or death; and maintains both a registry of persons who suffer fire-related injury or death, and a computerized database concerning injuries and health effects of fire. For information routinely collected about fires, the Center is a repository. Information collected by the Center and intended for use in research, however, is confidential and not discoverable or admissible as evidence in a civil or criminal action to determine cause of death or liability for injury or death.

Pilot studies on issues or factors affecting injuries from or the health effects of fire are funded by the Center which also applies for federal or private research grants to investigate such issues. In addition, the Center communicates with national scientific data bases on toxicology, chemistry, epidemiology, and related scientific disciplines; collaborates with agencies, such as the National Bureau of Standards, that are involved in programs related to health effects of fire; and promotes interest in fire-related issues at educational institutions in Maryland (Code Health-General Article, secs. 18-701 through 18-711).

ADVISORY COUNCIL TO THE CENTER FOR THE STUDY OF HEALTH EFFECTS OF FIRE
The Advisory Council to the Center for the Study of the Health Effects of Fire reviews the work of the Center for the Study of Health Effects of Fire. The Council also advises the Director concerning the scientific evaluation of information collected by the Center and helps the Center set research priorities.

To five-year terms, the Secretary of Health and Mental Hygiene appoints the Council's seven members (Code Health-General Article, secs. 18-706 through 18-710).

TOXICOLOGY

OFFICE OF PREPAREDNESS & RESPONSE

In April 2004, the Office of Preparedness and Response began as Emergency Preparedness and Response to coordinate Departmental response to any hazardous health situations, including natural disasters, such as blizzards and hurricanes, as well as biological, chemical or nuclear incidents. In February 2006, Emergency Preparedness and Response merged with the Office of Public Health Preparedness and Response. The Office had been established under the Community Health Administration in October 2002 to upgrade Maryland's readiness and response capability for public health threats and emergencies, such as bioterrorism and infectious disease outbreaks. The merger formed the Office of Preparedness and Response in February 2006.

The Office of Preparedness and Response plans for rapid mobilization of public health personnel, and ensures that they are organized, trained, and equipped for all types of hazards. The Office coordinates the Maryland Professional Volunteer Corps, trained health care professionals who provide emergency care during catastrophic events. The Office also is responsible for the Department's Emergency Management Team. On-call 24 hours a day, the Team responds to any health emergency such as a natural disaster, or act of bioterrorism.

STATE ANATOMY BOARD

Authorized in 1947, the State Anatomy Board was organized in 1949 (Chapter 669, Acts of 1947). The Board's purpose is to ensure the proper distribution of cadavers to qualified hospitals, medical schools, and other agencies engaged in medical education and research. Bodies are distributed equitably to the anatomy department of each medical school in Maryland. The Board also carries out the legal provisions regulating Consent to Post Mortem Examination (Chapter 315, Acts of 1961) and the Anatomical Gift Act (Chapter 467, Acts of 1968).

The Board consists of two representatives from each of the departments of anatomy of medical schools in the State of Maryland and one representative of the Department of Anatomy of the University of Maryland School of Dentistry. Members of the Board are designated by the administrative officers of each school (Code Health-General Article, secs. 5-401 through 5-409).

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