§ 63-1-738l. Complications of Induced Abortion Report - Sample form.

A.  Complications of Induced Abortion Report.  By March 1, 2012, the State Department of Health shall prepare and make available, on its stable Internet website, a Complications of Induced Abortion Report for all physicians licensed and practicing in the State of Oklahoma.

B.  Subsection C of this section shall become operative on the later of:

1.  April 1, 2012; or

2.  Thirty (30) calendar days following the date on which the State Department of Health posts on its stable Internet website the Individual Abortion Form and instructions concerning its electronic submission referenced in Section 3 of this act.

C.  Any physician practicing in Oklahoma who encounters an illness or injury that a reasonably knowledgeable physician would judge is related to an induced abortion shall complete and submit, electronically or by regular mail, a Complications of Induced Abortion Report to the Department as soon as is practicable after the encounter with the induced-abortion-related illness or injury, but in no case more than sixty (60) days after such an encounter.  Nothing in the Complications of Induced Abortion Report shall contain the name, address, hometown, county of residence, or any other information specifically identifying any patient.  Knowing or reckless unreasonable delay or failure to submit a Complications of Induced Abortion Report shall be sanctioned according to the provisions of the Statistical Abortion Reporting Act.

D.  The Complications of Induced Abortion Report shall contain a notice containing an assurance that in accordance with subsection F of Section 5 of this act, public reports based on the form submitted will not contain the name, address, hometown, county of residence, or any other identifying information of any individual female, that the State Department of Health will take care to ensure that none of the information included in its public reports could reasonably lead to the identification of any individual female about whom information is reported in accordance with the Statistical Abortion Reporting Act, or of any physician providing information in accordance with the Statistical Abortion Reporting Act, and that such information is not subject to the Oklahoma Open Records Act.

E.  Complication(s) of Induced Abortion Report.  The Complications of Induced Abortion Report shall be substantially similar to, but need not be in the specific format of, the following form:

Complications of Induced Abortion Report

1.  Name and specialty field of medical practice of the physician filing the report: _________________________________

2.  Did the physician filing the report perform or induce the abortion? ________________________________________________

3.  Name, address, and telephone number of the health care facility where the induced abortion complication was discovered or treated: __________________________________________________________

4.  Date on which the complication was discovered: ________

5.  Date on which, and location of the facility where, the abortion was performed, if known: _________________________________

6.  Age of the patient experiencing the complication: _____

7.  Describe the complication(s) resulting from the induced abortion: ______________________________________________________

8.  Circle all that apply:

a.Death

b.Cervical laceration requiring suture or repair

c.Heavy bleeding/hemorrhage with estimated blood loss of greater than or equal to 500cc

d.Uterine Perforation

e.Infection

f.Failed termination of pregnancy (continued viable pregnancy)

g.Incomplete termination of pregnancy (Retained parts of fetus requiring re-evacuation)

h.Other (May include psychological complications, future reproductive complications, or other illnesses or injuries that in the physician’s medical judgment occurred as a result of an induced abortion.  Specify diagnosis.): _______________________________

9.  Type of follow-up care, if any, recommended: ______________________

10.  Will the physician filing the Complications of Induced Abortion Report be providing such follow-up care (if not, the name of the medical professional who will, if known)? _____________________________

11.  Name and license number of physician filing the Complications of Induced Abortion Report: _________________________

Added by Laws 2010, c. 276, § 4, eff. Nov. 1, 2010.