Rule 420-5-1-AA
Ala. Admin. Code r. 420-5-1-AA
Appendix A
Effective Nov 24, 2014New Rule: Filed April 17, 2003; effective May 22, 2003. Amended: Filed September 18, 2003; effective October 23, 2003. Amended: Filed January 22, 2004; effective February 26, 2004. Amended: Filed October 20, 2014; effective November 24, 2014.Alabama Department of Public Health
Attachment to420-5-1-.03
NOTICE TO ALL PATIENTS
Alabama law provides that abortions may be performed only with the voluntary and informed consent of the patient. This form (front and back) is important to ensure that you have been provided all the information you need to make a fully informed decision. Please complete the form truthfully and accurately.
| CERTIFICATION OF OPPORTUNITY TO VIEW ULTRASOUND I certify that Dr._____________________________, who is the referring physician or the physician who is to perform the abortion, has performed an ultrasound of my unborn child. I certify that I have been offered the opportunity to see this ultrasound and (check only one): ____ I have reviewed the ultrasound before the abortion. OR ____ I rejected the opportunity to view the ultrasound before the abortion. _____________________________ ________________________ Signature of Patient Date |
Author: Rick Harris, Walter T. Geary, J., M.D.
Statutory Authority: Code of Ala. 1975, §§22-21-20, et seq.
History: New Rule: Filed April 17, 2003; effective May 22, 2003. Amended: Filed September 18, 2003; effective October 23, 2003. Amended: Filed January 22, 2004; effective February 26, 2004. Amended: Filed October 20, 2014; effective November 24, 2014.