PURPOSE: The Department of Health under sections 188.052 and 188.055, RSMo 1986 is given the responsibility to provide abortion forms to health facilities and physicians. This rule establishes the content of the report of induced termination of pregnancy to be filed with the Department of Health for statistical purposes.

1. (1) The report of induced termination of pregnancy will include the following items: name of abortion facility or hospital; the city, town or location of the abortion facility or hospital; county where the abortion facility or hospital is located; patient identification number; age of patient; marital status of patient; date of pregnancy termination; residence of patient state, county, city or town, inside city limits (yes or no) and zip code; patient’s race; patient’s education; previous pregnancy history; number of live births now living; number of live births now dead; number of spontaneous terminations and number of induced terminations; type of termination procedures used; complications of pregnancy termination; date last normal menses began; physician’s estimate of gestation; signature of attending physician; physician’s Missouri license number; and name of person completing report.

AUTHORITY: sections 188.052, 188.055, 191.420 and 192.020, RSMo 1986. This rule was previously filed as 13 CSR 50-151.010 and 19 CSR 30-15.010. Original rule filed Sept. 30, 1980, effective Jan. 12, 1981. Changed to 19 CSR 10-15.010 July 30, 1998.