34-23A-34. Physician's reporting form--Contents. The Department of Health shall prepare a reporting form for physicians which shall provide for the collection of the following information:

(1) The month, day, and year of the induced abortion;

(2) The method of abortion used for each induced abortion;

(3) The approximate gestational age, in weeks, of the unborn child involved in the abortion;

(4) The age of the mother at the time of the abortion and, if the mother was younger than sixteen years of age at the time the child was conceived, the age of the father, if known;

(5) The specific reason for the induced abortion, including the following:

(a) The pregnancy was a result of rape;

(b) The pregnancy was a result of incest;

(c) The mother could not afford the child;

(d) The mother did not desire to have the child;

(e) The mother's emotional health was at risk;

(f) The mother would suffer substantial and irreversible impairment of a major bodily function if the pregnancy continued;

(g) Other, which shall be specified;

(6) Whether the induced abortion was paid for by:

(a) Private insurance;

(b) Public health plan;

(c) Other, which shall be specified;

(7) Whether coverage was under:

(a) A-fee-for-service insurance company;

(b) A managed care company; or

(c) Other, which shall be specified;

(8) A description of the complications, if any, for each abortion and for the aftermath of each abortion;

(9) The fee collected for performing or treating the abortion;

(10) The type of anesthetic, if any, used for each induced abortion;

(11) The method used to dispose of fetal tissue and remains;

(12) The specialty area of the physician;

(13) Whether the physician performing the induced abortion has been subject to license revocation or suspension or other professional sanction;

(14) The number of previous abortions the mother has had;

(15) The number of previous live births of the mother, including both living and deceased;

(16) The date last normal menses began for the mother;

(17) The name of physician performing the induced abortion;

(18) The name of hospital or physician office where the induced abortion was performed;

(19) A unique patient number that can be used to link the report to medical report for inspection, clarification, and correction purposes but that cannot, of itself, reasonably lead to the identification of any person obtaining an abortion;

(20) Certain demographic information including:

(a) State, county, and city of occurrence of abortion;

(b) State, county, and city of residence of mother;

(c) Marital status of mother;

(d) Education status of mother;

(e) Race of mother;

(21) Certain Rhesus factor (Rh) information including:

(a) Whether the mother received the Rh test;

(b) Whether the mother tested positive for the Rh-negative factor;

(c) Whether the mother received a Rho(D) immune globulin injection;

(22) The sex of the unborn child and the following information:

(a) Whether the pregnant mother used a sex-determining test;

(b) What type of sex-determining test the pregnant mother used; and

(c) The approximate gestational age of the unborn child, in weeks, when the test was taken;

(23) The post-fertilization age of the unborn child and the following information:

(a) How the post-fertilization age was determined or if a determination was not made, the basis of the determination that an exception existed;

(b) Whether an intra-fetal injection was used in an attempt to induce fetal demise;

(c) If the unborn child was deemed capable of experiencing pain, pursuant to § 34-23A-70, the basis of the determination that it is a medical emergency;

(d) If the unborn child was deemed capable of experiencing pain pursuant to § 34-23A-70, whether the method of the abortion used was that, in reasonable medical judgment, provided the best opportunity for the unborn child to survive and, if such a method was not used, the basis of the determination that termination of the pregnancy in that manner would pose a greater risk either of the death of the pregnant woman or of the substantial and irreversible physical impairment of a major bodily function, not including a psychological or emotional condition, of the woman than other available methods.Source: SL 1998, ch 209, § 1; SL 2004, ch 234, § 1; SL 2014, ch 168, § 5; SL 2016, ch 180, § 7.