CAP. 212] Termination of Pregnancy Regulations
[Subsidiary]
[1982 Ed.
L.N. 50/82.
CONFIDENTIAL
(*Delete as appropriate)
(Ring appropriate number)
(Ring appropriate letter)
I,
of
and I.
of
FORM 2
[reg. 3.]
Not to be destroyed within five years of the date of operation
OFFENCES AGAINST THE PERSON ORDINANCE (Chapter 212)
CERTIFICATE TO BE COMPLETED IN RELATION TO THE TERMINATION OF A PREGNANCY IN EMERGENCY UNDER SECTION 47A(4) OF THE ORDINANCE
1. Name and qualifications of practitioner in block capitals;
2. Full address of practitioner;
3. Name and qualifications of practitioner in block capitals;
4. Full address of practitioner;
hereby certify that we
are* / were*
of the opinion, formed in good faith, that it
is* / was*
immediately necessary to terminate the pregnancy of
Full name of pregnant woman in block capitals
of
Usual place of residence of pregnant woman in block capitals,
in order-
1. to save the life of the pregnant woman; or
2. to prevent grave permanent injury to the physical or mental health of the pregnant woman,
This certificate of opinion is given-
A. before the commencement of the treatment for the termination of the pregnancy to which it relates;
or, if that is not reasonably practicable, then
B. not later than 24 hours after such termination.
Signed
Signed
Date
Date