A 8
[Subsidiary]
L.N. 50/82.
CAP. 212] Termination of Pregnancy Regulations
FORM 3
INT889
CONFIDENTIAL
OFFENCES AGAINST THE PERSON ORDINANCE
(Chapter 212)
HEALTH
[1982 Ed.
NOTIFICATION TO THE Director of MEDICAL SERVICES
OF THE TERMINATION OF A PREGNANCY UNDER SECTION 47A OF THE ORDINANCE
A.
I
(To be completed in all cases)
(Name and qualifications of practitioner in block capitals;
of
(Full address of practitioner,
hereby give notice that I terminated the pregnancy of
of
at
on
• Full name of pregnant woman in block capitals:
Usual place of residence of pregnant woman in block capitals:
(date) at
(reg. 4.)
(time).
B.
(To be completed in all cases)
(Ring appropriate number)
C.
(To be completed only in emergency cases)
The termination of the pregnancy was certified as necessary because-----
1.
2.
3.
the continuance of the pregnancy would have involved risk to the life of the pregnant woman greater than if the pregnancy were terminated:
the continuance of the pregnancy would have involved risk of injury to the physical or mental health of the pregnant woman greater than if the pregnancy were terminated:
there was a substantial risk that if the child had been born, it would have suffered from such physical or mental abnormality as to be seriously handicapped.
IN CASE OF EMERGENCY where the termination of pregnancy is not carried out in a hospital or clinic maintained by the Crown or in an approved hospital or clinic
The termination of the pregnancy was certified as immediately necessary-
(Ring appropriate number)
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.
The circumstances giving rise to the emergency and relating to the termination of the pregnancy were--
Include details of the pregnant woman's medical condition