A. No abortion-inducing drug shall be provided without the informed consent of the pregnant woman as described in this section to whom the abortion-inducing drug is provided. B. Informed consent to a chemical abortion shall be obtained at least seventy-two (72) hours before the abortion-inducing drug is provided to the pregnant woman, except if in reasonable medical judgment, compliance with this subsection would pose a greater risk of: 1. The death of the pregnant woman; or 2. The substantial and irreversible physical impairment of a major bodily function not including psychological or emotional conditions, of the pregnant woman. C. A form created by the State Department of Health shall be used by a qualified physician to obtain the consent required prior to providing an abortion-inducing drug. D. A consent form is not valid and consent is not sufficient, unless: 1. The patient initials each entry, list, description or declaration required to be on the consent form as detailed in paragraphs 1 through 6 of subsection E of this section; 2. The patient signs the "consent statement" described in paragraph 11 of subsection E of this section; and 3. The qualified physician signs the "qualified physician declaration" described in paragraph 12 of subsection E of this section. E. The consent form shall include, but is not limited to, the following: 1. The probable gestational age of the unborn child as determined by both patient history and by ultrasound results used to confirm gestational age; 2. A detailed description of the steps to complete the chemical abortion; 3. A detailed list of the risks related to the specific abortion-inducing drug or drugs to be used including, but not limited to, hemorrhaging, failure to remove all tissue of the unborn child which may require an additional procedure, sepsis, sterility and possible continuation of pregnancy; 4. Information about Rh incompatibility including that if she has an Rh-negative blood type, she should receive an injection of Rh immunoglobulin at the time of the abortion to prevent Rh incompatibility in future pregnancies; 5. That the risks of complications from a chemical abortion including incomplete abortion, increase with advancing gestational age; 6. That it may be possible to reverse the effects of the chemical abortion should she change her mind, but that time is of the essence; 7. That she may see the remains of her unborn child in the process of completing the abortion; 8. That initial studies suggest that children born after reversing the effects of Mifeprex/mifepristone have no greater risk of birth defects than the general population; 9. That initial studies suggest there is no increased risk of maternal mortality after reversing the effects of Mifeprex/mifepristone; 10. That information on and assistance with reversing the effects of abortion-inducing drugs are available in the state- prepared materials; 11. An "acknowledgment of risks and consent statement" which shall be signed by the patient. The statement shall include, but is not limited to, the following declarations, which shall be individually initialed by the patient: a. that the patient understands that the abortion- inducing drug regimen or procedure is intended to end her pregnancy and will result in the death of her unborn child, b. that the patient is not being forced to have an abortion, that she has the choice not to have the abortion and that she may withdraw her consent to the abortion-inducing drug regimen even after she has begun the abortion-inducing drug regimen, c. that the patient understands that the chemical abortion regimen or procedure to be used has specific risks and may result in specific complications, d. that the patient has been given the opportunity to ask questions about her pregnancy, the development of her unborn child, alternatives to abortion, the abortion- inducing drug or drugs to be used and the risks and complications inherent to the abortion-inducing drug or drugs to be used, e. that she was specifically told that "Information on the potential ability of qualified medical professionals to reverse the effects of an abortion obtained through the use of abortion-inducing drugs is available at www.abortionpillreversal.com, or you can contact (877) 558-0333 for assistance in locating a medical professional that can aide in the reversal of an abortion.", f. that she has been provided access to state-prepared, printed materials on informed consent for abortion and the state-prepared and maintained website on informed consent for abortion, g. if applicable, that she has been given the name and phone number of the associated physician who has agreed to provide medical care and treatment in the event of complications associated with the abortion- inducing drug regimen or procedure, h. that the qualified physician will schedule an in- person follow-up visit for the patient at approximately seven (7) to fourteen (14) days after providing the abortion-inducing drug or drugs to confirm that the pregnancy is completely terminated and to assess the degree of bleeding and other complications, and i. that the patient has received or been given sufficient information to give her informed consent to the abortion-inducing drug regimen or procedure, and j. that the patient has a private right of action to sue the qualified physician under the laws of this state if she feels that she has been coerced or misled prior to obtaining an abortion, and how to access state resources regarding her legal right to obtain relief; and 12. A "qualified physician declaration", which shall be signed by the qualified physician, stating that the qualified physician has explained the abortion-inducing drug or drugs to be used, has provided all of the information required in subsection E of this section, and has answered all of the woman's questions.
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