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(14) Summary of instructions given for followup observation and <br />care as well as recording of all referrals for counseling, family planning <br />or other medical conditions requiring further attention. <br />(15) Identification of the physician who actually discharges the <br />patient. <br />(c) Medical records shall be available for survey and review of <br />content at any time by authorized members of the Department. <br />(d) Medical records shall be maintained as confidential documents <br />with the following exceptions: <br />(1) Information required under these rules. <br />(2) Information required by law. <br />(3) Information authorized for disclosure by written release by the <br />patient. <br />(e) A facility in which abortions are performed shall maintain <br />records of the procedures, and shall file reports and furnish statistical and <br />such other information as may be required by the Director. The Director <br />shall take adequate measures to protect the confidentiality of identity of <br />the patient from the public. <br />There shall be reported on forms provided by the Director which <br />shall include at a <br />minimum the following information: <br />(1) Name and address of the facility. <br />(2) Patient number, with the identity of the patient to be kept <br />separate from the patient number on public records. <br />(3) Date of abortion. <br />(4) Zip code of residence of pregnant female. <br />(5) Age of pregnant female, and impregnating male, if known. <br />(6) Race. <br />(7) Marital status of pregnant female, and impregnating male, if <br />known. <br />(8) Number of previous pregnancies. <br />(9) Years of education. <br />(10) Number of living children. <br />(11) Number of previous induced abortions, spontaneous abortions <br />and still- births. <br />(12) Date of last induced abortion. <br />(13) Date of last live birth and health of such child at birth. <br />(14) Date of beginning of last menstrual period. <br />(15) Stated reason for abortion. <br />(16) Medical condition of female at time of abortion. <br />(17) Blood type and RH type. <br />(18) Type of abortion procedure. <br />(19) Medical indication for abortion, if any. <br />(20) Complications noted if any from previous or present <br />termination procedures. <br />(21) All certifications required by this chapter. <br />The report shall be signed in each instance by the physician <br />performing the procedure. <br />14 <br />