How to Comply with the Michigan 24 Hour Abortion Consent Law

Please read the information below to ensure you are printing proper legal form.

The Michigan 24 Hour Abortion Consent Law, also known as the Informed Consent Law, states that ALL people in the state of Michigan choosing to have an abortion must schedule an abortion appointment and receive specific state mandated verbal and printed material about pregnancy, parenting and abortion MORE THAN 24 HOURS BEFORE the abortion procedure will occur.

Scheduling and providing the verbal information may occur over the phone. The written information may be received in person, via the Internet, or faxed to a location where the patient is present.

If you are obtaining the printed information from the internet, you must print the Informed Consent Confirmation Form more than 24 hours before your scheduled appointment date and time, and bring this form with you to your appointment. The Informed Consent Confirmation Form is the only form accepted by the state of Michigan, and it will have 3 dates and times on it:

• The date/time you are printing the form
• The date/time it becomes valid (24 hours after printing it)
• The date/time it expires (2 weeks after printing it)

If the form you’ve printed does not have these 3 date/time stamps, it is not valid and will not be accepted. An example of the correct form, as well as instructions on how to obtain it, is provided below. After printing the form, check the dates and times to ensure it will be valid for your scheduled appointment. Click here to begin reviewing the documents.

EXAMPLE OF THE CORRECT FORM

(THIS IS ONLY TO SHOW YOU WHAT THE CORRECT FORM LOOKS LIKE; YOU MUST CLICK THE LINK ABOVE TO PRINT YOUR OWN FORM)

Informed Consent Confirmation Form

Michigan Department of Community Health

In order to comply with Public Act 345 of 2000 (PA 345), you must print this page and present it to the physician or other qualified person assisting the physician.

This is the only way to legally verify you have reviewed the state approved information through this website.

I, _____________________________, voluntarily and willfully hereby authorize Dr. __________________ (“the physician”) and any assistant designated by the physician to perform upon me the following operation(s) or procedure(s):

__________________________________________________________ (Name of operation(s) or procedure(s))

1. I understand that I am approximately _____ weeks pregnant. I consent to an abortion procedure to terminate my pregnancy. I understand that I have the right to withdraw my consent to the abortion procedure at any time before performance of that procedure.
2. I understand that it is illegal for anyone to coerce me into seeking an abortion.
3. I acknowledge that at least 24 hours before the scheduled abortion I have received a physical copy of each of the following:
   1. A medically accurate depiction, illustration, or photograph of a fetus at the probable gestational age of the fetus I am carrying.
   2. A written description of the medical procedure that will be used to perform the abortion.
   3. A prenatal care and parenting information pamphlet.
   4. If any of the documents listed in paragraph C were transmitted by facsimile, I certify that the documents were clear and legible.
   5. I acknowledge that the physician who will perform the abortion has orally described all of the following to me:
   6. The specific risk to me, if any, of the complications that have been associated with the procedure I am scheduled to undergo.
   7. The specific risk to me, if any, of the complications if I choose to continue the pregnancy.
   8. I acknowledge that I have received all of the following information:
   9. Information about what to do and whom to contact in the event that complications arise from the abortion.
   10. Information pertaining to available pregnancy related services.
   11. I have been given an opportunity to ask questions about the operation(s) or procedure(s).
   12. I certify that I have not been required to make any payments for an abortion or any medical service before the expiration of 24 hours after I received the written materials listed in paragraph C, or 24 hours after the time and date listed on the confirmation form if the information described in paragraph C was viewed from the state of Michigan internet website.

Utilizing this form, an abortion cannot take place prior to Tuesday, July 19, 2016 at 11:51:11 AM Eas.

To verify compliance with the 24-hour notification requirement of PA 345, this form shall be presented to the physician or a person assisting the physician and made part of the patient’s medical record.

This specific form is valid only through Wednesday, August 3, 2016.

I certify that I have reviewed the web site information on Monday, July 18, 2016

________________________________

Patient

INSTRUCTIONS

This legislation was originally proposed and passed in 1999 by Michigan anti-abortion groups and legislators. Those who wish to receive the state mandated written information over the Internet must visit the Michigan Department of Health and Human Services website to review the materials, print up the “Informed Consent Confirmation Form”, and bring it to their appointment!

When you go to the Michigan Department of Health and Human Services website you must review five sections of information and print the Informed Consent Confirmation Form to satisfy the law.

Section #1  Michigan’s Coercive Abortion Prevention Law Information for Patients                                  Review this material then select “Click here to review Abortion Procedure information” 

Section #2  Abortion Procedures
These are basic descriptions of abortion procedures which do not fully reflect the actual process at each individual clinic; therefore, do not fully rely on these explanations in order to prepare yourself for your visit to our office. You must choose and review at least one procedure.

Follow this guideline:

• If your pregnancy is estimated to be between 4 and 10 weeks, we recommend that you review “Suction Curettage” and “Medical Abortion Using Mifepristone and Misoprostol”. 
• If your pregnancy is estimated to be between 11 and 14 weeks, we recommend that you review “Suction Curettage” and “Dilation and Evacuation” (D&E).     
• If your pregnancy is estimated to be between 15 and 22 weeks, we recommend that you review “Dilation and Evacuation” (D&E).      

Review this material then select “Click Here to go to Fetal Development Page (Step 2 of 5)”

Section #3   Fetal Development
Click on the number of weeks closest to your length of pregnancy. Please note that the stages of fetal development presented go beyond the legal 24 week limit for abortion in the state of Michigan. This means that the fetal pictures labeled “Week 26” and “Week 28” are not relevant to abortion.

Select “Click Here to go to Pre-Natal Care Page (Step 3 of 5)”

Section #4  Prenatal Care
Review this material then select “Click here to go to Parenting Page (Step 4 of 5)”

Section #5  Parenting
Review this material then select “Click here to go to Informed Consent Confirmation Form (Step 5 of 5)”

After you finish reviewing the five sections, you must print the page immediately following the parenting section which is titled the “Informed Consent Confirmation Form”

This form is the only valid proof that you satisfied the 24 hour written requirements on the Internet so if you do not bring it or you bring the wrong page, we will have to reschedule your appointment.

If you have access to the Internet but do not have a working printer, you MAY NOT save the page to print out at another computer. The program is formatted to leave vital information off the page and an incomplete page is not satisfactory.

If you have to reschedule your appointment for any reason, make sure your form will not be expired on your new appointment date. You may always revisit the website to print another, just make sure you print it more than 24 hours before your scheduled appointment time.

Click Here For: MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES website now!

If clicking on the above link fails to connect you to the state website, please go directly to www.michigan.gov.

When you reach their home page, choose “State Departments” on the top bar, and then scroll part way down the page and select “Health and Human Services”. Once the Health and Human Services page appears, choose “Adult & Children’s Services”, then click on “Informed Consent for Abortion”. From there, click on “Michigan’s Informed Consent for Abortion Law” then scroll down and select “Click Here to Begin Review of Documents”.

This will take you to Section #1 as described above. Go through each section to get to the “Informed Consent Confirmation Form”.

Don’t forget to print the “Informed Consent Confirmation Form” and bring it to your appointment!

If you have any other difficulties accessing this information please contact our office and we will do our best to assist you.