The Medical Termination of Pregnancy Regulations, 2003
Published vide Notification G.S.R. 486(E), dated 13.6.2003, published in the Gazette of India, Extraordinary, Part 2, Section 3(i), dated 13.6.2003
(a) “Act” means the Medical Termination of Pregnancy Act, 1971 (34 of 1971);
(b) “Admission Register” means the register maintained under regulation 5;
(c) “Chief Medical Officer” means the Chief Medical Officer of a District by whatever name called;
(d) “Form” means a form appended to these regulations;
(e) “Hospital” means a hospital established or maintained by the Central Government or the Government of Union Territory;
(f) “section” means a section of the Act.
I_______________________________________________________________________(Name
and qualifications of the Registered Medical practitioner in block letters)
________________________________________________________________________(Full
address of the Registered Medical practitioner)
I_______________________________________________________________________
(Name and qualifications of the Registered Medical practitioner in block
letters)
________________________________________________________________________ (Full
address of the Registered Medical practitioner) hereby certify that *I/We
am/are of opinion, formed in good faith, that it is necessary to terminate the
pregnancy of
________________________________________________________________________ (Full
name of pregnant women in block letters) resident of
________________________________________________________________________ (Full
address of pregnant women in block letters) for the reasons given below**.
*I/We hereby give intimation that *I/We terminated the pregnancy
of the woman referred to above who bears the serial No. _______________ in the
Admission Register of the hospital/approved place.
Place :
Date :
                                                                                                                                                                                  Signature of the registered Medical Practitioner
                                                                                                                                                                                 Signature of the registered Medical Practitioners
*Strike out whichever is not applicable,
**of the reasons specified items (i) to (v) write the one which is appropriate.
(i) in order to save the life of the pregnant women,
(ii) in order to prevent grave injury to the physical and mental health of the pregnant women,
(iii) in view of the substantial risk that if the child was born it would suffer from such physical or mental abnormalities as to be seriously handicapped,
(iv) as the pregnancy is alleged by pregnant women to have been caused by rape,
(v) as the pregnancy has occurred as result of failure of any contraceptive device or methods used by married woman or her husband for the purpose of limiting the number of children.
Note : Account may be taken of the pregnant women’s actual or reasonably foreseeable environment in determining whether the continuance of her pregnancy would involve a grave injury to her physical or mental health.
Place :
Date :
                                                                                                                                                            Signature of the Registered Medical Practitioner/Practitioner
                                                                                                    Form II
                                                                                                [See regulation 4(5)]
1. Name of the State
2. Name of the Hospital/approved place
3. Duration of pregnancy (give total No. only)
(a) Up to 12 weeks.
(b) Between 12 – 20 weeks
4. Religion of woman
(a) Hindu
(b) Muslim
(c) Christian
(d) Others
(e) Total
5. Termination with acceptance of contraception.
(a) Sterilisation.
(b) I.U.D.
6. Reasons for termination :
(give total number under each sub-head)
(a) Danger to life of the pregnant woman.
(b) Grave injury to the physical health of the pregnant woman.
(c) Grave injury to the mental health of the pregnant woman.
(d) Pregnancy caused by rape.
(e) Substantial risk that if the child was born, it would suffer from such physical or mental abnormalities as to be seriously handicapped.
(f) Failure of any contraceptive device or method.
                                                                  Signature of the Officer Incharge with Date.
                                                                                        (See regulation 5)
                                                                                         Admission Register
                                            (To be destroyed on the expiry of five years from the dated of the last entry in the Register)
1.
2.
3.
4.
5.
6.
7.
S.No
Date of Admission
Name of the Patient
Wife/Daughter of
Age
Religion
Address
8.
9.
10.
11.
12.
13.
14.
Duration of Pregnancy
Reasons on which Pregnancy is terminated
Date of termination of Pregnancy
Date of discharge of patient
Result and Remarks
Name of Registered Medical Practitioner (s)
by who the opinion is formed
Name of Registered Medical Practitioner (s)
by whom Pregnancy is terminated
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