PART 505 PREGNANCY TERMINATION REPORT CODE : Sections Listing

TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER e: VITAL RECORDS
PART 505 PREGNANCY TERMINATION REPORT CODE


AUTHORITY: Implementing and authorized by the Illinois Abortion Law of 1975 [720 ILCS 510].

SOURCE: Emergency rules adopted at 17 Ill. Reg. 13631, effective August 1, 1993, for a maximum of 150 days; adopted at 18 Ill. Reg. 533, effective December 29, 1993; amended at 37 Ill. Reg. 1744, effective January 23, 2013.

 

Section 505.10  Statutes Referenced

 

The following Illinois statutes are referenced in this Part:

 

a)         Illinois Abortion Law of 1975  [720 ILCS 510]

 

b)         Illinois Medical Practice Act of 1987  [225 ILCS 60]

 

c)         Freedom of Information Act  [5 ILCS 140]

 

d)         Medical Studies Act  [735 ILCS 5/8-2101]

 

(Source:  Amended at 37 Ill. Reg. 1744, effective January 23, 2013)

 

Section 505.20  Purpose (Repealed)

 

(Source:  Repealed at 37 Ill. Reg. 1744, effective January 23, 2013)

 

Section 505.30  Definitions

 

            "Aggregate data" means a compilation of the data received by the Department on Induced Termination of Pregnancy Reports or Reports of Subsequent Complications after an Induced Termination of Pregnancy for each data set listed, except that the following will not be included:

 

Facility name;

 

Patient's identification number;

 

Physician's license number;

 

Any set of information for which the amount is so small (e.g., 50 or fewer) that identity of any person or persons to whom it relates may be discerned;

 

Education; and

 

Race and ethnicity.

 

"Complications" means those complications resulting from an abortion which, according to contemporary medical standards, are manifested by symptoms with severity equal to or greater than hemorrhaging requiring transfusion, infection, incomplete abortion, or punctured organs.  (Section 10.1 of the Law)

 

            "Department" means the Department of Public Health, State of Illinois. (Section 2 of the Law)

 

            "Director" means the Director, or his or her designee, of the Department of Public Health, State of Illinois.

 

            "Law" means the Illinois Abortion Law of 1975.

 

            "Patient identifying information" means any information or collection or grouping of data from which the identity of the person to whom it relates may be discerned.

 

            "Physician" means any person licensed to practice medicine in all its branches under the Illinois Medical Practice Act of 1987. (Section 2 of the Law)

 

            "Pregnancy termination" means the use of any instrument, medicine, drug or other substance or any device to terminate the pregnancy of a woman known to be pregnant with an intention other than to increase the probability of a live birth, to preserve the life or health of the child after live birth, or to remove a dead fetus.  (Section 2 of the Law)

 

            "Public Use File" means a computer file of aggregate data.

 

(Source:  Amended at 37 Ill. Reg. 1744, effective January 23, 2013)

 

Section 505.40  Submission of Information

 

a)         A report of each abortion performed shall be made to the Department on forms prescribed. The report forms shall not identify the patient by name, but by an individual number to be noted in the patient's permanent record in the possession of the physician.  (Section 10 of the Act)

 

b)         A report of each diagnosis of a complication resulting from an abortion shall be made to the Department on forms prescribed.

 

c)         The Induced Termination of Pregnancy Report consists of one form prescribed and promulgated by the Department as Appendix B of this Part.  The Department will provide this form.

 

d)         All Induced Termination of Pregnancy Reports shall be submitted to the Department not later than 10 days following the end of the month in which the  pregnancy termination was performed. (Section 10 of the Law)

 

e)         The Report of Subsequent Complications after an Induced Termination of Pregnancy consists of one form prescribed and promulgated by the Department as Appendix C of this Part.  The Department will provide this form.

 

f)         The Report of Subsequent Complications after an Induced Termination of Pregnancy shall be submitted to the Department within 10 days after the complications become known by any physician who diagnoses a woman as having complications resulting from an abortion.  (Section 10.1 of the Law)

 

(Source:  Amended at 37 Ill. Reg. 1744, effective January 23, 2013)

 

Section 505.50  Availability of Information

 

a)         All Reports of Induced Pregnancy Termination and Reports of Subsequent Complications after an Induced Termination of Pregnancy will be treated as confidential and are exempt from the Freedom of Information Act.

 

b)         The Department will compile the information contained in the Reports of Induced Pregnancy Termination and issue reports of aggregate data as it deems necessary.

 

c)         The Department will compile a Public Use File upon request.  Any person or entity making a request shall pay the cost of producing the Public Use File.  If a Public Use File has already been produced and paid for, each succeeding requestor shall pay only the cost of duplicating it.

 

d)         Data compiled from the Reports of Induced Pregnancy Termination and Reports of Subsequent Complications after an Induced Termination of Pregnancy, other than the Public Use Files, will not be released outside the Department.

 

e)         The Department will disclose individual patient or facility information only to the physician who originally supplied that information to the Department, upon written request of the physician.

 

f)         The patient identifying information submitted to the Department by those entities required to submit information under the Law and this Part is to be used in the course of medical study under the Medical Studies Act.  Therefore, the information is not admissible as evidence or discoverable in any action of any kind, in any court or before any tribunal, board, agency or person.

 

(Source:  Amended at 37 Ill. Reg. 1744, effective January 23, 2013)

 

Section 505.60  Reporting Complications Resulting from Termination of Pregnancy

 

a)         Any physician who diagnoses a woman as having complications resulting from an abortion shall report, within the time period specified in this Section, the diagnosis and a summary of her physical symptoms to the Department in accordance with this Section.

 

b)         Complications resulting from an abortion are those which, according to

contemporary medical standards, are manifested by symptoms with severity

equal to or greater than hemorrhaging requiring transfusion, infection,

incomplete abortion, or punctured organs. (Section 10.1 of the Law)

 

c)         If the patient with complications returns to the facility where the induced termination of pregnancy took place, the facility shall use the same patient identification number used in the Induced Termination of Pregnancy Report when updating the original Induced Termination of Pregnancy Report or completing a Report of Subsequent Complications after an Induced Termination of Pregnancy form.

 

d)         If the patient with complications selects a different medical facility, the physician making the diagnosis shall complete the Report of Subsequent Complications after an Induced Termination of Pregnancy form. The physician completing the Report of Subsequent Complications after an Induced Termination of Pregnancy in such circumstances shall not identify the patient by name, but shall create an individual identification number for that patient to be noted in the patient's permanent record in possession of the physician. If the name or location of the facility where the abortion was performed is known, the physician shall include it on the form. (Section 10.1 of the Law)

 

e)         The Report of Subsequent Complications after an Induced Termination of Pregnancy form shall be submitted to the Department within 10 days after the diagnosis of the complication.

 

(Source:  Added at 37 Ill. Reg. 1744, effective January 23, 2013)



 

Section 505.APPENDIX A   Report of Induced Termination of Pregnancy (Repealed)

 

(Source:  Repealed at 37 Ill. Reg. 1744, effective January 23, 2013)

 

Section 505.APPENDIX B   Induced Termination of Pregnancy Report

 

INDUCED TERMINATION OF PREGNANCY REPORT

 

COMPLETE THIS FORM AND MAIL IT TO:

Illinois Department of Public Health, Division of Vital Records

925 E. Ridgely Ave., Springfield IL 62702-2737

 

(All information submitted shall be confidential pursuant to the Pregnancy Termination Report Code (77 Ill. Adm. Code 505))

 

1.         FACILITY NAME (If not ambulatory surgical treatment centers, hospitals, and other facilities, give address)

 

2.         COUNTY OF PREGNANCY TERMINATION (See County Code table)

 

3.         PATIENT IDENTIFICATION NUMBER

 

4.         REPORTING PHYSICIAN'S IDFPR LICENSE NUMBER

 

5.         PATIENT INFORMATION

 

a.         PATIENT'S RESIDENT STATE (See State Code table)

 

b.         COUNTY (See County Code table)

 

c.         ZIP CODE (Chicago only)

 

6.         RACE/ETHNICITY

 

a.         Race

 

            White

            Black or African American

            American Indian or Alaska Native (Name of the enrolled or principal tribe)

            Asian Indian

            Chinese

            Filipino

            Japanese

            Korean

            Vietnamese

            Other Asian (Specify)

            Native Hawaiian

            Guamanian or Chamorro

            Samoan

            Other Pacific Islander (Specify)

            Other (Specify)

 

b.         Hispanic Origin

 

            No, not Spanish/Hispanic/Latina

            Mexican, Mexican American, Chicana

            Puerto Rican

            Cuban

            Other Spanish/Hispanic/Latina

 

7.         AGE LAST BIRTHDAY

 

8.         MARRIED/CIVIL UNION?

 

9.         DATE OF PREGNANCY TERMINATION (Mo/Day/Year)

 

10.       EDUCATION (Specify only highest grade completed)

 

Elementary/Secondary (0-12)

College (1-4 or 5+)

 

11.       CLINICAL ESTIMATE OF GESTATION (Number of Weeks)

 

12.       PREVIOUS PREGNANCIES (Complete each section)

 

LIVE BIRTHS

 

a.         NOW LIVING (Number)

 

b.         NOW DEAD (Number)

 

OTHER TERMINATIONS

 

a.         SPONTANEOUS (Number)

 

b.         INDUCED (Number) (Do not include this termination)

 

13.       Rh DETERMINATION (Not done/Rh Pos/Rh Neg)

 

14.       IF Rh NEGATIVE, ANTI Rh (Given/Not offered to patient/Refused by patient/Medically not indicated)

 

15.       REASON FOR TERMINATION (Patient's Request/Other)

 

16.       TERMINATION PROCEDURES

 

a.         PROCEDURE THAT TERMINATED PREGNANCY (check only one)

 

            Antiprogestins (such as Mifepristone)

            Suction Curettage

            Sharp Curettage

            Dilation and Evacuation (D & E)

            Intra-Uterine Saline Instillation

            Intra-Prostaglandin Instillation

            Hysterotomy

            Hysterectomy

            Other (Specify)

 

b.         ADDITIONAL PROCEDURES USED FOR THIS TERMINATION, IF ANY

 

17.       COMPLICATIONS OF PREGNANCY TERMINATION?     Y        N   (check all that apply)

 

            Hemorrhage

            Uterine Perforation

            Anesthesia

            Retained Products

            Cervical Laceration

            Infection

            Death

Other (Specify)

 

18.       HOSPITALIZATION REQUIRED AS A RESULT OF COMPLICATION(S)?

   Y        N 

 

19.       This is a corrected version of a previously submitted form.     Y 

 

(Source:  Added at 37 Ill. Reg. 1744, effective January 23, 2013)

 

Section 505.APPENDIX C   Report of Subsequent Complications after an Induced Termination of Pregnancy

 

REPORT OF SUBSEQUENT COMPLICATIONS AFTER

AN INDUCED TERMINATION OF PREGNANCY

 

COMPLETE THIS FORM AND MAIL IT TO:

Illinois Department of Public Health, Division of Vital Records

925 E. Ridgely Ave., Springfield IL 62702-2737

 

(All information submitted shall be confidential pursuant to the Pregnancy Termination Report Code (77 Ill. Adm. Code 505))

 

1.         FACILITY NAME AND ADDRESS WHERE COMPLICATION WAS DIAGNOSED

 

2.         PATIENT IDENTIFICATION NUMBER

 

3.         REPORTING PHYSICIAN'S IDFPR LICENSE NUMBER

 

4.         PATIENT INFORMATION

 

a.         PATIENT'S RESIDENT STATE (See State Code table)

 

b.         COUNTY (See County Code table)

 

c.         ZIP CODE (Chicago only)

 

5.         RACE/ETHNICITY

 

a.         Race

 

            White

            Black or African American

            American Indian or Alaska Native (Name of the enrolled or principal tribe)

            Asian Indian

            Chinese

            Filipino

            Japanese

            Korean

            Vietnamese

            Other Asian (Specify)

            Native Hawaiian

            Guamanian or Chamorro

            Samoan

            Other Pacific Islander (Specify)

            Other (Specify)

 

b.         Hispanic Origin

 

            No, not Spanish/Hispanic/Latina

            Mexican, Mexican American, Chicana

            Puerto Rican

            Cuban

            Other Spanish/Hispanic/Latina

 

6.         AGE LAST BIRTHDAY

 

7.         MARRIED/CIVIL UNION?

 

8.         DATE OF PREGNANCY TERMINATION (Mo/Day/Year)

 

9.         COMPLICATIONS OF PREGNANCY TERMINATION (check all that apply)

 

            Hemorrhage

            Uterine Perforation

            Anesthesia

            Retained Products

            Cervical Laceration

            Infection

            Death

            Other (Specify)

 

10.       HOSPITAL ADMISSION REQUIRED ON DATE OF EXAMINATION? 

   Y        N

 

11.       FACILITY NAME OR LOCATION (IF KNOWN) WHERE THE ABORTION WAS PERFORMED

 

(Source:  Added at 37 Ill. Reg. 1744, effective January 23, 2013)