documentaion MTP

REGD. No. D. L.-33002/99 GOVERNMENT OF INDIA Delhi Gazette SG-DL-E-20012024-251544 EXTRAORDINARY PUBLISHED BY AUTHORITY No. 29] DELHI, THURSDAY, JANUARY 18, 2024/PAUSHA 28, 1945 [N. C. T. D. No. 398 PART IV GOVERNMENT OF THE NATIONAL CAPITAL TERRITORY OF DELHI 451 DG/2024 DIRECTORATE OF FAMILY WELFARE (Department of Health and Family Welfare) NOTIFICATION Delhi, the 18th January, 2024 F. 6(1012)/MH/DFW/2021-22/581-608 .—Pursuant to the provisions of the Medical Termination of pregnancy (Amendment) Act, 2021, read with the letter, dated 20th December, 2021 of the Ministry of Health and family Welfare, Government of India. The Lieutenant Governor of the National Capital Territory of Delhi is pleased to notify the updated formats, i.e. Form-I, Form -II and Form- III (Copies Enclosed) for the documentation of MTP as per the mandate of the Law. This notification shall come into force from the date of its publication in the official Gazette. By Order and in the Name of the Lt. Governor of National Capital Territory of Delhi, S. SUNIL, Dy. Secy. FORM I RMP Opinion Form (For gestation age upto twenty weeks) [See Regulation 3] (Name and qualifications of the Registered Medical Practitioner in block letters) (Full address of the Registered Medical Practitioner) hereby certify that I am of opinion, formed in good faith, that it is necessary to terminate the pregnancy of (Full name of pregnant woman in block letters) resident of (Full address of pregnant woman in block letters) for the reasons given below*. I hereby give intimation that I 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 *of the reasons specified items (a) to (e) write the one which is appropriate: a. in order to save the life of the pregnant women, b. in order to prevent grave injury to the physical and mental health of the pregnant woman, c. 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, d. as the pregnancy is alleged by pregnant woman to have been caused by rapе, e. as the pregnancy has occurred as a result of failure of any contraceptive device or methods used by a woman or her partner for the purpose of limiting the number of children or preventing pregnancy. Note: Account may be taken of the pregnant woman'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 FORM II [ Refer Regulation 4(5) ] Month & Year: .......................... 1. Name of the State: 2. Name of Hospital/approved place: 3. Duration of pregnancy: (Give total number only under each sub-head) (a) Upto 9 weeks (Medical Methods of Abortion Only): (b) Upto 12 weeks (Surgical Methods of Abortion Only): (c) Between 12-20 weeks: (d) Between 20-24 weeks: (e) Beyond 24 weeks: 4. Religion of woman: (Give total number under each sub-head) (a) Hindu: (b) Muslim: (c) Christian: (d) Others: 5. Termination with acceptance of contraception: (Give total number under each sub-head) (a) Sterilization: (b) IUCD: (c) OCP/Injectable Contraceptive: (d) Others: 6. Reasons for termination: (Give total number under each sub-head) A. Up to 20 weeks of gestation (a) Danger to the life of the pregnant woman: (b) Grave injury to the physical and mental health of the pregnant woman: (c) Pregnancy caused by rape: (d) Substantial risk that if the child was born, it would suffer from such physical or mental abnormalities as to be seriously handicapped: (e) Failure of any contraceptive device or method: B. Between 20-24 weeks of gestation (a) Survivors of Sexual Assault/Rape/Incest: (b) Minors: (c) Change of marital status during the ongoing pregnancy (widowhood and divorce): (d) Women with physical disabilities [major disability as per criteria laid down under the Rights of Persons with Disabilities Act, 2016 (49 of 2016)]: (e) Mentally ill women including mental retardation: (f) The foetal malformation that has substantial risk of being incompatible with life or if the child is born it may suffer from such physical or mental abnormalities to be seriously handicapped: (g) Women with pregnancy in humanitarian settings or disasters or emergency situations as declared by Government: C. Beyond 24 weeks of gestation (a) The foetal malformation that has substantial risk of being incompatible with life or if the child is born it may suffer from such physical or mental abnormalities to be seriously handicapped: FORM III [ Refer Regulation 5] Admission Register (To be destroyed on the expiry of five years from the date of the last entry in the Register) Name of Facility: Month Year +-----+-----------+--------------+------------+-----+----------+-----------+---------------------+---------------------+---------------+--------------+------------+-----------------------------------------------------------------------------------------------------+--------------------------------------------------------------------+----------------------------------------+----------------------------------------------------------------+ | S. | Date of | Name of | Wife/ | Age | Religion | Address | Duration of | Reasons on | Date of | Date of | Result & | Name of Registered Medical Practitioner(s) by whom opinion formed (for >24 weeks, Medical Board | Name of Registered Medical Practitioner(s) by whom Pregnancy is | Method of MTP | Post Abortion Contraception (TL/IUCD/OCP/Injectables/Others/ | | No. | Admission | the Patient | Daughter | | | | Pregnancy | which Pregnancy | termination | discharge | Remarks | members) | terminated | (MVA/EVA/MMA/D&C/Others) | None) | | | | | of | | | | | is terminated | | of patient | | | | | | +=====+===========+==============+============+=====+----------+-----------+---------------------+---------------------+===============+============+============+=====================================================================================================+====================================================================+========================================+================================================================+ | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | +-----+-----------+--------------+------------+-----+----------+-----------+---------------------+---------------------+---------------+--------------+------------+-----------------------------------------------------------------------------------------------------+--------------------------------------------------------------------+----------------------------------------+----------------------------------------------------------------+ | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | +-----+-----------+--------------+------------+-----+----------+-----------+---------------------+---------------------+---------------+--------------+------------+-----------------------------------------------------------------------------------------------------+--------------------------------------------------------------------+----------------------------------------+----------------------------------------------------------------+ Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064 and Published by the Controller of Publications, Delhi-110054.