Ariz. Admin. Code § 9-10-1509

Current through Register Vol. 30, No. 38, September 20, 2024

Section R9-10-1509 - Abortion Procedures

A. A medical director shall ensure that a medical evaluation of a patient is conducted before the patient's abortion is performed that includes:

1. A medical history including:

a. Allergies to medications, antiseptic solutions, or latex;

b. Obstetrical and gynecological history;

c. Past surgeries;

d. Medication the patient is currently taking; and

e. Other medical conditions;

2. A physical examination, performed by a physician that includes a bimanual examination to estimate uterine size and palpation of adnexa;

3. The following laboratory tests:

a. A urine or blood test to determine pregnancy;

b. Rh typing, unless the patient provides written documentation of blood type acceptable to the physician;

c. Anemia screening; and

d. Other laboratory tests recommended by the physician or medical director on the basis of the physical examination; and

4. An ultrasound imaging study of the fetus, performed as required in A.R.S. §§ 36-2156 and 36-2301.02(A).

B. If the medical evaluation indicates a patient is Rh negative, a medical director shall ensure that:

1. The patient receives information from a physician on this condition;

2. The patient is offered RhO(d) immune globulin within 72 hours after the abortion procedure;

3. If a patient refuses RhO(d) immune globulin, the patient signs and dates a form acknowledging the patient's condition and refusing the RhO(d) immune globulin;

4. The form in subsection (B)(3) is maintained in the patient's medical record; and

5. If a patient refuses RhO(d) immune globulin or if a patient refuses to sign and date an acknowledgment and refusal form, the physician documents the patient's refusal in the patient's medical record.

C. A physician shall estimate the gestational age of the fetus, based on one of the following criteria, and record the estimated gestational age in the patient's medical record:

1. Ultrasound measurements of the biparietal diameter, length of femur, abdominal circumference, visible pregnancy sac, or crown-rump length or a combination of these; or

2. The date of the last menstrual period or the date of fertilization and a bimanual examination of the patient.

D. A medical director shall ensure that:

1. The ultrasound of a patient required in subsection (A)(4) is performed by an individual who meets the requirements in R9-10-1506(3);

2. An ultrasound estimate of gestational age of a fetus is performed using methods and tables or charts in a publication distributed nationally that contains peer-reviewed medical information, such as medical information derived from a publication describing research in obstetrics and gynecology or in diagnostic imaging;

3. An original patient ultrasound image is:

a. Interpreted by a physician, and

b. Maintained in the patient's medical record in either electronic or paper form; and

4. If requested by the patient, the ultrasound image is reviewed with the patient by a physician, physician assistant, registered nurse practitioner, or registered nurse.

E. A medical director shall ensure that before an abortion is performed on a patient:

1. Written consent, that meets the requirements in A.R.S. § 36-2152 or 36-2153, as applicable, and A.R.S. § 36-2158 is signed and dated by the patient or the patient's representative;

2. Information is provided to the patient on the abortion procedure, including alternatives, risks, and potential complications;

3. Information specified in A.R.S. § 36-2161(A)(12) is requested from the patient; and

4. If applicable, information required in A.R.S. § 36-2161(C) is provided to the patient.

F. A medical director shall ensure that an abortion is performed according to the abortion clinic's policies and procedures and this Article.

G. A medical director shall ensure that:

1. A patient care staff member monitors a patient's vital signs throughout an abortion procedure to ensure the patient's health and safety;

2. Intravenous access is established and maintained on a patient undergoing an abortion after the first trimester unless the physician determines that establishing intravenous access is not appropriate for the particular patient and documents that fact in the patient's medical record;

3. If an abortion procedure is performed at or after 20 weeks gestational age, a patient care staff member qualified in neonatal resuscitation, other than the physician performing the abortion procedure, is in the room in which the abortion procedure takes place before the delivery of the fetus; and

4. If a fetus is delivered alive:

a. Resuscitative measures, including the following, are used to support life:

i. Warming and drying of the fetus,

ii. Clearing secretions from and positioning the airway of the fetus,

iii. Administering oxygen as needed to the fetus, and

iv. Assessing and monitoring the cardiopulmonary status of the fetus;

b. A determination is made of whether the fetus is a viable fetus;

c. A viable fetus is provided treatment to support life;

d. A viable fetus is transferred as required in R9-10-1510; and

e. Resuscitative measures and the transfer, as applicable, are documented.

H. To ensure a patient's health and safety, a medical director shall ensure that following the abortion procedure:

1. A patient's vital signs and bleeding are monitored by:

a. A physician;

b. A physician assistant;

c. A registered nurse practitioner;

d. A nurse; or

e. If a physician is able to provide direct supervision, as defined in A.R.S. § 32-1401 or A.R.S. § 32-1800, as applicable, to a medical assistant, as defined in A.R.S. § 32-1401 or A.R.S. § 32-1800, a medical assistant under the direct supervision of the physician; and

2. A patient remains in the recovery room or recovery area until a physician, physician assistant, registered nurse practitioner, or nurse examines the patient and determines that the patient's medical condition is stable and the patient is ready to leave the recovery room or recovery area.

I. A medical director shall ensure that follow-up care:

1. For a surgical abortion is offered to a patient that includes:

a. With a patient's consent, a telephone call made to the patient to assess the patient's recovery:

i. By a patient care staff member other than a surgical assistant; and

ii. Within 24 hours after the patient's discharge following a surgical abortion; and

b. A follow-up visit scheduled, if requested, no more than 21 calendar days after the abortion that includes:

i. A physical examination,

ii. A review of all laboratory tests as required in subsection (A)(3), and

iii. A urine pregnancy test;

2. For a medication abortion includes a follow-up visit, scheduled between seven and 21 calendar days after the initial dose of a substance used to induce an abortion, that includes:

a. A urine pregnancy test, and

b. An assessment of the degree of bleeding; and

3. Is documented in the patient's medical record, including:

a. A patient's acceptance or refusal of a follow-up visit following a surgical abortion;

b. If applicable, the results of the follow-up visit; and

c. If applicable, whether the patient consented to a telephone call and, if so, whether the patient care staff member making the telephone call to the patient:

i. Spoke with the patient about the patient's recovery, or

ii. Was unable to speak with the patient.

J. If a continuing pregnancy is suspected as a result of the follow-up visit in subsection (I)(1)(b) or (I)(2), a physician who performs abortions shall be consulted.

Ariz. Admin. Code § R9-10-1509

Adopted effective August 6, 1993, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1993, Ch. 163, Section 3(B). Repealed effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, §17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). New Section adopted effective April 1, 2000, under an exemption from the provisions of the Arizona Administrative Procedure Act pursuant to Laws 1999, Chapter 311; filed with the Office of the Secretary of State December 23, 1999 at 6 A.A.R. 351 (Supp. 99-4). Amended by exempt rulemaking at 20 A.A.R. 448, effective 4/1/2014. Renumbered from R9-10-1508 by final rulemaking at 24 A.A.R. 3020, effective 10/2/2018. Amended by final expedited rulemaking at 25 A.A.R. 1893, effective 7/2/2019.