Right to Know Act Consent
Under the Woman's Right to Know Act of 2005, all women must be provided
access to certain information prior to an abortion, except for medical
emergencies that place a woman at risk for death or organ malfunction.
This requirement applies to all abortions, including those for medical
cause, and for women of all ages.
It is recommended that procedures be adopted by the practitioner's office
to incorporate this information step in standard consent procedures.
Such consent statements should be made a part of the patient record,
either by including this language into existing consent procedures and
materials or by creating a separate form.
The following language reflects the stipulations of the consent requirement,
but it can be adapted to the particular setting of the practice.
The undersigned hereby acknowledges that she has been advised of the
following rights and information pursuant to the provisions of the Official
Code of Georgia Annotated (O.C.G.A.) §31-9A-3:
1. The medical risks associated with the procedure to be performed.
2. The probable gestational age of the fetus at the time this procedure
is to be performed.
3. The medical risks associated with carrying the pregnancy to term.
4. Medical assistance benefits may be available for prenatal care,
childbirth, and neonatal care.
5. That the father may be liable to assist with support of the child.
6. The right to review information available in writing or via the state
sponsored web-site pursuant to O.C.G.A. ¤31-9A-3(2) (C).
The following link will enable you to access information about abortion
provided by the state of Georgia Department of Human Resources Division
of Public Health. http://health.state.ga.us/wrtk/
If you have any questions about this requirement, please call us at (800)
282-1046 or (404) 892-8608
Patient Signature | Date
Witness Signature | Date