Michigan Department of Community Health
In order to comply with Public Act 345 of 2000 (PA 345), you must print this page and present it to the physician or other qualified person assisting the physician.
This is the only way to legally verify you have reviewed the state approved information through this website.
Pursuant to Public Act 345 of 2000 (P.A. 345), an individual is required to receive a physical copy, or view from the Department's web site, the following Department-approved information at least 24 hours prior to an abortion:
- A written summary of the abortion procedure
- A medically accurate depiction, illustration or photograph of a fetus at a gestational age nearest the probable gestational age of the patient's fetus.
- Prenatal care and parenting information or pamphlets.
This form confirms that you have been presented the above listed legal requirements of PA 345 through the Department web site on
Sunday, February 12, 2012 at 05:09:43 PM EST
Utilizing this form, an abortion cannot take place prior to
at 05:09:43 PM EST.
To verify compliance with the 24-hour notification requirement of PA 345, this form shall be presented to the physician or a person assisting the physician and made part of the patient's medical record.
This specific form is valid only through
at 05:09:43 PM EST.
I certify that I have reviewed the web site information on
Sunday, February 12, 2012
Patient
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