DEPARTMENT OF HEALTH
ABORTION FACILITIES
INFORMED CONSENT FORM
Chapter 44:67:04
APPENDIX A
See: 44:67:04:12
Source: 46 SDR 65, effective November 26, 2019; 48 SDR 59, effective December 5, 2021.
This medication can be taken up to 9 weeks after conception. The woman is given Mifepristone to be taken by mouth. After a period of time in the doctor's office, she may return home. At 24 - 72 hours after this dose, the woman returns to receive the proper amount of misoprostol.
The client should then be watched closely by doctors and nurses for a few hours. The fetus, placenta and membranes are usually expelled during this time. The woman should return to the doctor's office on the 14th day after taking the medication to assure that there are no problems and that the fetus, placenta and membranes have been fully expelled.
On [date], at [time of day), I,
[signature of pregnant woman], certify that I read and I understand the above disclosures on this page.
Any clarifications, explanations, or answers to my questions were provided to me in writing to my satisfaction.
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Discontinuation of Drug Induced Abortion
Even after a pregnant mother takes Mifepristone, or another drug approved by the United States Food and Drug Administration for the same use, it is still possible to discontinue a drug- induced abortion by not taking the prescribed Misoprostol. Information is available on the Department of Health website http://doh.sd.gov/abortion/. For more specific information, please contact your physician or medical provider.
On [date], at [time of day), I,
[signature of pregnant woman], certify that I read and I understand the above disclosures on this page.
Any clarifications, explanations, or answers to my questions were provided to me in writing to my satisfaction.
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1-g) The statistically significant medical risk associated with carrying her child to term compared to undergoing an induced abortion ― In an otherwise healthy woman, carrying a baby to term is usually a safe, healthy process for the mother. Based on data from the CDC, the following are some common maternal health conditions or problems a woman may experience during pregnancy: anemia, urinary tract infections, depression, hypertension, diabetes, obesity, infections, and Hyperemesis Gravidarum (a severe form of nausea and vomiting in pregnancy). To compare those risks to the risks of abortion, please refer to 1-e above, which sets out the risk factors presented by abortion to the mother. In regards to the unborn child, the abortion will terminate the life of a whole, separate, unique living human being. On the other hand, although every pregnancy has some risk of problems, continuing a pregnancy and delivering a baby is usually a safe and healthy process for an otherwise healthy woman.
On [date], at [time of day), I,
[signature of pregnant woman], certify that I read and I understand the above disclosures on this page.
Any clarifications, explanations, or answers to my questions were provided to me in writing to my satisfaction.
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1-j) Sex-selective abortions. Sex-selective abortions are illegal in the State of South Dakota and you as a pregnant mother cannot have an abortion, either solely or partly, due to the unborn child's sex, regardless of whether that unborn child is a girl or a boy or whether it is of your free will as the pregnant mother, or the result of the use of pressure and coercion.
1-k) Sex Trafficking. The abortion facility is required to provide the name, text, and telephone number of an organization fighting to end sex trafficking. By signing this document, you understand help is available and you have been provided the information above on how and where to get help.
On [date], at [time of day), I,
[signature of pregnant woman], certify that I read and I understand the above disclosures in compliance with SDCL § 34-23A-10.1.
Any clarifications, explanations, or answers to my questions were provided to me in writing to my satisfaction.
