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    Form I

    Uploaded by

    sakthi
    This document is an RMP opinion form regarding the termination of a pregnancy. It contains the name, qualifications, and address of the registered medical practitioner(s). It also includes the name and address of the pregnant woman. The practitioner(s) certify that in their good faith opinion, it is necessary to terminate the pregnancy for one of the following reasons: to save the life of the woman, prevent grave injury to her physical or mental health, if the child would suffer abnormalities, if the pregnancy was caused by rape, or if contraception failed. The practitioner(s) signature confirms they terminated the pregnancy.

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    Form I

    Uploaded by

    sakthi
    416 views2 pages
    This document is an RMP opinion form regarding the termination of a pregnancy. It contains the name, qualifications, and address of the registered medical practitioner(s). It also includes the name and address of the pregnant woman. The practitioner(s) certify that in their good faith opinion, it is necessary to terminate the pregnancy for one of the following reasons: to save the life of the woman, prevent grave injury to her physical or mental health, if the child would suffer abnormalities, if the pregnancy was caused by rape, or if contraception failed. The practitioner(s) signature confirms they terminated the pregnancy.

    Original Description:

    MTP FORM C

    Original Title

    Form-I

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    This document is an RMP opinion form regarding the termination of a pregnancy. It contains the name, qualifications, and address of the registered medical practitioner(s). It also includes the name and address of the pregnant woman. The practitioner(s) certify that in their good faith opinion, it is necessary to terminate the pregnancy for one of the following reasons: to save the life of the woman, prevent grave injury to her physical or mental health, if the child would suffer abnormalities, if the pregnancy was caused by rape, or if contraception failed. The practitioner(s) signature confirms they terminated the pregnancy.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    416 views2 pages

    Form I

    Uploaded by

    sakthi
    This document is an RMP opinion form regarding the termination of a pregnancy. It contains the name, qualifications, and address of the registered medical practitioner(s). It also includes the name and address of the pregnant woman. The practitioner(s) certify that in their good faith opinion, it is necessary to terminate the pregnancy for one of the following reasons: to save the life of the woman, prevent grave injury to her physical or mental health, if the child would suffer abnormalities, if the pregnancy was caused by rape, or if contraception failed. The practitioner(s) signature confirms they terminated the pregnancy.

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    RMP OPINION FORM

    FORM I

    I____________________________________________________________________

    (Name and qualifications of the Registered Medical practitioner in block letters)

    _____________________________________________________________________
    (Full address of the Registered Medical practitioner)

    I____________________________________________________________________
    (Name and qualifications of the Registered Medical practitioner in block letters)

    _____________________________________________________________________
    (Full address of the Registered Medical practitioner) hereby certify that *I/We am/are
    of opinion, formed in good faith, that it is necessary to terminate the pregnancy of

    _____________________________________________________________________
    (Full name of pregnant women in block letters) resident of

    _____________________________________________________________________
    (Full address of pregnant women in block letters)

    for the reasons given below**.

    * I/We hereby give intimation that *I/We terminated the pregnancy of the woman
    referred to above who bears the serial no. _______________ in the Admission
    Register of the hospital/approved place.

    Signature of the registered Medical Practitioner

    Signature of the registered Medical Practitioners


    Place :
    Date :
    *Strike out whichever is not applicable,
    ** of the reasons specified items (i) to (v) write the one which is appropriate.

    (i) in order to save the life of the pregnant women,

    (ii) in order to prevent grave injury to the physical and mental health of the
    pregnant women,

    (iii) 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,

    (iv) as the pregnancy is alleged by pregnant women to have been caused by rape,

    (v) as the pregnancy has occurred as result of failure of any contraceptive device
    or methods used by married woman or her husband for the purpose of limiting the
    number of children

    Note : Account may be taken of the pregnant women’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

    Signature of the Registered Medical Practitioners

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