Okla. Stat. tit. 63, § 63-1-740.13

Oklahoma Statutes - Title 63. Public Health and Safety Page 375

A. A form created by the State Department of Health shall be

used by physicians to obtain the consent required prior to

performing an abortion on a minor who is not emancipated.

B. A form is not valid, and therefore consent is not

sufficient, unless:

1. A parent or legal guardian initials each page of the form,

indicating that he or she has read and understands the information

included on that page;

2. A parent or legal guardian signs the last page of the form

in front of a person who is a notary public;

3. The minor initials each list of risks and hazards listed in

subsection C of this section;

4. The minor signs a consent statement described in subsection

C of this section; and

5. The physician signs the declaration described in subsection

C of this section.

C. The form shall include, but not be limited to, the

following:

1. A description of the minor's rights, including her right to

informed consent;

2. A description of the parent or legal guardian's rights

pursuant to Oklahoma law;

3. A detailed description of the surgical and medical

procedures that are planned to be performed on the minor;

4. A detailed list of the risks and hazards related to the

surgical and medical procedures planned for the minor, including but

not limited to:

a. risks and hazards that may occur in connection with

any surgical, medical, or diagnostic procedure,

including but not limited to infection, blood clots in

veins and lungs, hemorrhage, allergic reactions, and

death,

b. risks and hazards that may occur with surgical

abortion, including but not limited to hemorrhage,

uterine perforation, sterility, injuries to the bowel

and bladder, hysterectomy as a result of complication

or injury during the procedure, and failure to remove

all products of conception that may result in an

additional procedure,

c. risks and hazards that may occur with a medical or

nonsurgical abortion, including but not limited to

hemorrhage, failure to remove all products of

conception that may result in an additional procedure,

sterility, and possible continuation of pregnancy, and

d. risks and hazards of the particular procedure planned

for the minor, including but not limited to cramping

of the uterus, pelvic pain, infection of the uterus,

Oklahoma Statutes - Title 63. Public Health and Safety Page 376

tubes, and ovaries, cervical laceration, incompetent

cervix, and emergency treatment for any of the above

named complications;

5. A description of additional information that must be

provided by the physician to the minor pursuant to the provisions of

Section 1-730 et seq. of this title;

6. A consent statement which must be signed by the minor. The

consent statement must include, but not be limited to, the following

requirements, which must each be individually initialed by the

minor:

a. that the minor understands that the doctor is going to

perform an abortion on her which will end her

pregnancy and result in the death of her unborn child,

b. that the minor is not being forced to have an abortion

and that she has the choice not to have the abortion

and may withdraw consent prior to the abortion,

c. that the minor gives permission for the procedure,

d. that the minor understands that there are risks and

hazards that could affect the minor if she has the

surgical or medical procedures planned for her,

e. that the minor has been given the opportunity to ask

questions about her condition, alternative forms of

treatment, risks of not receiving treatment, the

procedures to be used, and the risks and hazards

involved,

f. that the minor has been given information required by

Section 1-730 et seq. of this title, and

g. that the minor has sufficient information to give

informed consent;

7. A physician declaration, which must be signed by the

physician, stating that the physician or his or her assistant has
ent, risks of not receiving treatment, the

procedures to be used, and the risks and hazards

involved,

f. that the minor has been given information required by

Section 1-730 et seq. of this title, and

g. that the minor has sufficient information to give

informed consent;

7. A physician declaration, which must be signed by the

physician, stating that the physician or his or her assistant has

explained the procedure and the contents of this form to the minor

and her parent or legal guardian, as required, and has answered all

questions. Further, to the best of the physician's knowledge, the

patient and her parent or legal guardian have been adequately

informed and have consented to the procedure;

8. A parental consent statement stating that the signing parent

or legal guardian:

a. understands that the doctor signing the physician

declaration is going to perform an abortion on the

minor which will end her pregnancy and result in the

death of her unborn child,

b. that the parent or legal guardian had the opportunity

to read this form or have it read to him or her and

has initialed each page,

c. that the parent or legal guardian had the opportunity

to ask questions to the physician or the physician's

Oklahoma Statutes - Title 63. Public Health and Safety Page 377

assistant about the information in this form and the

surgical and medical procedures to be performed on the

minor,

d. that the parent or legal guardian believes he or she

has sufficient information to give informed consent,

and

e. that by the parent or legal guardian's signature, the

parent or legal guardian affirms that he or she is the

minor's parent or legal guardian;

9. A page for the parent or legal guardian's signature that

must be notarized by a notary public; and

10. Any additional information that must be provided pursuant

to applicable laws of this state.