S.F. _____ DIVISION I 1 INFORMED CONSENT 2 Section 1. Section 146A.1, Code 2026, is amended by adding 3 the following new subsection: 4 NEW SUBSECTION . 1A. Prior to performing an abortion, 5 a physician shall perform an in-person examination of the 6 pregnant woman including screening for indicia of coercion or 7 abuse. A physician shall, if necessary, refer the woman to an 8 appropriate health care provider for treatment consistent with 9 the examination results. 10 Sec. 2. Section 146A.1, subsection 6, Code 2026, is amended 11 by adding the following new paragraphs: 12 NEW PARAGRAPH . 0a. “Abortion” means the same as defined in 13 section 146B.1. 14 NEW PARAGRAPH . 00a. “Health care provider” means a 15 person who is licensed, certified, or otherwise authorized or 16 permitted by the laws of this state to administer health care 17 in the ordinary course of business or in the practice of a 18 profession. 19 NEW PARAGRAPH . 0b. “Physician” means the same as defined 20 in section 146B.1. 21 Sec. 3. NEW SECTION . 146A.2 Dispensing abortion-inducing 22 drugs —— licensee discipline. 23 1. As used in this section, unless the context otherwise 24 requires: 25 a. “Abortion-inducing drug” means the same as defined in 26 section 146F.1. 27 b. “Chemical abortion” means the same as defined in section 28 146F.1. 29 c. “Dispense” means the same as defined in section 146F.1. 30 d. “Medical emergency” means the same as defined in section 31 146A.1. 32 e. “Pregnant” or “pregnancy” means the human female 33 reproductive condition of having a living unborn child within 34 the pregnant woman’s body throughout every stage of the unborn 35 -1- LSB 6852XC (1) 91 ak/ko 1/ 12

S.F. _____ child’s life and development, from fertilization to full 1 gestation and childbirth. 2 2. A physician shall do all of the following prior to 3 prescribing or dispensing an abortion-inducing drug to a 4 pregnant woman: 5 a. Obtain the signature of the woman on the United States 6 food and drug administration patient agreement form required 7 for each abortion-inducing drug authorized to be manufactured 8 or sold in the United States. 9 b. Obtain written confirmation from the woman that the woman 10 has been informed of all of the following information: 11 (1) The gestational age-specific risks of abortion-inducing 12 drugs. 13 (2) The risks related to the specific abortion-inducing 14 drug or drugs to be used, including hemorrhage, failure to 15 remove all tissue of the unborn child, sepsis, sterility, and 16 possible continuation of the pregnancy. 17 (3) That the United States federal food and drug 18 administration recommends that the pregnant woman follow up 19 with the woman’s health care provider approximately seven 20 to fourteen calendar days after the administration of an 21 abortion-inducing drug to confirm complete termination of 22 pregnancy has occurred and to evaluate the degree of bleeding. 23 (4) That women using abortion-inducing drugs have suffered 24 trauma from seeing the remains of the unborn child in the 25 process of a chemical abortion. 26 (5) That it may be possible to reverse the intended effects 27 of a chemical abortion, but time is of the essence. 28 (6) That information on reversing the effects of a chemical 29 abortion is available on the department’s internet site. 30 c. Advise the pregnant woman how to access emergency 31 surgical intervention in case of an incomplete abortion, severe 32 bleeding, or other medical complications. 33 3. Subsection 2 shall not apply to a chemical abortion 34 performed in a medical emergency. 35 -2- LSB 6852XC (1) 91 ak/ko 2/ 12

S.F. _____ 4. This section shall not be construed to impose civil or 1 criminal liability on a woman upon whom a chemical abortion has 2 been performed. 3 5. A physician who fails to comply with this section is 4 subject to licensee discipline under chapter 148. 5 6. The board of medicine shall adopt rules pursuant to 6 chapter 17A to administer this section. 7 Sec. 4. NEW SECTION . 146A.3 Informational materials. 8 1. As used in this section, “chemical abortion” means the 9 same as defined in section 146F.1. 10 2. The department shall publish on the department’s 11 internet site, in an easily accessible location and format, all 12 of the following: 13 a. Notice that it may be possible to reverse the effects of 14 a chemical abortion. 15 b. Information and resources on reversing the effects of a 16 chemical abortion. 17 DIVISION II 18 DISPENSING AND REPORTING —— ABORTION-INDUCING DRUGS 19 Sec. 5. NEW SECTION . 146F.1 Definitions. 20 As used in this chapter, unless the context otherwise 21 requires: 22 1. “Abortion-inducing drug” means any of the following: 23 a. Mifepristone. 24 b. Misoprostol. 25 c. Any other drug, measure, or chemical approved by the 26 United States food and drug administration when prescribed or 27 administered with the intent to terminate the pregnancy of a 28 woman known to be pregnant. “Abortion-inducing drug” includes 29 off-label use of a drug known to have abortion-inducing 30 properties, which is prescribed with the intent of causing an 31 abortion. “Abortion-inducing drug” does not include drugs that 32 may be known to cause an abortion but that are prescribed for 33 other medical conditions. 34 2. “Abortion-inducing drug complication” means any physical 35 -3- LSB 6852XC (1) 91 ak/ko 3/ 12

S.F. _____ or psychological condition which, in the reasonable medical 1 judgment of a health care provider, may occur as a primary or 2 secondary result of the patient’s use of abortion-inducing 3 drugs including but not limited to: 4 a. Uterine perforation. 5 b. Cervical laceration. 6 c. Infection. 7 d. Bleeding. 8 e. Vaginal bleeding that qualifies under the common toxicity 9 criteria established by the national cancer institute as a 10 grade 2 or higher. 11 f. Pulmonary embolism. 12 g. Deep vein thrombosis. 13 h. Failure to actually terminate the pregnancy. 14 i. Incomplete abortion or retained tissue. 15 j. Pelvic inflammatory disease. 16 k. Endometritis. 17 l. Missed ectopic pregnancy. 18 m. Cardiac arrest. 19 n. Respiratory arrest. 20 o. Renal failure. 21 p. Shock. 22 q. Amniotic fluid embolism. 23 r. Coma. 24 s. Free fluid in the abdomen. 25 t. Allergic reactions to anesthesia and abortion-inducing 26 drugs. 27 u. Mood, anxiety, or trauma-related disorder symptoms as 28 described in the most recent diagnostic and statistical manual 29 of mental disorders published by the American psychiatric 30 association. 31 3. “Chemical abortion” means an abortion performed by the 32 administration or use of an abortion-inducing drug. 33 4. “Department” means the department of health and human 34 services. 35 -4- LSB 6852XC (1) 91 ak/ko 4/ 12

S.F. _____ 5. “Dispense” means to distribute, administer, or send an 1 abortion-inducing drug to the ultimate user. 2 6. “Health care provider” means the same as defined in 3 section 146A.1. 4 7. “Health care setting” means a clinic, medical office, or 5 hospital. 6 8. “Hospital” means the same as defined in section 135B.1. 7 9. “Interested party” means any of the following persons: 8 a. A woman upon whom a chemical abortion was performed or 9 attempted. 10 b. The biological father of the unborn child who was aborted 11 or was attempted to be aborted through a chemical abortion. 12 c. A grandparent, parent, sibling, child, legal guardian, 13 or conservator of the woman upon whom a chemical abortion was 14 performed or was attempted. 15 10. “Medical emergency” means the same as defined in section 16 146A.1. 17 11. “Physician” means the same as defined in section 146B.1. 18 12. “Postfertilization age” means the same as defined in 19 section 146B.1. 20 13. “Pregnancy” or “pregnant” means the same as defined in 21 section 146A.2. 22 14. “Rural emergency hospital” means the same as defined in 23 section 135B.1. 24 Sec. 6. NEW SECTION . 146F.2 Dispensing of abortion-inducing 25 drugs —— restrictions. 26 1. A person shall not dispense an abortion-inducing drug in 27 this state unless all of the following criteria are met: 28 a. The drug is dispensed in a health care setting directly 29 to the woman prescribed the drug. 30 b. The person dispensing the drug is authorized to do so 31 pursuant to section 147.107. 32 2. Subsection 1 does not apply to the dispensing of an 33 abortion-inducing drug in response to a medical emergency. 34 Sec. 7. NEW SECTION . 146F.3 Abortion-inducing drug 35 -5- LSB 6852XC (1) 91 ak/ko 5/ 12

S.F. _____ complication —— reporting. 1 1. a. Within thirty calendar days of the date of discharge 2 or death of a woman who presented with or was treated for 3 an abortion-inducing drug complication, a hospital, rural 4 emergency hospital, or an attending physician shall file a 5 report with the department. The report shall be in a form 6 prescribed by the department and include a list of the most 7 common abortion complications and the most recent international 8 classification of diseases code as maintained by the world 9 health organization for each. The report must be completed and 10 signed by the woman’s attending physician and contain all of 11 the following information: 12 (1) The age of the woman who presented with or was treated 13 for an abortion-inducing drug complication. 14 (2) The state and county of residence of the woman who 15 presented with or was treated for an abortion-inducing drug 16 complication. 17 (3) The date the abortion-inducing drug was used by the 18 woman. 19 (4) The probable postfertilization age of the unborn child 20 on the date of the abortion-inducing drug complication. 21 (5) The identity of the physician who performed the 22 chemical abortion, the facility where the chemical abortion was 23 performed, and the referring physician, agency, or service, if 24 any. 25 (6) The specific complication or complications that led to 26 the treatment and the most recent international classification 27 of diseases code for each complication as maintained by the 28 world health organization, if applicable. 29 b. A report shall not contain the name of the woman or 30 other information or identifiers that would make it possible to 31 identify the woman who suffered the reported abortion-inducing 32 drug complication. 33 2. A report filed pursuant to subsection 1 shall be 34 confidential and not subject to disclosure under chapter 22. 35 -6- LSB 6852XC (1) 91 ak/ko 6/ 12

S.F. _____ 3. a. On or before December 31, 2026, and every calendar 1 year thereafter, the department shall prepare a comprehensive 2 statistical report based upon the aggregated data gathered from 3 reports filed pursuant to subsection 1 for the immediately 4 preceding calendar year. The aggregated data shall be 5 anonymized to prevent public disclosure of either of the 6 following: 7 (1) The hospital, rural emergency hospital, or attending 8 physician that filed a report. 9 (2) The woman about whom a report was filed. 10 b. The anonymized aggregated data shall be made available to 11 the public by the department in a downloadable format on the 12 department’s internet site. 13 Sec. 8. NEW SECTION . 146F.4 Private cause of action —— 14 strict liability. 15 1. A person who dispenses an abortion-inducing drug 16 in violation of this chapter shall be strictly liable 17 to any interested party for all damages caused by the 18 abortion-inducing drug. 19 2. In addition to compensatory or punitive damages, a 20 prevailing plaintiff who brings an action under this section is 21 entitled to all of the following: 22 a. Statutory damages in the amount of fifty thousand 23 dollars. 24 b. Court costs. 25 c. Reasonable attorney fees. 26 3. In an action brought under this section, the name and 27 other identifying characteristics of a woman who sought or 28 obtained an abortion-inducing drug shall be redacted without 29 a court order from all pleadings and documents filed in the 30 action. The court may make further orders as necessary to 31 protect the identity and privacy of the woman who sought or 32 obtained an abortion-inducing drug. 33 4. This section shall not be construed to impose civil or 34 criminal liability on a woman upon whom a chemical abortion is 35 -7- LSB 6852XC (1) 91 ak/ko 7/ 12

S.F. _____ performed. 1 Sec. 9. NEW SECTION . 146F.5 Licensee discipline. 2 A licensee who fails to comply with this chapter is subject 3 to licensee discipline under chapter 148. 4 DIVISION III 5 ABORTION-RELATED PROVISIONS 6 Sec. 10. Section 144.29A, subsection 1, paragraph k, Code 7 2026, is amended to read as follows: 8 k. The method used for an induced termination, including 9 whether mifepristone or misoprostol was used. 10 Sec. 11. Section 144.29A, subsection 1, Code 2026, is 11 amended by adding the following new paragraph: 12 NEW PARAGRAPH . l. If a spontaneous termination of 13 pregnancy, whether the patient ingested mifepristone or 14 misoprostol within fourteen calendar days prior to the date of 15 the spontaneous termination of pregnancy. 16 Sec. 12. Section 144.29A, subsection 7, paragraph c, Code 17 2026, is amended to read as follows: 18 c. “Spontaneous termination of pregnancy” , commonly known 19 as a miscarriage, means the occurrence of an unintended 20 termination of pregnancy at any time during the period from 21 conception to twenty weeks gestation and which is not a 22 spontaneous termination of pregnancy at any time during the 23 period from twenty weeks or greater which is reported to the 24 department as a fetal death under this chapter . 25 Sec. 13. Section 146B.1, subsection 1, Code 2026, is amended 26 to read as follows: 27 1. “Abortion” means the termination of a human pregnancy 28 with the intent other than to produce a live birth or to 29 remove a dead fetus. “Abortion” does not include a spontaneous 30 termination of pregnancy, commonly known as a miscarriage, if 31 not all the products of conception are expelled. 32 EXPLANATION 33 The inclusion of this explanation does not constitute agreement with 34 the explanation’s substance by the members of the general assembly. 35 -8- LSB 6852XC (1) 91 ak/ko 8/ 12

S.F. _____ This bill relates to abortions, including informed 1 consent, dispensing of abortion-inducing drugs, and reporting 2 abortion-inducing drug complications. 3 DIVISION I —— INFORMED CONSENT. Under the bill, a physician, 4 prior to performing or attempting to perform an abortion, is 5 required to perform an in-person examination of the woman 6 seeking an abortion, including screening for indicia of 7 coercion or abuse; if necessary, the physician shall make a 8 referral to an appropriate health care provider consistent with 9 the examination results. 10 The bill requires a physician, prior to prescribing 11 or dispensing an abortion-inducing drug, to do all of the 12 following: have the woman being prescribed or dispensed the 13 drug sign a patient agreement form, obtain written confirmation 14 that the physician has informed the woman of specific health 15 and safety information related to abortion-inducing drugs 16 as detailed in the bill, and advise the pregnant woman how 17 to access emergency surgical intervention in cases of an 18 incomplete abortion, severe bleeding, or other medical 19 complications. The bill specifies that these requirements 20 shall not apply to a chemical abortion performed in response to 21 a medical emergency. The bill provides that the prohibition on 22 dispensing of abortion-inducing drugs shall not be construed 23 to impose civil or criminal liability on a woman upon whom 24 a chemical abortion has been performed. Under the bill, 25 a physician who fails to comply with the informed consent 26 requirements is subject to licensee discipline. The bill 27 requires the board of medicine to adopt rules to administer 28 this division of the bill. The bill defines “abortion-inducing 29 drug”, “chemical abortion”, “dispense”, “medical emergency”, 30 and “pregnant” or “pregnancy”. 31 The bill requires the department of health and human 32 services (HHS) to publish on HHS’s internet site notice that it 33 may be possible to reverse the effects of a chemical abortion, 34 and information and resources on reversing the effects of a 35 -9- LSB 6852XC (1) 91 ak/ko 9/ 12

S.F. _____ chemical abortion. 1 DIVISION II —— DISPENSING AND REPORTING —— ABORTION-INDUCING 2 DRUGS. The bill defines “abortion-inducing drug”, 3 “abortion-inducing drug complication”, “chemical abortion”, 4 “dispense”, “interested party”, “medical emergency”, 5 “physician”, “postfertilization age”, and “rural emergency 6 hospital”. 7 The bill prohibits a person from dispensing an 8 abortion-inducing drug in this state unless the drug is 9 dispensed in a health care setting directly to the woman 10 prescribed the drug, and the person dispensing the drug is 11 authorized to do so pursuant to Code section 147.107 (drug 12 dispensing, supplying, and prescribing —— limitations). These 13 requirements do not apply to a medical emergency. 14 The bill requires a hospital, rural emergency hospital, 15 or the attending physician to file a report with HHS using a 16 prescribed form within 30 days of discharge or death of a woman 17 who presented with or was treated for an abortion-inducing 18 drug complication. The form must be signed and completed 19 by the attending physician and contain the age of the woman 20 experiencing the abortion-inducing drug complication, 21 the woman’s state and county of residence, the date the 22 abortion-inducing drug was used by the woman, and the probable 23 postfertilization age of the unborn child at the time of 24 the abortion-inducing drug complication. The report must 25 identify the physician who performed the chemical abortion, 26 the facility where the chemical abortion was performed, 27 the referring physician, agency, or service, if any, and 28 the specific complication or complications that led to the 29 treatment performed along with the most recent international 30 classification of diseases code for each, if applicable. The 31 report shall be confidential and not subject to disclosure 32 under Code chapter 22 (open records). 33 The bill also requires HHS to prepare annually on or 34 before December 31 a comprehensive statistical report based 35 -10- LSB 6852XC (1) 91 ak/ko 10/ 12

S.F. _____ upon the aggregated data gathered from the reports filed on 1 abortion-inducing drug complications. Under the bill, the data 2 gathered by HHS must be anonymized to prevent public disclosure 3 of either the physician or hospital that filed a report, or the 4 woman about whom a report is filed. HHS is required to make the 5 anonymized data publicly available in a downloadable format on 6 its internet site. 7 This division of the bill creates a private cause of action 8 against any person who dispenses an abortion-inducing drug 9 in violation of this division of the bill for all damages 10 caused by the abortion-inducing drug suffered by a woman upon 11 whom a chemical abortion was performed or was attempted; the 12 biological father of the unborn child who was or was attempted 13 to be aborted through a chemical abortion; or the grandparent, 14 parent, sibling, child, legal guardian, or conservator of 15 the woman upon whom a chemical abortion was performed or was 16 attempted. A prevailing plaintiff in an action brought under 17 this division of the bill, in addition to compensatory and 18 punitive damages, is entitled to statutory damages in the 19 amount of $50,000, court costs, and reasonable attorney fees. 20 In an action brought under this division of the bill, the name 21 and other identifying characteristics of a woman who sought or 22 obtained an abortion-inducing drug shall be redacted from all 23 pleadings and documents filed in the action without a court 24 order, and the court may make further orders as necessary to 25 protect the identity and privacy of the woman who sought or 26 obtained an abortion-inducing drug. This division of the bill 27 is not to be construed to impose civil or criminal liability 28 upon a woman upon whom a chemical abortion is performed. 29 Under the bill, a licensee that fails to comply with this 30 division of the bill is subject to licensee discipline. 31 DIVISION III —— ABORTION-RELATED PROVISIONS. The bill 32 amends Code section 144.29A (termination of pregnancy reporting 33 —— legislative intent) to require a health care provider that 34 diagnoses or induces a spontaneous termination of pregnancy 35 -11- LSB 6852XC (1) 91 ak/ko 11/ 12

S.F. _____ to include in the required report to HHS if mifepristone or 1 misoprostol was used to induce a spontaneous termination of 2 pregnancy. Current law requires the health care provider 3 to only disclose if mifepristone was used to induce a 4 spontaneous termination of pregnancy. The bill also requires 5 the health care provider to disclose whether mifepristone 6 or misoprostol were ingested by the patient within 14 days 7 prior to the spontaneous termination of pregnancy. The bill 8 excludes a spontaneous termination from the definition of 9 abortion for the purpose of the reporting requirements and 10 penalties on abortions under Code chapter 146B (abortion —— 11 postfertilization age). 12 -12- LSB 6852XC (1) 91 ak/ko 12/ 12