NORTH CAROLINA. General Statutes.
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Chapter7A. Judicial Department.
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§ 7A‑451. Scope of entitlement.
(a) An indigent person is entitled to services of counsel in the following actions and proceedings:
(1) Any case in which imprisonment, or a fine of five hundred dollars ($500.00), or more, is likely to be adjudged;
(2) A hearing on a petition for a writ of habeas corpus under Chapter 17 of the General Statutes;
(3) A motion for appropriate relief under Chapter 15A of the General Statutes if the defendant has been convicted of a felony, has been fined five hundred dollars ($500.00) or more, or has been sentenced to a term of imprisonment;
(4) A hearing for revocation of probation;
(5) A hearing in which extradition to another state is sought;
(6) A proceeding for an inpatient involuntary commitment to a facility under Part 7 of Article 5 of Chapter 122C of the General Statutes, or a proceeding for commitment under Part 8 of Article 5 of Chapter 122C of the General Statutes.
(7) In any case of execution against the person under Chapter 1, Article 28 of the General Statutes, and in any civil arrest and bail proceeding under Chapter 1, Article 34, of the General Statutes;
(8) In the case of a juvenile, a hearing as a result of which commitment to an institution or transfer to the superior court for trial on a felony charge is possible;
(9) A hearing for revocation of parole at which the right to counsel is provided in accordance with the provisions of Chapter 148, Article 4, of the General Statutes;
(10) Repealed by Session Laws 2003, c. 13, s. 2(a), effective April 17, 2003, and applicable to all petitions for sterilization pending and orders authorizing sterilization that have not been executed as of April 17, 2003.
(11) A proceeding for the provision of protective services according to Chapter 108A, Article 6 of the General Statutes;
(12) In the case of a juvenile alleged to be neglected under Chapter 7A, Article 23 of the General Statutes;
(13) A proceeding to find a person incompetent under Subchapter I of Chapter 35A, of the General Statutes;
(14) A proceeding to terminate parental rights where a guardian ad litem is appointed pursuant to G.S. 7B‑1101;
(15) An action brought pursuant to Article 24B of Chapter 7A of the General Statutes to terminate an indigent person's parental rights.
(16) A proceeding involving consent for an abortion on an unemancipated minor pursuant to Article 1A, Part 2 of Chapter 90 of the General Statutes. G.S. 7A‑450.1, 7A‑450.2, and 7A‑450.3 shall not apply to this proceeding.
(17) A proceeding involving limitation on freedom of movement or access pursuant to G.S. 130A‑475 or G.S. 130A‑145.
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§ 7A‑474.3. Eligible activities and limitations.
(a) Eligible Activities. Funds appropriated under this Article shall be used only for the following purposes:
(1) To provide legal assistance to eligible clients;
(2) To provide education to eligible clients regarding their rights and duties under the law;
(3) To involve the private bar in the representation of eligible clients pursuant to this Article.
(b) Eligible Cases. Legal assistance shall be provided to eligible clients under this Article only in the following types of cases:
(1) Family violence or spouse abuse;
(2) Assistance for the disabled in obtaining federal Social Security benefits;
(3) Representation of eligible farmers faced with the potential of farm foreclosure;
(4) Representation of eligible clients over the age of 60 regarding the following matters:
a. Wills and estates;
b. Safe and sanitary housing;
c. Pensions and retirement rights;
d. Social Security and Medicare rights;
e. Access to health care;
f. Food and nutrition; and
(5) Representation of eligible clients designed to enable them to obtain the necessary skills and means to obtain meaningful employment at a decent wage and reduce the public welfare rolls; and
(6) Representation of eligible clients under the age of 21 or eligible families with legal problems affecting persons under the age of 21 regarding the following matters:
a. Financial support and custody of children;
b. Child care;
c. Child abuse or neglect;
d. Safe and sanitary housing;
e. Food and nutrition; and
f. Access to health care.
(c) Limitations. No funds appropriated under this Article shall be used for any of the following purposes:
(1) To provide legal assistance with respect to any proceeding or litigation which seeks to procure a nontherapeutic abortion or to compel any individual or institution to perform an abortion, or assist in the performance of an abortion, or provide facilities for the performance of an abortion;
(2) To provide legal assistance with respect to any criminal proceeding;
To provide legal assistance to any agricultural employee or migrant farmworker
(4) To provide legal assistance to any prisoner within the North Carolina Department of Correction with regard to the terms of that person's incarceration; or
(5) To provide legal assistance to persons with mental handicaps residing in State institutions with regard to the terms and conditions of the treatment or services provided to them by the State.
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Chapter 7B. Juvenile Code.
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§ 7B‑2901. Confidentiality of records.
(a) The clerk shall maintain a complete record of all juvenile cases filed in the clerk's office alleging abuse, neglect, or dependency. The records shall be withheld from public inspection and, except as provided in this subsection, may be examined only by order of the court. The record shall include the summons, petition, custody order, court order, written motions, the electronic or mechanical recording of the hearing, and other papers filed in the proceeding. The recording of the hearing shall be reduced to a written transcript only when notice of appeal has been timely given. After the time for appeal has expired with no appeal having been filed, the recording of the hearing may be erased or destroyed upon the written order of the court.
The following persons may examine the juvenile's record maintained pursuant to this subsection and obtain copies of written parts of the record without an order of the court:
(1) The person named in the petition as the juvenile;
(2) The guardian ad litem;
(3) The county department of social services; and
(4) The juvenile's parent, guardian, or custodian, or the attorney for the juvenile or the juvenile's parent, guardian, or custodian.
(b) The Director of the Department of Social Services shall maintain a record of the cases of juveniles under protective custody by the Department or under placement by the court, which shall include family background information; reports of social, medical, psychiatric, or psychological information concerning a juvenile or the juvenile's family; interviews with the juvenile's family; or other information which the court finds should be protected from public inspection in the best interests of the juvenile. The records maintained pursuant to this subsection may be examined only by order of the court except that the guardian ad litem, or juvenile, shall have the right to examine them.
(c) In the case of a child victim, the court may order the sharing of information among such public agencies as the court deems necessary to reduce the trauma to the victim.
(d) The court's entire record of a proceeding involving consent for an abortion on an unemancipated minor under Article 1A, Part 2 of Chapter 90 of the General Statutes is not a matter of public record, shall be maintained separately from any juvenile record, shall be withheld from public inspection, and may be examined only by order of the court, by the unemancipated minor, or by the unemancipated minor's attorney or guardian ad litem.
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Chapter 14. Criminal Law.
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Article 11 - Abortion and Kindred Offenses.
§ 14‑44. Using drugs or instruments to destroy unborn child.
If any person shall willfully administer to any woman, either pregnant or quick with child, or prescribe for any such woman, or advise or procure any such woman to take any medicine, drug or other substance whatever, or shall use or employ any instrument or other means with intent thereby to destroy such child, he shall be punished as a Class H felon.
§ 14‑45. Using drugs or instruments to produce miscarriage or injure pregnant woman.
If any person shall administer to any pregnant woman, or prescribe for any such woman, or advise and procure such woman to take any medicine, drug or anything whatsoever, with intent thereby to procure the miscarriage of such woman, or to injure or destroy such woman, or shall use any instrument or application for any of the above purposes, he shall be punished as a Class I felon
§ 14‑45.1. When abortion not unlawful.
(a) Notwithstanding any of the provisions of G.S. 14‑44 and 14‑45, it shall not be unlawful, during the first 20 weeks of a woman's pregnancy, to advise, procure, or cause a miscarriage or abortion when the procedure is performed by a physician licensed to practice medicine in North Carolina in a hospital or clinic certified by the Department of Health and Human Services to be a suitable facility for the performance of abortions.
(b) Notwithstanding any of the provisions of G.S. 14‑44 and 14‑45, it shall not be unlawful, after the twentieth week of a woman's pregnancy, to advise, procure or cause a miscarriage or abortion when the procedure is performed by a physician licensed to practice medicine in North Carolina in a hospital licensed by the Department of Health and Human Services, if there is substantial risk that continuance of the pregnancy would threaten the life or gravely impair the health of the woman.
(c) The Department of Health and Human Services shall prescribe and collect on an annual basis, from hospitals or clinics where abortions are performed, such representative samplings of statistical summary reports concerning the medical and demographic characteristics of the abortions provided for in this section as it shall deem to be in the public interest. Hospitals or clinics where abortions are performed shall be responsible for providing these statistical summary reports to the Department of Health and Human Services. The reports shall be for statistical purposes only and the confidentiality of the patient relationship shall be protected.
(d) The requirements of G.S. 130‑43 are not applicable to abortions performed pursuant to this section.
Nothing in this section shall require a physician licensed to practice medicine
(f) Nothing in this section shall require a hospital or entionally possess or have immediate access to any dangerous weapon. Violation of this subsection shall be a Class 1 misdemeanor. It shall be presumed that any rifle or gun carried on a rack in a pickup truck at a holiday parade or in a funeral procession does not violate the terms of this act.
(b) For the purposes of this section the term "dangerous weapon" shall include those weapons specified in G.S. 14‑269, 14‑269.2, 14‑284.1, or 14‑288.8 or any other object capable of inflicting serious bodily injury or death when used as a weapon.
(c) The provisions of this section shall not apply to a person exempted by the provisions of G.S. 14‑269(b) or to persons authorized by State or federal law to carry dangerous weapons in the performance of their duties or to any person who obtains a permit to carry a dangerous weapon at a parade, funeral procession, picket line, or demonstration from the sheriff or police chief, whichever is appropriate, of the locality where such parade, funeral procession, picket line, or demonstration is to take place.
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Article 35 - Offenses Against the Public Peace.
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§ 14‑277.4. Obstruction of health care facilities.
(a) No person shall obstruct or block another person's access to or egress from a health care facility or from the common areas of the real property upon which the facility is located in a manner that deprives or delays the person from obtaining or providing health care services in the facility.
(b) No person shall injure or threaten to injure a person who is or has been:
(1) Obtaining health care services;
(2) Lawfully aiding another to obtain health care services; or
(3) Providing health care services.
(c) A violation of subsection (a) or (b) of this section is a Class 2 misdemeanor. A second conviction for a violation of either subsection (a) or (b) of this section within three years of the first shall be punishable as a Class 1 misdemeanor. A third or subsequent conviction for a violation of either subsection (a) or (b) of this section within three years of the second or most recent conviction shall be punishable as a Class I felony.
(d) Any person aggrieved under this section may seek injunctive relief in a court of competent jurisdiction to prevent threatened or further violations of this section. Any violation of an injunction obtained pursuant to this section constitutes criminal contempt and shall be punishable by a term of imprisonment of not less than 30 days and no more than 12 months.
(e) This section shall not prohibit any person from engaging in lawful speech or picketing which does not impede or deny another person's access to health care services or to a health care facility or interfere with the delivery of health care services within a health care facility.
(f) "Health care facility" as used in this section means any hospital, clinic, or other facility that is licensed to administer medical treatment or the primary function of which is to provide medical treatment in this State.
(g) "Health care services" as used in this section means services provided in a health care facility.
(h) Persons subject to the prohibitions in subsection (a) of this section do not include owners, officers, agents, or employees of the health care facility or law enforcement officers acting to protect real or personal property.
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Chapter 90. Medicine and Allied Occupations.
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Article 1A - Treatment of Minors.
Part 1. General Provisions.
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§ 90‑21.5. Minor's consent sufficient for certain medical health services.
(a) Any minor may give effective consent to a physician licensed to practice medicine in North Carolina for medical health services for the prevention, diagnosis and treatment of (i) venereal disease and other diseases reportable under G.S. 130A‑135, (ii) pregnancy, (iii) abuse of controlled substances or alcohol, and (iv) emotional disturbance. This section does not authorize the inducing of an abortion, performance of a sterilization operation, or admission to a 24‑hour facility licensed under Article 2 of Chapter 122C of the General Statutes except as provided in G.S. 122C‑222. This section does not prohibit the admission of a minor to a treatment facility upon his own written application in an emergency situation as authorized by G.S. 122C‑222.
(b) Any minor who is emancipated may consent to any medical treatment, dental and health services for himself or for his child.
Part 2. Parental or Judicial Consent for Abortion.
§ 90‑21.6. Definitions.
For the purposes of Part 2 only of this Article, unless the context clearly requires otherwise:
(1) "Unemancipated minor" or "minor" means any person under the age of 18 who has not been married or has not been emancipated pursuant to Article 35 of Chapter 7B of the General Statutes.
(2) "Abortion" means the use or prescription of any instrument, medicine, drug, or any other substance or device with intent to terminate the pregnancy of a woman known to be pregnant, for reasons other than to save the life or preserve the health of an unborn child, to remove a dead unborn child, or to deliver an unborn child prematurely, by accepted medical procedures in order to preserve the health of both the mother and the unborn child.
§ 90‑21.7. Parental consent required.
No physician licensed to practice medicine in
(1) A parent with custody of the minor; or
(2) The legal guardian or legal custodian of the minor; or
(3) A parent with whom the minor is living; or
(4) A grandparent with whom the minor has been living for at least six months immediately preceding the date of the minor's written consent.
(b) The pregnant minor may petition, on her own behalf or by guardian ad litem, the district court judge assigned to the juvenile proceedings in the district court where the minor resides or where she is physically present for a waiver of the parental consent requirement if:
(1) None of the persons from whom consent must be obtained pursuant to this section is available to the physician performing the abortion or the physician's agent or the referring physician or the agent thereof within a reasonable time or manner; or
(2) All of the persons from whom consent must be obtained pursuant to this section refuse to consent to the performance of an abortion; or
(3) The minor elects not to seek consent of the person from whom consent is required.
§ 90‑21.8. Procedure for waiver of parental consent.
(a) The requirements and procedures under Part 2 of this Article are available and apply to unemancipated minors seeking treatment in this State.
(b) The court shall ensure that the minor or her guardian ad litem is given assistance in preparing and filing the petition and shall ensure that the minor's identity is kept confidential.
(c) The minor may participate in proceedings in the court on her own behalf or through a guardian ad litem. The court shall advise her that she has a right to appointed counsel, and counsel shall be provided upon her request in accordance with rules adopted by the Office of Indigent Defense Services.
(d) Court proceedings under this section shall be confidential and shall be given precedence over other pending matters necessary to ensure that the court may reach a decision promptly. In no case shall the court fail to rule within seven days of the time of filing the application. This time limitation may be extended at the request of the minor. At the hearing, the court shall hear evidence relating to the emotional development, maturity, intellect, and understanding of the minor; the nature, possible consequences, and alternatives to the abortion; and any other evidence that the court may find useful in determining whether the parental consent requirement shall be waived.
(e) The parental consent requirement shall be waived if the court finds:
(1) That the minor is mature and well‑informed enough to make the abortion decision on her own; or
(2) That it would be in the minor's best interests that parental consent not be required; or
(3) That the minor is a victim of rape or of felonious incest under G.S. 14‑178.
(f) The court shall make written findings of fact and conclusions of law supporting its decision and shall order that a confidential record of the evidence be maintained. If the court finds that the minor has been a victim of incest, whether felonious or misdemeanor, it shall advise the Director of the Department of Social Services of its findings for further action pursuant to Article 3 of Chapter 7B of the General Statutes.
(g) If the female petitioner so requests in her petition, no summons or other notice may be served upon the parents, guardian, or custodian of the minor female.
(h) The minor may appeal an order issued in accordance with this section. The appeal shall be a de novo hearing in superior court. The notice of appeal shall be filed within 24 hours from the date of issuance of the district court order. The de novo hearing may be held out of district and out of session and shall be held as soon as possible within seven days of the filing of the notice of appeal. The record of the de novo hearing is a confidential record and shall not be open for general public inspection. The Chief Justice of the North Carolina Supreme Court shall adopt rules necessary to implement this subsection.
(i) No court costs shall be required of any minor who avails herself of the procedures provided by this section.
§ 90‑21.9. Medical emergency exception.
The requirements of parental consent prescribed by G.S. 90‑21.7(a) shall not apply when, in the best medical judgment of the physician based on the facts of the case before the physician, a medical emergency exists that so complicates the pregnancy as to require an immediate abortion, or when the conditions prescribed by G.S. 90‑21.1(4) are met.
§ 90‑21.10. Penalty.
Any person who intentionally performs an abortion with knowledge that, or with reckless disregard as to whether, the person upon whom the abortion is to be performed is an unemancipated minor, and who intentionally or knowingly fails to conform to any requirement of Part 2 of this Article shall be guilty of a Class 1 misdemeanor
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Chapter 115C. Elementary and Secondary Education.
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Article 8 - General Education.
Part 1. Courses of Study.
§ 115C‑81. Basic Education Program.
(a) The General Assembly believes that all children can learn. It is the intent of the General Assembly that the mission of the public school community is to challenge with high expectations each child to learn, to achieve, and to fulfill his or her potential. With that mission as its guide, the State Board of Education shall adopt a Basic Education Program for the public schools of the State. Before it adopts or revises the Basic Education Program, the State Board shall consult with an Advisory Committee, including at least eight members of local boards of education, that the State Board appoints from a list of nominees submitted by the North Carolina School Boards Association.
The State Board shall
implement the Basic Education Program within funds appropriated for that
purpose by the General Assembly and by units of local government. It is the
intent of the General Assembly that until the Basic Education Program is fully
funded, the implementation of the Basic Education Program shall be the focus of
State educational funding. It is the goal of the General Assembly that the
Basic Education Program be fully funded and completely operational in each
local school administrative unit by
It is further a goal of the General Assembly to provide supplemental funds to low‑wealth counties to allow those counties to enhance the instructional program and student achievement.
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(e1) School Health Education Program to Be Developed and Administered.
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(8) Students may receive information about where to obtain contraceptives and abortion referral services only in accordance with a local board's policy regarding parental consent. Any instruction concerning the use of contraceptives or prophylactics shall provide accurate statistical information on their effectiveness and failure rates for preventing pregnancy and sexually transmitted diseases, including Acquired Immune Deficiency Syndrome (AIDS), in actual use among adolescent populations and shall explain clearly the difference between risk reduction and risk elimination through abstinence.
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Chapter 131E. Health Care Facilities and Services.
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§ 131E‑269. Authorization to charge fee for certification of facilities suitable to perform abortions.
The Department of Health and Human Services shall charge each hospital or clinic certified by the Department as a facility suitable for the performance of abortions, as authorized under G.S. 14‑45.1, a nonrefundable annual certification fee in the amount of three hundred fifty dollars ($350.00).
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Chapter 135. Retirement System for Teachers and State Employees; Social Security; Health Insurance Program for Children.
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§ 135‑40. Undertaking.
(a) The State of North Carolina undertakes to make available a Comprehensive Major Medical Plan (hereinafter called the "Plan") exclusively for the benefit of its employees, retired employees and certain of their dependents which will pay benefits in accordance with the terms hereof. The Plan shall have all the powers and privileges of a corporation and shall be known as the North Carolina Teachers' and State Employees' Comprehensive Major Medical Plan. The Executive Administrator and Board of Trustees shall carry out their duties and responsibilities as fiduciaries for the Plan.
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§ 135‑40.1. General definitions.
As used in Parts 2 and 3 of this Article, the following terms have the meaning specified as follows:
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(16) Pregnancy. – Shall include resulting childbirth, miscarriage or abortion.
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§ 135‑40.4. Benefits in general.
(a) In the event a covered person, as a result of accidental bodily injury, disease or pregnancy, incurs covered expenses, the Plan will pay benefits up to the amounts described in G.S. 135‑40.5 through G.S. 135‑40.9.
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Medicaid covers nontherapeutic and therapeutic abortions. Therapeutic abortion coverage is
limited to termination of pregnancy for the following reasons:
1. the woman suffers from "a physical disorder, physical injury, or physical illness,
including a life-endangering physical condition caused by or arising from the
pregnancy itself, that would place the woman in danger of death unless an
abortion was performed.”
2. the pregnancy is the result of rape.
3. the pregnancy is the result of incest.
Any termination of pregnancy where there has been no manual or surgical interruption of the
pregnancy is considered a nontherapeutic abortion. Missed, incomplete, and spontaneous
abortions are examples.
Medicaid considers any termination of pregnancy where fetal heart tones are present at the
time of the abortive procedure as a therapeutic abortion.
The termination of pregnancy may be induced medically (prostaglandin suppositories, etc.) or
surgically (dilation and curettage, etc.). This includes the delivery of a nonviable (incapable
of living outside the uterus ) but live fetus, if labor was augmented by pitocin drip, laminaria
Medicaid will cover legal therapeutic abortions under the following circumstances:
1. In the case where a woman suffers from a physical disorder, physical injury, or physical
illness, including a life-endangering physical condition caused by or arising from the
pregnancy itself, that would as certified by physician, place the woman in danger of death
unless an abortion is performed. (Revised wording required by law.)
Medicaid must receive the physician’s abortion statement “that the abortion be
necessary in the case where a woman suffers from a physical disorder, physical
injury, or physical illness, including a life-endangering physical condition
caused by or arising form the pregnancy itself, that would as certified by
physician, place the woman in danger of death unless an abortion is performed.”
The statement must include the recipient’s complete name and address.
The medical diagnosis and medical records must support the statement.
If the abortion was necessary as stated above, regardless of whether the
pregnancy was a result of rape or incest, the diagnosis and medical records must
support the medical situation.
A minor must have parental consent to an abortion unless a medical emergency
exists that so complicates the pregnancy as to require an immediate abortion.
See “Legal Guidelines for Minors”.
Medicaid must receive the physician’s abortion statement that the recipient was
a victim of incest. The statement must contain the recipient’s complete name and
The diagnosis code V618 “other specified family circumstances” must be on the
claim. The medical record documentation must support this diagnosis and the
A minor must have parental consent to an abortion. See “Legal Guidelines for
Medicaid must receive the physician’s abortion statement that the recipient was
a victim of rape. The statement must include the recipient’s complete name and
The diagnosis code V715, rape, must be on the claim. The medical record
documentation must support this diagnosis and the abortion statement.
A minor must have parental consent to an abortion. See “Legal Guidelines for
Special note In cases of rape or incest state law establishes when abortion is not unlawful.
To advise, procure, or cause a miscarriage or abortion during the first 20 weeks
of a pregnancy when the procedure is performed by a physician licensed to
to be a suitable facility for the performance of abortions.
To advise, procure, or cause a miscarriage or abortion after the twentieth week
of a pregnancy if there is substantial risk that continuance or the pregnancy
would threaten the life or gravely impair the health of the woman.
For statistical purposes, the hospital is responsible for providing to the state annual samplings
of statistical summary reports.
All therapeutic abortions must be coded to one of the following procedure codes:
W8206 Legal therapeutic abortion, surgically completed
W8207 Legal therapeutic abortion, medically completed
Note: A diagnosis code of 635–635.92, 638–638.9 (Medical records required), must be on the
Septic abortions can be considered either a nontherapeutic abortion or a therapeutic abortion
depending on the diagnosis used.
The CPT code 59830, treatment of septic abortion, should be used when billing for a
nontherapeutic septic abortion with a nontherapeutic abortion diagnosis. Documentation must
The CPT code W8206 or W8207 should be used when billing for a therapeutic septic
abortion with a therapeutic abortion diagnosis. Documentation must be attached to determine
if federal guidelines are met.
State law mandates parental or judicial consent for an unemancipated minor’s abortion.
“Unemancipated minor” or “minor” is defined as any person under the age of 18 who has not
been married or has not been emancipated pursuant to Article 56 of Chapter 7A of the
General Statutes (N.C. House Bill 481, Chapter 462).
Before an abortion is performed on an unemancipated minor, the consent form must be signed
by the minor and:
1. A parent with custody of the minor, or
2. The legal guardian or legal custodian of the minor, or
3. A parent with whom the minor is living, or
4. A grandparent with whom the minor has been living for at least six months
immediately preceding the date of the minor’s written consent.
The pregnant minor may petition, on her own behalf or by guardian ad litem, the district court
judge assigned to the juvenile proceedings in the district court where the minor resides or
where she is physically present for a waiver of the parental consent requirement if:
1. None of the persons from whom consent must be obtained is available to the
physician performing the abortion or the referring physician within a reasonable
time or manner, or
2. All of the persons from whom consent must be obtained refuse to consent to the
performance of an abortion; or
3. The minor elects not to seek consent of the person from whom consent is
The requirements of parental consent shall not apply when a medical emergency exists that so
complicates the pregnancy as to require an immediate abortion.
Medicaid must receive the physician’s statement prior to processing any claims related to
abortions. The physician must submit the following abortion statement:
1. Recipient’s Name: _________________________________
2. Address: _________________________________
3. Medicaid Identification Number: _________________________________
4. Gestational Age: _________________________________
On the basis of my professional judgment, I have performed an abortion on the above-named recipient for
the following reason:
5. _____ The abortion was necessary due to a physical disorder, physical injury, or physical illness, including
a life-endangering physical condition caused by or arising from the pregnancy itself, that would
place the woman in danger of death unless an abortion was performed.
6. _____ Based on all the information available to me, I concluded that this pregnancy was the result of an act
7. _____ Based on all the information available to me, I concluded that this pregnancy was the result of an act
My signature on this statement is an attestation that the requirements were met and documentation is on file.
8. _________________________ 9. ________________________________
Physician’s Name Physician’s Signature
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Title 10A. Health and Human Services.
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SUBCHAPTER 14e ‑ CERTIFICATIONS OF CLINICS FOR ABORTION
SECTION .0100 ‑ CERTIFICATION PROCEDURE
10A NCAC 14E .0101 DEFINITIONS
The following definitions will apply throughout this Subchapter:
(1) "Clinic" means a freestanding facility (a facility neither physically attached nor operated by a licensed hospital) for the performance of abortions during the first 20 weeks of pregnancy.
(2) "Complication" includes but is not limited to hemorrhage, infection, uterine perforation, cervical laceration or retained products of conception.
(3) "Division" means the Division of Facility Services of the North Carolina Department of Health and Human Services.
(4) "Fetal age" means the length of pregnancy as indicated by the date of conception.
(5) "Governing authority" means the individual, agency or group or corporation appointed, elected or otherwise designated, in which the ultimate responsibility and authority for the conduct of the abortion clinic is vested.
(6) "New facility" means one that is not certified as an
abortion clinic by the Division as of
10A NCAC 14E .0102 CONFERENCE
Before proceeding with construction and operational plans, a potential sponsor or owner of a freestanding abortion clinic shall discuss with the staff of the Division of Facility Services the scope of the proposed facility. This will provide an opportunity for the owner and the Division's staff to discuss certification requirements.
10A NCAC 14E .0103 CHANGES
All stages of the plans from schematics through working drawings shall be reviewed by the Division's staff each time a change is made.
10A NCAC 14E .0104 PLANS
Three copies of the plans will be required for certification purposes.
10A NCAC 14E .0105 APPROVAL
Approval from the Division of Facility Services, the Division of Environmental Health, and the Department of Insurance should be obtained before construction is commenced.
10A NCAC 14E .0106 APPLICATION
(a) Prior to the admission of patients, an application from the clinic for certification shall be submitted to and approved by the Division.
(b) Application forms may be obtained by contacting the Division.
(c) The application form shall set forth the ownership, staffing patterns, clinical services to be rendered, professional staff in charge of services, and general information that would be helpful to the Division's understanding of the clinic's operating program.
(d) After construction requirements in Section .0200 of this Subchapter have been met and the application for certification has been received and approved, the Division shall conduct an on-site, certification survey.
(e) Each certificate must be renewed at the beginning of each calendar year. The governing authority shall file an application for renewal of certification with the Division at least 30 days prior to the date of expiration on forms furnished by the Division. Failure to file a renewal application shall result in expiration of the certificate to operate.
10A NCAC 14E .0107 ISSUANCE OF CERTIFICATE
(a) The Division shall issue a certificate if it finds the facility can:
(1) Comply with all requirements described in this Subchapter; and
Certificates shall be posted in a conspicuous place on the premises.
10A NCAC 14E .0109 RENEWAL
Each certificate, unless previously suspended or revoked, shall be renewable annually without charge upon the filing of an application and its approval by the Division.
10A NCAC 14E .0110 REVOCATION
The Department shall deny, suspend, or revoke a certificate in any case where it finds that substantial failure to comply with these regulations renders the facility unsuitable for the performance of abortions.
10A NCAC 14E .0111 INSPECTIONS
(a) The Division shall make such inspections as it may deem necessary.
(b) The Division shall have authority to investigate any complaint relative to the care, treatment or complications of any patient.
(c) Representatives of the Division may review any records in any medium necessary to determine compliance with the rules, while maintaining the confidentiality of the complainant and the patient, unless otherwise required by law.
10A NCAC 14E .0112 ALTERATIONS
Any certificate holder or prospective applicant desiring to make specified types of alteration or addition to a clinic or to construct a new clinic, before commencing such alteration, addition or new construction shall submit plans and specifications therefor to the Division for preliminary inspection and approval or recommendations with respect to compliance with the regulations and standards herein authorized.
SECTION .0200 ‑ MINIMUM STANDARDS FOR CONSTRUCTION AND EQUIPMENT
10A NCAC 14E .0201 BUILDING CODE REQUIREMENTS
(a) The physical plant for a facility must meet or exceed minimum
requirements of the North Carolina State Building Code for Group B occupancy
(business office facilities) which is incorporated by reference including
subsequent amendments. Copies of The North Carolina Building Code, Volume One,
General Construction, may be obtained for thirty dollars ($30.00) from the N.C.
Department of Insurance, P.O. 26387,
(b) The requirements contained in this Section shall apply to new facilities and to any alterations, repairs, rehabilitation work, or additions which are made to a previously certified facility.
10A NCAC 14E .0202 SANITATION
Abortion clinics must comply with the rules governing the sanitation of hospitals, nursing and rest homes, sanitariums, sanatoriums and educational and other institutions, contained in 15A NCAC 18A .1300 which is hereby incorporated by reference including subsequent amendments and editions. Copies of 15A NCAC 18A .1300 may be obtained at no charge from the Environmental Health Services, Division of Environmental Health, N.C. Department of Environment and Natural Resources, 1630 Mail Service Center, Raleigh, NC 27699-1630.
10A NCAC 14E .0203 ELEVATOR
(a) In multi‑story buildings, at least one elevator for patient use shall be provided.
(b) At least one dimension of the elevator cab shall be six and one‑half feet to accommodate stretcher patients.
(c) The elevator door shall have an opening of no less than three feet in width, which is minimum for stretcher use.
10A NCAC 14E .0204 CORRIDORS
The width of corridors shall be sufficient to allow for patient evacuation by stretcher, but in no case shall patient-use corridors be less than 60 inches.
10A NCAC 14E .0205 DOORS
Minimum width of doors to all rooms needing access for stretchers shall be three feet. No door shall swing into corridors in a manner that might obstruct traffic flow or reduce the required corridor width except doors to spaces such as small closets not subject to occupancy.
10A NCAC 14E .0206 ELEMENTS AND EQUIPMENT
The physical plant shall provide appropriate elements and equipment to carry out the functions of the facility with the following minimum requirements:
(1) Mechanical requirements
(a) Temperatures and humidities:
(i) The mechanical systems shall be designed to provide the temperature and humidities shown in this Paragraph:
Area Temperature Relative Humidity
Procedure 70-76 degrees F. 50-60 %
Recovery 75-80 degrees F.
(b) All air supply and exhaust systems for the procedure suite and recovery area shall be mechanically operated. All fans serving exhaust systems shall be located at the discharge end of the system. The ventilation rates shown herein shall be considered as minimum acceptable rates.
(i) The ventilation system shall be designed and balanced to provide the pressure relationships shown herein.
(ii) All air supplied to procedure rooms shall be delivered at or near the ceiling of the room and all exhaust or return from the area shall be removed near the floor level at not less than three inches above the floor.
(iii) Corridors shall not be used to supply air to or exhaust air from any procedure or recovery room except to maintain required pressure relationships.
(iv) All ventilation or air conditioning systems serving procedure rooms shall have a minimum of one filter bed with a minimum filter efficiency of 80 percent.
(v) Ventilation systems serving the procedure or recovery rooms shall not be tied in with the soiled holding or work rooms, janitors' closets or locker rooms if the air is to be recirculated in any manner.
(vi) Air handling duct systems shall not have duct linings in ducts serving procedure or recovery rooms.
(vii) The following general air pressure relationships to adjacent areas and ventilation rates shall apply:
Area Pressure Relationship Minimum Air
Procedure P 6
Recovery P 6
Soiled holding N 10
Clean work or
Clean holding P 4
(P = positive pressure N = negative pressure)
(2) Plumbing And Other Piping Systems
(a) Medical Gas and Vacuum Systems
(i) Piped-in medical gas and vacuum systems, if installed, shall
meet the requirements of NFPA-99-1990, type one system, which is hereby
incorporated by reference including subsequent amendments and editions. Copies of NFPA-99-1990 may be purchased from
the National Fire Protection Association, 1 Batterymarch Park,
(ii) If inhalation anesthesia is used in any concentration, the facility must meet the requirements of NFPA 70-1993 and NFPA 99-1990, current editions relating to inhalation anesthesia, which are hereby incorporated by reference including subsequent amendments and editions. Copies of NFPA 70-1993 and NFPA 99-1990 may be purchased from the National Fire Protection Association, 1 Batterymarch Park, P.O. Box 9101, Quincy, MA 02269-9101, for thirty two dollars and fifty cents ($32.50) and twenty eight dollars and fifty cents ($28.50) respectively.
(b) Lavatories and sinks for use by medical personnel shall have the water supply spout mounted so that its discharge point is a minimum distance of five inches above the rim of the fixture with mixing type fixture valves which can be operated without the use of the hands.
(c) Hot water distribution systems shall provide hot water at hand washing and bathing facilities at a minimum temperature of 100 degrees F. and a maximum temperature of 116 degrees F.
(d) Floor drains shall not be installed in procedure rooms.
(e) Building drainage and waste systems shall be designed to avoid installations in the ceiling directly above procedure rooms.
(3) Electrical Requirements
(a) Procedure and recovery rooms, and paths of egress from these rooms to the outside shall have at a minimum, listed battery backup lighting units of one and one-half hour capability that will automatically provide at least five foot candles of illumination at the floor in the event of a utility or local lighting circuit failure.
(b) Essential electrically operated medical equipment necessary for the safety of the patient shall have, at a minimum, battery backup.
(c) Receptacles located within six feet of sinks or lavatories shall be ground-fault protected.
(d) Provide at least one wired-in, ionization-type smoke detector within 15 feet of each procedure or recovery room entrance.
(4) Each facility and its grounds shall be maintained to minimize hazards and enhance safety for staff and patients. Buildings systems and medical equipment must have preventative maintenance conducted as recommended by the equipment manufacturers' or installers' literature to assure satisfactory operation.
10A NCAC 14E .0207 AREA REQUIREMENTS
The following areas are considered minimum requirements for abortion clinics:
(1) Receiving area;
(2) Examining room;
(3) Preoperative preparation and holding room;
(4) Individual patient locker facilities or equivalent;
(5) Operating room;
(6) Recovery room;
(7) Clean workroom;
(8) Soiled workroom;
(9) Medicine room (may be defined as area in the clean workroom if a self‑contained secure cabinet complying with security requirements of state and federal laws is provided);
(10) Linen Storage. Separate and distinct areas for storage and handling clean and soiled linen shall be provided;
(11) Patient toilet;
(12) Personnel lockers and toilet facilities;
(14) Nourishment station with storage and preparation area for serving meals or in‑between meal snacks;
(15) Janitor's closets appropriately located;
(16) Adequate space and equipment for assembling, sterilizing and storing medical and surgical supplies;
(17) Storage space for medical records;
(18) Office space for nurses' charting, doctors' charting, communications, counseling, and business functions.
10A NCAC 14E .0208 SHARED SERVICES
When there is written indication that services are to be shared or purchased, appropriate modifications or deletions in space requirements may be anticipated.
SECTION .0300 ‑ ADMINISTRATION
10A NCAC 14E .0301 OWNERSHIP
The ownership of the abortion clinic shall be fully disclosed to the Division.
10A NCAC 14E .0302 PERSON IN AUTHORITY
The governing authority shall designate a person to have authority and responsibility for the administrative and professional functions of the clinic.
10A NCAC 14E .0303 POLICIES AND PROCEDURES
The governing authority shall prepare a manual of clinic policies and procedures for use by employees, medical staff, and contractual physicians to assist them in understanding their responsibilities within the organizational framework of the clinic. These shall include:
(1) Patient selection and exclusion criteria, and clinical discharge criteria.
(2) Policy and procedure for each type of abortion procedure performed at the clinic.
(3) Protocol for determining fetal age.
(4) Protocol for referral of patients for whom services have been declined.
(5) Protocol for discharge instructions that informs patients who to contact for post-procedural emergencies.
10A NCAC 14E .0304 ADMISSION AND DISCHARGE
(a) There shall be on the premises throughout all hours of operation an employee authorized to receive patients and to make administrative decisions on their disposition.
(b) All patients shall be admitted only under the care of a physician
who is currently licensed to practice medicine in
(c) Any patient not discharged within 12 hours following the abortion procedure shall be transferred to a general hospital.
(d) Following admission and prior to obtaining the consent for surgery required by Rule .0305(a) of this Section, representatives of the clinic's management shall provide to each patient the following information:
(1) A fee schedule and any extra charges routinely applied;
(2) The name of the attending physician(s) and hospital admitting privileges, if any. In the absence of admitting privileges a statement to that effect shall be included;
(3) Instructions for post-procedure emergencies as outlined in Rule .0313(d) of this Section;
(4) Grievance procedures a patient may follow if dissatisfied with the care and services rendered; and
(5) The telephone number of the Complaints Investigation Branch of the Division.
10A NCAC 14E .0305 MEDICAL RECORDS
(a) A complete and permanent record shall be maintained for all patients including the date and time of admission and discharge; the full and true name; address; date of birth; nearest of kin; diagnoses; duration of pregnancy; condition on admission and discharge; referring and attending physician; a witnessed, voluntarily-signed consent for each surgery or procedure and signature of the physician performing the procedure; and the physician's authenticated history and physical examination including identification of pre-existing or current illnesses, drug sensitivities or other idiosyncrasies having a bearing on the operative procedure or anesthetic to be administered.
(b) All other pertinent information such as pre- and post-operative instructions, laboratory report, drugs administered, report of operation and follow-up instruction including family planning advice shall be recorded and authenticated.
(c) If Rh is negative, the significance shall be explained to the patient and so recorded. The patient in writing may reject or accept the appropriate desensitization material. A written record of the patient's decision shall be a permanent part of her medical record.
(d) An ultrasound examination shall be performed and the results posted in the patient's medical record for any patient who is scheduled for an abortion procedure.
(e) The facility shall maintain a daily procedure log of all patients receiving abortion services. This log shall contain at least patient name, estimated length of gestation, type of procedure, name of physician, name of RN on duty, and date and time of procedure.
(f) Medical records shall be the property of the facility and shall
be preserved or retained in the State of
(g) The facility shall have a plan for destruction of medical records to identify information to be retained and the manner of destruction to ensure confidentiality of all material.
(h) Should a facility cease operation, arrangements shall be made for preservation of records for at least 20 years. The facility shall notify the Division, in writing, concerning the arrangements.
10A NCAC 14E .0306 PERSONNEL RECORDS
(a) Application. Each prospective employee or contractual employee must submit an application for employment which includes education, training, experience, and references.
(b) Job Descriptions:
(1) The facility shall have a written description which describes the duties of every position.
(2) Each job description shall include position title, authority, specific responsibilities and minimum qualifications. Qualifications shall include education, training, experience, special abilities and license or certification required.
(3) The facility shall review annually and update all job descriptions, and shall provide a current copy to each employee or contractual employee assigned to the position.
(c) The facility shall provide an orientation program to familiarize each new employee or contractual employee with the facility, its policies and the employee's job responsibilities.
(d) The governing authority shall be responsible for implementing health standards for employees, as well as contractual employees, which are consistent with recognized professional practices for the prevention and transmission of communicable diseases.
(e) Employee and contractual employee records for health screening, education, training and verification of professional certification shall be available for review by the Division.
10A NCAC 14E .0307 NURSING SERVICE
(a) There shall be a minimum of one registered nurse with experience in post‑operative or post‑partum care who is currently licensed to practice professional nursing in North Carolina on duty in the clinic at all times when patients are in the facility.
(b) There shall be supporting personnel sufficient to meet patient needs and to provide safe patient care.
10A NCAC 14E .0308 reserved for future codification
10A NCAC 14E .0309 LABORATORY SERVICES
(a) Pre-operative Tests. As a minimum, there shall be performed for each patient the following laboratory tests which must be recorded in the patient's medical record prior to the abortion:
(1) Pregnancy testing, except when a positive diagnosis of pregnancy has been established by ultrasound;
(2) Anemia testing (hemoglobin or hematocrit); and
(3) Rh factor testing.
(b) Blood and Blood Products. Those patients requiring the administration of blood shall be transferred immediately to a local hospital having blood bank facilities.
(c) The facility shall have instructions for each test procedure performed, including:
(1) Sources of reagents, standard and calibration procedures; and
(2) Information concerning the basis for the listed "normal" ranges.
(d) The facility shall perform and document, at least quarterly, calibration of equipment and validation of test results.
10a NCAC 14E .0310 EMERGENCY BACK‑UP SERVICES
The facility shall provide intervention for emergency situations. These provisions shall include but are not limited to:
(1) Basic cardio-pulmonary life support;
(2) Emergency protocols for:
(a) Venous access supplies,
(b) Air-way support and oxygen,
(c) Bag-valve mask unit with oxygen reservoir, and
(d) Suction machine;
(3) Emergency lighting available in the operating room; and
(4) Ultrasound equipment.
10A NCAC 14E .0311 SURGICAL SERVICES
(a) Facilities. The operating room shall be maintained exclusively for surgical procedures and shall be so designed and maintained to provide an atmosphere free of contamination by pathogenic organisms. The facility shall establish procedures for infection control and universal precautions.
(b) Tissue Examination:
(1) The physician performing the abortion is responsible for examination of all products of conception (P.O.C.) prior to patient discharge. Such examination shall note specifically the presence or absence of chorionic villi and fetal parts or the amniotic sac. The results of the examination shall be recorded in the patient's medical record.
(2) The facility shall have written procedures, supplies and equipment available for gross and microscopic evaluation of abortion specimens. If placental or fetal tissue is not identified by gross examination, a microscopic examination must be done on the P.O.C. In cases where the microscopic evaluation is negative for chorionic villi and fetal parts, or the weight of the P.O.C. falls substantially below the appropriate weight range for the fetal age, a microscopic examination by a board certified or board eligible pathologist shall be done on the P.O.C.
(3) The results of this examination, the findings of further patient evaluation and any subsequent treatment must be recorded in the patient's medical record.
(4) The facility shall establish procedures for obtaining, identifying, storing and transporting specimens.
(5) The facility shall establish a method for follow-up of patients on whom no villi are seen.
10A NCAC 14E .0312 MEDICATIONS AND ANESTHESIA
(1) No medication or treatment shall be given except on written order of a physician.
(2) Medications must be administered in accordance with the Nurse Practice
Act of the State of
(1) The anesthesia must be administered only under the direct supervision of a licensed physician.
(2) Flammable anesthetics shall be prohibited except when construction, storage and equipment meet the standards of the National Fire Protection Association (N.F.P.A.) incorporated in Bulletin No. 56, "Code for Use of Flammable Anesthetics."
10A NCAC 14E .0313 POST‑OPERATIVE CARE
(a) Patients whose pregnancy is terminated on an ambulatory basis should be observed in the abortion clinic for a reasonable number of hours, not less than one, to insure that no immediate post‑operative complications are present. Thereafter, such patients may be discharged if their course has been uneventful.
(b) Any patient having an adverse condition or complication known or suspected to have occurred during or after the performance of the abortion shall be transferred to the back‑up hospital for evaluation or admission.
(c) Any non‑ambulatory patient shall be accompanied by an attending medical or nursing staff member during any transfer within or outside the facility.
(d) Written instructions shall be issued to all patients in accordance with the rules of the physician in charge of the abortion service and shall include the following:
(1) symptoms and complications to be looked for,
(2) activities to be avoided,
(3) specific telephone number to be used by the patients should any complication occur or question arise.
10A NCAC 14E .0314 CLEANING OF MATERIALS AND EQUIPMENT
(a) All supplies and equipment used in patient care shall be properly cleaned or sterilized between use for different patients.
(b) Methods of cleaning, handling, and storing all supplies and equipment shall be such as to prevent the transmission of infection through their use.
10A NCAC 14E .0315 HOUSEKEEPING
Abortion clinics shall meet the standards for sanitation as required by the Division of Environmental Health in the rules and regulations governing the sanitation of private hospitals, nursing and rest homes, sanitariums, sanatoriums, and educational and other institutions, 10 NCAC 10A, with special emphasis on the following:
(1) There must be cleaning of such a frequency as to maintain the floors, walls, woodwork and windows in a manner to minimize the spread of dust particles in the atmosphere. Accumulated waste material must be removed at least daily.
(2) The premises must be kept free from rodents and insect infestation.
(4) Linen which comes directly in contact with the patient shall be provided as needed for each individual patient. No such linen shall be interchangeable from one patient to another before being properly cleaned, sterilized, or laundered.
10A NCAC 14E .0316 FOOD SERVICE
(a) Nourishments shall be available and offered to all patients.
(b) Sanitary conditions shall be maintained in accordance with regulations of the North Carolina Sanitation Code administered by the Division of Environmental Health.
SECTION .0400 ‑ MEDICAL STAFF
10A NCAC 14E .0401 QUALIFICATIONS
Every person admitted to practice in the clinic shall qualify by submitting a signed application in writing which shall contain the following data: age, year and school of graduation, date of licensure, statement of postgraduate work, and experience.
10A NCAC 14E .0402 FILE
An individual file for each physician practicing in the clinic shall be maintained. Each file shall contain the information outlined in Rule .0401 of this Section.
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