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This version of the form is not currently in use and is provided for reference only. Download this version of
State Form 56522
for the current year.
State Form 56522 Abortion Complication Report - Indiana
What Is State Form 56522?
This is a legal form that was released by the Indiana State Department of Health - a government authority operating within Indiana. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 56522?A: Form 56522 is the Abortion Complication Report for the state of Indiana.
Q: Who is required to fill out Form 56522?A: Health care providers in Indiana who perform abortions are required to fill out Form 56522.
Q: What is the purpose of Form 56522?A: The purpose of Form 56522 is to document and report any complications that may arise from abortions performed in Indiana.
Q: Is Form 56522 confidential?A: No, Form 56522 is not confidential. It is used for public health surveillance and reporting purposes.
Q: What information is required on Form 56522?A: Form 56522 requires information such as the type of abortion procedure, any complications that occurred, and the patient's demographic information.
Q: When should Form 56522 be submitted?A: Form 56522 should be submitted within 30 days after the completion of the abortion procedure.
Q: What happens to the data collected on Form 56522?A: The data collected on Form 56522 is used for public health surveillance, research, and reporting purposes to ensure the safety of abortion procedures in Indiana.
Q: Are there any penalties for not submitting Form 56522?A: Failure to submit Form 56522 can result in penalties or sanctions, as required by the state law in Indiana.
Q: Can patients access the information reported on Form 56522?A: No, the information reported on Form 56522 is not accessible to the public. It is used for statistical purposes only and individual patient information is kept confidential.
Form Details:
- Released on July 1, 2018;
- The latest edition provided by the Indiana State Department of Health;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of State Form 56522 by clicking the link below{class="scroll_to"} or browse more documents and templates provided by the Indiana State Department of Health.
