APPENDIX TO PART TWO

STANDARD AGREEMENT, REFERRED TO IN 2° OF ARTICLE R. 2212-9, SETTING THE CONDITIONS UNDER WHICH DOCTORS PRACTISING IN HEALTH CENTRES CARRY OUT VOLUNTARY INTERRUPTION OF PREGNANCY BY INSTRUMENTAL METHOD.

BETWEEN

The health establishment

located at

represented by Mr or Mrs

duly authorised in their capacity as

Hereinafter referred to as the health establishment

On the one hand,

AND

The health centre

located at

represented by Mr or Mrs

Duly authorised in their capacity as:

Hereinafter referred to as the health centre

On the other hand,

It is agreed as follows:

Art. 1 - The health centre provides proof of compliance with the specifications drawn up by the Haute Autorité de santé (HAS) referred to inarticle L. 6323-1-1 of the Public Health Code for the performance of voluntary interruption of pregnancy by instrumental methods outside the health establishment, in particular the qualifications of the doctor(s) concerned and the operating rules specified by decree.

The health establishment undertakes to respond to any request for information relating to the practice of voluntary interruption of pregnancy by instrumental method, submitted by the health centre. It organises training courses for doctors who meet the conditions set out in II of article R. 2212-11 of the same code and for the health care team of the voluntary health centre, in order to update all the knowledge required for the practice of voluntary interruption of pregnancy by instrumental method.

Art. 2 -If there is any doubt as to the date of the pregnancy, the existence of an ectopic pregnancy or, at the time of the check-up, whether the uterus is empty, the doctor practising in the health centre will refer the woman to the health establishment, which will take all measures appropriate to her condition.

Art. 3 - Once the voluntary interruption of pregnancy by instrumental method has been carried out, the doctor practising in the health centre will send the health establishment a copy of the liaison sheet containing the relevant information from the patient's medical file.

Art. 4 - The health establishment undertakes to welcome the woman at all times and to ensure that she is cared for in the event of any complications or failures. Where necessary, it will ensure the continuity of the care provided.

For complex situations, the health centre and the health facility draw up a protocol relating to the arrangements for expert support from the health facility to the health centre and, for cases of emergency transfer of patients, protocols relating to the transfer and care arrangements. These protocols are appended to this agreement.

Art. 5 - The doctor who carried out the voluntary interruption of pregnancy will keep in the medical file the certificates of consultations prior to the voluntary interruption of pregnancy as well as the woman's written consent to this procedure.

Art. 6 - This agreement, established for a period of one year, takes effect on the date of signature. It is renewed each year by tacit agreement on the anniversary date of its signature. It may be terminated at any time by either of the contracting parties by any means that provides a date certain for notification. Termination takes effect one week after this date. In the event of non-compliance with this agreement by one of the parties, termination by the other party shall take effect immediately.

Art. 7.-A copy of this agreement shall be sent, for information purposes, by :

By the health establishment to the regional health agency to which it reports or,

1° For Saint-Pierre-et-Miquelon, to the territorial health administration;

2° For Saint-Barthélemy and Saint-Martin, to the health agency for Guadeloupe, Saint-Barthélemy and Saint-Martin;

And

By the health centre to the departmental medical association council and the primary health insurance fund or the general social security fund to which it belongs or,

1° For Mayotte, to the departmental medical association council of Mayotte and the social security fund of Mayotte;

2° For Saint-Pierre-et-Miquelon, to the territorial medical association council or, failing that, to the delegation which carries out its functions and to the provident fund of Saint-Pierre-et-Miquelon;

3° For Saint-Barthélemy and Saint-Martin, to the Conseil départemental de l'ordre des médecins de la Guadeloupe and to the caisse générale de sécurité sociale de la Guadeloupe.