La. Admin. Code tit. 48 § V-12317

Current through Register Vol. 50, No. 11, November 20, 2024

Section V-12317 - Notice of Parental Rights Form

A. Procedure of Notice of Parental Rights

1. Prior to the final disposition of a miscarried child, but not more than 24 hours after the miscarriage occurs in a health facility, the facility shall notify the patient, or if the patient is incapacitated, the spouse of the patient, both orally and in writing, of both of the following:

a. the parents right to arrange for the final disposition of the child through the use of a parental rights form;

b. the availability of a chaplain or other counseling services concerning the death of the child, if such services are provided by the health facility.

B. Notice of Parental Rights Form

1. The notice of parental rights form shall contain, at a minimum, all of the following:

a. a definitive statement that reads as follows: "This notice of parental rights form is required to be provided to you pursuant to Louisiana law;"

b. a brief description of the provisions of R.S. 40:1191 along with concise instructions for the patient to follow regarding how to properly complete the form and return it to the health facility in the event the patient desires to arrange for the final disposition of the child;

c. a concise statement of the timelines that must be satisfied in order for the patient to arrange for the final disposition of the miscarried child;

d. a listing of state, regional, or national grief counseling organizations that may provide counseling services concerning the death of a child.

2. The form should be in substantially the following form or in conformance therewith.

Notice of Parental Rights

Louisiana law requires this form to be given to you to inform you of your right to arrange for the final disposition of fetal remains resulting from a miscarriage. Please read carefully.

You are only required to sign and return this form if you would like to make arrangements for the burial or cremation of the fetal remains. If you do not sign and return this form the health facility will be allowed to make final disposition of the remains according to state law.

By signing and returning this form, you are choosing to make arrangements for the final disposition of the remains and agree to the following:

1. I understand that Louisiana law requires me to return this completed and signed form to the location listed below within forty-eight (48) hours of the health facility providing me the form. Failure to return the form within forty-eight hours will allow the facility to make final disposition of the remains according to state law. Return the form to:

(Health Facility Contact Information Here)

2. I understand that the health facility will notify me or my designee that the fetal remains may be obtained from the facility within seventy-two (72) hours from the time the facility notifies me or my designee. Failure to obtain the remains within seventy-two (72) hours will allow the hospital to make final disposition of the remains according to state law. Please provide below your contact information and the contact information of your designee who will be taking possession of the remains.

Patient/Spouse/Legal Guardian Signature Date

3. I understand that choosing to arrange for the final disposition of the fetal remains is at my expense and it is my responsibility to ensure that the final disposition of the fetal remains is in accordance with Louisiana law.

I have read and understand the information presented to me on this form and my signature indicates my desire to arrange for the final disposition of the fetal remains.

You may inquire about the chaplain or other counseling services that may be offered by this facility. Other counseling options can be located on the Louisiana Department of Health website at http://new.dhh.louisiana.gov/index.cfm/page/2656.

La. Admin. Code tit. 48, § V-12317

Promulgated by the Department of Health, Office of Public Health, LR 431393 (7/1/2017).

AUTHORITY NOTE: Promulgated in accordance with R.S. 40:1191.3.