S.I. No. 539/2013 - Protection of Life During Pregnancy Act 2013 (Section 10) (Application for review of medical opinion) Regulations 2013.

Notice of the making of this Statutory Instrument was published in

“Iris Oifigiúil” of 3rd January, 2014.

I, James Reilly, Minister for Health, in exercise of the powers conferred on me by section 4 of the Protection of Life During Pregnancy Act 2013 (No. 35 of 2013), hereby make the following regulations:

1. (1) These Regulations may be cited as the Protection of Life During Pregnancy Act 2013 (Section 10) (Application for review of medical opinion) Regulations 2013.

(2) These Regulations shall come into operation on 1st day of January 2014.

2. In these Regulations, “medical speciality” means the medical speciality in respect of which the medical practitioner is registered in the Specialist Division of the register.

3. The form specified in the Schedule is prescribed for the purposes of section 10 of the Protection of Life During Pregnancy Act 2013 .

SCHEDULE

Protection of Life During Pregnancy Act 2013

Form to be completed in relation to an application under section 10 of the Protection of Life During Pregnancy Act 2013 for review of a relevant decision

Please complete this form in BLOCK CAPITALS.

Part 1 (a) — Applicant details (where the application is made by the pregnant woman)

Name, address and contact details of Applicant
1	First name
2	Surname
3	Address
4	Contact telephone number
5	Date of birth
6	Are you making this application on your own behalf?

Part 1 (b) — Applicant details and details of pregnant woman (where the application is made by another person (“third party”) on behalf of the pregnant woman)

This section should be completed where the application is being made by a third party acting on behalf of the pregnant woman.

Name, address and contact details of the third party
1	First name
2	Surname
3	Address
4	Contact telephone number
5	Basis on which the third party is acting on behalf of the pregnant woman

Name, address and contact details of the pregnant woman
1	First name
2	Surname
3	Address
4	Contact telephone number
5	Date of birth

Part 2 — Details of medical practitioner or medical practitioners whose relevant decision or relevant decisions are the subject of the application

Details of medical practitioner(s) consulted
1	Address of medical practitioner (if known) Date consulted in regard to risk of loss of lifeMedical speciality (if known)
2	Name of medical practitioner Address of medical practitioner (if known) Date consulted in regard to risk of loss of lifeMedical speciality (if known)
3	Name of medical practitioner Address of medical practitioner (if known) Date consulted in regard to risk of loss of lifeMedical speciality (if known)

Part 3 — Medical information

Medical information in relation to the pregnant woman
1	Name of general practitioner (if any) Address of general practitioner (if known)
2	Name of obstetrician (if any and if different to medical practitioner(s) listed at Part 2 above) Address of obstetrician (if known)
3	Name of other relevant medical practitioner (if any and if different to medical practitioner(s) listed at Part 2 above) Address of medical practitioner (if known) Medical speciality (if known)
4	Hospital attended for maternity services (if any)
5	Estimated gestational age in weeks

Signature of person making application

Signed: ................................................................... Date: .........................................

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GIVEN under my Official Seal,

19 December 2013.

JAMES REILLY,

Minister for Health.

Protection of Life During Pregnancy Act 2013

Regulations — Application for review of medical opinion

EXPLANATORY NOTE

(This note is not part of the instrument and does not purport to be a legal interpretation.)

These Regulations may be cited as the Protection of Life During Pregnancy Act 2013 (Section 10) (Application for review of medical opinion) Regulations 2013. They have been developed under Section 4 of the Protection of Life During Pregnancy Act.

These Regulations provide for a prescribed form to be used for the purpose of applying for a formal review of medical opinion under Section 10 of the Act.