reports of ru-486 abortion pill events for the state of ohio · 2018. 10. 9. · state medical...

State Medical Board of Ohio

Report of RU-486 Event (Required pursuanllo Re. 2119.123)

To be completed by the physician who provided RlJ.486

1. Date RU·486 was provided: tJf/ I) Month Day

2. Name of medical practice or facility at which RU·486 was provided:

~t-e:+ e. r- ""'-

3. Address of medical practice or facility at which RU-486 was provided:

/;)000 sJ,...;.Kcr ;jIve<, ~ 1< v-c(ev...d L/'f/~D

4. Date post RU·486 event began: 09(J 7jelO/I

5. Event(s) (Please check all that apply):

;1.011 Year

X Incomplete abortion - Adverse reaction to RU-486 Patient hospitalized

- Patient received a transfusion Severe bleeding

_ Other serious event (specify)

6. Duration of event: Hours ;Z Days

7. Remarks:

{~kI;-oJ St.kG;{~ <!Po/II, "0 ;1borJi(rtA

8. Namao! ,",,;0," who 'r ~ ~b~ 8. b. PhYSICian's signature &- ~. I D~ . (1/((

Send completed fOm1s to:

Prescnbe<J: 51··/2011


Legal Department

30 E. Broad St., 3rd Floor

Columbus,OH 43215·6127

~J"~r (~¥/:{~ft~ ,

Ln,I) IJ "t .~'~ ~.O

MEDICAL BOARD JUL 19 2011

.


Report of RU-486 Event (Required pursuant to R.e. 2119.123)

To be completed by the physician who provided RU·486

1. Date RU-486 was provided:

Month Year

2. Name of medical practice or facility at which RU-486 was provided:

~t-e~ 3. Address of medical practice or facility at which RU-486 was provided:

I;). 000 Skk'er l3/vc1. t\ev~ 441.).D

4. Date post RU-486 event began:

oS /It /11 5. Event(s) (Please check all that apply):

'i-- Incomplete abortion - Adverse reaction to RU-486 _ Patient hospitalized

- Patient received a transfusion _ Severe bleeding


6. Duration of event: ;)., Hours Days

7. Remarks:

~O~;tT>-- (~\bJ Sk~C~ ~ft/") ~o \w-~r (~t{d,~.

8. a. Name of physician who prttu-~ 8. b. Physician's signature

Date 1 \ \ '¥\ \ \

Send completed forms to:

Prescribed: 5/--/2011


. Legal Department


Columbus,OH 43215-6127

fJe t/'; t:,N).. • ,t.1,1).

~D.O

MEDICAL BOARD JUl 19 2011

State Medical Board of Ohio Report of RU-486 Event

(Required pursuant to R.C. 2119.123)

To be completed by ...... physician who provided RU-486

1. Date RU-486 was provided: /2.-I

Month Day


flA.'1Nd pdftn-fnoo-i d'r:; NrrvHvA-5 r Oh.,.(J


11C;su (20 aU;!'1 rk rzJ 6ed~ O/J-I

tty / '10

4. Date post RU-486 even~ rg~7 '7f h /I


:WI/ Year

_ Incomplete abortion _ Adverse reaction to RU·4a6 V;atient hospitalized

~atient received a transfusion ~vere bleeding


6. Duration of event: 3C; Hours Days D<?Y" I7r nOll Y' ,

7. Remarks:

/'" ~ 8. a. Name of physician who prOVidey ~76J:/)aVld /2"uLcn S , M b B. b. Physician's signature I I


Prescribed: 51-/2011

'" ~ate' Cj /:2/ / / F I •


Legal Department

30 E. Broad St., 3ed Floor

Columbus,OH 43215·6127

M.D./D.O

1.

2.


Report of RU-486 Event (Required pursuant to R.C. 2119.123)

To be completed by the phy"',""n who proYlded RU-486

Date RU-486 was provided: IU t1 Month Day

Name of medical practice or facility at which RU-486 was provided:

fltvtV\t6 t7ttrU!v(hlJ'l5?l .. tA· N~ 01+-'-I


l I Year

11fhu ,~Wh1U ~ ~kv1t tfH- L{l//L/~

4. Date post Ru-:;;;zvent pagan:

I v21/1 5. Event(s) (Please check all that apply):

~ncomplete abortion - Adverse reaction to RU-486 _ .. _ Patient hospitalized


1-Other serious event (specify)

i 6. Duration of event: -z-- Hours Days

7. Remarks:

L"" L'\ / /"\ '} ('

8. a. Name of physician who %viXl-4E / ~D Alf'W;) f..-J(rU f~ flJVJ 8. b. Physician's Signature ' I V I

M.D./D.O


Prescribed: 51~-I2011

i / ~'-/ '-" '- I \ ate


Legal Department

30 El ~idaj.j$t. p~ f;iOc).d Columbus, ()H 43215-6127

:2-if, 12- .


Report of RU-486 Event (Required pursuantto R. C. 2119.123)

To be compleled by the physicIan who provIded RU_

1. Date RU-486 was provided: 11/ Monlh Day


fl~~tm1 . 3. Address of medical practice or facility at which RU·486 was provided:

\Ct i~ ~ ~ f;d ~ LfL(1ifll

all that apply):

I I Year

~ncomplete abortion Adverse reaction to RU-486 Patient hospitalized

Patient received a transfusion _ Severe bleeding

_ Other serious event (specify) ______________________ _

6. Duration of event:

. a. Name of physician wh

8. b. PhysiCian's signature

Send completed forms, to: ,

PISSCribed: 51-12011

Y Hours ____ Days

-.,L,L,~SL------_r_-=::==-.,,_-- M.D. I 0.0


Legal Department

30 E. Broad St., tt;F.lpqI1d OS L\fT ,:' Gl Columbus,OH 43215-6127

.; ,



To be compl_ by file physICIan _ pro_ RU-488

1. Date RU·4B6 was provided: \2 Day

2. Name of medical practice or facility at which RU486 was provided:

- . 3. Address of medical practice or facility at which RU-4B6 was provided:

Zolz' Vear

1~1.SS Ea5,+ Mn:.A ~+ Co\' ~bLl"> oH 4~' \ 1-4. Date post RU-486 event began:

:lIto/a 5. Event(s) (Please check all that apply):

__ I ncomplete abortion ____ Adverse reaction to RU-486 _ Patient hospitalized

I .. ~ Patient received a transfusion _ Severe bleeding

~ Other serious event (specify) J1UrJuoA IXJ.u/J .-~

6. Duration of event 2 Hours _.~ ___ .. ___ Days

7. Remarks: Dp"t/C tiPJtL ot tY11/~ htg"", 17~.Y~ cO ~rvF~ 6,/t vp.

8. a. Name of phYSician who provided RU-486 ~~~v' 8. b. Physician's Signature


'10 :8 Wlf 12 AlfW llDl

Ol/iO .:i0 O!!\I08 l'IIJI03I-J 31\115

Prescribed: 5/·~/2011

/J?1tt...... t Date Pith-


Legal Department

30 E. Broad St., 3'" Floor


M.D./D.O

ME91GAl S9AR9


Report of RU-486 Event (Required pursuant to Re. 2119.123)

To be_i_by die phyalclon _pro __

1. Date RU-486 was provided: .!.fY\~g1.J" (t;,J.bo...... ___ IL'lL.-__ .. lon .. Monlh Day Year

2. Name of medical practice or facility al which RU-486 was provided:

's r, 1..,



5. Event/s) (please check all that apply):

~omplete abomon _ Adverse reaction to RU·486 _ Patient hospitalized

_ Severe bleeding

_ Other serious even! (specify) ________________ ~ ____ _

6. Duration of event: ____ Hours _. __ ... _ .. Days

17. Remarks:

. a. Name of physician who provided RU-488 _.-1.*~<I.4.~~:""....L.""-!...::.JiL!"Ift.-c::..·!:.b __ _

___ "('~"'-""~--'-_-'-""--;-:""'-:-:=::--___ M.D. I 0.0 8. b. Physician's signature


Date Cj /I'{ /17-State Medical Board of Ohio

Legal Department

30 E. Broad St .. 3rd Roar

Columbus, OH 43215-8127 MA'i ~ 4 2012


Report of RU-486 Event (Required pursuantto R.C. 2119.123)


1. Date RU-486 was provided: 01 Month Day


NN

13 Add ress 0 medIca practIce or acility at whic., RU-486 was provided: f . I f

11/)550 fLo CfCS. I i) /UJ . ../bFDI


:<JI~ /,1-5. Event(s) (Please check all that apply):

Year

/lncomPlete abortion - Adverse reaction to RU·486 _ Patient hospitalized

- Patient received a transfusion



17, Remarks:

~t

Send completed forms

Prescribed: 51·42011

I

_ Severe bleeding

Hours ft Days

State Medical 80 rd of Ohio

Legal Department

30 Broad St., 3fd Floor

, ,10.0



To be completed by the physician who provided RU-486

1. Date RU-486 was provided: (it

Month Day


ft'N eu

3. Address of medical practice Oi facility at which RU-486 was provided:

Ii ~~ !2» (JL...s I J) E /'4)( c/3bWfO,1.-LJ J

01/ '-Ilfl Lflo


I "2-/ 1 S- /11


Year

/lncomPlete abortion Adverse reaction to RU-486 Patient hospitalized

Patient received a transfusion -

'i, etlle~Q~s ElI7ElIlt (sr;u:n:~if~)

6. Duration of event: ))'

7. Remarks:

8. a. Name of physician who

8. b. Physician's signature


_ Severe bleeding

.tj ~l ~ IS I¥l ~ ~ ~t:f.f

Hours L3

State Medical Boa

legal Department

..v~

Days

30 Broad St! Floor

-State Medical Board of tn1io



1. Date RU-486 was provided: II o I Month Day


fptJ elJ


I q s- ~ 0lL S t./) (;S" /'UJ, fb 1!j) Fb cU> ( oK 4-4-1 4- Ie


'III 1-//11 5. Event(s) (Please check all that apply):

Year

~ncomplete abortion - Adverse reaction to RU·486 _ Patient hospitalized

_ Patient received a transfusion _ Severe bleeding


6. Duration of event: I Hours j;( Days

7. Remarks:

8. a. Name of physician who provi





Legal Department

30 E. Broad Sf., Floor

"-State Medical Board of CJflio Report of RU-486 Event

(Required pursuant to Re. 2119.123)


1. Date RU-486 was provided: (KJ

Month Day


ff~


I C) ;;-so rLo GfL-Sj!J ;Lo 1, t1J fb (L1) J oH I


/0/1'1/ /I 5. Event(s) (Please check all that apply):

201 L Year

4tf I L-f f;>

_Incomplete abortion _ Adverse reaction to RU-486 _ Patient hospitalized

_ Patient received a transfusion _ Severe bleeding

~her serious event (specify) ~ ,/fit> m l.:?Il1-IT

6. Duration of event: 'I Hours ~ Days

7. Remarks:

8. a. Name of physician who provide

8. b. Physician's Signature


Prescribed: 5/··/2011

--r-"7f--.r::r'-t--::::---:fr------ M. D. I D.O


Legal Department

30 Broad St., 3m Floor


Report of RU ... 486 Event 21

Adverse reaction to RU·486 Patient hosuit~l!izE)d

transfusion

event """,,',~,~, """',"'"


(Required pursuant to R.e. 2119.123)


1. Date RU·486 was provided:

Month Day


ffI'J


;(5' JSO !Loc/[,J I 1)£ rLf)

,6{;!1) PO yU) fftlc; ftn,. I <PH L[ y: ( if- ""


(,J-~-I:<


Year

/~ncomplete abortion - Adverse reaction to RU·486 _ Patient hospitalized



6. Duration of event: I Hours C¥ Days

7. Remarks:

8. a. Name of physician who r'I4!',.,.W1'rI




--tA-++.;L--==="f:==.=+--------- M.D.! 0.0


Legal Department

30 E. Broad Sf., 3rc! Floor




1. Date RU·486 was provided:

Month Day


r? f,.J f3\)


~ 5..t;)'l) IZoLIl-S,lnt:: rlf)

Ib8"DPVM HT3{ 'OM ~f41p


<t,-'1-/:2.


Year

~ncomplete abortion - Adverse reaction to RU-486 _ Patient hospitalized



6. Duration of event: 1 Hours S2f Days

7. Remarks:

8. a. Name of physician Wh()'.~ .

8. b. Physician's signature -+l-~"--+-r--":"-~:"""""~~----- M.D. / D.O


Legal Department

30 Broad St.! 3rd Floor

Proscribed: 5/··/2011


Report of RU-486 Event pursuant to Re. 2119.1

To be completed by the physician who provided RU-4S6


Month Day

practice or facility at which RU-486 was provided:

I 1<


t(s) (Please check all that apply):

Year

Incompiete abortion Adverse reaction to RU·486 Patient hospitalized


_ Other serious event (specify) _~_~~,,~~ ____ "~ _____ • ____ ~_. _____ "._

6. Duration

7.




1. Date RU-486 was provided: 1\ 10 Month Day


PfNl?b


20,t

Year

I C1 550 VLo CAL £ If) E YLtJ, Jb (31) Pu ;U) I 01-{ <.f Lf} if- \p

4. Date post RU-486 event began: I~/ :3//1

5. Event{s) (Please check all that apply);

_ Incomplete abortion

_ Patient received a transfusion

/ Other serious event (specify)

6. Duration of event: 1

7. Remarks:


Prescribed; 51--/2011

_ Adverse reaction to RU·486

_ Severe bleeding

~1t1UJY1~

Hours fiJ Days


Legal Department

30 Broad Sf., 3rd Floor

_ Patient hospitalized

10.0



To be completed by the physician who provided RU-48a


Month Day




Year

/lncomPlete abortion Adverse reaction to RU-486 Patient hospitalized

Patient received a transfusion Severe bleeding

Other serious event (specify) _______________________ _

6. Duration of event: __ -'--_ Hours ____ Days

7. Remarks:

8. b. PhYSician's signature



7------~-==--=---- M.D.! 0.0


Legal Department

30 E. Broad St., Floor





1. Date RU-486 was provided: Of Month Day


3. Address of medical practice or facility at which RU-486 was provided: :J..S3SD fLo CAL-';' I 1) E fLo h~H>!LJJ t/1:l C, 1-t/3) () 1-1 7fCj(4- (P


io«/-/:<


Year

v1ncomp,ete abortion - Adverse reaction to RU-486 _ Patient hospitalized



6. Duration of event: 1?1

7. Remarks:



Prescribed: 5/ .. /2011

_ Severe bleeding

Hours ( Days

~--r--+------- M.D. 10.0


Legal Department

30 Broad Sf., Floor


Report of RU-486 Event pursuant to Re. 2119.1



Day

of medical practice or facility at which RU-486 was provided:

Address of medical practice or facility at which RU-486 was provided:


Year

abortion Adverse reaction to RU-486 Patient hospitalized


Other serious event (specify) ________________________ _

6. Duration of event: ____ Hours ____ Days

physician who nrr\\lIr''''£l

0.0





Month Day





Year

~complete abortion Adverse reaction to RU-486 Patient hospitalized






to: Medical Board of Ohio

Legal Department

30 Broad 8t., Floor

Columbus, OH 43215-61





Month Day




Year

abortion Adverse reaction to RU-486 Patient hospitalized


_ Other serious event (specify) _______________________ _


8. a. Name of physician who provi

8. b. Physician's signature 0.0

completed to:




1. Date RU-486 was provided: (2-Month Day Year


r(tl~~ VtlrtJvv-f:1;L~ (J~ NdV~)+ o~ a

3. Address of medical practice or facility at whicYl RU-486 was provided:

ry:;2yc:;o tLoz1L~·~ ~ ~(-ovfHk (}t:+ 4L((L(Cp


! 3{VOl (~ 5. Event(s) (Please check all that apply):

v' Adverse reaction to RU-486 _ Patient hospitalized _ Incomplete abortion -


_ Other serious eve~t (specify)


8. a. Name of physIcian who

b. Physician's signature

Send completed forms

Prescribed: 5/-·/2011

I

_ Severe bleeding

Hours Days


Legal Department

30 Broad St., 3rd Floor





Month Day



4. Date pOpt RU-486 event began:

I 5. Event(s) (Please check all that apply):

Year

/~complete abortion Adverse reaction to RU-486 Patient hospitalized



6. Duration of event: ----1-- Hours ____ Days

7. Remarks:

8. a. Name of physician wh~pr f



PrPR,r:rihr'ri' 51--12011


Legal Department

30 Broad St., Floor

Columbus,OH 4321

10.0


(Required pursuant to R.e. 2119.123)


1. Date RU-486 was provided: 3 k~ Month Day


1/ccVU;v .1 V 6l IT ltv f'lAdiJ7;{ d\ ~\~t'vy~ {5k0 ( I

3. Address of medical practice or facilitY at which RU-486 was provided:

''''S3&7b Qlg~u ~ &ut~A ~S (}}t L{l/ (<-{Co

4. Date post RU-486 event began: ! I L{/c{ Iv


U;) /7 ____ Year


Patient received a transfusion -



7. Remarks:





J

Severe bleeding

Hours Days


Legal Department

30 Broad St, Floor

State Medical Board of 0 io



1. Date RU-486 was provided: ';2-, ft~ ;/ Month Day


V'llt~U1lld 9{1~ ~l'J~Q4r 6~D tJ


~0S"5b ~~d.€ U PxLf¢YlA ut-4 tj1. LfL{IL{h v

4, Date post RU-486 e~ilt b\,gan:

Li '/'0, I~ 5. Event(s) (Please check aI/ that apply):

I?/ Year

V Incomplete abortion - Adverse reaction to RU-486 Patient hospitalized



6. Duration of event: L Hours Days

7. Remarks:

8. a. Name of physician



Prescribed: 51-·/2011

_~....j-..-,~~=-_____ -:----=~ ____ M.D.! 0.0

Lf/t'1Ul--State Medical Board of Ohio

Legal Department





1. Date RU-486 was provided: ,3 Month Day


rlrJlV\V\tJ YCV-<AJ\.i{'kv-u-zL ~ N~ ~o


?:t; '?J:,~~cL0~'- <lR U 16P A ~ () l-t- vtWI4eo

4. Date post RU-486 event be~T5Jl'v

5. Event(s) (Please check all that apply): -

Year

/lncomPlete abortion - Adverse reaction to RU-486 _ Patient hospitalized

I - Patient received a transfusion _ Severe bleeding


6. Duration of event: I Hours Days

7. Remarks:

8. a. Name of physician who nY,",1111nC"'"





Legal Department

30 Broad Floor

'State Medical Board of Ohio




Month Day


f J I~

5. Event(s) (Please check all that apply): /'

Year

JlncomPlete abortion Adverse reaction to RU·486 Patient hospitalized



6. Duration of event: __ -/-_ Hours ____ Days

7. Remarks:

8. a. Name of physician who pro

/ 8. b. Physician's signature


Prescribed:

0.0

Date _____ ~~~~----------~--------


Legal Department

30 Broad St., Floor




To be completed by the phys!chm who provided RU-4S6

1, Date RU-486 was provided:

Month Day

4. Date post RU-486 event began: [0\ \Ll \1. ... ../


Year

~mp'ete abortion Adverse reaction to RU·486 _ Patient hospitalized


_ Other serious event (specify) __________________ .~ ____ _

6. Duration of event: Hours Days

D.

27






P\anneol Pt:trev-rt'nccx:i of- Grect-k:r- DY\ to

3. Address of medical practice or facility at which RU-486 was provided: Z ~ s 0 R.oG-~s ~ \2.J Be.J forvt ttrs I cH Y~ltflo


I J I 4 /'2-0 I L


Loll..-Year

/ncomPlete abortion - Adverse reaction to RU·486 _ Patient hospitalized



6. Duration of event: Hours I Days

7. Remarks:

8. a. Name of physician who provid Cl

8, b. Physician's signature


Prescribed: 5/·-12011


Legal Department

30 E. Broad Sf.! 3rd Floor






P\o\\'\V\~ PG\r~ooJ of Grut-\-et{' O\tlIO


Z <5 '3 S {) f-o"k,.s ~ K.d I edfOni ttTs/ot-\ 4~ ILf~


1/ l s/2-e>I'Z-5. Event(s) (Please check all that apply):

'2.01

Year





7. Remarks:

8. a. Name of physician who pr




_ Severe bleeding

/'

Hours ( '-.t~~ays


Legal Department

30 E. Broad Sf., 3rd Floor


Re~ort of RU-486 vent [

(Required pursuant to R. C. 2119.12 )

T~ be completed by the physician who provided jRU-486

j 1. Date RU-486 was provided:

Month Day

2. Name of medical practice or fa,cility at which RU-486 was provid d:

P\(A'A~ci PCl'l'E'ft\~~ G~A:"~'ef dI\\\J

3. Address of medical practice or iacility at which RU-486 was provi ed:

'2... S 0 ~ck$f ~ (24 il §ed . .fOrd +tt:;; 0 H Lf I Lt l.o

4. Date post RU-486 event beganl I

10/ '2..- /'2- ! 5. Event(s) (Please check all that ~pply):

Year

~ncomplete abortion i Adverse reaction to RU-486 Patient hospitalized


_ Other serious event (specify) _--: _____________ -+ ________ _

6. Duration of event: ____ +ours _ ........... 1 __ Days

7. Remarks:

8. b. Physician's signatur



state Medical Board of ,Ohio

Report of RU-486 ~vent I <

! j ; (Required pursuant to R.C. 2119.121)

Tf be ",mp~I'" by Ih. phy.'OM who pm~d'" I"U ... 6

< I


Month

2. Name of medical practice or f~cility at which RU-486 was provid d:

fl.A't74l~ e:"JJ Ptttk)\lT1too}!> 0 ~(lk~ 6f-rAo

3. Address of medical practice or facility at which RU-486 was provi ed: I

.,;( 53 SD r'l.-o qLS. !!> ~ t1Jb !

1'b~1>ro ltD 1h3, () H l+i if I Lt lp I

4. Date post RU-486 event began; I

II) I ~ f I :;;I. <


I

Year

_ Incomplete abortion i Adverse reaction to RU-486 I-

Patient hospitalized I

1

_ Patient received a transfusion 1_ Severe bleeding I

/ Other serious event (specify) --,-~~/".:::..nL...!,.;t(>...:.r4...::..-_______ -+-_______ _

6. Duration of event: _--....;.RS=--_ ~ours lif Days

8. a. Name of physician who provi ed IVi .& .

8. b. Physician's signature @ 0.0



Medical 80a d of Ohio

Department

E. Broad St., 3rd Floor

Report of RU-486 . vent I

l (Required pursuant to R.C. 2119.121)

Tr be-completed by the physician who provided rU.486

I I

1. Date RU-486 was provided: i 10 17- 0201.).. Month Day Year I

2. Name of medical practice or fability at which RU-486 was providE d:

P '-1TN rJ t?Jj f tHl>Pr.f r7fO 0 !) r:; rZ-;err~ o l'jJ .0

I

3. Address of medical practice or facility at which RU-486 was provh ed: :J ~ J Sv fvO cAL-J ) Jj (:! fLo j

QjFf)fi; f'J) hi 01+ : LfLfI4~

4. Date post RU-486 event beganl

1/- <j -(:< ! I


I _ Incomplete abortion i- Adverse reaction to RU·486 _ Patient hospitalized

_ Patient received a transfusion I ~evere bleeding

I

I

i

_ Other serious event (specify) !

!

J I

If 6. Duration of event: ~ours Days I

7. Remarks:

I

8. a. Name of physician who provi~




-------+,t-+----,I'--~~_I_:_ _ __1_14__+---- M.D. / 0.0

Medical Board of

Department

E. Broad St., 3rd Floor

, I St,: ate Medical Board of ~hiO

Report of RU-486 fvent , (Required pursuantto R.C. 2119.121) , i

Tp be completed by the physician who provldedlRU-486

1. Date RU-486 was provided: 1/

Month Year

2. Name of medical practice or facility at which RU-486 was provid d: !

f Gfh-J i~ oj) vF C,.. Oth Q

3. Address of medical practice or lacility at which RU-486 was provifed:

;<4.)};'S()JC-l! (-iLS. tf::, '1Lo. f"B fL!) 1/713 ( 'u H I J

4. Date post RU-486 event beganj . Jlj.2 1 -h b ..

5. Event{s) (Please check all that ~pply):



Other serious event (specify) ----7-----------+---------

i 6. Duration of event: _---'::...-_ ftiours ___ Days

7. Remarks:

8. b. PhYSician's signature



. j S~ate Medical Board of IOhio

Re*ort of RU-486 fvent ; (Required pursuant to R.C. 2119.123) : l

Tf be completed by the physician who provided rU-4S6

1. Date RU·486 was provided: I Month Day

2. Name of medical practice or fa,bility at which RU·486 was provid~d: I

p ~ I~ ~ P ~ Tltco ~ 0 6>~"'fl-, oth ()

3. Address of medical practice or ~acility at which RU-486 was provi ed:

~ 5" 3> 51> yU; uW I1H~ (LIJ i

b ~ /'t6 Itr3 0 11 Lf t\f ( 4- (,0

4. Date post RU-486 event began! . II / ;1"7 I I ~ i

5. Event(s) (Please check all that ~pply):

Year

_ Incomplete abortion i- Adverse reaction to RU·486 Patient hospitalized

_ Patient received a transfusion 1-Severe bleeding

I / Other serious event (Sp6cify)ttJ" A-n>", ~ ~ ~ 1m U]tS e, ,utn ON

6. Duration of event: __ L_· _,_ ~ours _--'-10'_ Days

7. Remarks:

8. b. Physician's Signature


Department

E. Broad St. j Srd Floor

OH

Prescribed: 5/··12011

! , I

State Medical Board of !Ohio Re~ort of RU-486 ~vent

! 1

. (Required pursuant to R.e. 2119.123) 1

Tp be completed by the physician who provided lRU-486

1. Date RU-486 was provided: ,0 Month

2. Name of medical practice or f~cility at which RU-486 was ProVid,d:

fUhJr4~ P~'4nt1)o,:) op qM~ tJ/ho

3. Address of medical practice or tacility at which RU-486 was provi ed: ;(5350 iWu&.s.,b" ~ 6trbrbfL{) /-f73 I £) tf ~ 'fl'f ~

4. Date post RU-486 event began!

to/~7-I{';). I 5. Event(s) (Please check all that ~pply):

1 ,

Of;J..

Year


_ Patient received a transfusion Severe bleeding

_ Other serious event (specify) ---t------------t---------

6. Duration of event: __ =%'---- Hours __ .a->--_ Days 1

7. Remarks:

8. a. Name of physician who prOvj~ed RU-486 .[)




I

I i

----:------+-..,..~-i+Jt-+_-4-..,t.._p,~::::.......___j'--- M.D. / 0.0

Date

Medical Bard of Ohio

Department

E. Broad 81.. Srd Floor


Report of RU-486 Event (Required pursuant to R~C. 2919.123)


L Date RU-486 was provided: I ! Month Day


IJ t . J,~ :r v't.".


4. Date post RU-486 complication began:

5. Event(s} (Please check all that apply):

L~ncomplete abortion Adverse reaction to RU-486 _ Patient hospitalized


Year

_ Other serious event (specify) ______________________ _

6. Duration of event: _--''-''-_ _--,-__ Days

7. Remarks:

18~ a. Name of physician who provided RU-486 I 18. b. Physician's signature

Send completed forms to: Medical Board of Ohio

Department

30 E. Broad Floor

OH 43215-6127

1.

2.

State Medical Board Of!OhiO

Report of RU-486 ~vent \ ,

I (Required pursuant to R.C. 2119.12~)

j Tp be completed by the physician who provided \RU-486

, I

I I

Date RU-486 was provided: '=/ f Month Day

Name of medical practice or fability at which RU-486 was providE d: !

I , P L/fh~l-..1 ~b P.I}'fV<v-N ;1')100 ~ c;f ~, {U:rtTt:j'1- if 1110 \

3. Address of medical practice or facility at which 8U-486 was provirl ed:

::z 5.3 S b ~ (41.0·:; f -JJ F';1,.4) ,(b Fi) 1::0 ILl) 1fT3 lOr/ Lf 4 I Lf ~ I

4. Date post RU-486 event began1

I

I -L/ Year

5. Event(s} (Please check all that ?-pply):

~complete abortion ; Adverse reaction to RU-486 ~ Patient hospitalized

I _ Patient received a transfusion Severe bleeding

_ Other serious event (specify) ----i------------+---------

6. Duration of event: ____ 1H0urs ____ Days

7. Remarks:

! ~/ 1 8. a. Name of physiCian who provided ,Rt,Y-486





Legal DeJ)artment

3,0 E. Broad Sf., 3rd Floor , qolumbus, OH

I State Medical Board of IOhio

Report of RU-486 ~vent i

(Required pursuant to R.C. 2119.12~)

To be completed by the physician who provided iRU-486 I


Month t Day

2. Name of medical practice or facility at which RU-486 was provid~d:

I (:)\ {,

3. Address of medical practice or facility at which RU-486 was provi~ed: I

\.~ i


5. Event{s) (Please check all that apply):

"/

Year

~ Incomplete abortion Adverse reaction to RU·486 Patient hospitalized


_ Other serious event (specify) _____________ -+ ________ _

6. Duration of event: __ ----'-_ Hours ____ Days

7. Remarks:

8. a. Name of physician who provided





Legal Department

30 E. Broad Sf., 3rd Floor

Columbus, OH

--,.---....... J~ / D.O

1.

2.

i i

State Medical Board of jOhio

Report of RU-486 ~vent (Required pursuant to R.C. 2119.12J)

1 Tp be completed by the physician who provided jRU-486

I Date RU·486 was provided: :<

~~ •..

Name of medical practice or f~cility at which RU·486 was providE. d: ; i

p L/t1-NN ~b r {l{L~-N ~11<DO "-' (;f ~ {LtcI'tTl?{L. I ~ Hlo

i

3. Address of medical practice or 1acility at which 8U-486 was provifed:

:< 5 J, S'b /U; (.f6.s, I.;) F /J;A) .b f?i) (v,I'l . .lJ 1iT3 o,i L{ 4 I 4 '-: I I 'P



/

~;{ f S Year

vlncomplete abortion Adverse reaction to RU-486 Patient hospitalized

_ Patient received a transfusion :_ Severe bleeding

_ Other serious event (specify) ________________ -+ ________ _

6. Duration of event: ____ ~ours ______ Days

7. Remarks:

8. a. Name of physician who provided fltlJ-486





"egal De~artment

3P E. Broad St., 3rd Floor

Columbus, OH 43215-61

10.0

State Medical Board of JOhio

Report of RU-486 ~vent I

(Required pursuant to R.e. 2119.12~) I

To be completed by the physician who provided IRU-486 I I


Month

2. Name of medical practice or facility at which RU-486 was provid

3. Address of medical practice or facility at which RU-486 was provi~ed: I

I



Year

v:ncomPlete abortion _ Adverse reaction to RU-486 Patient hospitalized


_ Other serious event (specify) _____________ --+ ________ _


7. Remarks:

8. a. Name of physician who provided RU· 486 11 8. b. Physician's signature




legal Department



Report of RU-486 Event (Required pursuant to R.C 2919.123)



Month Day



4. Date post RU-486 complication began:


Incomplete abortion Adverse reaction to RU-486 _ Patient hospitalized


Year

_ Other serious event (specify) _______________________ _

6. Duration of event: ____ Hours _--'-__ Days

7. Remarks:

8. a. Name of physician who provided


Send completed forms to: State Medical Board of Ohio

Department

30 E. Broad Floor

reports of ru-486 abortion pill events for the state of ohio · 2018. 10. 9. · state medical...

Documents