Dieses Formular bleibt in der Krankengeschichte des Operateurs der Operateurin 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information in the designated fields: Name, Vorname (First Name), Strasse (Street), PLZ / Ort (Postal Code / City), and Geburtsdatum (Date of Birth). Ensure all details are accurate for proper processing.
3. Indicate your current situation by confirming that you are ungewollt schwanger (unintentionally pregnant) and that you find yourself in a Notlage (emergency situation) where you cannot carry the pregnancy to term.
4. Acknowledge that the physician has conducted an in-depth conversation with you, provided personal counseling, informed you about health risks associated with the procedure, and handed over the relevant guidelines from the Kantonsarztamt.
5. Fill in the Ort und Datum (Place and Date) before signing as the applicant. This confirms your request for a pregnancy termination.
6. Ensure that a medical professional completes their section by providing their signature and confirming prior consultation details.

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