Victorian Consolidated Regulations

Infertility Treatment Regulations 1997 - SCHEDULE 2

Regulation 14 INFORMATION REQUIRED TO BE RECORDED IN REGISTER KEPT BY APPROVED
DOCTOR
1. Information in relation to each artificial insemination of a woman with
donor sperm carried out at a place other than a licensed centre- 1.1. Patient
codes of the woman 1.2. Date and place at which the insemination took place
1.3. Reason for seeking treatment 1.4. Date the sperm was received by the
doctor 1.5. Donor identification code 1.6. Whether the donor is known to the
woman and her husband 1.7. If any drugs were used to induce ovulation, the
drugs used 1.8. Date of consent of the woman and her husband 1.9. Date of
consent of the donor of the sperm and of the donor's spouse, if any.
2. Information in relation to the donor of sperm used in the insemination,
including any known physical abnormalities of that donor- 2.1. Donor
identification code 2.2. Full name of the donor 2.3. Date of birth of the
donor 2.4. Place of birth of the donor (suburb/town and country) 2.5. Any
other name by which the donor is or has been known 2.6. Full name of the
donor's spouse (if any) 2.7. Residential address and contact telephone number
of the donor 2.8. Date on which the residential address and contact telephone
number were given 2.9. Date on and place at which the donor produced the sperm
2.10. Date on which the sperm of the donor was received by the approved doctor
2.11. Marital status 2.12. Occupation 2.13. Religion (if any) 2.14. Ethnic
background of the donor's parents and grandparents 2.15. Height 2.16. Build
2.17. Donor's blood group 2.18. Any known physical abnormality, history of
mental illness or intellectual disability of the donor 2.19. Any screening
tests undertaken in relation to item 2.18 and the results of those tests 2.20.
Number of children (if any) and sex of each child 2.21. Reason why the donor
made the donation 2.22. Date on and place at which counselling was first given
to the donor and to his spouse, if any 2.23. Date on which counselling in
relation to the prescribed matters was first given by an approved counsellor
to each person 2.24. Whether the donor has made sperm donations with any other
approved doctor or at any licensed centre 2.25. Total number of children born
or considered to have been born from sperm of the donor used by the doctor.
3. Information in relation to a woman who undergoes artificial insemination
with donor sperm carried out at a place other than a licensed centre and of
her husband- 3.1. Licensed centre record number or doctor's number (or both),
of the woman 3.2. Full name of the woman 3.3. Date of birth of the woman 3.4.
Full name of the husband 3.5. Occupations of the woman and her husband 3.6.
Details of any physical abnormality in either the woman or her husband 3.7. In
relation to a woman who has given birth to a child as a result of a previous
treatment procedure- (1) the name of the centre where the treatment procedure
was performed (2) the donor identification code (3) the name and address of
the hospital where the child was born (4) the medical record number of the
hospital where the child was born (5) the full name of the child (6) the date
and, if known, the time of birth of the child (7) the sex of the child (8) the
weight of the child at birth (9) the gestational age of the child at birth
(10) if applicable, a description of any malformation of or other
abnormalities in the child (11) if the child was not liveborn, the reason (12)
whether the birth of the child was a single or multiple birth (13) in relation
to a multiple birth- (a) the place of the child in the order of birth (b) the
total number of births, whether liveborn or not (c) the sex of each sibling
(d) if any of the other children were not liveborn, the reasons, if known.
4. Information in relation to any amounts paid to a donor of sperm- 4.1.
Travelling or attendance costs paid to the donor 4.2. Amount that the donor is
reimbursed for medical expenses 4.3. Dates on which any payments referred to
in items 4.1 and 4.2 were made.
5. Information in relation to the outcome of each artificial insemination with
donor sperm carried out at a place other than the licensed centre, including
details of a confirmed pregnancy resulting from the insemination and any
miscarriage resulting from the insemination- 5.1. Patient codes of the woman
who underwent the procedure 5.2. Donor identification code 5.3. Date on which
the procedure was carried out 5.4. Outcome of the procedure.
6. Information about a person born as a result of an artificial insemination
using donor sperm carried out at a place other than a licensed centre,
including particulars of the birth of that person and any physical abnormality
of that person- 6.1. Patient codes of the woman who underwent the procedure
6.2. Donor identification code 6.3. Date on which the procedure was carried
out 6.4. Name of the child 6.5. Date of birth 6.6. Place of birth (full
address) 6.7. Sex of child 6.8. Birth weight 6.9. Gestational age of child
6.10. Any physical or other abnormality discerned at or about the time of
birth 6.11. If the child was not liveborn, the reason 6.12. Whether the birth
was a single or multiple birth, and if the latter- (1) the place of the child
in the order of birth (2) the names of each sibling (3) the sex of each
sibling (4) the total number of children of the birth, whether liveborn or not
(5) if any of the other children were not liveborn, the reasons, if known.

7. Information relating to the destruction or disposal of any sperm- 7.1. Date
on which the sperm was received by the approved doctor 7.2. Donation or
reference number of the sperm 7.3. Date of destruction or disposal of the
sperm 7.4. Reason for the destruction or disposal of the sperm.
8. Information in relation to each consent, withdrawal or lapsing of consent
or objection given under the Act for donor insemination- 8.1. Donor or patient
code of person who gave the consent, withdrawal or objection 8.2. Name of the
spouse of the person who gave the consent, withdrawal or objection 8.3. Date
on which the consent, withdrawal or objection was given 8.4. Date that the
document evidencing the consent, withdrawal or objection was received by the
doctor 8.5. Manner in and place from which the document was received 8.6.
Purpose for which the consent, withdrawal or objection was given 8.7. Name and
position of any witness to the documentation 8.8. Name of the doctor who gave
the woman and her husband information under section 10 of the Act before
consent was given (only applicable to a couple consenting to undergo a
treatment procedure)

In relation to a couple consenting to a donor treatment procedure, or a donor
and his or her spouse consenting to the use of his sperm in a donor treatment-
8.9. Date on which counselling was first given by an approved counsellor to
the person giving consent 8.10. Date on which counselling in relation to the
prescribed matters was first given by an approved counsellor to each person
8.11. Name of any approved counsellor who gave that counselling Lapsing of a
consent 8.12. Date on which a consent of the person and his or her spouse, if
any, lapses.
9. Information in relation to each objection or withdrawal of objection for
the use of donated sperm- 9.1. Donor or patient code of person who gave the
objection or withdrawal of objection 9.2. Name of the spouse of the person who
gave the objection or withdrawal of objection 9.3. Date on which the objection
or withdrawal of objection was given 9.4. Date that the document evidencing
the objection or withdrawal of objection was received by the approved doctor
9.5. Manner in and place from which the document was received 9.6. Name and
position of any witness to the documentation 9.7. Date on which counselling
was first given by an approved counsellor to the person who gave consent 9.8.
Date on which counselling in relation to the prescribed matters was first
given by an approved counsellor to each person 9.9. Name of any approved
counsellor who gave that counselling.
10. Information in relation to any sperm transferred from premises where an
insemination may be carried out to-

* a licensed centre; or

* another approved doctor (at a place other than a licensed centre)- 10.1.
Date of transfer 10.2. Place to which the sperm was transferred 10.3. Person
who authorised the transfer 10.4. Patient or donor code of the person who
produced the sperm 10.5. Date on and place at which the man produced the sperm
10.6. Sperm reference number, if any 10.7. Reason for the transfer.
11. Information in relation to any sperm kept at the premises where an
insemination is to be carried out by the doctor- 11.1. Donor identification
code 11.2. Date on which the sperm was provided or obtained 11.3. Whether the
sperm was obtained on the premises and, if not, from where was it transferred
11.4. Reason for the collection of sperm 11.5. Date placed in storage 11.6.
Place of storage 11.7. Date removed from storage 11.8. Whether an extension of
the storage period was obtained under section 51 or 52 of the Act and, if so,
the extended date. __________________