Misoprostol and Mifepristone Access - Patient and Provider Reporting Form

The intent of this form is to allow the New Orleans Health Department (“NOHD”) to understand the impacts of ACT 246 throughout the City of New Orleans. Such impacts would include identifying challenges to legal and medically necessary access to mifepristone and misoprostol through a health care provider and/or pharmacist.  

New Orleans City Council passed a unanimous motion on September 18, 2024 to task the Health Department to investigate and study any delay of care issues that result from Act 246, which classifies mifepristone and misoprostol as scheduled drugs effective October 1, 2024. 

Any information provided on this form will be kept strictly confidential. Please do not include protected health information (i.e medical records, diagnosis, treatment), unless you are the patient and are willing to self-disclose to the New Orleans Health Department (“NOHD”) for the purpose of follow up.  

Thank you for your time.  

Disclaimer: NOHD is a HIPAA covered entity and is subject to privacy and security regulations. 

2. Please select the option that best describes you:  *
Follow-up is completely optional at your discretion. If yes, please share your name and preferred contact method.