103 STAT. 2246 PUBLIC LAW 101-239—DEC. 19, 1989 (B) by adding at the end the following new sentence: "The >. hospital shall take all reasonable steps to secure the individual's (or person's) written informed consent to refuse such transfer.". (c) AUTHORIZATION FOR TRANSFERS.— (1) INFORMED CK>NSENT FOR TRANSFERS AT INDIVIDUAL RE- QUEST. —Subsection (c)(l)(A)(i) of such section is amended by striking "requests that the transfer be effected" and inserting "after being informed of the hospital's obligations under this section and of the risk of transfer, in writing requests transfer to another medical facility". (2) CLARIFYING PHYSICIAN AUTHORIZATION FOR TRANSFERS.— Subsection (c)(l)(A) of such section is amended— ^ (A)by striking "or" at the end of claused); (B) in clause (ii)— (i) by striking ", or other qualified medical personnel when a physician is not readily available in the emer- gency department,", and (ii) by inserting "of transfer" after "information available at the time"; (C) by striking "; and" at the end of clause (ii) and inserting ", or", and (D) by adding at the end the following new clause: "(iii) if a physician is not physically present in the emer- gency department at the time an individual is transferred, a qusdified medical person (as defined by the Secretary in r^ulations) has signed a certification described in clause (ii) after a physician (as defined in section 1861(r)(l)), in consultation with the person, has made the determination described in such clause, and subsequently countersigns the certification; and". (3) STANDARD FOR AUTHORIZING TRANSFER.—Subsection (c)(l)(A)(ipofsuch section is amended— (A) by striking ", based upon the reasonable risks and benefits to the patient, and", and (B) by striking "individual's medical condition" and inserting "individual and, in the case of labor, to the unborn child". (4) INCLUSION OF SUMMARY OF RISKS AND BENEFITS IN CERTIFI- CATE OF TRANSFER. — SubsectioD (c)(1) of such section is amended by adding at the end the following: "A certification described in clause (ii) or (iii) of subparagraph (A) shall include a summary of the risks and benefits upon which the certification is based.". (5) PROVISION OF SERVICES PENDING TRANSFER. —Subsection (c)(2) of such section is amended— \ (A) by redesignating subparagraphs (A) through (D) as subparagraphs (B) through (E), respectively, and (B) by inserting before subparagraph (B), as so redesig- , ' nated, the following new subparagraph: "(A) in which the transferring hospital provides the medi- cal treatment within its capacity which minimizes the risks to the individual's health and, in the case of a woman in "^ labor, the health of the unborn child;". (d) REQUIRING MAINTENANCE OF RECORDS OF TRANSFERS.—Subsec- tion (c)(2)(C) of such section, as redesignated by subsection (c)(5)(A) of this section, is amended— (1) by striking "provides" and inserting "sends to", and
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