Thank you for taking my comments.  

Removing the requirement for further evaluation and replacing it with a discussion based around cost in 12VAC5-412-240.C. goes against evidence-based guidelines and standards published by the National Abortion Federation (NAF). NAF's 2016 Clinical Policy Guidelines state, "STANDARDS are intended to be applied in virtually all cases. Deviations will be rare and difficult to justify." Listed below are the standards as listed in NAF's 2016 CGG.

13. EVALUATION OF EVACUATED UTERINE CONTENTS

• Standard 8.1: Termination of pregnancy must be confirmed prior to the patient leaving the facility or further evaluation must be initiated.
• Standard 8.2: When insufficient tissue or incomplete products of conception are obtained, the patient must be reevaluated.

8. MANAGEMENT OF PREGNANCY OF UNCERTAIN LOCATION

• Standard 8.1 The patient must be evaluated in order to assess for the risk of ectopic implantation in early pregnancy.
• Standard 8.2 Each facility must have a written protocol to evaluate ectopic pregnancy. All relevant staff at the site must be familiar with the protocol.
• Standard 8.3 All patients with a pregnancy of uncertain location must be informed of the options for evaluation and management. The symptoms and dangers associated with ectopic pregnancy, and a plan for when and how to seek emergency medical attention must be reviewed and documented.
• Standard 8.4 When a medical or aspiration abortion is initiated for a patient with a pregnancy of uncertain location, resolution of the pregnancy must be verified and documented.
• Standard 8.5 Patient follow-up must continue until one of the following: (1) the diagnosis of ectopic pregnancy has been excluded; (2) clinical resolution of a possible ectopic pregnancy has been ensured; or (3) transfer of care to an appropriate provider has been made and documented.

It is medically appropriate to incorporate NAF's own standards of care into Virginia's abortion regulations.