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Guidance note for completing HSA4 electronic forms

Updated 20 December 2022

Applies to England and Wales

This guidance has been updated to reflect the additional information required to be provided in relation to the use of medicines at home for early medical abortion following the amendment to the abortion legislation. The additional information covers:

• situations where both or one of the medicines is taken at home
• situations where treatment is entirely in hospital or clinic
• whether any part of the patient pathway (consultation and treatment) was provided face to face (in person)
• an optional question on which organisation provided the termination

There will be a 3-month transition period (between 31 December 2022 and 31 March 2023) during which it will be optional for practitioners or providers to submit the additional information if your systems allow for this. Practitioners or providers will be legally required to submit this additional data where the medicine prescription for EMA was prescribed on or after 1 April 2023.

New Abortion Notification System

The old Abortion Notification System has been replaced with a new system.

You’ll need to register on the new system before you can use it. The guidance on this page explains how to register and how to use the new system.

If you need more information on completing HSA4 forms online, telephone 020 7972 5541 or email HSA4@dhsc.gov.uk.

The electronic Abortion Notification System (ANS) allows registered medical practitioners to complete and send HSA4 forms to the Chief Medical Officer (CMO) online, in accordance with the Abortion Act 1967, within 14 days of the termination.

This document provides guidance for completing HSA4 forms electronically.

Accessing the service online

The Abortion Notification Service can be accessed online through GOV.UK.

We recommend that you add the link to your favourites in your browser task bar to make accessing the service easier.

Before using the service you must register. If you had an account on the old ANS, your username and password for that account will not be recognised – you’ll need to register for a new account.

Account types

We’re aware that hospital or clinic staff assist registered medical practitioners with the completion of HSA4 forms. Therefore, the system has been designed to allow administrators and registered medical practitioners to enter information.

There are 2 types of accounts on ANS:

• accounts for registered medical practitioners
• accounts for hospital or clinical staff who are assisting registered medical practitioners

Throughout this document we refer to hospital or clinical staff who are assisting registered medical practitioners as ‘clinic account administrators’.

Hospital or clinic staff have administrative log in and access rights. However, only the registered medical practitioner who terminated the pregnancy can authorise forms, which is the equivalent of a signature and enables the information to be released to the CMO. The form can only be authorised once the registered medical practitioner is content that the information provided is correct and complete.

Saving information and automatic timeouts

Your information will be saved as you progress through the form. For security reasons, there is an automated ‘timeout’ after 10 minutes of inactivity on the system. If ‘timeout’ occurs, your form will be saved up to the last completed page.

Registration

Clinic account administrators must get authorisation from a lead physician or a senior member of their clinic. This will need to be provided in writing to HSA4@dhsc.gov.uk before access is given.

Registered medical practitioners will need to provide their GMC (General Medical Council) number, which will be validated against their credentials at registration.

Both registered medical practitioners and clinic account users must register with their work email address.

Logging in

On the ANS log-in page you should enter the username and the password you selected when you registered.

Each time you log in, you’ll need to validate your credentials using a multi-factor authentication process.

You have 3 options for getting your multi-factor authentication code. You can:

• get a text message on the mobile phone number associated with your account
• download the Authy app, which you can access via your mobile phone
• get an email sent to the email address associated with your account (if you do not receive the email, check your ‘junk folder’)

The Authy app allows you to get multi-factor authentication codes without mobile signal, which is useful for those working in areas of poor reception.

Please note: if you delete the Authy app and need support restoring your account, use the Authy Help Centre to guide you through this process.

Homepage

On the homepage, you’ll see a list of your latest cases and messages.

My profile

Under your profile, you can update your personal details, contact information and password.

My cases

The ‘My cases’ page contains a list of your cases. By default, the cases are ordered by newest date to oldest.

Search

You can use the search function to find documents. Once you’ve typed in a search phrase – such as a clinic name or patient reference, for example — your cases and messages will be searched using the selected text.

Section 1: practitioner

If you’re logged on using an administrator account, you must select the terminating registered medical practitioner from the drop-down list. The place of termination will be populated and appear on the page once you’re logged in.

Once you’ve selected the registered medical practitioner, their details will be displayed in the box. Click on the 3 radio buttons to complete the declaration as appropriate.

You should then select ‘next page’ for section 2.

If there are any errors or missing data, the section with the errors will appear in red. You must correct the errors before you continue to the next section – this is the same for all sections of the form.

Section 2: certification

Adding or amending practitioners’ details

You must select the first certifying doctor from the drop-down list. If the doctor is not on the list, you’ll need to add their details manually to the form.

Manually entered registered medical practitioners will show in your list next time you come to complete a form.

Selecting a practitioner

Click on the drop-down menus to select the 1 or 2 registered medical practitioners who signed the HSA1. If the registered medical practitioners who terminated the pregnancy also certified that the patient had grounds for the abortion, do not select their name again for certifying.

A second registered medical practitioner should always be added to the form. The exception to this rule is in the event of an urgent abortion.

You must complete the information on certification underneath by clicking ‘yes’ or ‘no’ as appropriate.

You should then select ‘next page’ for section 3.

Section 3: patient’s details

Patient’s reference

You should enter the patient’s hospital or clinic number, or NHS (National Health Service) number. Only provide the patient’s full name if the patient’s hospital or clinic number, or NHS number are not available.

Date of birth

In all cases, you must enter the patient’s date of birth.

If an invalid date has been entered, a prompt will appear at the end of this page.

If the patient is under 14 years of age or older than 50 years of age, a pop-up will appear. Confirm the date is correct before proceeding.

Postcode

For residents of England or Wales, you must state the patient’s full postcode. If the full postcode is not available, enter the patient’s complete address in the box provided.

If a message appears at the end of the section stating ‘invalid postcode’, you should enter the patient’s full address. Enter each line of the address on the separate lines provided.

Do not enter the patient’s address all on one line, as this shows as an error and will therefore not allow you to submit the form.

For residents outside of England and Wales, you must provide the patient’s country of residence. If the country of residence is not known, you should state the full postcode or address for the patient’s temporary stay in England or Wales.

For residents of the Republic of Ireland, you should select ‘Irish Republic’ and the relevant county.

Ethnicity

You must select the patient’s self-reported ethnicity, if known, from the drop-down menu provided.

If the patient’s self-reported ethnicity is not known, you should select ‘not known’.

Marital status

You must select the patient’s marital status, if known.

If the patient is ‘single’ but in a long-term relationship and/or living with her partner, you should select ‘single (with partner)’ from the drop-down menu.

If the patient is single and the partner status is not known, you should select ‘single (not stated)’.

If the patient’s marital status is not known, you should select ‘not known’ from the drop-down menu.

Parity

For parity, you must enter the total numbers of any previous pregnancies (resulting in a live birth and/or stillbirth over 24 weeks, spontaneous miscarriage and/or ectopic pregnancy, and legal terminations) in each of the 3 drop-down boxes as appropriate.

If the number of previous pregnancies resulting in legal terminations is 5 or more, a pop-up will appear. Confirm the entered number is correct before proceeding.

You should then select ‘next page’ for section 4.

Section 4: treatment details

You must select whether the abortion was NHS funded or privately funded.

You should select the ‘method of termination’.

Surgical

For surgical terminations, you must select ‘surgical’ and select the relevant dates and method used from the drop-down menu. Only complete the ‘date of admission’ if an overnight stay was required.

You must select the place of termination if you are logged on as a practitioner.

An evacuation of retained products of conception is not a termination and should not be reported on an HSA4 form.

Medical

For medical terminations, you must select ‘medical’ and then select from the following options.

Antiprogesterone and prostaglandin

Select antiprogesterone and prostaglandin, then answer the question regarding where the medicine was administered. Different options will appear depending on the answer.

If all medicine was administered in hospital or clinic:

• select the option for all medicine administered in hospital or clinic. You must then complete the relevant treatment dates
• answer the question regarding whether treatment with prostaglandin happened in another place. If you answered ‘yes’, then select the place of treatment with prostaglandin
• you must complete the date the termination was confirmed. If an overnight stay was required, you must complete the dates of admission and discharge
• select place of treatment. This is the place of treatment with antiprogesterone

If one medicine was administered in hospital or clinic and one medicine was administered at patient’s usual place of residence:

• select the option for one medicine administered in hospital or clinic and one medicine administered at patient’s usual place of residence.
• answer whether any part of the consultation and treatment was provided face to face by a registered medical practitioner, nurse or midwife. In this scenario, face to face means a physical (in person) appointment rather than a remote teleconsultation. If you answered ‘no’ to this question, you may answer the next (optional) question to indicate whether the patient was seen in person by another healthcare professional, such as a sonographer
• complete the relevant treatment dates and the date the termination was confirmed
• complete place of termination

If all medicine was administered at patient’s usual place of residence (home):

• select the option for all medicine administered at patient’s usual place of residence
• answer whether any part of the consultation and treatment was provided face to face by a registered medical practitioner, nurse or midwife. In this scenario, face to face means a physical (in person) appointment rather than a remote teleconsultation. If you answered ‘no’ to this question, you may answer the next (optional) question to indicate whether the patient was seen in person by another healthcare professional, such as a sonographer
• you can also answer the optional question regarding which organisation provided the abortion. If your organisation is not listed, please select ‘other’ and state the name of your organisation
• complete the relevant treatment dates and the date the termination was confirmed

Prostaglandin only

Select ‘prostaglandin only’, then answer the question regarding where the medicine was administered. Different options will appear depending on the answer.

If all medicine was administered in hospital or clinic:

• select the option for all medicine administered in hospital or clinic. You must then complete the relevant treatment date
• you must complete the date the termination was confirmed. If an overnight stay was required, you must complete the dates of admission and discharge
• select place of treatment

If all medicine was administered at patient’s usual place of residence (home):

• select the option for all medicine administered at patient’s usual place of residence
• answer whether any part of the consultation and treatment was provided face to face by a registered medical practitioner, nurse or midwife. In this scenario, face to face means a physical (in person) appointment rather than a remote teleconsultation. If you answered ‘no’ to this question, you may answer the next (optional) question to indicate whether the patient was seen in person by another healthcare professional, such as a sonographer
• you can also answer the optional question regarding which organisation provided the abortion. If your organisation is not listed, please select ‘other’ and state the name of your organisation
• complete the relevant treatment date and the date the termination was confirmed

Antiprogesterone only

Select ‘antiprogesterone only’, then answer the question regarding where the medicine was administered. Different options will appear depending on the answer.

If all medicine was administered in hospital or clinic:

• select the option for all medicine administered in hospital or clinic. You must then complete the relevant treatment date
• you must complete the date the termination was confirmed. If an overnight stay was required, you must complete the dates of admission and discharge
• select place of treatment

If all medicine was administered at patient’s usual place of residence (home):

• select the option for all medicine administered at patient’s usual place of residence
• answer whether any part of the consultation and treatment was provided face to face by a registered medical practitioner, nurse or midwife. In this scenario, face to face means a physical (in person) appointment rather than a remote teleconsultation. If you answered ‘no’ to this question, you may answer the next (optional) question to indicate whether the patient was seen in person by another healthcare professional, such as a sonographer
• you can also answer the optional question regarding which organisation provided the abortion. If your organisation is not listed, please select other and state the name of your organisation

Complete the relevant treatment date and the date the termination was confirmed.

Selective

Enter the number of original fetuses and the number reduced to.

A medical practitioner scrutinises all forms relating to selective terminations and more information may be requested on a case-by-case basis.

Feticide

For all methods of termination, you must select ‘yes’ or ‘no’ as to whether feticide was used. Select the date and method of feticide from the drop-down menu.

Feticide is recommended for abortions at 22 weeks and beyond.

If feticide was offered and the patient refused, you should fill in the date that the feticide was offered and select ‘confirmed null’ from the drop-down list. Then click on ‘next step’ at the bottom of the page.

General

If a surgical or medical termination has failed (the fetus has not been expelled) and the procedure is repeated, you should complete 1 form only.

You should then select ‘next page’ for section 5.

Section 5: gestation

You must enter a value between 02 and 42 weeks.

You should then select ‘next page’ for section 6.

Section 6: grounds

You must select the certified grounds as stated on the HSA1 form.

In addition, you must select the following, depending on which ground was selected on the HSA1 or HSA2 form:

• grounds A or B – you must state the main medical condition
• ground C – you must select ‘yes’ if there was a risk to the woman’s mental health; if the risk was to the woman’s physical health, you should select ‘no’ and state the main medical condition
• ground D – you must tick the box
• ground E – you must state the fetal abnormality and the method of diagnosis, or other reason for termination – for example, condition in pregnant woman causing suspected condition in the fetus
• grounds F or G – you must state the main medical condition

If the pregnancy was terminated after it had exceeded 23 weeks and 6 days, you must give a full statement of the medical condition of the pregnant woman or fetus.

You should then select ‘next page’ for section 7.

Section 7: chlamydia screening

You must select ‘yes’, ‘no’ or ‘not known’.

The ‘yes’ box should not be ticked if prophylactic treatment alone was offered.

You should then select ‘next page’ for section 8.

Section 8: complications

You must select any complications that occurred up until the time of discharge from the place of termination.

You must select the boxes as appropriate. If ‘other’ is selected, you should provide details in the relevant text box. You should not enter evacuations of retained products of conception or failed terminations as a complication. A medical practitioner scrutinises all complications given in ‘other’ and more information may be requested on a case-by-case basis.

You should then select ‘next page’ for section 9.

Section 9: death of woman

If a death occurs resulting from the termination, you must enter the date using the drop-down menu and state the cause of death.

Saving, submitting or authorising forms

You can save and close or submit for authorisation at this stage. Pressing ‘Submit for authorisation’ will take you to the next page where you can check all your answers in one place.

Review for authorisation page

You now need to check your answers. If any of your answers require a change, you can select ‘change’ to the right of your answer.

If you’re logged in as an administrator, click on ‘submit for authorisation’. You’ll be redirected to your cases page.

If you’re a registered medical practitioner creating your own form, click on ‘authorise’. You’ll be redirected to your cases page.

Submitting the form following 2-factor authentication login is the equivalent of the terminating registered medical practitioner’s signature. Therefore, it is essential that the practitioner’s username and password remain confidential. Doctors are responsible for any information submitted under their log-in.

Once the form has been submitted to the CMO, you can no longer access it and make changes. Any subsequent amendments will need to be put in writing to the CMO.

Additional information

For medical abortions, when more than one doctor may be involved in the termination, the terminating registered medical practitioner is the doctor taking responsibility for the abortion. Usually, this will be the registered medical practitioner prescribing the mifepristone.

All forms must be electronically signed within 14 days of the termination. Doctors should therefore log in to their accounts to check and send their electronic forms to the CMO. A reminder will be sent to doctors who have forms awaiting their signature at the end of each week.

If forms are not electronically signed within 14 days of the date of termination, they may be removed from the doctor’s account and sent back on paper to be checked and for a written signature that the information provided is correct.

Dealing with unsigned electronic forms generates additional work for clinic staff and staff who process forms on behalf of the CMO. Therefore, you should ensure forms are signed off promptly. Also, statistics for both abortions and conceptions are published quarterly, and missing information affects the quality of these data outputs.

*[EMA}: early medical abortion