Section 3111.93 - Provisions of consent form(A) Prior to a non-spousal artificial insemination, the physician associated with it shall do the following:(1) Obtain the written consent of the recipient on a form that the physician shall provide. The written consent shall contain all of the following: (a) The name and address of the recipient and, if married, her husband;(b) The name of the physician;(c) The proposed location of the performance of the artificial insemination;(d) A statement that the recipient and, if married, her husband consent to the artificial insemination;(e) If desired, a statement that the recipient and, if married, her husband consent to more than one artificial insemination if necessary;(f) A statement that the donor shall not be advised by the physician or another person performing the artificial insemination as to the identity of the recipient or, if married, her husband and that the recipient and, if married, her husband shall not be advised by the physician or another person performing the artificial insemination as to the identity of the donor;(g) A statement that the physician is to obtain necessary semen from a donor and, subject to any agreed upon provision as described in division (A)(1)(n) of this section, that the recipient and, if married, her husband shall rely upon the judgment and discretion of the physician in this regard;(h) A statement that the recipient and, if married, her husband understand that the physician cannot be responsible for the physical or mental characteristics of any child resulting from the artificial insemination;(i) A statement that there is no guarantee that the recipient will become pregnant as a result of the artificial insemination;(j) A statement that the artificial insemination shall occur in compliance with sections 3111.88 to 3111.96 of the Revised Code;(k) A brief summary of the paternity consequences of the artificial insemination as set forth in section 3111.95 of the Revised Code;(l) The signature of the recipient and, if married, her husband;(m) If agreed to, a statement that the artificial insemination will be performed by a person who is under the supervision and control of the physician;(n) Any other provision that the physician, the recipient, and, if married, her husband agree to include.(2) Upon request, provide the recipient and, if married, her husband with the following information to the extent the physician has knowledge of it:(a) The medical history of the donor, including, but not limited to, any available genetic history of the donor and persons related to him by consanguinity, the blood type of the donor, and whether he has an RH factor;(b) The race, eye and hair color, age, height, and weight of the donor;(c) The educational attainment and talents of the donor;(d) The religious background of the donor;(e) Any other information that the donor has indicated may be disclosed.(B) After each non-spousal artificial insemination of a woman, the physician associated with it shall note the date of the artificial insemination in the physician's records pertaining to the woman and the artificial insemination, and retain this information as provided in section 3111.94 of the Revised Code.Effective Date: 3/22/2001 .