34-23A-39. Reporting form for use of notice described in § 34-23A-7. The Department of Health shall prepare a reporting form for physicians which shall provide for the collection of the following information:

(1) The number of females or parents whom the physician or agent of the physician provided the notice described in § 34-23A-7; and of each of those numbers, the number of females who, to the best of the reporting physician's information and belief, went on to obtain the abortion;

(2) The number of females upon whom the physician performed an abortion without providing to the parent of the minor the notice described in § 34-23A-7; of that number, the number who were emancipated minors, and the numbers from whom each of the exceptions to § 34-23A-7 were applicable;

(3) The number of abortions performed upon a female by the physician after receiving judicial authorization to do so without parental notice;

(4) The same information described in subdivisions (1) through (3) of this section with respect to females for whom a guardian or conservator has been appointed pursuant to statutes on guardianship or conservatorship because of finding of incompetency ;

(5) The name of hospital or physician office;

(6) The date of report by month, day, and year; and

(7) A unique patient number that can be used to link the report to medical report for inspection, clarification, and correction purposes but that cannot, of itself, reasonably lead to the identification of any person obtaining an abortion.Source: SL 1998, ch 209, § 6; SL 2004, ch 234, § 4.