50-20-1004. (Effective on occurrence of contingency) Reporting -- forms. (1) If a physician or physician assistant performs a dismemberment abortion procedure because of a medical emergency, the physician or the physician assistant shall, within 15 days, file with the department on a form supplied by the department a report containing the following information:

(a) the date the procedure was performed;

(b) the probable gestational age of the unborn human being and the method used to calculate gestational age;

(c) a statement declaring that the procedure was necessary because of a medical emergency;

(d) the specific medical indications supporting the determination that a medical emergency existed; and

(e) the physician's or the physician assistant's attestation under oath that the information stated on the form is true and correct to the best of the person's knowledge.

(2) Reports required by and submitted pursuant to this section may not contain the name of the pregnant woman on whom the dismemberment abortion procedure was performed or any other information or identifiers that would make it possible to identify, in any manner or under any circumstances, the woman who underwent the procedure.