(14)__Whether the physician performing an induced abortion has been subject to license revocation or suspension or other professional sanction; and

(15) The number of previous abortions the mother has had.

3.__Induced abortion complication report form.__The following provisions govern induced abortion complication report forms.

A.__No later than 90 days after the effective date of this section, the department shall prepare an induced abortion complication report form for all physicians licensed and practicing in this State.__A copy of this section must be attached to the induced abortion complication report form.

B.__The Board of Licensure in Medicine and the Board of Osteopathic Licensure shall ensure that induced abortion complication report forms required by this section, together with a copy of this section, are provided:

(1)__No later than 120 days after the effective date of this section to all physicians licensed to practice in this State;

(2)__To each physician who subsequently becomes licensed to practice in this State at the same time that official notification is made to that physician that the physician is so licensed; and

(3)__By December 1st of each year, other than the calendar year in which the induced abortion complication report forms are distributed in accordance with subparagraph 1, to all physicians licensed to practice in this State.

C.__Any physician practicing in this State who encounters an illness or injury that is related to an induced abortion shall complete and submit an induced abortion complication report form to the department.

D.__Any physician required to submit an induced abortion complication report form to the department shall do so as soon as is practicable after the encounter with the induced-abortion- related illness or injury, but in no case