; or, as an alternative, documentation from a law enforcement agency that the rape or incest was reported prior to the abortion. (G) Informed consent (i) Consent form required The physician who intends to perform or attempt to perform an abortion under the provisions of subparagraph (B) may not perform any part of the abortion procedure without first obtaining a signed Informed Consent Authorization form in accordance with this subparagraph. (ii) Content of consent form The Informed Consent Authorization form shall be presented in person by the physician and shall consist of— (I) a statement by the physician indicating the probable post-fertilization age of the pain-capable unborn child; (II) a statement that Federal law allows abortion after 20 weeks fetal age only if the mother’s life is endangered by a physical disorder, physical illness, or physical injury, when the pregnancy was the result of rape, or an act of incest against a minor; (III) a statement that the abortion must be performed by the method most likely to allow the child to be born alive unless this would cause significant risk to the mother; (IV) a statement that in any case in which an abortion procedure results in a child born alive, Federal law requires that child to be given every form of medical assistance that is provided to children spontaneously born prematurely, including transportation and admittance to a hospital; (V) a statement that these requirements are binding upon the physician and all other medical personnel who are subject to criminal and civil penalties and that a woman on whom an abortion has been performed may take civil action if these requirements are not followed