(1) A physician shall not perform an abortion upon a pregnant woman unless: In the case of a woman who is less than eighteen (18) years of age, he or she obtains the notarized written consent of both the pregnant woman and one (1) of her parents or her legal guardian; or
(2) In the case of woman who is an incompetent person, the physician first obtains the notarized written consent of her legal guardian.
(3) The notarized written consent shall include without limitation the following information: The name and birthdate of the minor or incompetent woman;
(4) The name of the parent or legal guardian;
(5) A statement from the parent or legal guardian that he or she is aware that the minor or incompetent woman desires an abortion and that he or she does consent to the abortion; and
(6) The date.