(a) Prior to the administration of pertussis vaccine, the health care provider shall provide to the individual's parent or guardian written information satisfying the requirements of this section, and by appropriate inquiries attempt to elicit the information necessary to make the determinations required by this section:
(1) The frequency, severity and potential long-term effects of pertussis;
(2) Possible adverse reactions to pertussis vaccine which, if they occur, should be brought to the immediate attention of the health care provider;
(3) A form listing symptoms to be monitored and containing places where information can be recorded to assist in reporting to the health care provider, health officer and the department;
(4) Measures parents should take to reduce the risk of, or to respond to, any adverse reaction;
(5) Early warning signs or symptoms to which parents should be alert as possible precursors to an adverse reaction;
(6) When and to whom parents should report any adverse reaction; and
(7) The information required under section four of this article.