(1) In addition to the information required by 40-1-203 and 40-1-204 , MCA, the certificate form shall include the following:

(a) an indication by the certifying physician that either:

(i) the applicant submitted to a standard serological test for rubella immunity within the past six months and that both the applicant and the other party to the proposed marriage have examined the report of such test; or

(ii) the applicant is exempt from the requirement for serological testing on medical grounds, as specified in ARM 37.12.608;

(b) certification by the applicant; and

(c) acknowledgment of receipt of the certificate by the clerk of the district court who is to issue the marriage license.