5. a. A valid written request for medication under P.L.2019, c.59 (C.26:16-1 et al.) shall be in substantially the form set forth in section 20 of P.L.2019, c.59 (C.26:16-20), signed and dated by the patient and witnessed by at least two individuals who, in the patient's presence, attest that, to the best of their knowledge and belief, the patient is capable and is acting voluntarily to sign the request.
b. At least one of the witnesses shall be a person who is not:
(1) a relative of the patient by blood, marriage, or adoption;
(2) at the time the request is signed, entitled to any portion of the patient's estate upon the patient's death under any will or by operation of law; and
(3) an owner, operator, or employee of a health care facility, other than a long term care facility, where the patient is receiving medical treatment or is a resident.
c. The patient's attending physician at the time the request is signed shall not serve as a witness.