(A) The POST form must be a uniform document based on the standards recommended by the National Physician Orders for Life-Sustaining Treatment (POLST) paradigm and must include the information set forth in subsection (C).
(B) A copy, facsimile, or electronic version of a completed POST form is considered to be legal.
(C) The POST form must include the following information:
(1) patient name and contact information;
(2) date of birth;
(3) effective date of form;
(4) diagnosis;
(5) treatment plan;
(6) health care representative or health care agent contact information;
(7) CPR preference;
(8) medical intervention preferences;
(9) preferences for antibiotics; and
(10) assisted nutrition and hydration preferences.