(1) The department shall make available a standard form and explanation for declarations for mental health treatment in simple language and easily read type with adequate space to express the preferences and instructions of the service recipient.
(2) The form shall include at least the following information: The effect of making the declaration;
(3) The basic power of a service recipient to control mental health treatment and involuntary treatment authority;
(4) The general range of mental health treatment processes that the service recipient might consider;
(5) The conditions under which the declaration may be acted on; and
(6) How to revoke a declaration.
(7) The form shall include places for at least the following types of preferences and instructions to be written: Symptoms that may suggest use of the declaration;
(8) Psychoactive medication;
(9) Electroconvulsive or other convulsive treatment;
(10) Admission to and remaining in mental health facilities;
(11) Actions that the service recipient refuses to permit;
(12) Mental health service providers; and
(13) Other matters on which the service recipient may have preferences or instructions or wish to provide information to mental health service providers.