Written information informing patients of their rights shall include a preamble or preliminary statement in substantial form as follows:

1. (a) Further facility requirements are set forth in the Health and Safety Code, and in Title 22 of the California Administrative Code.
2. (b) Willful or repeated violations of either code may subject a facility and its personnel to civil or criminal proceedings.
3. (c) Patients have the right to voice grievances to facility personnel free from reprisal and can submit complaints to the State Department of Health Services or its representative.