The report shall consist of the following reported information to the extent available:

1. (1) Name, address, and date of birth of the victim.
2. (2) Address where the burn injury occurred.
3. (3) Date and time of the burn occurrence.
4. (4) Degree of burn injury, percentage of the body affected by the burn injury, and the specific area of the body affected by the burn injury.
5. (5) The name and address of the facility treating the patient.

(Source: P.A. 94-828, eff. 1-1-07.)