1. (a) The reasons for the request; indicating how the patient will benefit from the transfer.
2. (b) The name and address of the person requesting the transfer and his relationship to the patient.

3. (c) The name of the facility to which the transfer is proposed, and the written consent of the director of such facility to the transfer.

   1. (1) If the patient is voluntary or informal and is not requesting the transfer, the request shall include his written consent.
   2. (2) If the patient is involuntary or non-objecting, the proposed transfer shall be discussed with the patient. No request shall be made by the facility if the patient objects unless he has had the opportunity to appeal the decision to the director. The request shall state that the patient does not object or the result of any appeal.

   (d) The age of the patient.

   In the case of a voluntary patient under 18 years of age if the request for transfer is not made by his parent or legal guardian, the request shall include the written consent of the parent or guardian unless the patient was admitted on his own motion in which case his written consent must be obtained.

   (e) The legal admission status of the patient.

4. (f) A statement that no court proceedings are pending involving the patient.

The written request for an order of transfer shall state or include: