1.6. The medical assessment report necessary for the temporary representation of an incapable person of full age must contain(1) the identification of the person of full age, namely, the person’s name, commonly used, if any, date of birth, gender, health insurance number, address, e-mail address, if any, and telephone number;
(2) the circumstances giving rise to the application for assessment, the applicant’s name and relationship to the person of full age;
(3) a description of the act for which the person of full age needs to be temporarily represented;
(4) the date of each examination conducted by the assessor and the date of the initial meeting with the person of full age, the identification of each person consulted, namely, the person’s name, relationship to the person of full age, telephone number, date of consultation and identification of the relevant documents consulted by the assessor and referred to in the assessor’s report;
(5) the diagnosis regarding the incapacity of the person of full age, the date thereof and the severity of the symptoms;
(6) the relevant medical history of the person of full age, the relevant physical examination, intellectual and cognitive functions tests, the assessment of decision-making faculties with respect to the specific act and the relevant paraclinical assessment demonstrating the impact of the diagnosis concerning the person’s inability to perform the specific act;
(7) the wishes and preferences of the person of full age concerning the application for temporary representation, if any;
(8) the opinion of the assessor regarding the incapacity of the person of full age to perform the specific act; and
(9) the identification of the assessor, namely, the assessor’s name, professional permit number, professional address, e-mail address and telephone number.