The executive commissioner by rule shall prescribe a form that must be completed and signed on a resident’s admission to an institution by or on behalf of the resident. The form must state:
(1) that a person who places an electronic monitoring device in the room of a resident or who uses or discloses a tape or other recording made by the device may be civilly liable for any unlawful violation of the privacy rights of another;
(2) that a person who covertly places an electronic monitoring device in the room of a resident or who consents to or acquiesces in the covert placement of the device in the room of a resident has waived any privacy right the person may have had in connection with images or sounds that may be acquired by the device;
(3) that a resident or the resident’s guardian or legal representative is entitled to conduct authorized electronic monitoring under Subchapter R, Chapter 242, Health and Safety Code, and that if the institution refuses to permit the electronic monitoring or fails to make reasonable physical accommodations for the authorized electronic monitoring that the person should contact the Department of Aging and Disability Services;
(4) the basic procedures that must be followed to request authorized electronic monitoring;
(5) the manner in which this chapter affects the legal requirement to report abuse or neglect when electronic monitoring is being conducted; and
(6) any other information regarding covert or authorized electronic monitoring that the executive commissioner considers advisable to include on the form.