21. A physician who communicates information protected by professional secrecy in order to prevent an act of violence, including a suicide, must, for each communication, indicate in the patient’s record the following items:
(1) the date and time of the communication;
(2) the identity of the person exposed to danger or of the group of persons exposed to danger;
(3) the identity of the person to whom the communication was made, specifying, according to the case, whether it was the person or persons exposed to danger, their representative or the persons likely to come to their assistance;
(4) the act of violence he aimed to prevent;
(5) the danger he had identified;
(6) the imminence of the danger he had identified;
(7) the information communicated.