(1) Any person or entity may donate cancer drugs to the program. Any person or entity who donates to the program must contact a pharmacy or facility to obtain a form on which the donor must specify the cancer drug to be donated. The board will supply the form to be used which will include:

(a) name of the cancer drug;

(b) quantity of the cancer drug;

(c) the name of the person to whom the cancer drug was originally prescribed;

(d) the relationship between the person or entity donating the cancer drug and the person to whom the drug was prescribed;

(e) signature of the person donating the cancer drug; and

(f) date the form was signed.