Annually and prior to treatment, a physician may request that a Medicare beneficiary sign a statement prepared in accordance with this section to determine whether or not the beneficiary may be balance billed. The exceptions contained in subdivision 6503(1) of this title shall not apply if the physician does not request that the beneficiary sign the statement. The statement shall be prepared by the Department of Disabilities, Aging, and Independent Living, and shall incorporate the exceptions contained in subdivision 6503(1) of this title. (Added 1987, No. 51, § 1; amended 1989, No. 219 (Adj. Sess.), § 9(a); 2005, No. 174 (Adj. Sess.), § 125.)