(B) The record must contain:
(1) The radiopharmaceutical;
(2) The patient's or human research subject's name, or identification number if one has been assigned;
(3) The prescribed dosage, the determined dosage, or a notation that the total activity is less than 1.1 megabecquerels (thirty microcuries);
(4) The date and time of the dosage determination; and
(5) The name of the individual who determined the dosage.