1. Purpose of Transfer: To be included when specific reason for records transfer needs to be documented (e.g., continuing care, legal proceedings)

2. Authorization Reference: Include when referencing a separate authorization form from the patient

3. Electronic Format Statement: Required when records are received in digital format, confirming successful electronic transfer

4. Third Party Authorization: Include when records are being received by someone other than the patient

5. Special Handling Instructions: For records requiring specific storage or handling requirements

1. Schedule A - Detailed Record Index: Itemized list of all medical records received, including document types, dates, and page counts

2. Schedule B - Missing or Incomplete Items: List of any noted gaps or incomplete records, if applicable

3. Appendix 1 - Transfer Method Details: Documentation of how records were transferred (e.g., secure email, encrypted drive, physical handover)

4. Appendix 2 - Authorized Personnel List: List of individuals authorized to access these records, if applicable