1. Emergency Contacts: Additional section for designated emergency contacts if different from authorized family members - used when patient wants to distinguish between routine information sharing and emergency situations

2. Special Instructions: Specific instructions about what information can be shared under what circumstances - used when patient wants to set specific conditions or limitations

3. Electronic Communication Consent: Additional authorization for sharing information via email or patient portals - used when electronic communication is likely

4. Mental Health Information: Specific authorization for mental health information - used when mental health records may be involved

5. Substance Abuse Information: Specific authorization for substance abuse treatment information - used when substance abuse records may be involved

1. Schedule A - Types of Information: Detailed checklist of specific types of information that may be released

2. Schedule B - Authorized Healthcare Providers: List of specific healthcare providers or facilities authorized to release information

3. Appendix 1 - Revocation Form: Standard form for revoking authorization

4. Appendix 2 - Privacy Policy Summary: Summary of relevant privacy policies and patient rights regarding information sharing