1. Emergency Contact Authorization: Additional provisions for emergency situations where immediate access to medical information may be required

2. Mental Health Information: Specific provisions for release of mental health information, required when mental health records are included

3. Guardian Authorization: Required when the patient has a legal guardian or when the patient lacks capacity to provide consent

4. Interstate Information Sharing: Additional provisions for cases where medical information needs to be shared across state borders

5. Digital Access Authorization: Specific provisions for granting access to digital health records and online portals

1. Schedule A - Types of Medical Information: Detailed checklist of specific medical information types that are authorized for release

2. Schedule B - Healthcare Providers: List of healthcare providers and facilities authorized to release information under this form

3. Schedule C - Identification Requirements: Details of acceptable identification documents required for authorized family members to access information

4. Appendix 1 - Revocation Form: Template form for revoking the authorization if needed

5. Appendix 2 - Privacy Laws Summary: Summary of relevant privacy laws and patient rights for reference