1. Special Authorization for Sensitive Information: Additional authorization for release of sensitive information such as mental health records, HIV status, or genetic information

2. Emergency Release Authorization: Special provisions for emergency situations requiring expedited release of records

3. Minor Patient Information: Additional fields for parent/guardian authorization when the patient is a minor

4. Legal Representative Authorization: Section for cases where someone other than the patient is authorizing the release

5. Fee Schedule: Information about any applicable fees for records release

6. Electronic Transfer Authorization: Specific authorization for electronic transfer of records if applicable

7. Re-disclosure Notice: Statement regarding restrictions on further disclosure by the recipient

1. Schedule A - Types of Records: Detailed checklist of specific types of medical records that may be released

2. Schedule B - Fee Schedule: Detailed breakdown of any applicable fees for different types of records or delivery methods

3. Appendix 1 - Glossary: Definitions of medical and legal terms used in the form

4. Appendix 2 - Privacy Notice: Detailed privacy notice explaining how the information will be handled and protected

5. Appendix 3 - Instructions: Step-by-step instructions for completing the form and what to expect after submission