1. Research Use Authorization: Optional section for consenting to use medical history for research purposes, required if data might be used for research

2. Third Party Access: Optional section defining which other healthcare providers or entities may access the medical history, used when data sharing is anticipated

3. Electronic Records Consent: Additional consent for electronic storage and processing, required if using electronic health records

4. International Data Transfer: Required when medical data might be transferred outside Switzerland

5. Cantonal-Specific Provisions: Additional provisions required by specific cantonal laws, included based on location

6. Language Declaration: Required in multilingual cantons, confirming the patient understands the consent in their preferred official language

1. Schedule 1: Types of Medical Information: Detailed list of categories of medical information to be collected and processed

2. Schedule 2: Data Protection Measures: Technical and organizational measures for protecting medical data

3. Schedule 3: Authorized Recipients: List of healthcare providers and other entities authorized to access the medical history

4. Appendix A: Patient Rights Guide: Detailed explanation of patient rights regarding their medical data

5. Appendix B: Privacy Notice: Detailed privacy notice compliant with Swiss data protection law

6. Appendix C: Withdrawal Form: Template form for withdrawing consent