1. Emergency Contact Information: Alternative contact details in case of emergency, recommended for ongoing treatments or where patient may be incapacitated

2. Medical History: Relevant medical history or conditions that may affect the authorized treatment

3. Insurance Details: Health insurance information for private treatment or insurance claims

4. Specific Limitations and Conditions: Any restrictions, conditions, or specific exclusions on the authorization

1. Schedule 1 - Medical Reports: Relevant medical reports or test results supporting the treatment decision

2. Schedule 2 - Capacity Assessment: Documentation of mental capacity assessment if relevant to the authorization

3. Schedule 3 - Power of Attorney: Copy of lasting power of attorney for health and welfare if authorization is given by attorney

4. Schedule 4 - Treatment Information: Detailed information about proposed treatment, including risks, benefits, and alternatives