1. Specific Treatment Restrictions: Any specific treatments or procedures that are explicitly excluded from the authorization

2. Religious or Cultural Preferences: Specific religious or cultural considerations that should be taken into account in medical treatment

3. Alternate Representative: Designation of an alternate representative if the primary authorized representative is unavailable

4. Medical History Summary: Brief overview of relevant medical history, allergies, or conditions that may affect treatment decisions

5. Revocation Clause: Specific terms under which the authorization may be revoked by the patient

1. Schedule A - Medical History: Detailed medical history including current medications, allergies, and pre-existing conditions

2. Schedule B - Identification Documents: Copies of HKID/passport of both patient and authorized representative

3. Schedule C - Relationship Evidence: Documents proving relationship between patient and authorized representative (if applicable)

4. Schedule D - Specific Instructions: Detailed instructions for specific medical scenarios or treatments

5. Appendix 1 - Witness Details: Complete information and identification details of witnesses to the authorization