1. Advance Directives: Section for specifying any pre-existing advance directives or living will provisions - include when patient has specific treatment preferences

2. Religious/Cultural Considerations: Space to document any religious or cultural preferences affecting medical treatment - include when patient indicates specific religious/cultural requirements

3. Guardian/Power of Attorney Details: Section for legal guardian or power of attorney information - include when consent is given by someone other than the patient

4. Language and Communication Needs: Section specifying any special communication requirements or preferred language - include for patients with communication barriers

5. Mental Capacity Assessment: Additional section for documenting patient's mental capacity - include when there are concerns about decision-making capacity

1. Schedule A - Specific Procedures Consent: Detailed list of specific medical procedures covered by the consent, with option to accept or decline each

2. Schedule B - Medical History Form: Detailed medical history questionnaire for completion when time permits

3. Appendix 1 - Hospital Locations: List of local hospitals and emergency care facilities where consent is valid

4. Appendix 2 - Patient Rights: Summary of patient rights and relevant contact information for patient advocacy services

5. Appendix 3 - Revocation Form: Form that can be used to revoke consent if patient wishes to do so in the future