1. Insurance Information: Details of medical insurance coverage, to be included if treatment may involve insurance claims

2. Religious or Cultural Considerations: Specific religious or cultural preferences affecting treatment, included when relevant to the minor's background

3. Traveling Minor Provisions: Additional provisions for minors traveling or temporarily away from their legal residence

4. Specific Treatment Exclusions: List of treatments or procedures specifically not authorized, included when there are specific restrictions

5. Alternative Contact Information: Additional emergency contacts, included when multiple backup contacts are needed

6. Interpreter Certification: Section for interpreter details and certification when form is explained in a language other than English

7. Photography Consent: Authorization for medical photography if needed for treatment documentation

1. Schedule A - Proof of Authority: Attached documentation proving the representative's authority to consent (power of attorney, court order, etc.)

2. Schedule B - Medical History Form: Detailed medical history questionnaire and responses

3. Schedule C - Emergency Contact List: Comprehensive list of emergency contacts and their contact information

4. Appendix 1 - Specific Procedures Authorized: Detailed list of specific medical procedures covered under the consent

5. Appendix 2 - Hospital Policies: Relevant hospital policies regarding treatment of minors without parental presence