1. Guardian Authorization: Additional section when the patient is a minor or legally incompetent, including guardian's legal authority

2. Medical History Summary: Brief overview of relevant medical history when authorization is for specific ongoing treatments

3. Special Instructions: Any specific medical instructions or restrictions that need to be followed

4. Religious or Cultural Preferences: Special considerations regarding religious or cultural beliefs affecting medical treatment

5. Insurance Information: Details of medical insurance when authorization includes insurance claims handling

6. Translator Certification: Required when the form is explained through a translator to non-English speaking parties

1. Appendix A - Specific Medical Procedures: Detailed list of specific medical procedures being authorized

2. Appendix B - Medical History Form: Comprehensive medical history form if required for the authorization

3. Appendix C - List of Authorized Healthcare Providers: Complete list of healthcare providers or facilities covered under the authorization

4. Appendix D - Emergency Protocol: Specific instructions for emergency situations

5. Appendix E - Medication List: Current medications and known allergies of the patient