1. Electronic Records Transfer: Specific provisions for digital transfer of records, used when records will be shared electronically

2. Payment Terms: Include when fees are applicable for record copying and transfer

3. Special Categories of Information: Additional authorization sections for sensitive information like HIV status, mental health records, or genetic information

4. Emergency Contact: Alternative contact information section, used when immediate medical attention might be required

5. Language Certification: Required when the document is executed in multiple languages or with non-English speaking patients

1. Schedule A - Description of Medical Records: Detailed list of specific medical records, test results, and dates covered by the authorization

2. Schedule B - Recipient Information: Detailed contact information and credentials of all authorized recipients

3. Schedule C - Fee Schedule: If applicable, breakdown of any charges for copying and transferring records

4. Appendix 1 - Patient Rights Summary: Summary of patient rights regarding medical records under Indian law

5. Appendix 2 - Consent Revocation Form: Template form for future revocation of the authorization if needed