1. Third Party Authorization: Additional section when consent includes allowing access to third parties beyond the primary recipient

2. Specific Exclusions: Section listing any specific medical records or information that should NOT be included in the access

3. Witness Section: Required when the patient is elderly, under specific medical conditions, or as per facility policy

4. Translator Confirmation: Required when the consent form has been explained in a language other than the written form

5. Guardian Details: Required when consent is being given on behalf of a minor or person lacking capacity

1. Schedule A - List of Medical Records: Detailed list of specific medical records, documents, or test results covered by the consent

2. Schedule B - Authorized Healthcare Facilities: List of specific healthcare facilities from which records may be accessed if multiple facilities are involved

3. Appendix 1 - Identity Documents: Copies of identity documents of the patient and/or guardian giving consent

4. Appendix 2 - Supporting Documents: Any additional documents supporting the need for access (e.g., court orders, power of attorney)