1. Special Medical Conditions: Section for listing any pre-existing conditions, allergies, or special medical needs of the minor

2. Insurance Information: Details of medical insurance coverage and payment responsibilities

3. Religious or Cultural Considerations: Any specific religious or cultural factors affecting medical treatment

4. Limitations of Consent: Specific procedures or treatments explicitly excluded from the consent

5. Transportation Authorization: Permission for emergency medical transportation if needed

6. Interpreter Certification: Required when consent form is explained through an interpreter

1. Schedule A - Proof of Authority: Supporting documents proving the authority of the consenting party (court orders, power of attorney, etc.)

2. Schedule B - Medical History Form: Detailed medical history of the minor including vaccinations, previous conditions, and medications

3. Schedule C - Witness Verification Form: Additional witness verification details and requirements

4. Appendix 1 - Emergency Procedures Protocol: Standard procedures to be followed in emergency situations

5. Appendix 2 - Contact Attempt Log: Documentation of attempts made to contact parents/legal guardians