1. Special Medical Conditions: Section for listing any existing medical conditions, allergies, or specific health concerns - recommended when relevant to ongoing care

2. Religious or Cultural Preferences: Space to document any religious or cultural considerations that may affect medical treatment

3. Insurance Information: Details of medical insurance coverage and policy information - include when treatment may involve insurance claims

4. Specific Exclusions: List of any specific treatments or procedures that are explicitly not authorized

5. Language Preference: Preferred language for communication - important in multilingual contexts

6. Medical History Summary: Brief overview of relevant medical history - recommended for long-term authorizations

1. List of Authorized Procedures: Detailed list of specific medical procedures being authorized, if applicable

2. Current Medication List: Schedule of current medications and treatments the patient is receiving

3. Identification Documents: Copies of relevant identification documents for both patient and authorizing party

4. Healthcare Facility List: List of specific healthcare facilities covered by the authorization, if multiple