1. Legal Representative Authorization: Required when someone other than the patient is authorizing the release, including proof of authority

2. Specific Exclusions: Section detailing any specific information the patient wishes to exclude from the release

3. Emergency Contact Information: Optional section for emergency contact details, recommended for comprehensive care coordination

4. Revocation Instructions: Detailed process for revoking the authorization before its expiration

5. Payment Information: Required when there are fees associated with records release

6. Electronic Records Consent: Additional consent specifically for release of electronic health records when applicable

1. Schedule A - Types of Information Covered: Detailed checklist of specific types of mental health information that may be released

2. Schedule B - Authorized Recipients List: If multiple recipients are authorized, detailed list with specific permissions for each

3. Appendix 1 - Patient Rights Summary: Summary of patient rights under Nigerian mental health and privacy laws

4. Appendix 2 - Glossary of Terms: Definitions of medical and legal terms used in the release form