1. Specific Exclusions: Section listing any specific information that should NOT be disclosed, used when there are particular items that should be withheld

2. Third Party Authorization: Additional section when the person giving authorization is doing so on behalf of another person (e.g., parent/guardian, power of attorney)

3. Redisclosure Provisions: Section specifying whether the recipient may further disclose the information to other parties, used when chain of disclosure needs to be controlled

4. Emergency Contact: Details of emergency contact person, used particularly in medical information disclosure forms

5. Special Instructions: Any specific instructions about how the information should be handled, transmitted, or used

1. Schedule A - Detailed Information List: Comprehensive list of specific documents/information to be disclosed when the main form needs to reference a detailed inventory

2. Schedule B - Authorized Recipients List: List of all authorized recipients when multiple parties are approved to receive the information

3. Appendix 1 - Privacy Notice: Detailed privacy notice explaining how the information will be handled, stored, and protected by the recipient

4. Appendix 2 - Revocation Form: Template form for revoking the authorization if the individual wishes to withdraw consent in the future