1. Specific Medical Conditions: Used when the authorization is limited to specific medical conditions or treatments rather than general medical information

2. Multiple Healthcare Providers: Include when authorization covers multiple healthcare providers or medical facilities

3. Third Party Disclosure: Required when the employer may need to share the information with other parties (e.g., health and safety consultants)

4. Emergency Contacts: Optional section for including emergency contact information in case of medical emergencies

5. Cost Provisions: Include if there are costs associated with obtaining medical records and specifying who will bear these costs

1. Schedule 1 - Healthcare Providers List: List of specific healthcare providers authorized to release information, including contact details

2. Schedule 2 - Specific Medical Information Checklist: Detailed checklist of specific medical information authorized for release

3. Schedule 3 - Authorized Employer Representatives: List of specific employer representatives authorized to receive and handle the medical information

4. Appendix A - Privacy Rights Summary: Summary of employee's privacy rights under NZ law regarding medical information

5. Appendix B - Revocation Form: Standard form for revoking the authorization if needed