1. Religious or Cultural Considerations: Specific religious or cultural preferences that should be considered during medical treatment

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

3. Alternative Decision Maker Designation: Appointment of alternative decision-makers if primary contact cannot be reached

4. Insurance Information: Details of health insurance coverage and policy numbers

5. Organ Donation Preferences: Statement regarding organ donation preferences in critical situations

6. Advanced Care Directives Reference: Reference to any existing advanced care directives or living will documents

1. Schedule A - Detailed Medical History: Comprehensive medical history including past surgeries, chronic conditions, and family history

2. Schedule B - Current Medication List: Detailed list of current medications, dosages, and prescribing physicians

3. Schedule C - Treatment Preferences: Specific preferences for certain types of medical treatments or procedures

4. Appendix 1 - Glossary of Medical Terms: Definitions of medical terms used in the document for clarity

5. Appendix 2 - Hospital Contacts: List of preferred hospitals and their emergency contact information