1. Emergency Contact Hierarchy: Used when multiple representatives are authorized, establishing the order in which they should be contacted

2. Specific Medical Conditions: Include when the patient has pre-existing conditions that require special consideration or specific treatment preferences

3. Religious or Cultural Preferences: Added when the patient has specific religious or cultural requirements that should be considered in medical treatment

4. Insurance Information: Include when the authorization extends to handling insurance claims and coverage decisions

5. Digital Communication Consent: Added when electronic communications will be used for sharing medical information or decisions

1. Schedule A - Specific Medical Procedures: List of specific medical procedures or treatments that are explicitly included or excluded from the authorization

2. Schedule B - Healthcare Facilities: List of specific healthcare facilities where the authorization is to be honored

3. Appendix 1 - Identification Documents: Copies of valid government IDs of the patient and authorized representative(s)

4. Appendix 2 - Medical History Summary: Optional brief summary of relevant medical history, allergies, and current medications