1. Treatment Limitations: Specific procedures or treatments that are explicitly not authorized

2. Religious/Cultural Considerations: Any specific religious or cultural preferences that should be considered during treatment

3. Insurance Information: Details of medical insurance coverage and billing instructions

4. Alternative Decision Maker: Designation of an alternative person who can make decisions if the primary grantor is unavailable

5. Specific Medical History: Relevant medical history that healthcare providers should be aware of

6. Language Preference: Preferred language for communication if different from the letter's language

7. Travel Authorization: Permission for medical transport or treatment at different facilities if needed

1. Medical History Form: Detailed medical history including allergies, current medications, and previous surgeries

2. Identification Documents: Copies of relevant ID documents for both grantor and patient

3. Insurance Documentation: Copies of insurance cards and coverage details

4. List of Authorized Procedures: Detailed list of specific medical procedures being authorized

5. Emergency Contacts List: Comprehensive list of emergency contacts with full contact details

6. Proof of Legal Authority: Documents proving the grantor's legal authority to give medical permission (e.g., guardianship papers)