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1. Special Conditions: Additional conditions or restrictions on the use or further disclosure of the released records, used when specific limitations need to be imposed

2. Emergency Contact: Details of an emergency contact person, used particularly for medical record releases

3. Witness Section: Space for witness details and signature, used when additional verification of identity is required or for high-sensitivity records

4. Revocation Notice: Information about how to revoke the authorization before its expiration date, used for longer-term authorizations

5. Fee Schedule: Details of any applicable fees for record retrieval and copying, used when charges apply to the release of records

1. Schedule A - Record Types: Detailed listing of specific record types being authorized for release, particularly useful for complex or multiple record types

2. Schedule B - Authorized Recipients: List of all authorized recipients and their respective access levels, used when multiple recipients are involved

3. Appendix 1 - Identity Verification Requirements: Documentation requirements for identity verification of the requestor and/or recipient

4. Appendix 2 - Privacy Policy Extract: Relevant excerpts from the organization's privacy policy regarding record handling and disclosure