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1. Specific Medical Conditions: Details of any existing medical conditions that require special attention or consideration, used when the authorization is related to ongoing medical treatment

2. Restricted Actions: List of specific medical decisions or procedures that are explicitly excluded from the authorization, used when certain limitations need to be placed on the authorized party's decision-making power

3. Alternative Authorized Parties: Names and details of secondary authorized parties who can act if the primary authorized party is unavailable, used when backup decision-makers are needed

4. Religious or Cultural Preferences: Specific religious or cultural considerations that should be taken into account in medical decision-making, used when these factors are important to the authorizing party

5. Digital Health Records Access: Specific authorization for access to electronic health records and digital health platforms, used when digital access is required

1. Schedule A - Medical History: Detailed medical history including current medications, allergies, and past surgeries

2. Schedule B - Healthcare Provider List: List of current healthcare providers, including primary care physician, specialists, and their contact information

3. Schedule C - Insurance Information: Details of medical insurance coverage and policy numbers

4. Appendix 1 - Identification Documents: Copies of government-issued ID for both authorizing and authorized parties

5. Appendix 2 - Witness Attestation Form: Formal attestation form for witnesses to sign, confirming they observed the authorization