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1. Legal Representative Information: Required when someone other than the patient is authorizing the release, including their relationship to the patient and basis of authority

2. Witness Section: Used when additional verification of signature is required or when the authorizing party cannot sign

3. Urgency Declaration: When records are needed urgently, specifying the timeframe and reason for urgency

4. Specific Restrictions: Any limitations or specific exclusions from the authorization

5. Revocation Rights: Statement explaining how and when the authorization can be revoked

6. Foreign Use Declaration: Required when records will be used outside Hong Kong

1. Schedule A: Specific Records List: Detailed list of specific medical records being requested, including dates and types of records

2. Schedule B: Healthcare Providers List: List of all healthcare providers/facilities from whom records are being requested, if multiple

3. Schedule C: Authorized Recipients List: List of all authorized recipients if multiple parties are to receive the records

4. Schedule D: Identity Verification Documents: Copies of HKID/passport and any relevant legal documents proving authority to request records