tiktok���˰�

1. Special Categories of Records: Additional authorization sections for sensitive information such as HIV/AIDS records, mental health records, or substance abuse treatment records

2. Legal Representative Authorization: Section to be included when someone other than the patient is authorizing the release, including proof of authority

3. Electronic Records Transfer: Specific provisions for electronic transfer of records, including email consent and security acknowledgments

4. Re-disclosure Notice: Additional provisions regarding potential re-disclosure by the recipient, particularly relevant for records going to non-healthcare entities

5. Payment Authorization: Section for cases where fees may be charged for record copying and transmission

1. Schedule A - Types of Records Checklist: Detailed checklist of specific types of medical records that may be released (e.g., lab results, imaging reports, consultation notes)

2. Schedule B - Fee Schedule: If applicable, breakdown of potential fees for different types of record requests and delivery methods

3. Appendix 1 - Proof of Identity: Requirements and acceptable forms of identification for verification purposes

4. Appendix 2 - Revocation Form: Template form for revoking the authorization if needed