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1. Emergency Contact Information: Additional emergency contacts besides the authorized person, used when multiple backup contacts are needed

2. Specific Medical Conditions: Details of any existing medical conditions or pregnancy complications that the authorized person should be aware of

3. Religious or Cultural Preferences: Any specific religious or cultural considerations regarding medical treatment or procedures

4. Revocation Clause: Specific terms under which the authorization can be revoked before its expiry

5. Language Declaration: If the authorizer's primary language is not English, a declaration that the contents have been explained in their preferred language

1. Medical History Form: Detailed medical history of the pregnant woman including current pregnancy details

2. Specific Procedures Consent: List of specific medical procedures for which authorization is granted or withheld

3. Witness Identification Details: Copies of identification documents of witnesses

4. Healthcare Provider Information: List of healthcare providers and facilities where the authorization is intended to be used