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1. Sensitive Information Authorization: Additional authorization for release of sensitive information such as mental health records, genetic testing, or HIV status - used when such records are part of the request

2. Legal Representative Authorization: Required when someone other than the patient is authorizing the release, including proof of authority and relationship to patient

3. Electronic Records Transfer: Specific provisions for electronic transfer of records, including preferred format and security measures - used when digital transfer is requested

4. Translation Declaration: Required when the form is provided in multiple languages, confirming the patient's understanding of the content

5. Research Use Authorization: Additional provisions when records are being released for research purposes, including specific research project details

1. Schedule A - Detailed Record List: Itemized list of specific medical records being requested, with dates and record types

2. Schedule B - Fee Schedule: List of applicable fees for record copying and transmission, if any

3. Appendix 1 - Identity Verification Documents: List of acceptable identification documents and verification requirements

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