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1. Specific Medical Conditions: Details of existing medical conditions, allergies, or medical history when relevant to the treatment

2. Medication List: Current medications being taken by the patient, to be included when there might be interactions with proposed treatment

3. Insurance Information: Medical insurance or medical aid details, when treatment costs are to be claimed

4. Travel Authorization: Additional permission for medical transport or transfer to other facilities, used when treatment might require relocation

5. Interpreter Declaration: Section for interpreter details and signature when language barriers exist

6. Religious or Cultural Preferences: Specific religious or cultural considerations that might affect treatment choices

1. Medical History Form: Detailed medical history of the patient including past procedures, conditions, and allergies

2. Specific Treatment Protocol: Detailed description of the authorized medical procedures or treatment plan

3. Medication Schedule: List of current medications with dosages and timing

4. Cost Estimate: Breakdown of expected costs for the authorized treatment, if applicable