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1. Medical History Summary: Brief overview of relevant medical history, used when authorization includes access to medical records

2. Specific Medical Procedures: Detailed list of specific procedures or treatments being authorized, used when authorization is for specific medical interventions

3. Religious or Cultural Preferences: Statement of specific religious or cultural requirements that should be considered in medical care

4. Insurance Information: Health insurance details and authorization for insurance-related communications

5. Revocation Clause: Specific terms under which the authorization may be revoked, used when additional control over the authorization is desired

1. Identification Documents: Copies of valid government-issued ID of the pregnant woman and authorized persons

2. Pregnancy Confirmation: Medical documentation confirming pregnancy status

3. Medical Power of Attorney: If applicable, existing medical power of attorney documents

4. Witness Attestation Form: Separate form for witness signatures and details

5. List of Authorized Medical Facilities: If authorization is limited to specific facilities, list of approved healthcare providers and facilities