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1. Special Medical Conditions: Details of any existing medical conditions, allergies, or medications that healthcare providers should be aware of

2. Religious/Cultural Preferences: Any specific religious or cultural considerations that may affect treatment decisions

3. Insurance Information: Details of medical insurance coverage and policy information

4. Specific Restrictions: Any procedures or treatments specifically excluded from the authorization

5. Alternative Decision Maker: Designation of alternative person to make decisions if primary authorizing party is unavailable

6. Interpreter Declaration: Required when the authorizing party needs language interpretation services

1. Medical History Summary: Summary of relevant medical history, previous treatments, and ongoing conditions

2. Medication List: Current medications, dosages, and known drug allergies

3. Specific Treatment Details: Detailed information about specific procedures or treatments being authorized

4. Identification Documents: Copies of relevant identification documents of patient and authorizing party

5. Legal Authority Documentation: Documents proving legal authority to give consent (e.g., guardianship papers)