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1. Specific Medical Conditions: Detailed information about particular medical conditions that are relevant to the authorization

2. Treatment Preferences: Specific preferences or restrictions regarding medical treatments or procedures

3. Religious/Cultural Considerations: Any religious or cultural preferences that should be considered in medical treatment

4. Secondary Authorized Parties: Information about backup authorized persons if the primary authorized party is unavailable

5. Revocation Clause: Specific terms under which the authorization can be revoked before its expiration

6. Digital Communication Consent: Authorization for electronic communication of medical information

1. Copy of Grantor's Identification: Certified copy of grantor's government-issued ID or passport

2. Medical History Summary: Brief summary of relevant medical history, if applicable

3. Existing Medical Directives: Copies of any existing advance directives or living will

4. Witness Declaration: Formal declaration signed by witnesses confirming the authenticity of the authorization

5. Healthcare Provider Information: List of current healthcare providers and their contact information