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1. Specific Medical Conditions: Details of any existing medical conditions that require special consideration - include when the authorization is for a person with specific health issues

2. Emergency Contact Chain: Hierarchy of additional contacts if primary representative cannot be reached - include for complex family situations or when multiple backups are needed

3. Treatment Preferences: Specific preferences for medical treatments or procedures - include when there are particular religious, cultural or personal preferences

4. Insurance Information: Health insurance details and coverage information - include when the representative needs to handle insurance matters

5. Revocation Clause: Specific terms for revoking the authorization - include when the grantor wants explicit control over termination

1. List of Healthcare Providers: Contact information for primary care physician and other relevant healthcare providers

2. Medical History Summary: Brief summary of relevant medical history, allergies, and current medications

3. Specific Instructions: Detailed instructions for specific medical scenarios or treatments