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1. Specific Restrictions: Optional section for patients to specify certain information they do NOT want released, used when patient wants to restrict certain aspects of their records

2. Emergency Contact Authorization: Section authorizing release of information to emergency contacts, included when patient wants to designate specific individuals for emergency situations

3. Electronic Communication Consent: Additional authorization for release of information through electronic means, used when electronic transmission of records is anticipated

4. Legal Representative Information: Section for cases where someone other than the patient is authorizing the release, used when patient lacks capacity or is a minor

5. Substance Use Records: Special authorization section for substance use treatment records, included when applicable to patient's case

1. Schedule A - Types of Information Checklist: Detailed checklist of specific types of mental health information that can be released (e.g., diagnostic records, treatment plans, session notes, medication records)

2. Schedule B - Authorized Recipients List: List of all authorized recipients and their specific access levels, used when multiple parties are involved

3. Appendix 1 - Patient Rights Summary: Summary of patient rights under Philippine Mental Health Act and Data Privacy Act regarding their medical information

4. Appendix 2 - Revocation Form: Form that can be used by patient to revoke the authorization in the future