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1. Electronic Disclosure Provisions: Additional terms specific to electronic transmission of medical information, required when digital sharing is involved

2. Third Party Authorization: Required when allowing specific third parties to access the information on behalf of the primary recipient

3. Translation Declaration: Required when the document is provided in multiple languages, confirming the patient's understanding in their preferred language

4. Special Categories of Information: Required when disclosure includes sensitive information like mental health records, genetic information, or HIV status

5. Emergency Contact Authorization: Optional section authorizing disclosure to emergency contacts under specific circumstances

1. Schedule 1 - Specific Medical Information: Detailed list of specific medical records, test results, or treatments authorized for disclosure

2. Schedule 2 - Authorized Recipients: Complete list of authorized recipients including their contact details and roles

3. Schedule 3 - Prohibited Uses: List of specifically prohibited uses or disclosures of the medical information

4. Appendix A - Patient Rights Summary: Summary of patient rights under Saudi healthcare laws regarding medical information disclosure

5. Appendix B - Revocation Form: Standard form for revoking the consent if needed