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1. Emergency Contact Information: Additional contacts to be reached in case of emergency - include when patient requests

2. Specific Treatment Restrictions: Any specific procedures or treatments that are explicitly not authorized - include when patient has specific exclusions

3. Language Preference: Preferred language for medical communication - include in cases of non-English/non-Chinese speaking patients

4. Religious or Cultural Considerations: Specific religious or cultural preferences affecting medical treatment - include when relevant to patient's beliefs

5. Insurance Information: Details of medical insurance coverage - include when treatment costs are to be claimed from insurance

1. Schedule A - Medical History: Relevant medical history, current medications, and known allergies

2. Schedule B - Specific Procedures: Detailed list of specific procedures being authorized, if any

3. Appendix 1 - Identity Documents: Copies of relevant identification documents of patient and/or representative

4. Appendix 2 - Supporting Medical Documentation: Any relevant medical reports or documentation supporting the need for authorization