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1. Special Conditions: Any specific conditions or limitations on the authorization, used when the authority needs to be restricted in some way

2. Emergency Contact: Additional contact information for emergencies, used when the authorized person cannot be reached

3. Revocation Clause: Specific terms for revoking the authorization, used when there's a need to outline the cancellation process

4. Medical Capacity Statement: Statement from a medical professional confirming the authorizer's capacity, used when there might be questions about mental capacity

5. Interpreter Declaration: Declaration by an interpreter if one was used, required when the authorizer needs language assistance

1. List of Specific Benefits: Detailed list of all benefits covered by the authorization

2. Identification Documents: Copies of required identification documents for both parties

3. Agency-Specific Forms: Any additional forms required by specific benefit providers or government agencies

4. Proof of Relationship: Documents proving the relationship between the authorizer and authorized person, if required