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1. Interpreter Declaration: Required when the patient needs language assistance, including certification of accurate translation

2. Mental Capacity Assessment: Used when there are concerns about the patient's capacity to provide informed consent

3. Guardian/Representative Authority: Required when someone other than the patient is authorized to make medical decisions

4. Specific Treatment Disclosure: Detailed information about specific high-risk procedures or treatments

5. Research Participation: Optional section for consent to use medical information in research studies

6. Medicare/Insurance Details: Extended section for detailed healthcare coverage information

7. Cultural Considerations: Special section for recording cultural or religious requirements affecting medical care

1. Schedule A - Detailed Privacy Policy: Comprehensive privacy policy explaining all aspects of information handling

2. Schedule B - Rights and Responsibilities: Detailed explanation of patient rights and responsibilities

3. Schedule C - Information Sharing Protocol: List of circumstances and entities with whom information may be shared

4. Appendix 1 - Glossary of Medical Terms: Definitions of medical terminology used in the form

5. Appendix 2 - Relevant Healthcare Providers: List of healthcare providers and specialists involved in patient care

6. Appendix 3 - Consent Withdrawal Form: Template for withdrawing consent for specific aspects of information sharing