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1. Alternate Representatives: Designation of backup representatives if the primary representative is unavailable - used when patient wants to ensure continuous coverage

2. Specific Treatment Authorizations: Detailed permissions for specific medical procedures or treatments - included when certain procedures are anticipated

3. Geographic Limitations: Specifications of geographic areas where the authority is valid - used for patients who receive treatment in multiple jurisdictions

4. Religious or Cultural Preferences: Special instructions regarding religious or cultural considerations in medical treatment - included when patient has specific beliefs affecting medical care

5. Revocation Clause: Specific terms for revoking the authority - included when patient wants to outline clear cancellation procedures

1. Schedule A - Proof of Identity: Copies of government-issued ID for patient and representative(s)

2. Schedule B - Capacity Assessment: Medical assessment confirming patient's capacity to grant authority, if required

3. Schedule C - Specific Medical Conditions: List of patient's relevant medical conditions and current treatments

4. Appendix 1 - Healthcare Facilities: List of healthcare providers and facilities where the authority is to be used

5. Appendix 2 - Witness Declarations: Additional witness statements or notarization documents if required by jurisdiction