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1. Alternative Dispute Resolution: Optional section specifying mediation or arbitration procedures for disputes, recommended for more complex medical procedures

2. Insurance Coverage Declaration: Section addressing the patient's insurance coverage and responsibility for costs, used when treatment involves significant expenses

3. Photography Consent: Permission to photograph or record the procedure for medical documentation, training, or marketing purposes

4. Research Participation: Used when the medical procedure may be part of a research study or clinical trial

5. Language Acknowledgment: Required in bilingual jurisdictions or when the patient's first language is not English

6. Specific Health Conditions: Additional sections for patients with specific health conditions that may affect treatment

7. Guardian Consent: Required when the patient is a minor or has a legal guardian making decisions on their behalf

1. Schedule A - Detailed Procedure Description: Detailed technical description of the medical procedure or treatment being performed

2. Schedule B - Risk Disclosure: Comprehensive list of specific risks and potential complications associated with the procedure

3. Schedule C - Patient Medical History: Patient's relevant medical history and current health status

4. Schedule D - Post-Procedure Care Instructions: Detailed instructions for post-procedure care and recovery

5. Appendix 1 - Emergency Contacts: List of emergency contacts and their relationship to the patient

6. Appendix 2 - Facility Policies: Relevant facility policies and procedures that affect patient care