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1. Proxy Decision Maker Authorization: Section authorizing specific individuals to make medical decisions if the patient becomes incapacitated

2. Special Medical Conditions: Section for documenting any relevant pre-existing conditions, allergies, or special medical needs

3. Religious or Cultural Preferences: Section for specifying any religious or cultural considerations that may affect treatment

4. Language Assistance: Section confirming if translation services were used and details of the translator

5. Research Participation Consent: Optional authorization for use of medical data in research studies

6. Photo/Video Documentation Consent: Specific authorization for visual documentation of procedures when applicable

1. Schedule A: Specific Procedures Detail: Detailed description of authorized medical procedures and treatments

2. Schedule B: Medication List: Current medications and known drug allergies

3. Schedule C: Cost Estimation: Estimated costs and insurance coverage information for planned procedures

4. Appendix 1: Patient Rights: Complete list of patient rights under German law

5. Appendix 2: Revocation Form: Form for withdrawing authorization if needed

6. Appendix 3: Medical History Form: Detailed medical history questionnaire