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1. Specific Treatment Details: Detailed description of specific procedures or treatments, used when authorization is for specific medical interventions rather than general care

2. Insurance Information: Patient's insurance details and coverage information, included when treatment involves insurance claims

3. Translator Certification: Section for translator details and certification when the patient requires language assistance

4. Mental Capacity Declaration: Additional section when there are questions about the patient's capacity to provide consent

5. Religious/Cultural Preferences: Section specifying any religious or cultural considerations that may affect treatment decisions

6. Telehealth Authorization: Specific authorization for virtual healthcare services, included when telehealth services may be used

1. Schedule A - Authorized Procedures: Detailed list of specific medical procedures or treatments being authorized

2. Schedule B - Authorized Personnel: List of specific healthcare providers or specialists authorized to provide treatment

3. Appendix 1 - Patient Rights: Document outlining patient rights and responsibilities under Indonesian healthcare law

4. Appendix 2 - Privacy Policy: Detailed privacy policy and information handling procedures of the healthcare facility

5. Appendix 3 - Cost Estimate: Optional breakdown of estimated costs for authorized procedures or treatments