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1. Specific Treatment Exclusions: List of any treatments or procedures specifically NOT authorized, used when grantor wishes to exclude certain types of treatment

2. Religious or Cultural Preferences: Specific religious or cultural considerations that should be respected during treatment, included when relevant to the patient

3. Financial Authorization: Details about payment authorization and financial responsibility, included when treatment costs need to be addressed

4. Transportation Authorization: Permission for medical transport if needed, included when patient might require transfer between facilities

5. Alternate Decision Maker: Designation of another person who can make decisions if the primary grantor is unavailable, included in complex cases

1. Medical History Summary: Detailed medical history of the patient including allergies, current medications, and pre-existing conditions

2. Insurance Information: Details of medical insurance coverage and policy information

3. Specific Treatment Protocol: Detailed description of authorized treatments or procedures when complex medical care is involved

4. Medication List: Current medications and known drug allergies or adverse reactions