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1. Specific Medical Conditions: Details of any existing medical conditions that require special consideration - include when patient has chronic or specific conditions

2. Religious or Cultural Preferences: Specific religious or cultural considerations affecting medical decisions - include when patient has specific religious or cultural requirements

3. Alternative Representatives: Appointment of secondary or tertiary representatives - include when multiple backup representatives are desired

4. Limited Duration Authority: Specific provisions for temporary authorization - include when authority is needed for a specific procedure or limited time

5. Mental Capacity Assessment: Reference to mental capacity assessment if relevant - include when there are concerns about patient's current or future mental capacity

6. Special Instructions: Any specific instructions regarding particular treatments or procedures - include when specific medical procedures are anticipated

1. Schedule A - Glossary of Medical Terms: Definitions of medical and legal terms used in the document

2. Schedule B - Specific Treatments Authorized: Detailed list of specific medical treatments or procedures covered by the authorization

3. Schedule C - Emergency Protocols: Specific procedures to be followed in emergency situations

4. Appendix 1 - Identity Documents: Copies of IC/Passport of patient and authorized representative(s)

5. Appendix 2 - Certification of Capacity: Medical certification of patient's mental capacity at time of signing (if required)