��������Ƶ

1. Specific Treatments Authorization: Detailed list of specific medical procedures or treatments being authorized, used when authorization is needed for particular procedures rather than general care

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

3. Financial Responsibility: Statement regarding who assumes financial responsibility for the medical treatment, included when payment authority needs to be established

4. Medical History Summary: Brief overview of relevant medical history, included when authorization is for ongoing or specific treatment

5. Language Preference: Specification of preferred language for communication, included in multilingual settings or when translation services might be needed

1. Schedule A - List of Authorized Procedures: Detailed list of specific medical procedures covered by the authorization

2. Schedule B - Additional Authorized Representatives: List of secondary authorized representatives with their contact details and relationship to patient

3. Appendix 1 - Medical Facility Information: List of medical facilities where the authorization is valid

4. Appendix 2 - Documentation Requirements: List of required identification and supporting documents for authorized representatives