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1. Authorized Representatives: Section for naming other persons authorized to act on behalf of the patient, used when the patient wants to delegate authority to family members or caregivers

2. Mental Capacity Declaration: Required when the authority is being given by someone other than the patient due to the patient's lack of capacity

3. Specific Exclusions: Section listing any specific information or procedures that are explicitly excluded from the authority

4. Emergency Contact Information: Details of emergency contacts, used when the form needs to include emergency notification provisions

5. Interpreter Declaration: Required when the form has been explained to the patient through an interpreter

6. Revocation Terms: Detailed information about how and when the authority can be revoked, used in more comprehensive versions of the form

1. Schedule 1 - Types of Medical Information: Detailed list of specific types of medical information covered by the authority (e.g., test results, prescriptions, medical history)

2. Schedule 2 - Authorized Healthcare Providers: List of specific healthcare providers or facilities authorized to receive or share information

3. Schedule 3 - Specific Procedures: Details of specific medical procedures or treatments covered by the authority, if applicable

4. Appendix A - Glossary: Definitions of medical and legal terms used in the document

5. Appendix B - Patient Rights: Summary of relevant patient rights under New Zealand law