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1. Interpreter Declaration: Required when the patient's primary language is not English or Filipino, confirming that all terms have been properly translated

2. Guardian Consent: Required for minors or patients who cannot provide legal consent themselves

3. Religious or Cultural Considerations: Special provisions regarding religious or cultural preferences affecting medical treatment

4. Insurance and Financial Responsibility: Details about insurance coverage and financial obligations, if relevant to the procedure

5. Photography Consent: Permission to photograph or record the procedure for medical documentation or educational purposes

6. Clinical Trial Provisions: Required for experimental procedures or clinical trials

7. Revocation Rights: Terms under which the patient can revoke the waiver

1. Schedule A: Detailed Procedure Description: Technical description of the medical procedure including steps, methods, and materials used

2. Schedule B: Risk Disclosure: Comprehensive list of all potential risks, side effects, and complications

3. Schedule C: Post-Procedure Care Instructions: Detailed instructions for post-procedure care and recovery

4. Schedule D: Emergency Contact Information: List of emergency contacts and relevant medical personnel

5. Appendix 1: Medical History Form: Patient's relevant medical history and current conditions

6. Appendix 2: Medication List: List of current medications and known drug allergies

7. Appendix 3: Alternative Treatments: Description of alternative treatment options that were discussed and declined