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1. Medical History Summary: Brief overview of relevant medical history, allergies, or conditions - used when the treatment relates to ongoing medical issues

2. Insurance Information: Details of medical insurance coverage - included when treatment costs will be claimed through insurance

3. Travel Authorization: Permission for medical transport or treatment during travel - used when patient may need treatment while away from usual location

4. Specific Procedure Details: Detailed description of particular procedures - included when permission is for specific planned treatments rather than general authorization

5. Religious or Cultural Preferences: Specific religious or cultural considerations affecting treatment - included when there are specific religious or cultural requirements that should be observed

6. Language Preference: Preferred language for communication and need for interpreter - included when patient or grantor has specific language requirements

1. Medical History Documents: Copies of relevant medical records, test results, or previous treatment documentation

2. Identification Documents: Copies of valid government ID of both grantor and patient

3. Legal Authority Documentation: Documents proving legal authority to grant permission (e.g., court orders, power of attorney, proof of guardianship)

4. Insurance Cards/Documentation: Copies of relevant insurance cards and policy information

5. Specific Treatment Plans: Detailed treatment plans or procedures provided by healthcare providers