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1. Religious/Cultural Considerations: Special instructions regarding religious or cultural preferences for treatment, used when specific religious or cultural requirements need to be observed

2. Insurance Information: Details of medical insurance coverage, included when the minor is covered by insurance

3. Travel Authorization: Permission for medical transport if needed, included when there's potential need for medical transfer

4. Limitation of Treatments: Specific procedures or treatments that are explicitly not authorized, used when certain treatments should be excluded

5. Interpreter Declaration: For cases where the temporary caregiver requires language interpretation, including interpreter's certification

1. Schedule A - Medical History Form: Detailed medical history including vaccinations, previous conditions, and ongoing treatments

2. Schedule B - Parent/Guardian Authorization: Copy of original authorization from parents/guardians appointing the temporary caregiver

3. Schedule C - Identification Documents: Copies of ID documents for the minor and temporary caregiver

4. Schedule D - Emergency Contact Protocol: Detailed procedure for contacting parents/guardians in various scenarios

5. Schedule E - Approved Procedures List: List of specific medical procedures pre-approved by parents/guardians