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1. Emergency Contact Authorization: Additional authorization for emergency contacts to receive medical information, used when patient wants to designate specific individuals for emergency situations

2. Electronic Communications Consent: Additional consent for sharing information via electronic means, used when digital transmission of records is anticipated

3. Minor Patient provisions: Special provisions for patients under 18, used when the patient is a minor

4. Translation Declaration: Declaration that the form has been explained in a language understood by the patient, used when patient's primary language is not Indonesian

5. Legal Representative Authorization: Additional section for cases where a legal representative is acting on behalf of the patient

1. Schedule A - Types of Medical Information: Detailed checklist of specific medical information types authorized for release (e.g., diagnostic records, lab results, treatment history)

2. Schedule B - Authorized Recipients List: Comprehensive list of all authorized recipients and their respective access levels, used when multiple parties are involved

3. Schedule C - Specific Exclusions: List of specific medical information explicitly excluded from the authorization

4. Appendix 1 - Patient Rights Information: Detailed explanation of patient rights under Indonesian law regarding medical information disclosure

5. Appendix 2 - Privacy Notice: Detailed privacy notice explaining how the medical information will be handled and protected