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1. Witness Section: Section for witnesses to sign, used when additional verification of identity is required

2. Revocation Clause: Statement regarding the principal's right to revoke the authorization, included when the authorization is for an extended period

3. Specific Treatment Facility: Details of specific hospital or healthcare facility where the authorization will be used, included when the authorization is facility-specific

4. Emergency Contact Information: Additional contact persons in case of emergencies, included for high-risk pregnancies or when principal has specific medical conditions

5. Limitation of Authority: Specific restrictions on the representative's authority, included when the authorization needs to be limited in scope

1. ID Documents: Photocopies of valid government IDs of both principal and representative

2. PhilHealth Member Data Record: Copy of updated PhilHealth Member Data Record showing pregnancy status

3. Medical Certificate: Proof of pregnancy from attending physician if required

4. PhilHealth Claim Form: Relevant PhilHealth claim forms that the representative is authorized to process