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1. Legal Guardian Details: Required when the patient is a minor or lacks capacity to make medical decisions

2. Translator Confirmation: Required when the patient's primary language is not Arabic or English, confirming accurate translation of all information

3. Witness Section: Additional witnesses may be required in high-risk cases or when the patient cannot sign

4. Religious/Cultural Considerations: Section documenting any religious or cultural reasons for refusal, particularly relevant in the UAE context

5. Alternative Treatment Options: Documentation of any alternative treatments discussed or accepted by the patient

6. Follow-up Care Plan: Optional section detailing any agreed follow-up care or monitoring despite treatment refusal

1. Schedule A - Patient Information Leaflet: Detailed information about the refused treatment and its importance

2. Schedule B - Risk Documentation: Comprehensive list of specific risks and potential outcomes related to treatment refusal

3. Schedule C - Alternative Treatment Options: Detailed information about alternative treatments if applicable

4. Schedule D - Emergency Contact Protocol: Instructions for what to do in case of emergency following treatment refusal