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1. Specific Treatment Exclusions: Section to list any treatments or procedures specifically refused or excluded from the consent

2. Alternative Medicine Preferences: Section for documenting preferences regarding complementary or alternative medical treatments

3. Religious or Cultural Considerations: Special instructions regarding religious or cultural requirements affecting medical care

4. End of Life Preferences: Optional section linking to or incorporating advance care directives

5. Secondary Decision Makers: Appointment of backup decision makers if primary decision maker is unavailable

6. Specialized Medical Conditions: Additional consents required for specific ongoing medical conditions

1. Schedule A - Current Medical Conditions: List of existing medical conditions, current medications, and allergies

2. Schedule B - Healthcare Provider Details: Contact information for primary care physician and other relevant healthcare providers

3. Schedule C - Emergency Contacts: Prioritized list of people to contact in medical emergencies

4. Appendix 1 - Glossary of Medical Terms: Definitions of medical and legal terms used in the document

5. Appendix 2 - Patient Rights Summary: Summary of relevant patient rights under New Zealand law