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1. Guardian/Representative Authorization: Required when consent is being given by a legal guardian or authorized representative for minors or incapacitated patients

2. Interpreter Declaration: Required when the patient requires language interpretation services to understand the consent form

3. Specific Procedure Consent: Additional section when medical history access is related to a specific medical procedure

4. Third Party Access: Required when medical history may be shared with specific third parties such as insurance companies or other healthcare providers

5. Electronic Access Consent: Additional section when providing consent for electronic access to medical records through patient portals or other digital platforms

6. Research Use Consent: Required when medical history may be used for research purposes, including anonymization procedures

1. Schedule A - Types of Medical Information: Detailed list of categories of medical information covered by the consent

2. Schedule B - Authorized Recipients: List of specific departments, healthcare providers, or third parties authorized to access the medical history

3. Schedule C - Privacy Policy Summary: Summary of the healthcare provider's privacy policy and data protection measures

4. Appendix 1 - Patient Rights Guide: Detailed guide explaining patient rights regarding medical information in Saudi Arabia

5. Appendix 2 - Withdrawal Process: Detailed procedure for withdrawing consent and associated forms