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Authorization Letter

Last Updated On July 3, 2018 By Letter Writing Leave a Comment

Issues related to your health, such as medical issues require serious attention. It is a grave issue and must be treated with utmost care. In cases where you have given someone else the authority to make medical decisions on your behalf require you to give them that permission in writing. It is a legal document where you can give your parent, guardian or any friend the permission to make medical decisions on your behalf. 

In such cases, you are required to write the person a Medical Authorization Letter. These can be treated as a legal document and therefore must be clear and to the point. It should be precise and should carefully state all the relevant details. Be specific about whom you are giving the authority to and what you expect the reader to do. Below given letter is an authorization letter for the release of medical documents. Ensure that your tone is professional and straightforward throughout the letter.

Authorization Letter Writing Tips

The main importance of this type of letter is that you acknowledge and you are aware by authorization and giving consent for medical decisions by an individual:

  • The name and address of legal guardian as well as the person who is authorized. 
  • The names and date of birth of the concerned person should be mentioned.
  • The purpose of the letter and medical treatment authorization.
  • A detailed history of past medical complications of the patient along with all reports.

Write the letter in a formal tone since this is an official letter of consent

Medical Authorization Letter Template

Learn how to write Authorization Letter. You can use this sample Authorization Letter format directly as well.

From,

__________

__________

__________

Date

To,

__________

__________

__________

To whomsoever it may concern,

I _________________ (your name) hereby authorize ____________(doctors name) to provide __________(another doctors name ), all my medical reports:

1. X-rays
2. lab reports
3. Any other relevant document

and all information of the treatment I took from ___________ doctor since ____________(date). I give my permission to use the information for further diagnosis and treatment of my ____________(name of the illness). I do not allow this to be used for any other purpose.

You can contact me at __________ if you have any further questions

Your name

Signature

Date of signature

Sample Letter

Refer to our sample letter to customize your very own medical authorization letter

From,

Aisha Khurana

123, House No

Linkin Road

123456, New Delhi

23rd Sept’16

To,

345, AMK Hospital

Linkin Park

432222, New Delhi

Subject: Medical Authorization Letter

To whomsoever, it may concern,

I, Aisha Khurana, at this moment authorize Jenny Singh to provide Dr. Manor with all my medical reports:

1. X-rays
2. lab reports
3. Any other relevant document

And all information about the treatment I took from Dr. Manor since May 2012. I give my permission to use the information for further diagnosis and treatment of my heart problems. I do not allow this to be used for any other purpose.

You can contact me at 7865433689 if you have further questions.

Aisha Khurana

Email Format

Follow this sample to write your own customized Medical Authorization Letter

To: amkhospital@email.com

from: Personal@email.com

Subject: Medical Authorization Letter

To whomsoever, it may concern,

I, Aisha Khurana, at this moment authorize Jenny Singh to provide Dr. Manor with all my medical reports:

1. X-rays
2. lab reports
3. Any other relevant document

And all information about the treatment I took from Dr. Manor in May 2012. I give my permission to use the information for further diagnosis and treatment of my heart problems. I do not allow this to be used for any other purpose.

You can contact me at 7865433689 if you have further questions.

Aisha Khurana

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