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
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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