Free Medical Assistance Authorization Letter Template

Medical Assistance Authorization Letter


March 12, 2050


Damien Royce

Medical Representative
2845 Military Trail,

West Palm Beach, FL 94901

Dear Mr. Royce,

I am writing to formally authorize Ms. Jane Simmons to act as my representative in obtaining medical assistance on my behalf. My name is Ace Parker, and I am confident that Ms. Simmons will effectively handle the necessary correspondence and transactions for this medical endeavor.

Effective immediately, this authorization is granted and will remain in effect until further notice. During this period, Ms. Simmons is empowered to make decisions, communicate with healthcare professionals, and undertake any necessary actions to ensure my well-being and address any medical needs that may arise.

I kindly request your full cooperation and support in assisting Ms. Simmons throughout this authorization. Your prompt attention to this matter is greatly appreciated, and I am confident that Ms. Simmons will uphold the responsibilities entrusted to her with diligence and care.

I would like to express my gratitude in advance for your understanding and cooperation in facilitating a seamless process during this time.

Thank you for your prompt attention to this matter.

Sincerely,

Ace Parker