Free Nursing Home Authorization Letter Template
Nursing Home Authorization Letter
Date:
[Recipient's Name or Title]
[Your Company Name]
[Your Company Address]
[City, State, Zip Code]
Dear [Recipient's Name],
I hope this letter finds you well. I am writing to formally grant authority to [Designee’s Full Name], whom I fully trust, to act as my legal representative in all matters concerning my residency and care at [Your Company Name], located at [Your Company Address].
As my designated representative, [Designee’s Name] is hereby authorized to perform the following actions on my behalf:
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Access and review all my medical records and healthcare information related to my stay at your facility.
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Discuss treatment plans and healthcare options with doctors, nurses, and other medical staff involved in my care.
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Make informed decisions regarding medical procedures, treatments, or any aspect of my healthcare and wellbeing, including but not limited to, consenting to or refusing medical intervention as deemed necessary.
This authorization comes into effect immediately upon receipt of this letter and will remain valid until formally revoked by me in writing. Please be assured that this decision is made with sound judgment and full awareness of its implications, reflecting my trust in [Designee’s Name] to act in my best interest concerning my health and overall wellbeing.
I request that [Designee’s Name] be treated with full cooperation and given access to all necessary information to fulfill the responsibilities I have entrusted to them. Should you require any additional information or documentation to facilitate this authorization, please do not hesitate to contact me at [Your Phone Number] or [Your Email Address].
Thank you for your attention to this matter and for your continued support in providing care during my stay at your facility.
Sincerely,
[Your Name]
[Designee's Full Name] - Designated Representative
