Free Medical Authorization Letter Template
Medical Authorization Letter
September 17, 2050
To Whom It May Concern,
I, [Your Name], residing at Spokane, WA 99201 hereby authorize Maria Turner, residing at 456 Spokane, WA 99201, to act on my behalf regarding my medical information and treatment.
Scope of Authorization: Maria Turner is authorized to access my medical records, discuss my health conditions and treatment plans with my healthcare providers, and make decisions related to my medical care if I am unable to do so myself.
This authorization is effective from September 17, 2050, and will remain in effect until December 31, 2050, unless revoked earlier by me in writing.
Please provide Maria Turner with all necessary information and access to my medical records as required. Thank you for your attention to this matter.
Sincerely,
[Your Name]
Witness/Notary (if required):
Witness Name: Ernesto Murphy
