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Sample Medical Authorization Letters

Examples of a medical authorization letter include the letter that authorizes a medical office to transfer medical records of a patient to another office . . . and the letter that authorizes a day care center to seek emergency care for an infant without seeking prior permission of the parent(s), or a nursing home to provide a clearly defined therapy to an ailing senior citizen under their care.

In general, the entity initiating or requiring such a letter will be able to help you with the general format of the letter. They may even be able to show you some examples that you can model your letter on.

Depending on the purpose, the medical authorization letter can run for just a few short paragraphs or take up more than a page.

Sometimes, lives may depend on the accuracy of the information that a medical authorization letter provides. For example, an ailing senior citizen in a care home may require drugging. Inaccurate or incomplete drugging information may not only undermine the quality of life of the senior citizen, it may eventually lead to their death.

Accurate information may also insulate you from any legal liability, if it comes to that. Revisit the letter a day after you write it to ensure nothing of consequence has been misspelled, omitted or can be misconstrued.

[Ms./Mr. Name]
[Title]
[Organization]

Dear [Ms./Mr. Last name],

My mother, [Name], has started staying at your care home since September 18, 2011.

I was asked by the care home admissions supervisor, [Ms./Mrs./Mr. Name], to furnish a medical authorization letter authorizing one of your trained personnel to administer the following drugs to my mother:

  1. [Drug], [Manufacturer], [Dosage], and [Frequency]
  2. [Drug], [Manufacturer], [Dosage], and [Frequency]
  3. [Drug], [Manufacturer], [Dosage], and [Frequency]
  4. [Drug], [Manufacturer], [Dosage], and [Frequency]
  5. [Drug], [Manufacturer], [Dosage], and [Frequency]
  6. [Drug], [Manufacturer], [Dosage], and [Frequency]
  7. [Drug], [Manufacturer], [Dosage], and [Frequency]

Because mother is also diabetic and an Alzheimer's patient, she also requires:

  1. [Drug], [Manufacturer], [Dosage], and [Frequency]
  2. [Drug], [Manufacturer], [Dosage], and [Frequency]

Please ensure that the same care provider be responsible for my mother's drugging until further notice. Any change must be only with my permission.

I was also asked to furnish a letter authorizing the care home to take any and all action to ensure mother receives emergency medical care, if such a situation arises any time during the course of her stay at the care home. I understand that by giving the care home the emergency care authorization, I will not be asked permission by the care home before emergency medical care is sought for mother.

I authorize the care home to take up 1. the drugging explained above, and to 2. provide emergency medical care to mother if she ever requires it without first seeking my permission.

I also take this opportunity to remind the care home that mother has mobility problems and requires round-the-clock care.

If you have any questions or need any clarification, please let me know.

Please sign the attached photocopy of this letter and mail it back to me for my records.

Thank you very much for your time.

Take care.

Sincerely,

[Signature]
[Name]
[Case #]

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