Medical Authorization Letter

Being a parent or legal guardian means you always have to be on top of your child’s well-being, including their health. Sometimes, however, other responsibilities such as work, school, or travel can leave you unable to make medical decisions for them. This is where a medical authorization letter comes in handy. When written and signed by a parent or legal guardian, this document gives another party temporary authority to make medical decisions concerning your child. Here is what you need to know.

What Is a Medical Authorization Letter?

A medical authorization letter is a formal document that grants another person permission to seek and get treatment for a child, elderly person, or other party mentioned in letter. It is usually prepared by a parent, legal guardian, or primary caregiver when they are unable to make medical decisions for the person mentioned in the letter. In most cases, this letter is given to babysitters, nannies, relatives such as grandparents, and other trusted parties.

Purpose of a Medical Authorization Letter

A medical authorization letter temporarily transfers the power to make medical decisions to another party in the absence of a parent, legal guardian, or primary caregiver. Its purpose is to ensure that the subject can get the medical care or treatment they need when necessary. Without it, and in the absence of the decision maker, the subject’s life could be in danger with no one allowed to seek, get, or agree to medical care. The letter should always indicate what decisions the authorized person can make and which ones they cannot, to prevent abuse of privilege.

Essential Elements of a Medical Authorization Letter

Essentially, a medical authorization letter should show that you are willingly and knowingly giving temporary authority to a third party to make medical decisions related to your child. While what you include in it may vary slightly depending on the requirements in your state, you should at the very least provide the following key details:

  • Your full name as the child’s parent or legal guardian
  • Your address, phone number, and email address
  • The name, age, and address of the child
  • The name, address, and contact information of the authorized person
  • Your reason for writing, i.e. to authorize a third party to make medical decisions.
  • The validity period of the authorization.
  • Any health issues, medications, vaccines, or allergies and other relevant information about your child.
  • The type of care or treatment you are authorizing
  • Your medical insurance details

Medical Authorization Letter Template

I [your name] being the [your relationship with the child] of [child’s name] authorize [authorized person’s name] to seek, get, and agree to emergency, dental, and medical care and treatment for [child’s name] as considered necessary by the physician. This authorization is valid between [start date] as long as I am reasonably unavailable and until I revoke it.

Child’s Information

Full Name: _______________

Address: _______________

Date of Birth: _______________

Age: _______________

Parent/Legal Guardian

Full Name: _______________

Address: _______________

Phone No.: _______________

Email: _______________

Authorized Party

Name: _______________

Address: _______________

Phone Number: _______________

Signature: _______________

Child’s Health Information

Health Conditions: _______________

Allergies: _______________

Prescription Medications: Dosage: _______________ Time: _______________

Child’s Doctor: _______________ Phone Number: _______________

Child’s Dentist: _______________ Phone Number: _______________

Insurance Firm: _______________ Policy Number: _______________

Policy Holder’s name: _______________

Parent/Legal Guardian Signature: _______________ Date: _______________

Print Name: _______________

Sample Letter Giving Grandparents Medical Authority

David Jonathan

200 Union Street

Denver, CO 20901

23 October, 2030

To,

Denver Medical Center

923 Philly Road

Denver, CO 90299

Re: ​ Authorization for Medical Treatment of Chris Jonathan

To Whom It May Concern,

I am writing this letter to give Mary and Gregory Jonathan authorization to seek medical treatment for my son, Chris Jonathan, at Denver Medical Center in case of an emergency when I am unavailable. Mary and Gregory Jonathan, my parents, are also allowed to administer Chris’ medication if he gets an allergy attack. Chris is allergic to soy. If necessary, they can provide the hospital with my insurance information. This authorization is valid as from 23 October 2030 until 2 November 2030, while I am out of town.

Sincerely,

David Jonathan

Sample Medical Treatment Authorization Letter

Michelle Garson

123 Full Street

Los Angeles, CA 12011

23 October 2030

To,

Millicent Keller, Ph.D.

MediHeal National Hospital

120 Second Street

Los Angeles, CA 100019

Re: Authorization for Medical Treatment

Dear Dr. Keller,

I, Michelle Garson, being the mother of Athena Garson authorize Grace Wicker of ID number US90130 to seek, get, and agree to medical treatment for Athena in my absence as you consider necessary. This authorization will be effective from 23 October 2030 for as long as I am reasonably unavailable and until I revoke it. I have included more information below:

Child’s Information

Full Name: Athena Garson

Address: 123 Full Street, Los Angeles, CA 12011

Date of Birth: 6 September, 2020

Age: 10

Parent/Legal Guardian

Full Name: Michelle Garson

Phone No.: +1209199029

Email: [email protected]

Authorized Party

Name: Grace Wicker

Address: 200 First Avenue, Los Angeles, CA 30220

Phone Number: +19020009

Child’s Health Information

Health Conditions: Asthma

Allergies: Peanuts

Sincerely,

Michelle Garson

Minor (Child) Medical Consent Form

I, [your name], as the [state your relationship with the child] of [child’s name] born on [date] hereby authorize [authorized person’s name] of [identification number] and [address] to seek, get, and agree to emergency, dental, and routine medical care and treatment for [child’s name] as considered necessary by a physician. This authorization is valid for the duration during which [child’s name] is under the care of [authorized person’s name] and I am not reasonably reachable by phone to give consent. It will remain so until [I revoke it/end date].

Signature of Parent or Legal Guardian: ________________

Date: ________________

Family Address: ________________

Parent’s/Guardian’s Telephone: ________________

Preferred Hospital: ________________

Child’s Doctor: ________________

Phone: ________________

Allergies: ________________

Blood Type: ________________

Medications: ________________

Insurance: ________________

Policy Number: ________________

Final Thoughts

Always address your medical authorization letter to the hospital or specific doctor from whom your child will get treatment. If you cannot access this information, address it to the hospital and write “To Whom It May Concern” as the greeting line.

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