Permission Letter for Medical Treatment

A permission letter for medical treatment is an authorization document issued by parents or legal guardians permitting another person or organization to obtain medical treatment for their minor children.

A permission letter for medical treatment will ensure that your child receives medical care without any delays or questions regarding who is allowed to seek medical treatment for him or her in your absence. For instance, if your son is going on a camping trip with a friend and his parents, giving this document to the friend’s parents will authorize them to obtain medical treatment for your son if he is injured or becomes ill.

Anytime your children are in someone’s care, you should give that person or organization a letter of permission to obtain medical treatment. Give this letter to:

  • Grandparents
  • Sitters
  • Daycare
  • Camps
  • Schools

Be sure that anyone who will be caring for your minor child is aware of any medical conditions or allergies your child has. Let the caregiver know about any medication your child regularly takes, also instructions regarding when and how the medication should be given to your child. This information can be included in the authorization letter.

How to Write a Permission Letter for Medical Treatment

Formats for permission to treat letters are varied, but they all include essential information that medical personnel will need if a caregiver arrives at a hospital or clinic with your child. The requirements of authorization may vary from state to state, so it is a good idea to check your state’s legal requirements when writing your letter.

Important Information to Include

  • Your name
  • Your legal relationship to the child
  • Your child’s name
  • Your child’s birth date
  • Your authorization for medical care
  • Beginning and ending dates of authorization
  • Your signature
  • Witness name and signature

Additional Optional Information

This information is not required to permit a caregiver to treat your minor child, but it is helpful to both the caregiver and medical personnel.

  • Parent’s names and cell phone numbers
  • Your child’s drug and food allergies
  • Medications your child takes
  • Any medical conditions your child has, such as diabetes
  • Your child’s doctor’s name and phone number
  • Your child’s insurance information
  • Your preferred hospital

Permission Letter for Medical Treatment (Format)

Authorizing someone else to have your child medically treated is a legal process. As such, the format and language of this letter are legal. This authorization letter is somewhat difficult to write, but the format given below can be used and adapted as needed.

{Your Name}

{Your Address}

{Contact}

{Date}

{Name}

{Organization/Individual}

{Address}

Re: Permission Letter for Medical Treatment

Respected {Mr. /Ms. Last Name}:

I, {parent or guardian’s legal name} as the {(parent) or (legal guardian)} of {child’s legal name}, born on {child’s birthdate}, do hereby consent to medical care determined by a physician to be necessary to the welfare of my child while said child is in the care of {caregiver}, and I am not available to give consent.

This authorization is effective from {start date} to {end date}.

{your signature}

{witness signature}

{legal name of witness}

Additional Information

Mother: {Mother’s name and cell phone number}

Father: {Father’s name and cell phone number}

Food and Drug Allergies: {list any known allergies}

Medical Conditions: {list any known medical conditions}

Physician: {child’s doctor’s name and phone number}

Insurance: {Insurance company and policy number}

Preferred Hospital: {preferred hospital}

Sample Permission Letter for Medical Treatment

Here is a sample permission letter for medical treatment based on the above format.

Jessica Lewis

596 Bridle Street
Defiance, OH 43578

102-345-7210
102-345-7234

08/03/2026

Ross Geller
Paleontology Department

7118 Hawthorne Ave.
Westford, MB 01986

Re: Permission Letter for Medical Treatment

Respected Mr. Geller:

I, Jessica Lewis, as the parent of Shawn Lewis, born on January 28, 2021, do hereby consent to medical care determined by a physician to be necessary to the welfare of my child while said child is in the care of Elaine Lewis and I am not available to give consent.

This authorization is effective from 07/03/2026 to 07/08/2026.

Jessica Lewis

Witness: Sarah Jackson

Witness Name: Sarah Jackson

Additional Information

Mother: Jessica Lewis 102-345-7210

Father: Anthony Lewis 102-345-7234

Food and Drug Allergies: Peanut Allergy

Medical Conditions: None

Physician: Dr. Jeremy Hyatt 102-343-8976

Insurance: Allied Insurance 102-798-3700

Preferred Hospital: St. Jerome Medical Center

Conclusion

A permission letter for medical treatment relieves parents and guardians of concerns about their minor children’s medical care when they are not available. Making sure everyone who takes care of your children has a current copy of this letter can ease your mind and make time away from your kids more relaxing and worry-free.