Authorization Letter for Release of Medical Records

Authorization Letter for Release of Medical Records. Sample Authorization Letter for Medical Care. The given formats of authorization letter to collect medical reports can be used by people who want to give authorization or responsibility to any other person.

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Authorization Letter for Release of Medical Records

Mr. John Smith,
Northway Colony.
8. Dec.2015.

Subject: Authorization letter to receive medical reports/records on my behalf.

Dear Sir,

I, Jane jade, writing this letter to indicate that I authorities the Mr. Kate to receive my medical reports on my behalf from your testing laboratory. My medical record number is ser 321 and I am your valued customer from last seven years. Your services were always superb and you maintained extra ordinary privacy and confidentiality. I am diabetic, examine and maintain my blood sugar tests always through your laboratory. Due to some personal reasons, I am out of town and it would take time to come back to my town. I need my results of blood test reports because I have to consult a doctor here for my advance treatment. So I, Mr. Jane Jade, hereby authorize the Mr. Kate, to receive my medical reports on my behalf from your laboratory.
Kindly did not hand over my other any medical report to anyone else. Make sure you will properly investigate the Mr. Kate through his original ID cards and authorize letter with my valid signatures. This authorization is valid for only this month of December. Enclose with this letter all information of Mr. Kate are attached. Please contact me if you need any other information. My contact number is 090998876. This is my personal number and I am available here for 24/7 hours.
I appreciate both you and Mr. Kate’s assistance in this matter. Please accept my vehement protestation of gratitude in this matter. Hopefully a trust established among us will continue ever after like this, and I think it’s a mutual trust, even more than mutual confidentiality, that holds us associations together.

Thank you.


Mr. Jane Jade
Green villas Joseph road street 10
Date 5th December

Sample Authorization Letter to Receive Medical Reports

Agfa khan testing laboratory.
Main Franchise.
Street 23, Canada

Subject: Letter to testing laboratory to authorize other person to receive  medical reports /records/certificate on his behalf

Dear Sir,

It is stated that I am patient of diabetes and regularly maintain my blood test record through your center. Recently I have my blood sample for my keen investigation about my health. Unfortunately in these days I am out of station and cannot come to your center to collect my medical reports. I am sending my brother to your franchise to collect my medical reports as I cannot come but I can’t wait more for results of my reports. My registered patient number is SRE56.
I am giving the authority to my brother Mr. kales to collect my medical reports on my behalf. You are requested to allow him to collect medical reports on my behalf. Feel free to contact me at 11123345666.Thank you very much.

Respectfully Yours,
Carl Rogers

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