Medical Authorization Letters: Examples & Templates for Peace of Mind

Sample Sentences

• I authorize Dr. Johnson or his associate to administer any medical treatment he deems necessary for my son, John Doe, and my daughters, Suzanne and Jane Doe, while I am abroad from April 10 to May 1, 2019.
• I give my consent for medical procedures to be performed on me in the event that I am rendered unable to make such a decision for myself.
• I give my permission for the leaders of Boy Scout Troop 123 to administer or obtain medical treatment they deem necessary for my son, Eric, between August 3 and August 15.
• If I am injured in any way while driving for Doe Corporation, I give my permission for emergency medical treatment deemed necessary by the paramedics or attending medical staff.
• If I require medical attention while taking flying lessons from Doe Air Service and am unable to personally communicate my wishes regarding medical care, I authorize physicians at Doe General Hospital to administer whatever medical treatment they deem necessary for my best good.

Key Phrases

• any emergency medical treatment
• authorize Dr. Doe to
• between the dates of
• extends to emergency care only
• for the duration of
• for medical procedures to be performed by
• give my consent for
• give permission for
• hereby authorize physicians at
• if I require medical attention
• if unable to
• if rendered unable to
• in the event of an emergency
• not to extend beyond
• permission to administer to
• should medical treatment be deemed necessary by
• this authorization takes effect on
• to perform all necessary procedures
• to carry out necessary treatment
• to make such decisions for ourselves
• to communicate my wishes regarding
• under the following conditions
• whatever care is deemed necessary by
• whatever medical treatment she deems necessary
• while in the employment of

Sample Sentences

• I appoint my brother, John Doe of 1600 Main Street, Springfield, Kansas, telephone 555-5555, as my legal representative in obtaining such treatment as the situation may require until I return on October 23.
• I authorize the scoutmaster, John Doe, to make medical decisions until such time as I can be notified.
• I hereby appoint my supervisor, Jane Doe, to make any decisions regarding my treatment until I am able to make such decisions on my own, or until my wife can be notified, at which time I authorize my wife to secure any medical treatment I may need.
• I give this authority to Mr. John Doe until my husband, Robert Johnson, or I can be notified, at which time we will assume the responsibility for medical care.
• I authorize Jane Doe to obtain any medical treatment I may require until my husband or I am available to make decisions.

Key Phrases

• act as my legal representative in
• allow an official representative of Doe Corporation to
• appoint my brother, John Doe, as
• appoint John Doe to
• as the situation may require
• at which time
• authorize the aforementioned party to
• authorize the manager, John Doe
• give this authority to
• give my consent to
• hereby appoint my supervisor
• in the absence of
• in obtaining treatment
• in my spouse's absence
• make medical decisions until
• make decisions regarding my welfare
• not to exceed a period of
• secure any treatment I may need
• to authorize and obtain any medical treatment
• treatment beyond emergency care
• until my next-of-kin has been notified
• until I am able to
• until my spouse has been notified
• will be in effect from April 15, 2019, until
• will assume responsibility for

Sample Sentences

• John Doe
  June 28, 2019

Key Phrases