Authorization Letter To Get Medical Records // Get FREE Letter Templates (Print or Download)

Here is a sample template you can use to write an authorization letter to get medical records.

To,

[Recipient’s Name]

Dear [Name],

I, [Name], was admitted at your medical facility on [Date] and was discharged on [Date]. During my stay there, I was treated by Doctor [Name].

I am writing to request the release of copies of all my medical records that your medical facility has on my diagnosis and treatment. That should include all my charts, pathology reports, X-ray plates, and consultation notes regarding my medical care during my admission period.

I hereby authorize [Name], my [relation] to obtain the aforementioned medical records from your medical facility on [Date].

[He/She/They] will present you with this letter and identification document to complete the handover of medical records.

Kindly do the needful.

Best Regards,

[Name]

[Signature]