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If you would like to authorize someone to pick up an x-ray on your behalf, here is a sample template you can use to write an authorization letter to pick up an x-ray.



[Hospital Name]

Subject: Authorization to Pick Up X-Ray

Dear [Name],

I had recently undergone an X-Ray of [Mention X-Ray details] at your hospital on [Date]. Since I am not well, I cannot get my X-Ray reports by visiting the hospital. Therefore, I am authorizing [Name] to collect the X-Ray reports from your hospital on my behalf.

I request you to kindly consider this authorization letter and hand over my X-Ray reports to him/her without fail.

For your reference, here are my details.


Date of birth:


X-Ray Date:

In case you have any doubt regarding this authorization letter, kindly reach me at [Email/contact number] 


[Your Name]