If you would like to authorize a hospital to share your medical history, you can use this Medical Authorization Letter to give consent.
[Sender’s Name]
[City, State and Zip Code]
[Mobile Number]
[Date]
[Recipient’s Name]
[Hospital’s Name]
[City, State and Zip Code]
[Email Address]
To Whom It May Concern,
I [Sender’s Name] would like to express consent to [Hospital’s Name] to provide all my medical information to all authorized parties. I have been [Doctor’s Name] patient for [Duration] and undertaken several research studies.
I authorize the hospital o share all results from these studies. I also give my authorization for the available information to diagnose and treat whenever needed. For any clarification, you can reach out to me through my mobile number [Number].
Sincerely,
[Sender’s Signature]
[Sender’s Name]
