You can use this Medical Authorization Letter to consent to the hospital to share your medical information with the authorized party.
[Sender’s Name]
[City, State and Zip Code]
[Email Address]
[Date]
[Doctor’s Name]
[Hospital’s Name]
[City, State and Zip Code]
[Email Address]
Ref: Medical Authorization
I [Patient’s Name] would like to authorize my doctor [Doctor’s Name] of [Hospital’s Name] to share my medical information with [Name]. This will include all the doctor’s reports from the date I was admitted to the hospital on [Date] up until my last appointment on [Date].
This information is meant for [Reason for sharing medical information]. I believe this will help in a better and faster diagnosis of my condition. If you have any questions regarding this authorization, contact me on [Mobile Number].
Sincerely,
[Sender’s Signature]
[Sender’s Name]
