Keep in mind that the recipient is not the same as the one authorized to make decisions for you. You are granting authority to a third party (a proxy) to act on your behalf, but the letter should be addressed to second party (the one with whom you and your proxy are dealing). [2] X Research source You may have to leave this portion blank if you do not know the party with which you will be dealing. For example, if you have granted emergency medical powers over your child to a child care worker in case you cannot be reached, you may not know which hospital your proxy will have to deal with.
Use the full name and title of the person to whom the letter is addressed. If you do not know the specific name of the party with whom your proxy will be dealing, write “To whom it may concern. "
I, (insert your full name), hereby authorize (insert proxy’s full name) to release to (insert the organization that will receive your medical records), the following medical information from my personal medical records: (list the medical information here). [3] X Trustworthy Source US Occupational Safety and Health Administration U. S. government agency responsible for setting and enforcing workplace safety standards Go to source Give very specific details for this authorization. If the letter is regarding your medical information, include your medical insurance number and claim information. If you need assistance regarding a legal matter, include the case number. For financial matters, include the applicable account information.
In some cases, you may be unsure of the dates, such as if you are authorizing in case of an emergency. For this type of authorization, specify a length of time. For example, you might write, “In the event of an emergency, the proxy has authorization to act on my behalf for 30 days. ”
This person should not be anyone named in the letter.
Have your witness sign and date the letter as well, or ask the notary public to notarize the letter.
A parent or guardian may grant child care workers authorization to make basic emergency medical decisions regarding the children in their care. It is advisable to give an authorization letter for minors traveling with adults who are not their parents or guardians. This will protect the minor from child trafficking and child custody issues. [7] X Research source If you have money held in a regional bank that you can no longer easily access, you may need to write a letter of authorization to allow someone else to handle issues that arise with the account or financial institution. An authorization letter can allow release of personal information, such as medical records. [8] X Trustworthy Source US Occupational Safety and Health Administration U. S. government agency responsible for setting and enforcing workplace safety standards Go to source You may also need to authorize another party to act on your behalf to handle especially fast-moving financial transactions. Not every business deal can wait for you; if you are temporarily indisposed, you can write a letter of authorization and temporarily grant decision-making powers to a trusted colleague.
The letter will explain the rights granted to the proxy who will be acting in your place. [9] X Research source If the second party is not known (especially in cases where authority was granted for potential emergency situations), you will have to address the letter simply “To whom it may concern. "
