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Here’s an authorization letter sample to release information.

AUTHORIZATION LETTER SAMPLE – This is a guide you can follow in formally writing an authorization letter sample to release information.

In some cases, you will need to send someone to go over through some tasks for you due to some incidents which will unable you to do so. And what you will need in times like this is an authorization letter. This letter is an official written communication to allow someone you trust do something in your behalf.

This type of letter is often written for medical, legal, business fields, and for personal purposes. And at times like this, you might need to write an authorization letter for release of some important information. For an instance, your doctor will need some information about your condition and here’s a sample letter.

For this situation, what you have to do is to write an authorization letter to the authorities of the hospital to release such essential information about you to help with your treatment.

Below is an authorization letter sample to be sent to the hospital to release your medical records:

September 5, 2015

Juan Dela Cruz
Atis Street, Deca Homes Phase 2
Bacolod City, Negros Occidental
0912-345-6789 / 434-1234

General Hospital
Rizal Street
Silay City, Negros Occidental

To whom it may concern:

I, Juan Dela Cruz, do hereby authorize the authorities of the General Hospital to release any information that Dr. Percival Riego, M.D., may need and require. Kindly allow Dr. Riego to have all the x-ray reports, CT scans, and any other information which he feels is essential for my treatment.

I give my permission for these information to be of use in the diagnosis and treatment of my recurring headache and any re-disclosure for any other use will not be allowed.

Respectfully yours,

Juan Dela Cruz

For formal letters, it is important to keep in mind that the intention in your letter is indicated clearly, concisely, and to firmly state that you are authorizing the third person in the process. You must also state your set arrangements and conditions and to maintain a professional tone.


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