How to Write a Medical Release Letter

A medical release letter is a document communicating the requirement of medical attention and authorization regarding medical care to any concerned person, organization, or authority. As it is a legal document, it should be drafted properly. There are certain steps you can follow to ensure that your medical release letter serves its exact purpose.

Medical release letters are important documents that authorize a third party to take judicious steps regarding medical attention and care of a person, as and when required. It is a legal document giving permission to the holder of the document to care for someone in absence of the undersigned. This letter is, at times, misunderstood for a medical information release letter. It is important to understand that while the latter authorizes access to private medical information of a person to a third party, the former simply gives permission to attend to the medical needs by a third party.

As this document is important and has legal implication, utmost care is required while drafting this letter. The information must be precise, without the scope of any ambiguity. Also, the letter must be signed by either of the parents, or guardian, in case of minors. There are certain steps that you can keep in mind while drafting a medical release letter.

Steps to Write a Medical Release Letter

1. Situation: The first step is identification of the situation that presents a need for writing a medical release letter. Generally, this document is required to be furnished on a request of an educational or daycare institute that your ward attends. There are many situations where you might be unreachable when your kid needs medical attention. This document merely enables the nearest authorized person to look into the matter. Some other situations where a medical release letter may be required are:

Kids going for camping, or an overseas trip organized by a school or college
Kids staying with grandparents or babysitter, when parent/s or guardian/s are out of town
School sports team, which your ward is a member of, visiting another institute for a game
Kids traveling to another state or country with a person other than parent/s or guardian/s

Note: In a medical release letter, the person, or organization authorized must be of sane mental state and fit to undertake the responsibility thereby bestowed upon them.

2. Pre-existing Forms: There are many sample medical release letter templates available on the web, which you can use the services of. Many organizations and hospitals have their own templates for this particular use and only require specific information and your signature. A sample letter is given at the end of this article for your reference.

Note: With an overwhelming number of options for a medical release letter available over the Internet, it can be confusing for you to select the right one. Always read the title and the statement to ascertain the relevancy of the letter template suitable to your needs.

3. Title: Give the letter an appropriate title indicating the terms of the document. Remember that the document will be used only in case of an emergency. So, provide a title that can get an exact and immediate response. Some titles you can use are:

Medical Authorization Form
Medical Permission Letter
Authorization Letter for Medical Care
Consent Form for Medical Care

Note: While drafting the title, be concise and precise. Avoid long and ambiguous sentences.

4. Description: In this section, you have to give the explicit message regarding the nature of the document. The information will include the name of the ward/s who requires medical help, the name of the person who is authorized and nature of the actions he/she is authorized to take in context of your ward’s health, in your absence. If you want the third party to have limited access in taking decisions for your ward, remember to mention it here. For example: if you want to restrict the authority of the third party only up to primary medication and not invasive treatment, you must mention it in this section.

Note: Include information of the child/children, like name/s, age/s, date/s of birth, and address. Also mention the name, age, and address of the third party and the nature of relationship between this party, you, and the ward/s.

5. Medical Information: Include all relevant medical information of the person who may require medical help. This will include:

Medical history
Any evident family medical history
Allergies, if any
Any health disorder
Ongoing medication or treatment, if any
Contact information of Family Physician
Details of Insurance cover

Note: Attach copies of prescription or, any medical document if it seems necessary. Mention the name of the specific healthcare institute you want the third party to contact regarding your ward, in case a medical emergency presents itself.

6. Validity of Letter: A medical release letter is a legal document. So, to avoid wrongful use, mention the validity and scope of the document. Duration of validity must be mentioned in exact dates, like “This document is valid from (dd-mm-yy) to (dd-mm-yy)” and not “This document is valid for one week from the date of signing.”

7. Notarize: The document will be valid and of true nature only if it is signed by an appropriate authority. In case of minors, either of the surviving parents, or guardian/s must sign the document. Always put your name and the date with your signature.

8. Make Copies: Before submitting the letter or form, make copies and keep them for yourself. If you want the authorized person to visit a specific healthcare institute, you can also submit a copy of the document with that institute and expedite the process as and when required.

MEDICAL RELEASE LETTER SAMPLE

Name of the Undersigned: Mr. John Smith
Relationship with Minor: Father/Guardian
Address: 312/B, Summer Chateau, Rustic Lane, Tucson AZ 25412, USA
Phone: Home — 555-12333-12333
Phone: Work — 555-12334-12334
Phone: Mobile — 555-12335-12335

Name of the Minor: Ms. Eva Smith
Date of Birth: March 15, 2003
Blood Group: O+ve
Allergies: Food or Drug allergy
Medical History: Mention any previous health scare, or problem, and any invasive procedure undergone. Also, mention if any prescription or medical document is attached.

Authorized Person: Mr. Mark Johnson
Relationship with Minor: Maternal Uncle
Address: W-432, Rosalyn Villas, 24th street, Tucson AZ 254861, USA
Phone: Home — 555-12340-12340
Phone: Work — 555-12341-12341
Phone: Mobile — 555-12342-12342

Family Physician: Dr. Anthony, MD
Address: Star Clinic, 28th street, Tucson AZ 24854, USA
Phone: Clinic — 555-12343-12343

Dentist’s Name: Dr. Dunlap
Address: Smile Clinic, Office no:23, 2nd Floor, Tudor Towers, Tucson AZ 245862, USA
Phone: Clinic — 555-12344-12344

(Page 1)

Insurance Company: XYZ Life and Health Insurance
Phone: 555-12345-12345
Policy Holder’s Name: Mr. John Smith
Address: 312/B, Summer Chateau, Rustic Lane, Tucson AZ 25412,USA
Relationship with Child: Father/Guardian
ID: #15427GHDTEJ
Policy Type: Group
Policy Number: #4545

Declaration of Consent: (To be signed in presence of legalized notary public):

As a parent/legal guardian of Ms. Eva Smith, I hereby authorize and grant permission, in case of emergency or non-emergency to Mr. Mark Johnson thereof, to take an appropriate decision regarding medical or dental administration required by my daughter, in case of accidental injury or illness, until such time as I can be contacted. This permission includes, but is not limited to, administering first aid, performing diagnostic procedures, treatment procedure, and using ambulance and/or any recommended surgical procedure by and under qualified and trained professionals. I understand and accept that the success of any treatment administered has not been guaranteed. I authorize the medical facility to dispose any sample, specimen, or tissue taken from the above-named minor.

This document is valid from March 15, 2013 to March 20, 2013.

Signature

Date (March 15, 2013)

Notarization:
On this 15th day of March, 2013, Mr. John Smith personally appeared before me in Tucson, Pima County of Arizona, and in my presence signed this medical release letter.

Name of Notary Official: Mr. Gordon Nash
Signature: ______
Commission Expires: ______

(Page 2)

This above-given letter is a sample indicating that the undersigned has authorized the maternal uncle regarding his daughter’s medical care for a time period of 6 days. In case a medical release letter is being furnished to a boarding school, validity of the document should be one year and renewed for another year, until your child graduates or transfers to another school. For a camping trip, the validity of this document will be from the day of departure for the camp to the day of arrival.

A medical release letter ensures that your child/children get required treatment in your absence. So, be careful with the information that you furnish in this document. In case you are undecided about the matter to be included, use samples available with the hospitals, organizations, and on the web.