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Medical treatment authorization letters are documents that give a third party permission to get medical attention for a person when their legal guardian is not available to give permission.
A medical treatment authorization letter may also give permission for treatment to be given when a person is incapacitated and unable to authorize the care on their own.
Written for Grandparents?
These letters are often written for grandparents who take care of children or schools that may need to seek emergency medical treatment for a student who is injured at school.
They may also be written for babysitters, day care centers, summer camps and sports organizations.
If the letter is for an organization such as a school or hospital, there is usually a form that can be filled out and signed. However, if it is for a grandparent or baby sitter, a formal letter needs to be written.
The letter should contain the following information:
• The name of the person or institution such as school or summer camp being given the authority needs to be stated along with the address.
It is recommended to give the names of the people responsible if possible, For example, the name of the principal of the school, the director of the day care center or coach of a sports club should be mentioned.
If the person receiving authority is a grandparent or babysitter, their name should be stated in the letter. Any name mentioned should also include a phone number and address.
• The name of the doctor or hospital that can provide the medical attention should be given. For example, the doctor’s name, address and phone number, or the hospital’s name and address should be given. It may also be stated that in the case of an emergency, the person can be taken by ambulance to the nearest hospital.
• If the letter is intended only for a specified period of them, this should be mentioned. For example, if the parent or parents are going away and leaving their child with a grandparent, the dates that the authorization is valid should be mentioned. If the letter is to a school or babysitter, it may not have a beginning and ending date.
• If the person has any allergies or intolerances to medications, this should be mentioned. Even if there are no allergies or intolerances, that should also be mentioned. It will make it easier for a doctor to act if this information is known from the start.
• The parent or guardian who signs the medical authorization letter should also state their relationship to the child or elderly person. In some states, such letters need to be notarized. This can be done in most banks for no charge.
• Insurance information should also be included in the letter. This will save time on paperwork.
Parents and Guardians
Some parents and guardians give this type of letter to their child’s school even if the parent is locally available, because it allows the school to take action in an emergency rather than waiting for the parent to be informed to take action.
Separate letters can be written to schools, camps, day care centers and nannies, so the parent can rest assured that if their child is injured, he or she will receive fast emergency care.
Authorization letters should be updated regularly, so they contain the correct names of the people receiving the permission. For example, the principal may change, the nanny may change and a new letter would need to be provided.
Sample 1 – Medical Treatment Authorization Letter For Grandparents
Name Of Parent
Address Of Parent
City, State, Zip Code
DATE
Name Of Grandparent
Address Of Grandparent
City, State, Zip Code
RE: Authorization for Medical Treatment of [Name of Child]
To Whom It May Concern:
The intent of this letter is to give [Name of Grandparent] the authorization to take my four-year-old son [Name of Son] to [Name of Doctor, Address of Doctor and Phone Number] or [Name of Hospital, Address of Hospital and Phone Number] if there is a medical emergency or medical attention is required when I am not available.
[Name of Grandparent] is also permitted to give [Name of Son] over the counter children’s Tylenol if he develops fever before reaching the doctor or hospital. [Name of Son] has no known intolerances or allergies to any medication.
If required by the hospital or doctor, [Name of Grandparent] has permission to give Insurance Information. This authorization becomes invalid when [Name of Grandparent] is no longer in my employ.
Sincerely,
Parent’s Signature
Parent’s Name Printed and Relation to the Child i.e. mother, father of child
Date of signing
Copies to: Name of Hospital, Name of Doctor, Name of Grandparent, Name of Insurance Agent or Company
Sample 2 – Medical Treatment Authorization Letter For Temporary Caregiver
Name of Legal Guardian
Address of Legal Guardian
City, State, Zip Code
DATE
RE: Medical Treatment Authorization
To Whom It May Concern:
I, Name of Legal Guardian, am the lawful guardian of the female child named below.
I give permission and consent to Name, Address and Phone Number of Temporary Caregiver to authorize medical treatment for Full Name of Child and date of birth. This permission is granted from DATE and will expire on DATE.
Sincerely,
Signature Of Legal Guardian DATE
Printed Name of Legal Guardian
Signature of Witness or Notary (if required by the state) DATE
Printed Name of Witness
Sample 3 – Medical Treatment Authorization Letter For Babysitter
Name Of Parent
Address Of Parent
City, State, Zip Code
DATE
Name Of Babysitter
Address Of Babysitter
City, State, Zip Code
RE: Authorization for Medical Treatment of Name of Child
To Whom It May Concern:
The intent of this letter is to give Name of Babysitter the authorization to take my four-year-old son Name of Son to Name of Doctor, Address of Doctor and Phone Number or Name of Hospital, Address of Hospital and Phone Number if there is a medical emergency or medical attention is required when I am not available.
Name of Babysitter is also permitted to give Name of Son OTC children’s Tylenol if he develops fever before reaching the doctor or hospital. Name of Son has no known intolerances or allergies to any medication.
If required by the hospital or doctor, Name of Babysitter has permission to give Insurance Information. This authorization becomes invalid when Name of Babysitter is no longer in my employ.
Sincerely,
Parent’s Signature
Parent’s Name Printed and Relation to the Child i.e. mother, father of child
Date of signing
Copies to: Name of Hospital, Name of Doctor, Name of Babysitter, Name of Insurance Agent or Company
Frequently Asked Questions (FAQs)
1. What is a medical treatment authorization letter?
Answer: A medical treatment authorization letter is a written document that gives permission for someone else to make decisions regarding your medical care or seek medical treatment on your behalf.
2. Who can sign a medical treatment authorization letter?
Answer: A medical treatment authorization letter can be signed by anyone who is legally capable of making their own medical decisions, usually the patient or the parent/guardian of a minor.
3. What information should be included in a medical treatment authorization letter?
Answer: A medical treatment authorization letter should include the patient’s name, date of birth, medical history, specific treatments authorized, and the name and contact information of the person authorized to make decisions. It may also include any limitations or restrictions on treatment.
4. Can a medical treatment authorization letter be used in an emergency?
Answer: Yes, a medical treatment authorization letter can be used in an emergency to give someone else the power to make decisions regarding your medical treatment. It is recommended to have a signed letter with you at all times in case of an emergency.
5. Is a medical treatment authorization letter legally binding?
Answer: A medical treatment authorization letter can be legally binding if it is properly executed and complies with applicable laws and regulations. However, it is always best to check with a lawyer to ensure that the letter is valid and enforceable in your jurisdiction.
6. How long does a medical treatment authorization letter last?
Answer: The duration of a medical treatment authorization letter depends on the specific instructions and restrictions included in the letter. It can be temporary or ongoing, and can be revoked at any time by the person who signed it.
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