Here’s an authorization letter sample to release information about someone on behalf of a third party.
AUTHORIZATION LETTER SAMPLE TO RELEASE INFORMATION – See the tips and format you can follow in writing this letter.
An authorization letter exists and is being honored for a reason. This formal document allows someone to act on your behalf and this is usually given when the direct person is unable to do the task. It bears consent, legality, clarity, documentation, prevention of fraud, for a person’s peace of mind, and efficiency.
This is a legal tool useful when handling tasks properly, securing confidential details, and your interests are being presented despite being physically active.
Here’s a format:
[Name]
[Address]
[Contact]
[Date]
[Recipient Name]
[Recipient Address]
[Recipient Contact]
SALUTATION (example: To Whom It May Concern: or Dear Mr./Ms./Dr. [Last Name])
BODY OF LETTER
(single space in between sentences and double space in between paragraphs)
(you can use the block style format)
CLOSING SALUTATION (example Respectfully yours, Yours sincerely, Cordially, Respectfully, and for the less formal letter, you may use All the best, Best, Thank you, Regards)
SIGNATURE
(Under your closing, leave four single spaces between your typed full name, title, and other contact details you may want to include)
Here’s an example authorization letter for the body:
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 that 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,
(signature)
Juan Dela Cruz