If you would like to authorize someone to collect your medical results on your behalf, here is a sample authorization letter to pick up medical results.
[Date]
From
[Your Name]
[Your Address]
[Contact Information]
To
[Recipient’s Name]
[Recipient’s Designation]
[Name of Medical Institute]
[Address]
Subject: Authorization To Collect Medical Results On My Behalf
Please allow the medical results for my recent tests to be collected by [Name of Entrusted Person]. I have included my medical information, the tests’ payment receipt, and an attested copy of my identification.
Mentioned Below are the verification details of the authorized person.
Authorized Person’s Name: [Name of Entrusted Person]
Signature: [Signature of Entrusted Person]
Thank you for your consideration.
Sincerely,
[Your Name]
[Your Signature]
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