SAMPLE - AUTHORIZATION TO RELEASE MEDICAL RECORDS

Sample – Authorization to Release Medical Records

MEDICAL AUTHORIZATION

TO:  [NAME OF DOCTOR]

RE:  [NAME OF PATIENT]

You are hereby authorized and directed to furnish to [NAME AND ADDRESS OF RECIPIENT OF MEDICAL RECORDS] copies of any clinical notes and medical records prepared by you relating to the above patient.

You are requested not to disclose any other information to any other persons without my written authority to do so.

Dated: [DATE]

_______________________________
[NAME OF PATIENT]

SAMPLE - AUTHORIZATION FROM EMPLOYER TO PERMIT EMPLOYEE TO REMOVE CERTAIN ARTICLES

Sample Authorization from Employer to Permit Employee to Remove Certain Articles

AUTHORIZATION

To Whom It May Concern:

The undersigned, employer, hereby authorizes [NAME OF EMPLOYEE] to remove the following articles from our premises on [DATE OF REMOVAL OF ARTICLES]:

[DESCRIPTION OF ARTICLES]

This shall be your good and sufficient authority for so doing.

Sincerely,

SAMPLE - LETTER OF AUTHORIZATION TO NEGOTIATE

TO: ______________________

This letter will authorize you to negotiate, discuss and in any other way communicate  with_______________in those areas relative to ___________________________

This letter will further authorize ___________to act in all matters on behalf of ___________________________

The intent of this authorization is not to be construed to limit, in any way, the power of ______________to act in our behalf, enter into agreements, or  contract________________________in both financial areas and sales areas.

Theefore, by the existence of this instrument we hereby authorize________________to accept or reject agreements, to enter into contracts binding upon_____________________, and to act in whatever way necessary so as to accomplish that which is being untertaken which may occasion the necessity of this letter.

_______________________________

Date___________________________