Authorization for Medical Treatment of Your Child, Sample & Format

Introduction

When a child is enrolled in any institution, the child is obligated to provide a background as well as some context to his or her medical history. This is done in the best interest of the child so that necessary arrangements can be made in case something comes up. However, doing this requires the consent of the parent or guardians part so that the responsible people can help the situation and mitigate risks to the maximum extent possible.

This can be done by writing an authorization letter for medical treatment of the child in question while the parents. This requires a copy of the child’s medical history, signed off by the family doctor or child’s physician. This is a highly important document, often legal as well. So make sure the words used in Authorization for Medical Treatment of Your Child are not misleading in any way, but clear and concise. Refer to the sample Authorization for Medical Treatment of Your Child given below-

Authorization for Medical Treatment of Your Child – Sample

To:

The Medical Department

PDS Gurgaon

Sector 54

Gurgaon-12422

DD/MM/YYYY

From:

Mr & Mrs. Ramanan

12 Tower

South Close, Nirvana

Gurgaon-124222

Subject: Medical Authorization Letter

To whom so ever it may concern,

I, Rakhi Ramanan, the parent of Raz Ramanan of VII B give the school my authorization to take any medical action deemed necessary in the situation that prevails. His registration no is 97373BB,

A copy of his medical history has been submitted to his class teacher. Raz has chronic asthma, which gives him trouble breathing. The medication for his condition is mentioned below-

  1. RD Wheezer
  2. PP Tablets
  3. UU Cough Syrup

Raz is well aware of his condition and has training in what to do in case of an asthma attack. However, I would still recommend the doctor in charge to meet with him once to discuss his medical concern in person.

I have spoken to our family doctor, Dr. Divya dua who has signed this authorization letter as well. You will find a copy of Raz’s medical history attached to this letter along with a formal letter written by Dr. Dua which confirms my son’s disease.

In case a situation arises, where Raz suffers from an asthma attack, I would like to be notified at once. I also request the school to make arrangements to transfer Raz to Artemis hospital, under Dr. Dua’s supervision in case of an extreme condition.

Please find the necessary contact details below

Rakhi Ramanan- 187389303

Email ID: RR@gmail.com

Dr. Dua- 19287382098

Email ID: DoctorDua@gmail.com

Thank you

Rakhi Ramanan

Mother

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