Authorities are in force until further notice

August 23, 2011

Jack Martinez

456, X Street, Y Avenue,

Fillmore, UT-84631

Cell:-(123) 456-7890

[Subject: Normally bold, summarizes the intention of the letter] -Optional-

Dear Jack Martinez,

This letter serves as an authorization for City Doctor’s Hospital to execute urgently needed medical treatment for my daughter, Eve. In cases when medical attention is not that urgent, my authorized representative is Frances Miller. She will have the final say on matters relating to the medical requirements of my daughter in my absence. Their authorities are in force until further notice.

NOTE: This letter MUST be signed and dated by the person/s giving authority.


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