Authorization form for medical treatment of my father

August 23, 2011

Arnold Den

64, East 6 Street,

Lewistown, Montana, 03278,

Cell:-(194)-465 0217



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

Dear Arnold den,

This is a signed authorization form for medical treatment of my father, Ken Williams. It will be in effect from May 1 to May 16 during my trip abroad. It states that you are authorized to decide and approve of any medication/ treatment necessary for my father. In the event that an emergency treatment or confinement is needed, I suggest that it be done at City Doctors’ Hospital. Just call me at 123441 for any concern. Thank you for granting us this favor.

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

Dhruv hall

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