Worthington Area School District
ATT: James Drury, Superintendent
14 Atherton Street
Manhattan, NY-10009
Cell:-(123) 456-7890
[Subject: Normally bold, summarizes the intention of the letter] -Optional-
Dear James Drury,
I give authority to Well Life Retirement Home to carry out urgent medical treatment for my father, Ken Williams, in situations when I am abroad, unavailable, or difficult to contact. The authorization only applies to such emergency cases in my absence and my father is in the immediate care of this institution. It should also be in force in adherence to the policies of Well Life.
NOTE: This form MUST be signed and dated by the person/s giving authority.
Sincerely,
Ryan gale