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(Sample) Authority Letter to Pick up My Medical Result Report

A person may not always be in a situation to collect his medical test's result reports from the hospital/medical institution. In that case, he can very well authorize someone else on his behalf to pick up the documents for him.

Authority Letter to Pick up My Medical Result Report (Sample)Two things could be very important here - to make the it work:
(1) The person, who is authorizing, should give his self attested copy of any identity proof;
(2) The authorized person should carry his original identity proof as well as a self attested copy.

These will help the hospital/medical institution to verify the authenticity of both the person and would enable them to give the medical reports without any hesitation.

Modify the following format suitably.

FORMAT

Date: ................

From
(Name of the Person)
(Resident Address)
(Tel. No. ..............)
(Email id. ...............)

To
(Name of the Officer)
(Designation)
(Name of the Hospital/Medical Institution)
(Address, Tel. No. ............)

Sub.: Authority to collect medical results on my behalf

Dear Sir/Madam,

I had recently undergone some medical tests at your hospital/clinic as advised by my doctor. Following are my personal and tests details for your kind reference.

Name: .............................
Date of birth: ....................
Address: ............................
Medical tests done on (date)

The payment acknowledgement copy is enclosed herewith.

I am presently very sick and hence I am not in a position to visit your hospital/clinic personally to collect the report on the medical tests results done on me that day.

Therefore, I am hereby authorizing the following person who will collect the documents on my behalf.

Authorized Person's Name: ..................
Signature: ...............



He will be visiting the hospital/clinic tomorrow to collect the medical reports. Kind request to your goodself to please hand over the necessary documents and certificates to him without fail.

A copy of my identity proof self attested by me is enclosed herewith for verification purpose.

Thanking you for your cooperation!

Yours faithfully,

  signature
(Name of the Person)

Encl: A/a

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