Letter to Doctor Authorizing Release of Medical Records

Re. Request Letter for Authorization of Medical Reports Release at the Workplace Pursue

Dear Dr. [Doctor’s Last Name], I hope you are well and in good spirits. The purpose of this letter is to formally request your authorization to release my medical reports. I work at [Organization’s Name] as a [Position]. My organization needs to have a copy of my medical reports on the basis of which they granted me medical leave. I want you to authorize the release of my medical reports as soon as possible for my workplace convenience.

I am a [specify your problem] patient under your prime care at [Medical Clinic Name]. I really appreciate the attentive and professional medical services provided by you and the team, and that is why I always visit your clinic in case of any issue related to my health. My organization needs my medical history during this period and brief medical reports that can state in clear terms that I need two weeks of bed rest (prescribed by you as a part of my treatment).

The organization might need the following information in terms of my medical reports as part of the documents released by you:

  • Examination and diagnosis with date and day
  • Any medical conditions prevailing before the examination
  • Prescriptions and test notes
  • X-Rays and Imaging with reports
  • Medical reports with name and reference to the examination
  • Prescription of bed rest

I understand the confidentiality your team demonstrates in terms of medical histories and reports of their patients, and I really appreciate it. However, I hereby give my consent for the release of medical records to [Name of organization]. I request that you be very kind, authorize the release of medical reports as soon as possible, and direct your team to make the release smooth and prompt.

If there is any need to provide further information or additional data related to my work and organization, medical treatment, or personal identification, please feel no hesitation in reaching me. You can contact me at [Phone Number] or write to me at [Email Address].

Your clinic staff is very cooperative and professional. I conclude my letter with a note of appreciation and thankfulness for your continued process of spreading positivity and professional care to the patients. Thank you!


[Your Full Name]
[Organization’s Name]
[Your Patient ID]

[Your Authorized Signature (if you are sending a printed copy)]

Enclosure: An Authorization Release Form [if any] and a Copy of the Coordination Letter from [Name of the Organization].

Letter to Doctor Authorizing Release of Medical Records


Re. Authorization Request for the Release of Medical Reports, Prescriptions, X-Rays, and Ultrasound Reports from [Date] to [Date]

Dear Mr. [Name],

I am [Your Name], your patient in [specify the field of problem and treatment]. I am writing this letter to request that you authorize the release of my medical documents for the sake of an insurance claim.

I have received a letter from [Name of the Insurance Firm] where I have claimed reimbursement of my medical expenses in terms of my Medical Insurance (MI) at [Name of the Insurance Company]. To claim the amount of medical insurance, I need to submit some documents as part of the formal procedure. The procedure requires authorized documents from the clinic, i.e., my medical reports, the number of prescriptions with the charges paid, and medical slips where each amount paid is mentioned and verified by the authoritative person in charge of panel verification.

I request that you authorize the release of my medical documents for the aforementioned sake. I understand that the procedure might be time-consuming; however, I request that you authorize the release of the said documents as soon as possible so that the process of verification can be initiated.

I would appreciate your prompt attention and direction to your team for the release of medical reports. I appreciate the professionalism, diligence, and positive demeanor of your staff. I will visit the clinic again whenever needed. Thank you in advance for your cooperation.

If I need to submit any documents to aid the process of verification, authorization, and release of medical reports, let me know. You can contact me by calling me at [Phone Number] or sending me an email at [Email Address]. Thank you.

Best Regards,

[Full Name],
[Patient ID]
[NIC Number]

[Signature and Date]

Letter to Doctor Authorizing Release of Medical Records
Letter to Doctor Authorizing Release of Medical Records

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