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Medical Authorization Form

Every organization and company try their best to achieve great value.  Achieving good reputation and prestige is not enough. They have to take various sagacious steps and precautions in a professional way in order to maintain such reputation.

Likewise, a hospital or clinic is considered as one of the most esteemed institutions where experienced and skilled health care professionals leave no stone unturned to save patient’s life. They work hard day and night in order to save precious lives.

A medical authorization form is such a significant document which the medical institutions most frequently use.

There comes a number of patients on a routine basis in medical institutions for their treatment. During the treatment, there may happen any sort of mishap or there may be fewer chances of patient’s survival. Undoubtedly, it is a very critical situation and must be handled critically.

Having the risk of survival does not mean that the doctor should avoid to operate and save himself from the dispute that may arise in case of fatal outcomes.

Health care professionals have to perform their role in order to serve humanity. Hence, medical authorization can help them in this regard.

It saves both the operator and medical instate free from any sort of liability. Before the medical procedure or treatment, After getting authorization, the doctor or surgeon may proceed with full confidence.

It states the detail of rudimentary medical history which must be known to the doctor before giving the medical treatment to the patient.

If a patient has any sort of allergy from the medicine, food, dust, etc. or any pre-existing disease should be mentioned on the form. Signature of the guardian, witness and physician should be there at the bottom of the form.

If you are looking for the medical authorization form then get the most professionally designed form by simply clicking on the download button.

Get it downloaded and use it when required. Customize it the way you want and take as many prints as you want.

Sample Template

I, [Your Name], being the guardian and/or the legal guardian of [Patinet’s Name] do hereby authorize [Name to whom authorization is given] to seek and obtain medical treatment and care to my child(ren) in any event when my child(ren) would need medical care.

My child suffers from the allergies that are stated below: (if applicable)

[Allgery 1]
[Allergy 2]
[Allergy 3]

I hereby declare myself to be the financial guardian of my child(ren) and will be responsible for all the expense of the medical care provided to my child(ren) under this Authorization. [DETAILS] is my health insurance carrier and the number of my health insurance policy or certificate is [DETAILS].

Date: [on which authorization is guaranteed]

Signature of Legal Guardian or Parent:

Witness Signature:


Medical Authorization Form


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