Children’s Medical Authorization Letter

John Doe
123 Main Street
Los Angeles, CA 90001
(555) 123-4567
January 1, 2024

To Whom It May Concern,

I, John Doe, the parent and legal guardian of Emily Jane Doe, born on March 15, 2015, hereby grant full authorization to Sarah Johnson, residing at 456 Oak Lane, Los Angeles, CA 90002, to make all necessary medical decisions on behalf of my child during my absence. This includes permission to consent to medical treatments, diagnostic procedures, hospital admissions, surgeries, or emergency care as deemed essential by a licensed medical professional.

Emily Jane Doe has the following medical information:

• Medical Conditions: Asthma (requires daily inhaler use)
• Allergies: Penicillin and peanuts (severe allergic reactions)

Sarah Johnson is fully authorized to access Emily’s medical records, communicate with healthcare providers, and make decisions necessary for her well-being. She has been informed about Emily’s medical history and is trusted to act in the best interest of my child at all times.

This authorization is valid from January 10, 2024, to January 20, 2024. During this period, Sarah Johnson will have complete authority to represent me in all medical matters concerning Emily Jane Doe.

For any questions or further clarification, I can be reached directly at (555) 123-4567 or via email at john.doe@example.com.

Thank you for your understanding and assistance.

Sincerely,
John Doe
[Signature]

Witness:
Michael Brown
789 Pine Street
Los Angeles, CA 90003
(555) 987-6543
[Witness Signature]

Notary Public (if required):
Jane Smith
[Notary Signature]
[Official Notary Seal]