Permission Medical Authorization Letter

James Carter
789 Maple Street
New York, NY 10001
(555) 987-1234
January 1, 2024

To Whom It May Concern,

I, James Carter, hereby grant permission to Linda Mitchell, residing at 234 Oak Avenue, New York, NY 10002, to act on my behalf and make medical decisions for my child, Olivia Grace Carter, born on April 10, 2016, during my absence. This permission includes authorizing medical treatments, accessing medical records, and making necessary decisions in case of an emergency or routine medical care.

Olivia Grace Carter has the following relevant medical details:

• Medical Conditions: Type 1 Diabetes (requires daily insulin injections)
• Allergies: Latex and shellfish (severe reactions require immediate attention)

This authorization is valid from January 10, 2024, to January 20, 2024. During this time, Linda Mitchell is empowered to consent to any medical procedures or treatments deemed essential by a licensed healthcare provider.

Should there be any questions or further information needed, I can be contacted at (555) 987-1234.

Thank you for your cooperation in ensuring the safety and well-being of my child.

Sincerely,
James Carter
[Signature]

Witness:
Robert Evans
456 Birch Lane
New York, NY 10003
(555) 654-7890
[Witness Signature]

Notary Public (if required):
Emma Brown
[Notary Signature]
[Official Notary Seal]