Glow Medical Insurance Company
30th April 2014
Subject: Medical authorization letter
Dear Mr. Jacky,
Please accept this medical authorization letter as we give permission to authorize the medical treatments and procedures of our children Franz Charles and Sally Charles. We are Mr. Darwin Charles, father and Susie Charles, mother and we would like to present the medical authorization of our children in the event of our absence.
Through this letter, we would like to authorize Mr. And Mrs. Robert Charles, grandparents of Franz and Sally, to look after the medical procedures. We give full medical authority to our children’s grandparents to take care of their health, nutrition and good well being. With this medical authorization letter, we would like to put to your notice the following medical information:
Medical Insurance company name: Glow Medical Insurance Company
Member ID: 48384398
Parent: Mr. Darwin Charles (policy holder)
Children: Franz Charles and Sally Charles
Date of Birth: 15/03/2005 and 24/04/2007 respectively
Primary Care Physician: Dr. Troy Watson
The above mentioned authorization would be effective from 10th May 2014 and would remain in effect until 10th September 2014. We hope that you would cooperate with the medical authorization of our children as we wish to secure a good health and disease-free environment for them, during the course of our absence.
We request you to kindly reply back at your earliest convenience and let us know about the confirmation decision. If you need any information, please feel free to contact us on 4949394.
David Charles (Father)
Susie Charles (Mother)