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Authorization Letter For Medical Records
"I need an Authorization Letter For Medical Records to allow my insurance company to access my medical history from Singapore General Hospital for a claim related to my surgery in March 2025, with the authorization valid for 6 months."
1. Author Information: Full name, NRIC/Passport number, contact details of person giving authorization
2. Patient Information: Full name, NRIC/Passport number, date of birth if different from author
3. Healthcare Provider Details: Name and address of medical facility holding the records
4. Scope of Authorization: Specific medical records being authorized for release
5. Recipient Information: Details of person/entity authorized to receive records
6. Duration: Validity period of the authorization
7. Declaration: Statement of consent and understanding
1. Purpose Statement: Specific reason for requesting records, used when required by recipient
2. Proxy Authorization: Additional section when author is acting on behalf of patient
3. Confidentiality Statement: Additional privacy protection requirements and restrictions on use
1. Identity Verification Documents: Copy of NRIC/Passport of authorizing person
2. Proof of Relationship Documentation: Required when author is not the patient (e.g., birth certificate, marriage certificate)
3. Legal Authority Documentation: Power of attorney, court orders, or other legal documents establishing authority to request records
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