Permission Medical Authorization Letter Template for Hong Kong

1. Date and Location: Current date and place of execution of the authorization letter

2. Parties Identification: Full legal names and details of the person granting authorization (grantor) and the person receiving authorization (grantee)

3. Relationship Declaration: Statement of the relationship between the grantor and grantee

4. Purpose Statement: Clear statement of the purpose of the medical authorization

5. Scope of Authorization: Specific medical decisions and actions the grantee is authorized to make

6. Duration of Authority: Time period for which the authorization is valid

7. Emergency Contact Information: Contact details for both grantor and grantee, including alternative contacts

8. Signature and Witness Block: Space for signatures of grantor, grantee, and witnesses with their details

1. Schedule A - Medical History: Detailed medical history including past surgeries, medications, and chronic conditions

2. Schedule B - Authorized Healthcare Providers: List of specific healthcare providers or facilities where the authorization is to be used

3. Schedule C - Specific Procedures: List of specific medical procedures or treatments covered under the authorization

4. Appendix 1 - Identity Documents: Copies of identification documents of both grantor and grantee

5. Appendix 2 - Supporting Medical Documentation: Any relevant medical reports or documentation supporting the need for authorization