Medical treatment authorization letter

Ms. Elna Woods

Cherwell Drive, Birmingham

West Midlands, B39 0SS

November 29, 2010

Dr. Helen Reed


Cancer Department

Better Life Hospital

Dear Dr. Reed,

I write this letter to get your authorization regarding the treatment of my leukemia.  Dr. Lisa Adams is my attending physician and she has been treating my condition for five years now.  I have already undergone numerous treatments including chemotherapy but these have failed to prevent my cancer from spreading and worsening.

I have been informed of a new treatment that is in its experimental stage.  I am willing to try the treatment and Dr. Adams required me to get your authorization before pursuing the procedure.  She has already informed me of the risks and possible side effects of the treatment and I have signed pertinent documents regarding the matter.  I will take full responsibility for the outcome of the treatment.

My medical record is enclosed for your reference.

Thank you.

Yours sincerely,

Elna Woods

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