Authorization Consent Letter

Eliza Hedge
132 Vander Way
Longview, WA 98632
July 12, 2050

Henry Follers
Houston Hospital

418 Beaver Rd.

Longview, WA 98632

Dear Mr. Follers,

I, Eliza Hedge, am writing to give my consent and formally authorize my sister, Jane Hedge, to obtain my medical records from the hospital. She has my full authorization to have access to and retrieve my medical records.

I trust Jane Hedge in this responsibility and entrust her with the necessary information regarding my health. Please accommodate and assist her as necessary.

Yours sincerely,
Eliza Hedge