Medical Treatment Letter Of Authorization Template for Nigeria

1. Medical History Reference: Reference to attached medical history when relevant for specific ongoing treatments or conditions

2. Specific Treatment Restrictions: Any specific treatments or procedures that are explicitly excluded from the authorization

3. Religious or Cultural Preferences: Special instructions regarding religious or cultural considerations in medical treatment

4. Alternative Authorized Parties: Secondary or tertiary authorized parties in case the primary authorized party is unavailable

5. Language Preference: Specified language for communication if the patient/authorized party requires interpretations

6. Insurance Information: Details of medical insurance and payment authorization if the authorized party is permitted to handle insurance matters

1. Schedule A - Medical History Summary: Brief summary of relevant medical history, ongoing conditions, and current medications

2. Schedule B - Approved Healthcare Providers: List of pre-approved healthcare facilities and practitioners if specific ones are preferred

3. Schedule C - Identification Documents: Copies of identification documents for all parties involved

4. Appendix 1 - Emergency Protocols: Specific instructions for emergency situations and order of contact

5. Appendix 2 - Insurance Documentation: Copies of relevant insurance cards and policy information