24 North Avenue
Date: 26th January 2012
Subject: Permission for sharing Medical Reports with another doctor
To whomsoever it may concern
I, George Adams am giving written consent to Dr. Arnold Davis to share my medical reports with Dr. James Mathews. I am undergoing medical treatment at the XYZ Hospital and issuing this letter to my doctor to share any of my medical records including CT scans, X-rays, MRI reports, Blood reports and any other medical test reports associated with this treatment.
I am giving this consent as Dr. Arnold Davis is keen on taking a second opinion about my reports and the treatment I would be undergoing in the next couple of days. Though I trust Dr. Arnold Davis completely, however I would like to notify that these medical reports should not be used for any other purpose.
Thanks and Regards,