Authorization to collect lab results in Poland: printable template

In Poland another person may collect your lab results if you authorize them in writing (upoważnienie). This right comes from art. 26 of the Polish Act on Patient Rights. Below is a printable template in Polish. We checked this on 10 November 2026.

What to fill in

1. Your full name and PESEL. With no PESEL, enter your date of birth.
2. The full name of the person you authorize and the number of their ID card or passport.
3. The lab and the test date or the order number.
4. How long the authorization is valid: once, or until a set date.
5. The place, the date and your legible signature.

At pickup

The authorized person brings the authorization and their own photo ID. Labs may have their own forms and rules, so check the lab's site or call the collection point before the visit.

What this authorization does not cover

An authorization to collect results does not give access to your full medical records. Wider access needs a separate authorization.

When you need no authorization

Many labs show results online. At ALAB, for example, the PESEL and the order barcode are enough. Anyone with these details can download the PDF without an authorization, so share them only with a person you trust.

All your results in one place

If you keep track of a family member's results, add a separate profile for them in Biomarka. Biomarka reads the values, units and lab ranges, and you check them. Then you see a chart of each marker over time.

This guide is not legal advice. It describes art. 26 of the Polish Act on Patient Rights and the page of the Polish Patient Ombudsman.