Is it permissible to add two escorts to the medical referral letter for a daughter suffering from speech and hearing impairment abroad, especially since the governmental body that issued the letter is almost defunct, and the Libyan embassy stipulates this for the continuation of her treatment?

It is permissible for the director to accept the donation letter and amend it to include the patient's companions if he is authorized to do so, provided that there is no deception or fraud involved. Determining whether both parties or only one party should be informed depends on the law regulating the entitlement to the donation.