Work/school Medical Excuse

Work/School

Medical Excuse

Date: ____________________

To Whom It May Concern:

Please be advised that ________________________ was seen in my office on ______⁄______⁄______.

Diagnosis:

_____________________________________________________________________________

_____________________________________________________________________________.

________________________ is able to return to work/school on: ______⁄______⁄______.

Restrictions/Limitations:

_____________________________________________________________________________

_____________________________________________________________________________.

If you have any questions regarding this patient please do not hesitate to contact my office.

____________________________

Doctors Signature

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Parent category: Medical