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Doctors Note School Template

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TJ T
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776 views2 pages

Doctors Note School Template

Uploaded by

TJ T
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
  • Student Absence Authorization Form: A form used to authorize and document student absences, including physician and appointment information.
  • Copyright Information: Contains copyright details and usage permissions for the document template.

Student Absence Authorization

Patient’s Name:

Appointment Information

Date: Time:

This is to certify that the above-named Student / Patient was seen in our office by the:

Physician Nurse Physician’s Asst.

Office Staff Nurse Practitioner Other

Patient May Return to School:

Today Tomorrow On
(Day) (Date)

Physician’s Name:
Address:

Physician’s Signature
Copyright information - Please read
 
© This Free Microsoft Office Template is the copyright of [Link]. You can download and modify this template
for your own personal use. You can (and should!) remove this copyright notice (click here to see how) before
customizing the template.
 
You may not distribute or resell this template, or its derivatives, and you may not make it available on other
websites without our prior permission. All sharing of this template must be done using a link to
[Link] For any questions relating to the use of this template please email us - info@[Link]

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