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Doctor's Excuse Note For Work Template

Dr. Dylan Fisher examined Nina Tonkin on February 11, 2050 and diagnosed her with a severe upper respiratory infection, requiring 3 days of absence from work to recover properly. Dr. Fisher prescribed the antibiotic Amoxicillin and the pain reliever Acetaminophen, and scheduled a follow-up appointment for February 15th. Nina Tonkin is cleared to return to work on February 13th, with accommodations as needed during her transition back.

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933 views2 pages

Doctor's Excuse Note For Work Template

Dr. Dylan Fisher examined Nina Tonkin on February 11, 2050 and diagnosed her with a severe upper respiratory infection, requiring 3 days of absence from work to recover properly. Dr. Fisher prescribed the antibiotic Amoxicillin and the pain reliever Acetaminophen, and scheduled a follow-up appointment for February 15th. Nina Tonkin is cleared to return to work on February 13th, with accommodations as needed during her transition back.

Uploaded by

silamo2267
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • Header and Patient Information
  • Diagnosis and Recommendations
  • Return to Work Details

Serenity Wellnessa

Dr. Dylan Fisher


8945 Mayflower Drive, Woodside, NY 11377
serenitywellness.com
222-555-7777

DOCTOR’S EXCUSE NOTE FOR WORK

Date: February 12, 2050

Patient Information: Medical Provider Information:


Full Name: Nina Tonkin Name: Dr. Dylan Fisher
Date of Birth: July 18, 2023 Medical License Number: MD123456
Address: Bellmore, NY 11710
Phone Number: 222-555-7777 Clinic/Hospital Name: Serenity Wellness
Address: Woodside, NY 11377
Employer: Heath Moore Phone Number: 222-555-7777
Date of Absence: February 10, 2050 Email: [email protected]
Date of Examination: February 11, 2050

Diagnosis and Recommendations:


I, Dr. Dylan Fisher, a licensed medical provider at Serenity Medical Center, have
examined and diagnosed Nina Tonkin on February 11, 2050. Based on my
examination, the patient was diagnosed with a severe upper respiratory infection. This
condition required medical attention and warranted three (3) days of absence from
work to facilitate a proper recovery.

Recommendations:
The patient is advised to rest and recover during this period. I have prescribed the
following medications:
- Antibiotic: Amoxicillin, 500mg, 1 tablet three times a day after meals.
- Over-the-counter pain reliever: Acetaminophen, 500mg, as needed for fever and
discomfort.

A follow-up appointment is scheduled for February 15, 2050, at which time a


reassessment of the patient's condition will be conducted.
Return to Work:
Nina Tonkin is expected to recover fully and is cleared to return to work on February
13, 2050. Please consider any necessary accommodations or adjustments as the
patient transitions back to her regular work responsibilities.

Additional Notes:
If you require further information or clarification regarding the patient's medical
condition, feel free to contact me at 222-555-7777 or [email protected].

Sincerely,

Dr. Dylan Fisher

Serenity Wellness
8945 Mayflower Drive, Woodside, NY 11377
222-555-7777
[email protected]
serenitywellness.com

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