Administrative — Work/School Excuse Note Template
The Work/School Excuse Note Template is designed for physicians and healthcare providers completing simple documentation to excuse patient absences from work or school for medical reasons. This template provides a concise, standardized format for work and school excuse notes while maintaining appropriate medical documentation. The template includes sections for patient and employer/school information, dates of absence, medical reason for absence, return date, and any activity restrictions if applicable. This template streamlines the excuse note process, ensures clear communication with employers and schools, supports attendance policies, and protects provider time by standardizing documentation. The structured format is adaptable for various medical conditions causing temporary absence. Ideal for primary care practices, pediatric practices, and practices frequently completing work and school excuse notes.
Template
Dates & Activity
Patient was evaluated/treated on {DATE}. Excused from work/school from {DATE} to {DATE}.
Restrictions (If Applicable)
No lifting > {X} lbs; avoid prolonged standing/bending; light duty only until {DATE}.
Return Guidance
May return to regular activity on {DATE}. Follow-up with provider as scheduled.
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