Contents of the Template:
- Doctor and Clinic Information: Clearly displays the name, qualifications, and contact information of the doctor, as well as the hospital or clinic’s details.
- Patient Information: A dedicated space for essential details about the patient, including full name and date of birth.
- Diagnosis Details: Clearly states the type of depressive disorder diagnosed.
- Symptoms Presented Table: Allows for a detailed, organized listing of the patient’s symptoms, their severity, and duration.
- Treatment Recommended Table: An organized layout to clearly specify the treatments prescribed, including medication, therapy, and lifestyle recommendations.
- Special Notes/Recommendations: A section for the doctor to add additional context, advice, or special accommodations that may be necessary for the patient.
- Verification and Signature: Space for the doctor’s signature and, if applicable, official stamp, to authenticate the note.
Why Use This Template:
- Clarity and Organization: The template is designed to present all the required information in a clear and organized manner.
- Efficiency: It saves time for both healthcare professionals and patients by using a standardized format.
- Ease of Communication: The template facilitates clear communication between medical professionals and third parties (such as employers or educational institutions), ensuring that all parties understand the patient’s condition and needs.
- Accessibility: Available in Word and Google Docs formats, this template is easy to use and edit according to individual needs.
Ideal For:
- Work or School Leave Requests: When patients need to submit formal documentation to their employers or educational institutions to request a leave of absence due to their mental health condition.
- Medical Record Keeping: For use by healthcare professionals who want a standardized way to record their patients’ diagnoses and treatment plans.
- Legal or Administrative Use: In situations where proof of a medical condition is required, such as for insurance claims or legal proceedings.
- Patient Self-Advocacy: For patients who may need to share their medical status with various service providers (like special accommodations services) in a clear and professional way.
