Contents of the Template:
- Letterhead and Medical Practitioner’s Details: This ensures authenticity, showing the name, contact details, and license number of the doctor or medical facility.
- Patient Information: Provides a space for essential details about the patient, such as their name, date of birth, address, and contact information.
- Medical Evaluation Summary: A succinct section detailing the patient’s diagnosis, onset date, and duration of medical leave.
- Return to Work Authorization: Clearly marks the patient’s clearance status to return to work and specifies any restrictions or requirements.
- Additional Notes or Recommendations: Space for the doctor to provide any additional context or instructions for the employer.
Why Use This Template:
- User-Friendly: Designed for ease, both for the medical professional filling it out and the employer reviewing it.
- Clarity: The structure ensures that all essential information is easy to locate and understand.
- Flexibility: Suitable for a range of medical conditions, from short-term illnesses to more extended medical leaves.
- Professional Layout: Presented in a manner that is both authoritative and easily recognizable by employers.
Ideal For:
- Short-term Medical Absences: Such as recovery from flu, minor surgeries, or temporary health conditions.
- Long-term Health Issues: For patients recovering from major surgeries, accidents, or prolonged illnesses.
- Work-Related Injuries: Especially when there might be insurance claims or worker’s compensation considerations.
- Routine Medical Procedures: Like annual physicals where an employer requires a clearance.
