A doctor’s return to work note is used to formally communicate when an employee is medically cleared to resume work duties following an injury, illness, or surgery. Employers often require this document to ensure the employee is fit to return and to understand if any temporary work restrictions need to be observed during the recovery period.
This doctor’s note is specifically designed for this purpose. It is a clean fillable form that can be used for nearly any situation, including returning after surgery, recovering from an illness, or healing from an injury. Doctors can complete it digitally or by hand; it is adaptable for both in-office visits and remote documentation.
Basic Information
Start by entering the date, physician’s name, and contact information. Add the employee’s name, ID number if applicable, and the date of the medical event, such as injury, surgery, or illness. A short description of the condition can be included in the designated space. If the employee does not have a formal ID number, this field can be left blank or marked as N/A.
Return to Work Status
Select the option that best reflects the employee’s current work capacity. Indicate whether they are cleared for full duties, need temporary restrictions, require additional recovery time, or should be referred to another healthcare provider. Include the specific return date beside the selected option.
Lifting Restrictions
If needed, use the lifting restrictions section to define how much weight the employee can handle safely. Options include set weight limits ranging from 20 to 60 pounds, along with a “None” checkbox for unrestricted lifting. If the provided weight options don’t match the employee’s limitations, a custom range can be written next to the checkboxes.
Follow-Up Plan
In this area, the doctor can document any follow-up care, recommended therapy sessions, future evaluations, or notes regarding the employee’s ongoing recovery. This helps employers stay informed about expected adjustments or timelines. For time-sensitive follow-ups, it’s useful to include approximate dates or intervals for reassessments.
Signature and Contact Details
The physician should complete the form by signing at the bottom. A direct phone number or email address should also be included to allow employers to verify information or request clarification if needed. Signing and providing contact details formally closes the document and confirms that a licensed medical provider has reviewed the case.
This doctor’s return to work note template is available in Microsoft Word, Google Docs, and a fillable PDF format. It can be edited digitally or printed for handwritten use, depending on how the doctor prefers to complete the form.
Before handing over the completed form, save a digital copy for internal records. It can be useful if questions come up later about the employee’s medical clearance or recovery status.
