Work Excuse Note Template

Professional medical excuse form for work absences

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Medical Excuse Note

For Work Absence

Date: _______________

To Whom It May Concern:

This letter is to certify that [Patient Name] was under my medical care on [Date]. Due to their medical condition, they were unable to work from [Start Date] to [End Date].

They may return to work on [Return Date].

Doctors Signature: _______________

Medical License Number: _______________

How to Use This Template

1. Download the template in your preferred format (PDF or DOC)

2. Fill in the required information:

  • Patient's full name
  • Date of medical visit
  • Start and end dates of absence
  • Return to work date
  • Doctors signature and license number

3. Print the completed form

4. Submit to your employer

Important Notice

This template is for reference purposes only. A valid doctors note must be signed by a licensed medical professional.