A doctor’s note, also known as a medical certificate, is a crucial document that verifies a patient’s medical condition, absence from work or school, or need for specific accommodations. Having access to well-structured doctor’s note templates can save significant time and ensure all necessary information is included. This article provides 13 diverse doctor’s note samples covering various scenarios, offering a practical resource for both medical professionals and individuals seeking examples.
These templates are designed to be easily adaptable to your specific needs. Each sample provides a clear and concise format, covering details like patient information, diagnosis (if applicable and permitted), recommended duration of absence, and the doctor’s contact information. Remember to always consult with a qualified medical professional for accurate diagnosis and treatment recommendations.
Doctor’s Note Samples:
Sample 1: General Medical Excuse
[Doctor’s Letterhead]
[Date]
To Whom It May Concern:
Please be advised that [Patient Name] was seen in my office on [Date of Visit]. They were advised to rest and recover. They are excused from [work/school] from [Start Date] to [End Date].
Sincerely,
[Doctor’s Signature]
[Doctor’s Name], MD
[Doctor’s Contact Information]
Sample 2: Excused Absence from School
[Doctor’s Letterhead]
[Date]
To the School Administration:
This letter confirms that [Student Name], student ID [Student ID], was under my care on [Date of Visit] and is excused from school from [Start Date] to [End Date] due to illness.
Sincerely,
[Doctor’s Signature]
[Doctor’s Name], MD
[Doctor’s Contact Information]
Sample 3: Return to Work/School Note
[Doctor’s Letterhead]
[Date]
To Whom It May Concern:
This letter is to confirm that [Patient Name] is now cleared to return to [work/school] as of [Date of Return]. No restrictions apply.
Sincerely,
[Doctor’s Signature]
[Doctor’s Name], MD
[Doctor’s Contact Information]
Sample 4: Medical Leave of Absence Request
[Doctor’s Letterhead]
[Date]
To Whom It May Concern:
This letter confirms that [Patient Name] requires a medical leave of absence from [Start Date] to [End Date] due to a medical condition.
Sincerely,
[Doctor’s Signature]
[Doctor’s Name], MD
[Doctor’s Contact Information]
Sample 5: Dental Appointment Verification
[Dentist’s Letterhead]
[Date]
To Whom It May Concern:
This letter confirms that [Patient Name] had an appointment at our clinic on [Date of Appointment] at [Time of Appointment].
Sincerely,
[Dentist’s Signature]
[Dentist’s Name], DDS
[Dentist’s Contact Information]
Sample 6: Note for Limited Physical Activity
[Doctor’s Letterhead]
[Date]
To Whom It May Concern:
[Patient Name] is under my care and should refrain from strenuous physical activity from [Start Date] to [End Date]. Please accommodate their needs accordingly.
Sincerely,
[Doctor’s Signature]
[Doctor’s Name], MD
[Doctor’s Contact Information]
Sample 7: Pregnancy Related Absence
[Doctor’s Letterhead]
[Date]
To Whom It May Concern:
This confirms that [Patient Name] is under my care for pregnancy. She requires absence from work/school from [Start Date] to [End Date] for medical reasons related to her pregnancy.
Sincerely,
[Doctor’s Signature]
[Doctor’s Name], MD
[Doctor’s Contact Information]
Sample 8: Accommodations Required – Ergonomic Chair
[Doctor’s Letterhead]
[Date]
To Whom It May Concern:
[Patient Name] requires an ergonomic chair to support their back condition. This accommodation is necessary for them to perform their job duties effectively.
Sincerely,
[Doctor’s Signature]
[Doctor’s Name], MD
[Doctor’s Contact Information]
Sample 9: Note for a Specialist Referral
[Doctor’s Letterhead]
[Date]
To Whom It May Concern:
I am referring [Patient Name] to a specialist for further evaluation and treatment. Details: [Specialty and Reason].
Sincerely,
[Doctor’s Signature]
[Doctor’s Name], MD
[Doctor’s Contact Information]
Sample 10: Confirmation of Vaccination
[Doctor’s Letterhead]
[Date]
To Whom It May Concern:
This letter confirms that [Patient Name] has received the following vaccination(s): [List of Vaccinations] on [Date(s) of Vaccination].
Sincerely,
[Doctor’s Signature]
[Doctor’s Name], MD
[Doctor’s Contact Information]
Sample 11: Confirmation of Physical Therapy Session
[Doctor’s Letterhead]
[Date]
To Whom It May Concern:
This confirms that [Patient Name] attended a physical therapy session on [Date of Session] at [Time of Session].
Sincerely,
[Doctor’s Signature]
[Doctor’s Name], MD
[Doctor’s Contact Information]
Sample 12: Medical Note for Jury Duty Exemption
[Doctor’s Letterhead]
[Date]
To Whom It May Concern:
This letter is to confirm that [Patient Name] is under my care and is medically unable to fulfill jury duty obligations at this time. This is due to [brief explanation, avoid specifics].
Sincerely,
[Doctor’s Signature]
[Doctor’s Name], MD
[Doctor’s Contact Information]
Sample 13: Note for Emotional Support Animal (Consult Legal Regulations)
[Doctor’s Letterhead]
[Date]
To Whom It May Concern:
This letter confirms that [Patient Name] is under my care for [diagnosis, avoid specifics]. An emotional support animal has been deemed a necessary part of their treatment plan. [Animal Type]: [Animal’s Name]. Please note: Regulations regarding Emotional Support Animals vary. This letter should be used in conjunction with understanding those regulations.
Sincerely,
[Doctor’s Signature]
[Doctor’s Name], MD
[Doctor’s Contact Information]
Conclusion
These 13 doctor’s note samples provide a solid foundation for drafting clear and professional medical documents. Remember to tailor each template to the specific patient and situation, and always adhere to ethical and legal guidelines when providing medical information. Consulting with legal counsel is recommended when drafting notes with legal implications, such as those relating to jury duty or emotional support animals. This is for informational purposes only, always consult with a medical professional.