Doctor’s Note

Date: [Insert Date]

Patient Name: [Insert Patient Name]

Patient ID: [Insert Patient ID]

To Whom It May Concern,

This is to certify that [Insert Patient Name] has been under my care since [Insert Start Date]. The patient is diagnosed with [Insert Diagnosis] and requires a period of rest and recovery.

Recommended Treatment:

• [Insert Treatment 1]

• [Insert Treatment 2]

• [Insert Treatment 3]

Duration of Absence:

It is recommended that the patient refrain from work/school for a duration of [Insert Duration].

Follow-Up Appointment:

A follow-up appointment is scheduled for [Insert Follow-Up Date].

Doctor’s Information:

Doctor’s Name: [Insert Doctor’s Name]

License Number: [Insert License Number]

Contact Information: [Insert Contact Information]

Signature: [Insert Signature]