Work Excuse for Parent
Name of patient _________________________________________________ Diagnosis _______________________________________________________ Name of parent __________________________________________________ This patient had a medical visit today with me at ______________. Please take this into consideration when reviewing the parent's time away from work. Physician's name __________________________________________________ Physician's signature ___________________________ Date ____________ Physician's office phone number ____________________________
This content is reviewed periodically and is subject to
change as new health information becomes available. The
information is intended to inform and educate and is not a
replacement for medical evaluation, advice, diagnosis or
treatment by a healthcare professional.
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