To Whom It May Concern,
This is to confirm that (Student Name) was evaluated by me on / / and, due to medical reasons, is advised to refrain from school attendance from / / to / / . The student may resume academic activities on / / , with or without restrictions as necessary.
If additional verification is needed, please contact my office.
Sincerely,
Physician's Name:
Medical Facility:
Contact Information:
Date: / /
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