Free Doctor’s Note for Allergies Template
Doctor’s Note for Allergies
Patient Name: Sarah Thompson
Date of Visit: October 3, 2057
Medical Provider: Dr. [Your Name]
Clinic/Facility Name: Springfield Family Medicine Clinic
Contact Information: [Your Email]
To Whom It May Concern:
I am writing to confirm that my patient, Sarah Thompson, has been under my care since January 2023 for diagnosed allergies. After a thorough evaluation, it has been determined that Sarah is allergic to the following substances:
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Pollen (from trees, grasses, and weeds)
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Dust mites
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Pet dander (especially from cats and dogs)
Sarah has a history of allergic rhinitis, which manifests as severe sneezing, nasal congestion, itchy and watery eyes, and respiratory distress upon exposure to these allergens. During peak seasons, especially in the spring and fall, her symptoms can become exacerbated, necessitating appropriate management.
Due to these allergies, Sarah must avoid environments where these allergens are prevalent. Specifically, she should minimize exposure to outdoor pollen by staying indoors on high pollen count days and utilizing air purifiers at home. Additionally, she should refrain from contact with pets that produce dander and maintain a clean living environment to limit dust accumulation.
If you have any questions or require further information regarding Sarah's condition and recommended accommodations, please feel free to contact my office at (555) 123-4567.
Thank you for your understanding and support in managing Sarah's allergies.
Sincerely,
Dr. [Your Name], MD
Board-Certified Allergist
Medical License Number: 123456789
