Doctor's Note for Work
Created by
Andrew Kelly
Specialty
Hospitalist
Last edited
10/20/2026
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About this template
A reusable medical letter template for documenting a patient's work restriction, including identifying details, examination findings, diagnosis, treatment plan, leave period, return-to-work guidance, and clinician information.
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Patient Name: Liam Alexander Vance
Date of Birth: 14/08/1988
Date of Examination: 24/10/2023
Medical Record Number: 849-302-19
"To Whom It May Concern,"
This letter confirms that Liam Alexander Vance has received my medical care since 10/03/2019. The patient was assessed on 24/10/2023 and diagnosed with acute lumbar radiculopathy secondary to an L4-L5 disc protrusion. Because of this condition, the patient should remain away from work duties from 24/10/2023 through 03/11/2023 to support recovery and reduce the risk of worsening symptoms.
The treatment plan consists of targeted analgesia with naproxen (Naprosyn) 500 mg PO BID and paracetamol (Panadol) 1,000 mg PO QID PRN, alongside structured physiotherapy twice weekly. The patient is also advised to avoid heavy lifting, repetitive bending, and prolonged sitting for greater than 30 minutes at a time. The patient has been directed to follow all prescribed recommendations. In view of the patient's occupation and current health status, a phased return to work is advised beginning on 06/11/2023, with any required accommodations or activity limitations.
For additional information or clarification, please contact my office at (03) 9555 4821 or reception@melbournecentralgp.com.au.
"Thank you for your understanding and support of the patient's health and well-being."
"Sincerely,"
Dr Sarah Jenkins, MBBS, FRACGP
MED0001847293
24/10/2023
How to use this template
This template can be used to assist with various tasks in the medical field. You can use it to generate notes, manage patient information, or assist with diagnosis and the Assessment and Plan. To use this template, simply click the “Use Template” button above. If you have any questions or need assistance, feel free to reach out to the support team or refer to the description and example output provided above.