Urgent Care Visit And Restrictions Letter
Created by
Rebecca Thompson
Specialty
Counselors
Last edited
10/20/2026
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About this template
A reusable letter template for documenting an urgent care visit and any associated work or activity excuse. It captures the visit date, reported concerns, clinical findings, relevant history, treatments, recommendations, restrictions, and clinician contact details.
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"To whom it may concern,"
This letter confirms that Lachlan Vance was assessed at our urgent care facility on 18/05/2024. The patient reported an acute panic attack at work, presenting with SOB, palpitations, dizziness, and an overwhelming sense of dread following a period of high occupational stress.
On assessment, the patient had HR 110 bpm, BP 135/85 mmHg, RR 22 breaths/min, SpO2 99 % on RA; MSE revealed an anxious affect, tremulousness, rapid speech, and nil SI/HI, with a normal 12-lead ECG and DASS-21 indicating severe acute anxiety. Relevant history includes GAD and a prior appendicectomy (2018). Current treatments and supplements are escitalopram (Lexapro®) 10 mg PO OD and magnesium glycinate 400 mg PO nocte, and reported allergies are NKDA.
The patient was instructed to practice grounded breathing techniques, reduce caffeine intake, and follow up with his regular GP and psychologist within 5 days for ongoing CBT. The patient should rest from work duties from 18/05/2024 to 20/05/2024 inclusive, returning to modified, low-stress duties on 21/05/2024, and continue his regular prescribed medication regimen.
For additional information, please feel free to contact me.
"Sincerely," Dr. Sarah Jenkins, Clinical Psychologist (MAPS) Sydney Urgent Mental Health Care, 142 Pitt Street, Sydney NSW 2000 | Ph: (02) 9555 0192 | Provider No: 4829103B
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.