Free Bonus Doctor Notes Template 05
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Sample Doctor’s Note for Work

Name of Medical Clinic
Address
Phone Number

Patient’s Records
Name: ________________ Gender: _______
Age: _________________

Date: ________

Dear ________________
Please allow _____________ (patient’s name) from effective
_________________ days, due to the following medical condition.
Illness and prescription
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________

Sincerely
(Signature of the doctor).