7 Medical Excuse Templates for Work and School
Updated: January 21, 2026Quick templates for documenting patient absences from work or school. Saves time and keeps your excuse notes consistent.
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Why you need medical excuse templates
Medical excuse notes verify patient absences while protecting everyone involved. Your practice needs documentation that satisfies HIPAA requirements without exposing you to liability.
Templates solve several problems at once. First, they give employers and schools the verification they need without revealing private medical details. Second, they save your staff from drafting these notes from scratch during busy patient visits. Third, every excuse from your practice follows the same format, which looks more professional than a mix of different styles. Finally, your front desk can handle routine excuse requests without pulling you away from patients.
How to write medical excuses properly
The less detail, the better. Never put diagnoses, symptoms, or treatments in excuse notes. Just confirm the patient was seen and give the dates they need off. This protects their privacy and gives employers what they actually need.
What to include
Every excuse needs your name, license number, contact info, the patient’s name, visit date, and how long they should be excused. That’s it. More information creates more problems.
Use your letterhead
Print excuses on official clinic letterhead. This prevents forgery and gives employers a phone number they can call to verify if needed.
Be realistic about timeframes
Most routine illnesses need 1-3 days off. Longer absences should include when you’ll see the patient again and may need supporting documentation from specialists.
Spell out restrictions clearly
If someone can work but needs modifications—no lifting, light duty only, whatever—say exactly that. Vague restrictions confuse employers and can put patients in unsafe situations.
Why templates work
Templates cut documentation time from minutes to seconds. Your staff fills in the blanks instead of drafting from scratch, which means less waiting for patients and more time for actual care. Templates also reduce errors because all the required fields are already there, and the language already complies with HIPAA. You get consistent documentation without thinking about it.
Medical excuse templates
These templates cover the most common excuse scenarios. Fill in the bracketed fields with patient-specific information.
Basic medical excuse for work
[CLINIC LETTERHEAD]
Date: [Date]
TO WHOM IT MAY CONCERN
This is to certify that [Patient Name] was seen in our office on [Visit Date] for a medical condition.
The patient is advised to be excused from work from [Start Date] through [End Date].
The patient may return to full work duties on [Return Date].
If you have questions regarding this excuse, please contact our office at [Phone Number].
Sincerely,
[Provider Name], [Credentials]
[License Number]
[Clinic Name]
[Contact Information]
Medical excuse with work restrictions
[CLINIC LETTERHEAD]
Date: [Date]
TO WHOM IT MAY CONCERN
This is to verify that [Patient Name] was evaluated in our office on [Visit Date] for a medical condition requiring temporary work modifications.
Work Status:
The patient may return to work on [Return Date] with the following restrictions:
– [Restriction 1]
– [Restriction 2]
– [Restriction 3]
These restrictions are in effect from [Start Date] through [End Date]. A follow-up evaluation is scheduled for [Follow-up Date] to reassess work capacity.
Please contact our office at [Phone Number] if you need clarification regarding these work restrictions.
Sincerely,
[Provider Name], [Credentials]
[License Number]
[Clinic Name]
[Contact Information]
School absence medical excuse
[CLINIC LETTERHEAD]
Date: [Date]
TO WHOM IT MAY CONCERN
This letter confirms that [Student Name] was seen in our office on [Visit Date] for a medical evaluation.
The student is excused from school attendance from [Start Date] through [End Date] due to a medical condition that required treatment and recovery time.
The student is cleared to return to school on [Return Date] and may participate in all regular activities including physical education and sports without restrictions.
If the school requires additional information, please contact our office at [Phone Number].
Sincerely,
[Provider Name], [Credentials]
[License Number]
[Clinic Name]
[Contact Information]
Medical excuse for jury duty exemption
[CLINIC LETTERHEAD]
Date: [Date]
TO: [Court Name]
RE: Jury Duty Medical Exemption for [Patient Name]
To Whom It May Concern:
I am writing to request that [Patient Name], date of birth [DOB], be excused from jury duty service scheduled for [Jury Duty Date] due to medical reasons.
This patient has a medical condition that prevents them from serving on a jury at this time. The patient is unable to sit for extended periods and requires frequent medical attention that would interfere with jury duty obligations.
Based on my medical evaluation, I recommend that [Patient Name] be excused from jury service for [Time Period]. The patient may be reconsidered for jury duty after [Future Date] when their medical condition is expected to improve.
If you require additional medical documentation, please contact our office at [Phone Number]. Please note that specific medical details cannot be disclosed without patient authorization due to privacy regulations.
Sincerely,
[Provider Name], [Credentials]
[License Number]
[Clinic Name]
[Contact Information]
Urgent care medical excuse
[URGENT CARE LETTERHEAD]
Date: [Date]
Time: [Time]
TO WHOM IT MAY CONCERN
This letter certifies that [Patient Name] was treated at [Urgent Care Facility Name] on [Visit Date] at [Visit Time].
Treatment Summary:
The patient received medical evaluation and treatment for an acute condition. Following treatment, the patient is advised to rest and avoid work or school activities.
Excuse Period:
The patient should be excused from [Work/School] from [Start Date and Time] through [End Date and Time].
The patient may return to normal activities on [Return Date] unless symptoms worsen, in which case they should follow up with their primary care provider.
For verification purposes, you may contact our facility at [Urgent Care Phone Number]. Reference visit number: [Visit ID]
Provider on Duty:
[Provider Name], [Credentials]
[License Number]
[Urgent Care Facility Name]
[Facility Address and Phone]
Extended absence medical excuse
[CLINIC LETTERHEAD]
Date: [Date]
TO WHOM IT MAY CONCERN
This letter is to inform you that [Patient Name] is currently under my medical care for a condition that requires an extended absence from work.
Absence Period:
The patient is medically excused from work beginning [Start Date] and is expected to be absent for approximately [Duration/Number of Weeks].
Follow-Up Plan:
The patient will be re-evaluated on [Follow-up Date] to assess their ability to return to work. At that time, I will provide an updated medical excuse with either a return-to-work date or extended absence period as clinically indicated.
Intermittent Leave:
[If applicable: The patient may require intermittent absences for medical appointments occurring approximately [Frequency]. These appointments are necessary for ongoing treatment and monitoring.]
This excuse may be used in conjunction with FMLA or other leave programs. For questions about this patient’s medical leave, please contact our office at [Phone Number]. Specific medical information requires written patient authorization per HIPAA regulations.
Sincerely,
[Provider Name], [Credentials]
[License Number]
[Clinic Name]
[Contact Information]
Medical excuse for physical education exemption
[CLINIC LETTERHEAD]
Date: [Date]
TO: [School Name] Physical Education Department
RE: Physical Education Exemption for [Student Name]
To Whom It May Concern:
This letter is to request that [Student Name] be excused from physical education classes and athletic activities from [Start Date] through [End Date].
Restrictions:
The student should avoid the following activities during this period:
– [Restricted Activity 1]
– [Restricted Activity 2]
– [Restricted Activity 3]
Permitted Activities:
The student may participate in light activities such as walking or stretching as tolerated. Any activity that causes pain or discomfort should be avoided.
The student will be re-evaluated on [Re-evaluation Date]. At that time, I will determine if the student can return to full physical education participation or if continued modifications are needed.
Please contact our office at [Phone Number] if you have questions about appropriate alternative activities for this student during their PE exemption period.
Sincerely,
[Provider Name], [Credentials]
[License Number]
[Clinic Name]
[Contact Information]
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