MEDICAL EXCUSE NOTE

Doctor’s Name: Dr. Barbara K. Chen

＠
Address: 3001 FM2181 Suite 400, Corinth, TX
76208

Date: 05-12-2023

To Whom It May Concern:

Samantha Black
Please Excuse: ________________________________________________

From:
⃞ Work
⃞ School
⃞ Other: __________________________________________________

Due To:
⃞ Injury
⃞ Illness
⃞ Others: _________________________________________________

For the following dates: ______________ to ______________

Doctor’s Comments:
＠For 24 hours following the consumption of Meclomen.

__________________________
Dr. Chen

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