Serenity Wellnessa

Dr. Dylan Fisher

8945 Mayflower Drive, Woodside, NY 11377
serenitywellness.com
222-555-7777

DOCTOR’S EXCUSE NOTE FOR WORK

Date: February 12, 2050

Patient Information: Medical Provider Information:

Full Name: Nina Tonkin
Date of Birth: July 18, 2023
Address: Bellmore, NY 11710
Phone Number: 222-555-7777
Employer: Heath Moore
Date of Absence: February 10, 2050
Name: Dr. Dylan Fisher
Medical License Number: MD123456
Clinic/Hospital Name: Serenity Wellness
Address: Woodside, NY 11377
Phone Number: 222-555-7777
Email: dr.fisher@serenitywellness.com
Date of Examination: February 11, 2050

Diagnosis and Recommendations:

I, Dr. Dylan Fisher, a licensed medical provider at Serenity Medical Center, have
examined and diagnosed Nina Tonkin on February 11, 2050. Based on my
examination, the patient was diagnosed with a severe upper respiratory infection. This
condition required medical attention and warranted three (3) days of absence from
work to facilitate a proper recovery.

Recommendations:
The patient is advised to rest and recover during this period. I have prescribed the
following medications:
- Antibiotic: Amoxicillin, 500mg, 1 tablet three times a day after meals.
- Over-the-counter pain reliever: Acetaminophen, 500mg, as needed for fever and
discomfort.

A follow-up appointment is scheduled for February 15, 2050, at which time a

reassessment of the patient's condition will be conducted.
Return to Work:
Nina Tonkin is expected to recover fully and is cleared to return to work on February
13, 2050. Please consider any necessary accommodations or adjustments as the
patient transitions back to her regular work responsibilities.

Additional Notes:
If you require further information or clarification regarding the patient's medical
condition, feel free to contact me at 222-555-7777 or dr.fisher@serenitywellness.com.

Sincerely,

Dr. Dylan Fisher

Serenity Wellness
8945 Mayflower Drive, Woodside, NY 11377
222-555-7777
info@serenitywellness.com
serenitywellness.com