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Doctors Note Template 3

The document contains two sample doctors' notes. The first note is for a patient named Jane Doe who was diagnosed with a concussion and is not cleared to return to sports until further notice. The second note is for a patient named John Doe who was diagnosed with a left ankle sprain and is cleared to return to sports if he wears an ankle brace or has his ankle taped for practices and games. Both notes include the doctor's name, address, phone number, date, patient name, diagnosis, and restrictions or clearance, with the doctor's signature at the bottom.

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nipanipa
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Download as PDF, TXT or read online on Scribd
305 views

Doctors Note Template 3

The document contains two sample doctors' notes. The first note is for a patient named Jane Doe who was diagnosed with a concussion and is not cleared to return to sports until further notice. The second note is for a patient named John Doe who was diagnosed with a left ankle sprain and is cleared to return to sports if he wears an ankle brace or has his ankle taped for practices and games. Both notes include the doctor's name, address, phone number, date, patient name, diagnosis, and restrictions or clearance, with the doctor's signature at the bottom.

Uploaded by

nipanipa
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Examples of a Doctors Note

Dr. Summit Falcon


1780 Hawkins Rd.
Fenton, MO 63026
Phone: 555-555-5555
Date: _________
Patient Name: Jane Doe
Diagnosis: Concussion
Restricitions/Clearance:
Jane is out of sports until further notice.
Dr. Signature

Dr. Summit Falcon


1780 Hawkins Rd.
Fenton, MO 63026
Phone: 555-555-5555
Date: _________
Patient Name: John Doe
Diagnosis: Left ankle sprain
Restricitions/Clearance:
John is able to return to sports but must wear an
ankle brace or get taped for practices and games.
Dr. Signature

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