This information is approved and/or reviewed by U-M Health System providers but it is not a tool for self-diagnosis or a substitute for medical treatment. You should speak to your physician or make an appointment to be seen if you have questions or concerns about this information or your medical condition. Exención de responsabilidad en Español | Complete disclaimer
Child's name __________________________________________________ Diagnosis _____________________________________________________ This child was home for medical problems from _______________ to _____________________. This child is now able to return to school and is not contagious. Physical education: ___ Full activity ___ Limited activity as follows: _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ No gym for _____ days Physician's name ______________________________________________ Physician's signature ________________________ Date ___________ Physician's phone number _________________________
