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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.
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U-M Health SystemThis 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.
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Excuse from Work or School

Name_____________________________ needs to be excused from work/school/physical education for the following dates:

___________________________________________________________.

He/she may return to work/school but must still avoid physical activity as of this date:__________________________________.

He/she may return to full physical activity as of this date: _______________________.

Additional comments/instructions:

Printed name: _________________________________

____________________________________________________________

Signature Title Date

Published by RelayHealth.
Last modified: 2006-11-27
Last reviewed: 2006-09-01
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Women's Health Advisor 2009.1 Index
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