Subject:

SPECIFY DATES OFF WORK:

Pick the dates on the calendar fields, then click “set” to populate the text.

Last work date: Set
First sick date: Set
Return to work: Set

PHRASE SELECTION OPTIONS:

Click the “Reset” or “Clear Checkboxes” buttons to start again.

Seen today at this clinic Off work for 2 to 3 days Off work for 3 to 5 days Off work for 1 week Off work for 2 weeks Off work for 1 month Stress leave for 2 to 4 weeks RTW date uncertain RTW symptoms resolved

Return to work note Fit for job Flushot CPAP Rx Missed Appt warning Missed Appt + invoice

Return to daycare Psychologist Massage Physio Orthotics Compression stockings

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