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Midview Hospital |500 Dunn St., Meadowville, IL 55555 | 555-555-5555

WORK / SCHOOL EXCUSE & RESTRICTIONS

Arrived:

12:00 PM

01/20/16

Discharged:

4:00 PM

01/20/16

YOURNAMEHERE was seen today in the Emergency Department by Dr. Jim Stean.

FIRSTNAMEHERE is unable to return to work until 1/29/16.

If you have any questions regarding the validity of this note, please call the number above.

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