Letter to doctor requesting medical report
Letter to doctor requesting medical report
Dear Dr. [Name of Doctor],
Re: [full name of employee] [date of birth of employee] [address of employee]
I understand that you are [employee]'s GP. [Employee] has recently been off work ill and you have provided Doctor's Certificates from [date Certificates commenced] to [date Certificates finished] stating that he/she is absent from work due to [state reason(s) for absence].
I confirm that [employee] is employed by [Company name] as a [job title]. This position involves [brief description of work activities eg, lifting, handling, sitting/standing, shift working]. [Employee] works in a [ventilated/non ventilated warehouse/office/manufacturing unit] for periods of [number of hours] hours at a time. The environment within the [warehouse/office/manufacturing unit] is [eg, dusty] and contains particles of [list]. [Employee] is required to wear the following personal protective equipment, [list equipment] whilst carrying out his/her work.
I write to ask if you would provide a report stating when [employee] will be fit to return to work of this type and to this work environment and whether or not he/she will have any ongoing health issues which need to be considered.
I enclose [employee]'s authorisation to disclose medical information relating to him/her and you will note from this authorisation, that [employee] does wish/not wish to have access to the letter before it is supplied.
I understand that you may charge a reasonable fee for carrying out this work and I confirm that [Company name] would be prepared to discharge this fee provided the fee is agreed beforehand with myself.
Should there be any further information that you require then, please, do not hesitate to contact me. I look forward to hearing from you.
Yours sincerely
[name of writer] [Job Title] for [name of employer]
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- best practices for return to work stay at work
- letter to doctor requesting medical report
- functional capability forms workers compensation board
- employee checklist for return to work rom medical absence
- sample return to work policy
- f602501b return to work restrictions form
- sample medical ability to work form
- physician s return to work voucher report
Related searches
- doctor for medical marijuana card
- letter to judge requesting hearing
- letter to lawyer requesting help
- letter to customer requesting ach
- letter to vendor requesting ach
- letter from doctor for surgery
- sample letter from doctor about medical condition
- return to work letter from doctor sample
- is a do doctor a medical doctor
- is a naturopathic doctor a medical doctor
- letter to customer requesting information
- doctor to doctor letter template