Medical knowledge, Patient Education
Return to School
_______________________________________________ has permission to return to school on __________________________________.
He or she should continue to avoid the following activities: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Health care provider name (printed): _____________________________________________
Health care provider (signature): _________________________________________________
Date: _________________________________________
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You wish to return sooner than this date.
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You have problems that prevent you from returning on this date.
This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.
