Medical Clearance Letter: 4 Templates and Emails

It is a Doctor’s Sample Clearance Letter format. Your doctor will be required to fill out the form stating whether or not you are medically fit. An employee clearance letter certifies that the employee has been cleared of all outstanding debts and is free to leave the organization. In general, a medical clearance form is critical. When necessary, your doctor should provide it.

Letter Template: 1

Medical Clearance Letter

[Mention the name of the sender]

[Mention the address of the sender]

[Mention the contact details of the sender]

[Mention the Email address of the sender]

[Mention the date]

Subject- Medical clearance letter.

[Mention the name of the recipient]

[Mention the address of the recipient]

[Mention the contact information]

Dear [Mention the name of the recipient],

All necessary medical tests of (mention the name of the employee), D/O (mention the parent’s name and date of birth) have been performed as required by the recruitment agency (Company name). This letter includes the final medical report (mention the name of the employee).

If you require any additional information, please contact our laboratory at (mention the timing) by calling at (mention the contact details of the doctor) and speak with Doctor (mention the name of the doctor). Reviewed all pertinent lab work and tests, and certified that there is no medical contraindication to undergoing elective surgery under general and/or regional anesthesia. If any special instructions are required, I have clearly indicated them in a letter to Dr (mention the name of the doctor) that comes with this form.

The purpose of using this form is to ensure that selected employees are physically and mentally fit to perform tasks without endangering their own or others’ health and safety. Under certain conditions, all staff members may be required to undergo a medical examination to ensure that they remain medically fit to perform the functions assigned to them.

[Mention the name of the sender]

[Mention the phone number]

[Signature]

Medical Clearance Letter

Letter Template: 2

Medical Clearance Letter

[Mention the name of the sender]

[Mention the address of the sender]

[Mention the contact details of the sender]

[Mention the Email address of the sender]

[Mention the date]

Subject- Medical clearance letter.

[Mention the name of the recipient]

[Mention the address of the recipient]

[Mention the contact information]

Dear [Mention the name of the recipient],

On [mention the date], you were issued a written warning for using sick leave. Unfortunately, your attendance has not improved as a result of these efforts.

Attendance records now show that you have used a total of [mention the number of days] days on [mention the date] since [mention the date], with the most recent instance from [mention the starting date] to [mention the end date] showing days and [mention the occasion] occasions. As a result, your attendance for the year and the quarter remains unsatisfactory.

Because your attendance has not improved and you continue to use sick leave excessively, this letter serves as notice that you have been placed on a medical certificate required for each instance of absenteeism. This form must be returned to the Department of mention the department or [mention the department] before returning to work in order for accrued sick leave to be used. If you do not return with an acceptable medical certificate, you will be docked pay for the day, and your time card will show a “0.” (Zero time).

This letter will be filed in your personnel file. Because of your excessive use of sick leave, you may receive an attendance rating of unsatisfactory on your next performance appraisal. This could result in the denial of your annual raise. This is a serious matter that must be addressed immediately.

[Mention the name of the sender]

[Mention the phone number of the sender]

[Signature of the sender]

Medical Clearance Letter

Letter Template: 3

Medical Clearance Letter

[Mention the name of the sender]

[Mention the address of the sender]

[Mention the contact details of the sender]

[Mention the Email address of the sender]

[Mention the date]

Subject- Medical clearance letter.

[Mention the name of the recipient]

[Mention the address of the recipient]

[Mention the contact information]

Dear [Mention the name of the recipient],

I am writing on behalf of my patient (mention the name of the patient), to certify the medical necessity of (treatment or medication or equipment – item in question) for the treatment of (mention the symptoms) (mention the specific diagnosis). This letter contains information about the patient’s medical history and diagnosis, as well as a summary of my treatment rationale. History and Diagnosis of the Patient: (Include information about the patient’s condition and specific diagnosis here.) Include a history of the patient’s condition as well.)

(Include information on previous treatments, course of care, why the treatment/medication/equipment (item in question) is required, and how you expect it to benefit the patient). All pertinent lab work and tests were reviewed, and it was determined that there are no medical potential side effects to elective surgery under overall and/or local anesthesia.

Duration: (Length of time required for treatment or medication or equipment (item in question) – not to exceed (mention the number of months) months]

In conclusion, (treatment or medication or equipment – item in question) is medically necessary for this patient’s condition. Please contact me at my personal contact number [mention the contact number of the sender] or you can also contact me through email [mention the email id of the sender] if any additional information is required to ensure that (treatment or medication or equipment – item in question) is approved as soon as possible.

[Mention the name of the sender]

[Mention the phone number of the sender]

[Signature of the sender]

Medical Clearance Letter

Letter Template: 4

Medical Clearance Letter

[Mention the name of the sender]

[Mention the address of the sender]

[Mention the contact details of the sender]

[Mention the Email address of the sender]

[Mention the date]

Subject- Medical clearance letter.

[Mention the name of the recipient]

[Mention the address of the recipient]

[Mention the contact information]

Dear [Mention the name of the recipient],

All medical tests for (mention the employee’s name), D/O (mention the parents’ names and dates of birth) have been completed as required by the recruitment agency (Company name). The final medical report is included in this letter (mention the name of the employee).

If you need any additional information, please contact our laboratory at (mention the time) by calling (mention the doctor’s contact information) and speaking with the Doctor (mention the name of the doctor). Examined all relevant lab work and tests and certified that there are no medical contraindications to elective surgery under general and/or regional anesthesia.

Because your attendance has not enhanced and you continue to use sick leave excessively, you have been placed on a medical certificate necessity for each instance of absences. In order for accrued sick leave to be used, this form must be returned to the Dept of mention the dept or [mention the department] before returning to work.

This letter will be kept on file in your personnel file. Because of your excessive use of sick leave, you may receive an unsatisfactory attendance rating on your next performance appraisal. This could result in your annual raise being denied. This is a serious issue that must be addressed right away.

Please contact me at my personal contact number [mention the sender’s contact number] or via email [mention the sender’s email id] if any additional information is required to ensure that (treatment, medication, or equipment – item in question) is approved as soon as possible.

[Mention the name of the sender]

[Mention the phone number]

[Signature]

Medical Clearance Letter

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