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Fillable Form Doctors Note

A Document from a Doctor which attests to the result of a medical examination of a patient. It serve as a documentation that an employee is unfit for work or evidence of a health condition.

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What is a Doctor’s Note?

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A Doctors Note, sometimes referred to as a Medical Excuse Note or a Sick Note, is a short note or letter that is submitted to an employer or school administrator in order to explain why an employee or student will be absent from work or school, when the absence will begin (if it has not already begun), and for how long they will be absent for. Doctor’s Notes are often submitted alongside a medical certification or any other document that serves to prove the legitimacy of the excuse.

sick person needing a doctors note

The Family and Medical Leave Act (FMLA) is a United States labor law that provides employees with the right to take unpaid, job-protected leave for specified family and medical care reasons. This means that employees are entitled to return to their job or an equivalent position after the leave. Eligible employees can take up to 12 workweeks of leave in a 12-month period for reasons including personal or family illness, family military leave, pregnancy, adoption, or the foster care placement of a child. The FMLA aims to balance the demands of the workplace with the needs of families.

Doctor’s Notes are often necessary for employees and students to submit in order to serve as documentation of their absence, as well as proof that their stated reason(s) for being absent is reasonable and valid.

How do I fill out a Doctor’s Note?

Get a copy of Doctors Note template in PDF format.

doctor consulting patient for the doctors note

Doctor’s Notes should be filled out primarily by the doctor that performed the examination of the patient, whenever possible. This helps to ensure that all information included on the note is correct and updated, and further validates the note as being prepared by a medical professional. Make sure that you get a Doctor's Note from a legitimate source, whether it be through a walk-in clinic or a hospital visit, to avoid any issues with possibly fake or invalid Doctor's Notes.

Doctor’s Name

Enter the name of the doctor that performed the examination or procedure on the patient.


Enter the address of the doctor’s clinic or the hospital that they work at where the patient was examined or treated.


Enter the date that this note was created.

Name of Patient

Enter the name of the patient being excused from school or work.

Excuse From

Check the box or boxes that correspond to what the patient is being requested to be excused from. You may choose any of the following:

  • Work
  • School
  • Other (Specify in the space provided)

Due To

Check the boxes that correspond to the reason for why the patient should be excused. You may choose one or more of the following:

  • Injury
  • Illness
  • Others (Specify in the space provided.)

It would be beneficial as well to attach documents that provide details on the patient's diagnosed medical condition to this note.

Dates to be Excused

Enter the date that the patient’s exemption from the above indicated activity will start, then enter the date that the patient’s exemption will end.

Doctor’s Comment

Enter any comments or additional information the doctor feels is necessary to include in this note. If more space is required, you may write the doctor’s comments on a separate sheet of paper and attach it to this note.

Doctor’s Signature

Have the doctor sign the form in the space provided.

Doctor’s Name

Enter the doctor’s name.

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Frequently Asked Questions (FAQs)

frequently asked questions for doctors note

Can a Doctor's Note be requested by an employer?

Yes, employers can request a Doctor's Note to verify an employee's medical condition and need for time off.

How long is a Doctor's Note typically valid?

The validity of a Doctor's Note depends on the nature of the medical condition. Some notes may specify a return date, while others might be more open-ended. It can be assumed, generally, that a Doctor's Note will no longer be considered valid once the end date indicated on the note has passed, but in situations such as patients suffering from chronic illnesses, this will often change.

Are there legal implications for forging a Doctor's Note?

Yes, forging a Doctor's Note is illegal and can have serious consequences, not just as a breach of any agreements a person may have with their employer or the rules of their academic institution, but also as medical and identity fraud.

Can a doctor refuse to provide a note?

In some cases, a doctor may refuse to provide a note if they believe it is not medically justified or if it goes against their professional ethics.

What should I do if my doctor refuses to provide a note?

If your doctor refuses to provide a note, it's essential to discuss your situation with them and understand the reasons behind their decision. In some cases, seeking a second opinion or consulting with another healthcare professional may be an option.

Is a Doctor's Note always required for sick leave?

Policies vary per employer, institution, and school, but some may accept self-declaration for short-term sick leave without requiring a Doctor's Note. Make sure to review your employer/school/institution’s policies regarding leave to know whether you need a Doctor’s Note or not.

How much does a Doctor’s Note cost?

It depends on the doctor and/or hospital. Some doctors or hospitals will charge for a Doctor’s Note, while others will give one for free upon request. Make sure to check with your doctor to see whether you need to pay a fee or not.

Can a Doctor's Note be provided for mental health reasons?

Yes, doctors can provide notes for mental health reasons, just as they can for physical health conditions.

Do employers have the right to contact the doctor for verification?

Technically, yes, but they may not be given access to certain information due to doctor-patient confidentiality and other medical privacy laws unless they obtain the patient’s permission.

Can a Doctor’s Note be refused by an employer?

Individual policies may differ, but as a general rule, yes, employers, school administrators, and any other entity that a Doctor’s Note might be submitted to can refuse to accept a Doctor’s Note.

Can a nurse or physician assistant provide a valid Doctor's Note?

Yes, but it depends on the institution you are submitting the note to. Some may require that a medical doctor provide the note, while others may accept notes filled out by nurses or physician’s assistants. Make sure to check with your school admin or the human resources department of your company or otherwise to see what standards must be fulfilled for Doctor Notes submitted.

Can a Doctor's Note excuse an absence from court or jury duty?

It depends on the jurisdiction and the specific circumstances. In some cases, a court may require a formal medical certificate in addition to the actual note, and only accept excuses for very severe conditions.

Is a digital or electronic Doctor's Note acceptable?

The acceptability of a digital, electronic, or online Sick Note varies, and it often depends on the policies of the employer, school, or organization. Filling out a Doctor's Note online or making use of a general Doctor's Note template then printing it out for a doctor to sign will, however, generally be considered valid. Online doctor appointments are another way to receive an online Doctor's Note document.

Can a Doctor's Note be used for travel-related exemptions or accommodations?

Yes. Some travel-related situations may require a Doctor's Note, such as requesting special accommodations during air travel or explaining the need for medical supplies.

Can a Doctor's Note be contested or questioned by an employer or school authority?

While it's possible for an employer or school authority to question the validity of a note, challenging an official Doctor's Note may have legal and ethical implications for them. For that reason, real Doctor's Note documents are rarely contested, but some companies will still try in various ways to ensure that fake Doctor's Notes are not being submitted to them.

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Keywords: medical excuse note doctor note doctors note fake doctor note note from a doctor

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