MEDICAL EXCUSE NOTE
Doctor’s Name: Dr. Keith T. Aziz
Address: 4500 San Pablo Rd S
Date: 04/26/2023
To Whom It May Concern:
William Lackemacher
Please Excuse: ________________________________________________
From:
⃞
Work
⃞
School
⃞
Other: __________________________________________________
Due To:
⃞
Injury
⃞
Illness
⃞
Others: _________________________________________________
04/26/2023
04/26/2023
For the following dates: ______________
to ______________
Doctor’s Comments:
Appointment for carpometacarpal fracture in hand. Patient is required to wear a spica splint for
3 weeks.
__________________________
Dr. Keith T. Aziz
Powered by TCPDF (www.tcpdf.org)