Fillable Printable Medical Hardship Letter Samples

Medical Hardship Letter Samples

Hardship Letter from Doctor

{Your Name}

{Hospital Name}

{Your Address}

{Your Phone #}

{Case #}

{Date}

To Whom It May Concern:

As {Name}’s doctor, I am writing to confirm that {he/she} is unable to {perform

duty/work/make payments} due to {serious injury/illness}.

On {date}, I diagnosed {Name} with {injury/illness}. {He/she} was presenting

symptoms such as {list of symptoms}. Since these are serious symptoms that

require medication and rest, it means that {Name} is unable to {action}. This

period of rest and recuperation should last between {number} and {number}

days, or until {date}.

Please contact me if you have any further questions about {Name}’s abilities or

limitations.

Sincerely,

{Sender Name}