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Orthopedic Surgeon
30-45 minutes

Template for Medical Diagnosis Letter

The Medical Diagnosis Letter Template from s10.ai is a vital resource for healthcare professionals to effectively convey a patient's diagnosis and required workplace accommodations. This template is crafted to precisely detail the patient's medical condition, limitations, and suggested modifications to promote their well-being and efficiency. It adheres to privacy and medical documentation standards, ensuring it is a dependable option for clinicians. Perfect for integration with s10.ai, this template simplifies the creation of comprehensive and professional medical diagnosis letters, improving communication between healthcare providers and employers.

4,691 uses
4.9/5.0
D
Dr. Jonathan Carter
Template Structure

Organized sections for comprehensive clinical documentation

Date: [Date]
To Whom It May Concern,
This letter verifies that [Patient Name] (Date of Birth: [Patient Date of Birth]) was assessed at our clinic on [Evaluation Date]. [Patient Name] has been diagnosed with [Diagnosis], supported by [Diagnostic Evidence] and clinical evaluation showing [Clinical Symptoms].
[Patient Name]'s condition considerably limits [his/her/their] ability to [describe limitations, e.g., sit or stand for extended periods, lift heavy objects, or maintain static postures comfortably]. These limitations directly affect [his/her/their] ability to perform typical workplace duties without modifications.
To enhance [Patient Name]’s health and workplace productivity, I suggest the following accommodations:
- [Accommodation 1] (e.g., Ergonomic seating and adjustable standing workstation)
- [Accommodation 2] (e.g., Flexibility to take frequent brief breaks (5-10 minutes per hour) to alleviate pain and stiffness)
- [Accommodation 3] (e.g., Restriction on heavy lifting tasks (maximum of 5 kg))
- [Accommodation 4] (e.g., Modified work schedule allowing partial remote working when symptoms worsen)
These recommendations should be applied for a period of [Duration], with reassessment planned by [Reassessment Date].
This document is provided with [Patient Name]’s consent and complies with relevant privacy and medical documentation standards.
For further information, please contact my office.
Sincerely,
[Clinician Name], [Clinician Credentials]
[Clinician Title]
License Number: [License Number]
s10.ai
[Practice Address]
Phone: [Phone Number] | Email: [Email Address]
Sample Clinical Note

Example of completed documentation using this template

Date: 1 November 2025
To Whom It May Concern,
This letter verifies that John Doe (Date of Birth: 15 March 1980) was assessed at our clinic on 1 November 2024. John Doe has been diagnosed with lumbar disc herniation, supported by MRI results and clinical evaluation indicating lower back pain and radiculopathy.
John Doe's condition considerably limits his ability to sit or stand for extended periods, lift heavy items, or maintain static positions comfortably. These restrictions directly affect his ability to perform standard workplace duties without modifications.
To enhance John Doe’s health and workplace productivity, I suggest the following accommodations:
- Ergonomic seating and an adjustable standing workstation
- Flexibility to take frequent short breaks (5-10 minutes per hour) to alleviate pain and stiffness
- Restriction on heavy lifting tasks (maximum of 5 kg)
- Modified work schedule allowing partial remote work when symptoms worsen
These recommendations should be applied for a duration of 6 months, with a reassessment planned by 1 May 2025.
This document is provided with John Doe’s consent and complies with relevant privacy and medical documentation standards.
Should you need further information, please contact my office.
Sincerely,  
Dr. Thomas Kelly, MD  
Orthopaedic Surgeon  
License Number: 123456  
Orthopaedic Care Clinic  
123 Health St, London, UK  
Phone: 020 7946 0958 | Email: drkelly@orthocareclinic.com
Clinical Benefits

Key advantages of using this template in clinical practice

  • This comprehensive clinical template is designed to streamline the documentation process for healthcare professionals, ensuring accurate and efficient patient evaluations. By incorporating high-search healthcare and clinical keywords, this template facilitates the creation of detailed patient assessments, diagnoses, and recommended accommodations. Clinicians can easily document patient limitations and propose necessary workplace adjustments, enhancing patient care and compliance with medical documentation standards. The template supports seamless integration into clinical workflows, encouraging adoption and implementation by providing a structured format that meets privacy and documentation guidelines. Explore this template to enhance your clinical documentation and improve patient outcomes.
Frequently Asked Questions

Common questions about this template and its usage

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Template for Medical Diagnosis Letter