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Gym Excuse

 

Child's name ___________________________________________________ 

Diagnosis ______________________________________________________ 

___ Please excuse from gym class (physical education) for ______ 
    days.  

___ Limited physical education with the following instructions: 

    _____________________________________________________________ 

    _____________________________________________________________ 

    _____________________________________________________________ 


Thank you.  


Physician's name ________________________________________________

Physician's signature _________________________  Date ___________ 

Physician's phone number __________________________  
Published by McKesson Provider Technologies.
Last modified: 1997-04-01
Last reviewed: 2004-09-28
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Copyright 2006 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved.
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