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School Excuse


Child's name __________________________________________________ 

Diagnosis _____________________________________________________ 

This child was home for medical problems from _______________ to 


This child is now able to return to school and is not contagious.  

Physical education:

___ Full activity 

___ Limited activity as follows: 




No gym for _____ days 

Physician's name ______________________________________________

Physician's signature ________________________ Date ___________

Physician's phone number _________________________
Published by McKesson Provider Technologies.
Last modified: 1997-04-01
Last reviewed: 2004-08-28
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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