Return-to-Work/School Letter (Bereavement)

Return-to-Work/School Letter

(Do not include diagnoses unless explicitly requested by the patient and necessary for the recipient's process. Never include the name of the deceased, cause of death, detailed psychiatric history, or psychotherapy content.)

Date of Letter: [date letter is issued]

Patient: [full name], DOB [date of birth]

To: [recipient name/department / To Whom It May Concern]

Re: Return-to-Work/School Letter for [patient name]

I evaluated the above-named patient on [date(s) of evaluation]. This letter documents the patient's functional status and provides recommendations regarding return to [work / school]. (If the letter is provided directly to the patient for submission, add: "This letter is provided to the patient at their request.")

(Include this paragraph only if recommending time away, restrictions, or accommodations. Omit if returning without restrictions.) The patient reports bereavement-related symptoms impacting [relevant functional domains: concentration, energy, sleep, task completion, attendance]. (If clinician observations support functional limitations, add:) On examination, [objective functional or behavioral findings relevant to work/school capacity].

Based on the above, the patient [may return to full duties without restrictions effective (date) / may return with accommodations effective (date) / is excused from work/school from (start date) to (end date)]. (Select one option. Always include specific dates.)

(Include only if recommending accommodations or restrictions. Use functional, non-diagnostic language.) Recommended accommodations:

• [accommodation, e.g., flexible scheduling, temporary reduced workload, modified deadlines, permission to attend appointments, remote/hybrid participation]
• [additional accommodation if applicable]

(If accommodations or restrictions are recommended:) Anticipated duration: [timeframe or reassessment date].

(If functional limitations or specific dates were not assessed, replace recommendation paragraphs above with this abbreviated verification:) The patient was evaluated on [date(s) of evaluation]. This letter serves to verify the encounter only; formal recommendations will follow after reassessment on [planned reassessment date].

Please contact our office to verify this letter; additional clinical information requires patient authorization.

[Clinician name, credentials]
[Clinic name]
[Phone] | [Fax]