School/Daycare Letter (Return/Restrictions)

Date: [date of letter issuance]

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

Evaluated on: [encounter date]

Provider: [clinician name and credentials]

To: [school or daycare name, or "School/Daycare Administration" if unknown]

Re: Return to School/Daycare and Restrictions

Clinical Summary

[Reason for evaluation and brief condition summary] (Keep to 1–3 sentences. Include diagnosis only if it directly informs return timing, restrictions, or medication needs. Use general terms such as "acute viral illness" or "a medical condition" if diagnosis is sensitive or uncertain. Include test results only if they affect school guidance.)

Attendance and Return Guidance

• Excused absences: [start date] through [end date] (Include only if an excused absence window applies.)
• Return: [specific return date, or symptom-based return criteria] (Use a date if predictable; otherwise state objective criteria such as fever-free for specified period without antipyretics, symptoms improving and able to participate in routine activities, vomiting/diarrhea resolved with oral intake tolerated, or rash lesions covered.)
• Contagiousness: [brief statement on transmission risk and precautions] (Include only if condition may be contagious.)

Return guidance may be modified by school policy or local public health requirements.

Restrictions and Accommodations

[Restriction or accommodation: specific activity limited, degree of limitation, and duration with end date or "until re-evaluated"] (List each restriction on a separate line. If no limitations apply, state "No restrictions required.")

Medications at School

[Medication name]: [dose], [route], [timing during school hours]; Indication: [indication or "confidential"]; Duration: [start date] to [stop date]; PRN parameters: [criteria if applicable]; Self-carry: [yes / no / not assessed]

(Include only if medications are needed during school hours. List each medication separately. If none required, omit this section or state "No medications required during school hours.")

This letter may not replace district medication authorization forms.

Signature

[Clinician signature]

[Printed name, credentials]

[Clinic contact information]