Exercise Extreme Caution when using many of our free forms - or any legal material. While they may provide general ideas on format & content, validity requirements can and do vary greatly from state to state. Many MUST be Properly Modified for your own location and circumstances. (Hint: If in doubt it's usually safer to include unneeded clauses than to leave out necessary ones. . . . but it's even safer to consult a competent source or use current, state specific ones like ours mentioned below.) Also, we urge people (and lawyers too) to read our Relying On Legal Info FAQ.
The above referenced employee has been absent from work on the
days noted below. We have been advised that the employee has
been receiving treatment from you. It is our company policy to
verify prolonged medical absences. Accordingly, we would
appreciate your completing the form below and returning it to
our personnel office.
Dates of absences:
I consent to the release of the above information.
Signature of Employee
* * * * * * * * * * No one connected with the 'Lectric Law Library, including Sponsors, Advertisers, & Content Providers,
necessarily Endorses, Warrants or Approves of any of its material. Also, Library content is NOT meant
to provide Specific Legal Advice, or to Solicit or Establish Any Kind of Professional-Client Relationship.