Date: 1 November 2025
To Whom It May Concern,
This letter confirms that John Doe (Date of Birth: 15 March 1980) was evaluated at our clinic on 1 November 2024. John Doe has been diagnosed with lumbar disc herniation, as evidenced by MRI findings and clinical assessment demonstrating lower back pain and radiculopathy.
John Doe's condition significantly restricts his ability to sit or stand for prolonged periods, lift heavy objects, or maintain static postures comfortably. These limitations directly impact his capacity to fulfill typical workplace tasks without adjustments.
To support John Doeβs health and workplace effectiveness, I recommend the following accommodations:
- Ergonomic seating and adjustable standing workstation
- Flexibility to take frequent brief breaks (5-10 minutes per hour) to reduce pain and stiffness
- Limitation on heavy lifting tasks (maximum of 5 kg)
- Modified work schedule allowing partial remote working when symptoms intensify
These recommendations should be implemented for a period of 6 months, with reassessment scheduled by 1 May 2025.
This document is provided with John Doeβs consent and meets relevant privacy and medical documentation guidelines.
Should you require additional details, please contact my office.
Sincerely,
Dr. Thomas Kelly, MD
Orthopaedic Surgeon
License Number: 123456
Orthopaedic Care Clinic
123 Health St, London, UK
Phone: 020 7946 0958 | Email: drkelly@orthocareclinic.com
Date: [Date] (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank.)
To Whom It May Concern,
This letter confirms that [Patient Name] (Date of Birth: [Patient Date of Birth]) was evaluated at our clinic on [Evaluation Date]. [Patient Name] has been diagnosed with [Diagnosis], as evidenced by [Diagnostic Evidence] and clinical assessment demonstrating [Clinical Symptoms].
[Patient Name]'s condition significantly restricts [his/her/their] ability to [describe limitations, e.g., sit or stand for prolonged periods, lift heavy objects, or maintain static postures comfortably]. These limitations directly impact [his/her/their] capacity to fulfill typical workplace tasks without adjustments.
To support [Patient Name]βs health and workplace effectiveness, I recommend the following accommodations:
- [Accommodation 1] (e.g., Ergonomic seating and adjustable standing workstation)
- [Accommodation 2] (e.g., Flexibility to take frequent brief breaks (5-10 minutes per hour) to reduce pain and stiffness)
- [Accommodation 3] (e.g., Limitation on heavy lifting tasks (maximum of 5 kg))
- [Accommodation 4] (e.g., Modified work schedule allowing partial remote working when symptoms intensify)
These recommendations should be implemented for a period of [Duration], with reassessment scheduled by [Reassessment Date].
This document is provided with [Patient Name]βs consent and meets relevant privacy and medical documentation guidelines.
Should you require additional details, please contact my office.
Sincerely,
[Clinician Name], [Clinician Credentials]
[Clinician Title]
License Number: [License Number]
[Practice Name]
[Practice Address]
Phone: [Phone Number] | Email: [Email Address]
(Never come up with your own patient details, assessment, plan, interventions, evaluation, and plan for continuing care - use only the transcript, contextual notes or clinical note as a reference for the information include in your note. If any information related to a placeholder has not been explicitly mentioned in the transcript, contextual notes or clinical note, you must not state the information has not been explicitly mentioned in your output, just leave the relevant placeholder or omit the placeholder completely.) (Use as many lines, paragraphs or bullet points, depending on the format, as needed to capture all the relevant information from the transcript.)
