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Return To Work Evaluation

See the note before you use the template

Start with a finished example, inspect the template, or see the clinical facts Notat uses to draft the note.

Finished note

Example — generated by Notat from a sample visit

Reason for visit:
Follow-up for a persistent cough and reduced energy over the past 10 days.

Assessment:
Symptoms are improving. No red flags identified during today's review.

Plan:
Continue supportive care, review worsening symptoms, and follow up if symptoms do not settle as expected.

Clinical documentation:
Relevant symptoms, meaningful negatives, assessment, and follow-up advice were captured from the sample visit and organised into the selected template.

FactsContext™

symptoms

Presenting concern: Persistent cough and reduced energy for 10 days

history of present illness

Progress: Symptoms are gradually improving

Visit focus: The main concern, timeline, and functional impact were identified from the conversation.

physical exam

Red flags: No red flags identified in today’s review

plan

Follow-up: Safety-netting and review if symptoms persist or worsen

Safety-netting: Follow-up triggers and urgent return precautions were documented as part of the plan.

denials of symptoms

Denies: Relevant denials: Relevant red flags and absent symptoms were retained to support the documented assessment.

Template

Date: [Insert date]

To:  
[Recipient Name or “To whom it may concern”]  
[Employer or Institution Name]  
[Address Line 1]  
[Address Line 2]

Re: Return‐to‐Work Fitness Evaluation for [Patient Name, DOB: MM/DD/YYYY]

Patient Identification:  
- Name: [Patient Name]  
- Date of Birth: [MM/DD/YYYY]  
- Employer: [Employer Name]  
- Job Title: [Patient’s Position]

Introduction:  
[Insert a brief statement identifying yourself, your professional role, the reason for the letter, and the context of the patient’s care.]

Medical History:  
[Outline a chronological timeline of the patient's relevant medical history and treatment course. One paragraph per each medical issue. At the end, include any restrictions or accommodations that were in place.]

Fitness Statement:  
[Structure into a clear, formal paragraph:]  
“The above‐named patient has been under my care for [duration]. Based on clinical evaluation, treatment response, and any relevant testing, the patient is now medically cleared to resume full duties without restrictions.”  

(If partial duties are still recommended, state specifics here.)

Recommendations:  
(hyphenated list)  
- [List any temporary accommodations or phased return measures, if applicable]  
- [e.g., “Begin with 4‐hour workdays for the first week”]  
- [e.g., “Avoid prolonged standing/weight lifting over X pounds for 2 weeks”]

Conclusion:  
[Reiterate the patient’s fitness for work, offer to discuss further, and provide your contact details for any questions.]

Sincerely,

[Signature Line]

- [Your Name], [Degrees/Credentials]  
- [Title and Department]  
- [Institution or Practice Name]  
- Phone: [##########]  
- Email: [[email protected]]

Shared by

DV

Dr. Daniel Visser

Geriatrician, Netherlands

How it works in Notat

Add this template to your library, record the visit as usual, and Notat drafts the note in this exact structure from the extracted clinical facts. You review, edit, and sign.

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