CHRONIC ILLNESS SCHOOL ABSENCE LETTER

[Practice name]
[Address]
[Phone and email]

Date issued: [Date]
To: [Principal or attendance office]
School and district or board: [Names]

Student: [Student's full name]
Date of birth: [Date]
Grade: [Grade]

I have cared for [student name] as their [role, e.g. pediatrician or specialist] since [month and year], and last saw them on [date of the visit].

SHARED WITH CONSENT
[Student name] has a long-term health condition that will keep them out of school at times this year.
Consent given by: [Parent or guardian and student, or the adult student alone]
Condition named: [Only if they agree to name it; otherwise delete this line]

EXPECTED PATTERN OF ABSENCES
Kind: [On and off, one long absence, or both]
Each absence usually lasts: [e.g. 1 to 3 school days]
How often: [e.g. about once a month, or after each treatment]
Known appointment or treatment days: [Dates or schedule, or none]
This letter covers: [First date] to [last date]
I ask that absences from this condition during this period be recorded as medically excused, without a separate note each time. [A parent, or the adult student] will let the school know on each day missed.

KEEPING UP WITH SCHOOLWORK
Work while away: [e.g. class work posted online or sent home]
Deadlines and tests: [e.g. extra time, or a make-up date for missed tests]
School contact: [One staff member the family can reach, e.g. the school nurse]
After a longer absence: [e.g. half days for the first week, or not needed]

HOME OR HOSPITAL INSTRUCTION
[Delete this section if the student is not expected to miss a long stretch]
[Student name] cannot attend school from [first date] to [expected return date].
Able to take part in instruction: [Yes, about how many hours a day or week, or not yet and the date I will reassess]
Limits during instruction: [e.g. short sessions, video only on days with infection risk, or none]
Plan to return: [e.g. part days for 2 weeks, then full days]
If your district or board uses its own form for this, please send it to me.

REVIEW
I will review this letter by [date, within the school year], or sooner if things change.

Questions about this letter: [Practice phone]. I can answer only what the family has agreed to share.

[Your name, credentials]
[License or registration number]
[Signature]