UNABLE TO ATTEND COURT: MEDICAL LETTER

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

Date: [Date you sign the letter]
To: [Court or tribunal registry, the judge's office, or the patient's lawyer]
Case: [Case name or file number, if the patient gave it]
Hearing: [Date or dates, place, and type of hearing]

Re: [Patient's full name]
Date of birth: [Date]
Role in the case: [Party, accused, or witness, as the patient told me]

[Patient name] asked me to write this letter and agreed to what it says. They understand it may be shared with the other parties.

MY ASSESSMENT
I am [patient name]'s [treating physician, specialist, or nurse practitioner] and have [treated them since year, or seen them only for this condition].
I last assessed them on [date], [in person, or by video].
I relied on: [My examination, test results, hospital records, and anything that rests on the patient's own account]

MEDICAL REASON
[A plain description the patient agreed to, such as recovering from heart surgery, or: a medical condition I am treating. Leave out the diagnosis where the court or tribunal asks for it to be left out]

WHAT THEY CANNOT DO ON THE HEARING DATE
[Each limit and the reason for it: travelling to the courthouse, sitting through a court day, concentrating, following questions, giving evidence under stress, or being away from treatment]

TAKING PART ANOTHER WAY
By video or phone: [Possible now, possible from date, not possible, or not assessed]
With changes: [Breaks every number minutes, sessions of no more than number hours, a support person, or: no change would make it possible]

HOW LONG THIS WILL LAST
Expected to be able to take part: [Earliest date, and whether in person or remotely]
I will reassess on: [Date], and will write again if this changes.

Not assessed: [Anything outside my expertise or this assessment, such as the issues in the case]

This is my medical opinion. Whether to adjourn the hearing or allow remote attendance is for the [court or tribunal] to decide.

[Your name, credentials, specialty]
[License or registration number, and where issued]
[Signature]

To check this letter: [Practice phone or email]