Activity recommendations - school

Patient____________________________ Date:____________

This patient was seen today in my office.

ATTENDANCE

__No attendance until further notice

Return to school date with restrictions:___________

Activity

Physical education __Full __Splint must be worn __Not until further notice

Contact Sports __Full __Splint must be worn __Not until further notice

Swimming __Full __Splint must be worn __Not until further notice

Writing __Full __Splint must be worn __Not until further notice

Resume all normal activities on _______