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THE UNIVERSITY OF RHODE ISLAND

PHYSICIAN'S CERTIFICATE - RETURN FROM SICK LEAVE

__________________________                             _________________________
Beginning Date                                                           Expected Date of Return

_______________________________________
Physician's Signature

_______________________________________
Physician's Name (Typed or printed)

______________________
Date

*If the physician cannot certify that the employee is fully capable of returning, clarify restrictions and the term of restrictions (specific or expected date when restriction can be removed).  A job descriptions is available for the physician's review.

Please return this certificate to:

Laura Kenerson
Director, Personnel Services
The University of Rhode Island
80 Lower College Road
Kingston, RI 02881