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Clearview General Hospital

Urgent Care

Dr. James R. Whitman
Emergency Medicine
(704) 555-23788

Patient Name: Raj Chourasiya

Patient Date of Birth: 02/29/2000

Date of Consult: 07/16/2025


To Whom it May Concern;

This is to certify that I have evaluated Raj Chourasiya, and I recommend that they be excused from attending work on 07/16/2025, 07/17/2025, 07/18/2025, and 07/19/2025 due to an illness. Based on the current assessment, Raj is cleared to return to work on 07/20/2025.

For further questions, please contact my office.

Sincerely,

Dr. James R. Whitman, M.D.
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Physician Licensing Details
State Medical License:
OP846324448
National Provider Identifier:
14354964853
Secure Medical Document | Verify online: VerifyDrInfo.com
Document Ref: DD5KY-GMQRR-6BLTP-U8AXJ-YEAGX
Page 1 of 2
CERTIFICATE of SIGNATURE
REF. NUMBER
DD5RKY-GMQRR-6BLTP-U8AXJ
DOCUMENT COMPLETED BY ALL PARTIES ON
16 JUL 2025 07:21:56 UTC
SIGNER TIMESTAMP SIGNATURE
EMAIL hosp****@gmail.com SENT 16 JUL 2025 07:20:10 UTC
VIEWED 16 JUL 2025 07:21:11 UTC
SIGNED 16 JUL 2025 07:21:56 UTC
LOCATION WASHINGTON, UNITED STATES
RECIPIENT VERIFICATION
EMAIL VERIFIED 16 JUL 2025 07:21:11 UTC

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