Medical Leave of Absence Letter [Samples]

Learn how to write a medical leave of absence letter. Use our sample medical leave of absence letters as templates for your medical leave of absence letter.

Sample 1 – Medical Leave Of Absence Letter

Janet Gibson
1416 Action Street
Berkeley, CA, 94703

May 13, 2020

Larry Elton 
HR Manager
Big Company
2600 Flake Street
Berkeley, CA, 94703

RE: Requesting Medical Leave of Absence

Dear Mr. Elton, 

This letter is to formally request leave of absence for medical reasons. I will be having a hysterectomy on 06/01/2020 and will not be able to work for 90 days. I plan to return to work on DATE if the recovery goes well.

I have included a letter from my surgeon that states the need for surgery and the date of the surgery. If any other medical records are required, I will be happy to supply them.

Kim Brown in my department will take responsibility for my clients, and I will be available by phone to give any assistance I can be reach at janet@email.com or at 555-123-4567. 

I greatly appreciate your kind consideration in granting me this leave. 

Sincerely,

Signature
Janet Gibson
List of enclosures

Sample 2 – Medical Leave Of Absence Letter

August 3, 2020

Wolverine Supplies
89 Kendall Street
Vargas, ND 74569

RE: Requesting Medical Leave of Absence

Dear Mr. Jamison,

As you are well aware, I have been having health problems. Though many methods have been explored for how to correct the problem, surgery is inevitable.

The reconstructive surgery on my knee will require a lengthy absence from work. I am so sorry that I have to do this to you, but I am going to have to take the full 12 weeks allowed with FMLA.

My doctor has filled out the request form, which I got from HR. I have attached this to this letter to begin the process. In an effort to be fair to a company that I enjoy working for, I am allowing you a month’s notice to make other arrangements for my position.

My surgery is scheduled for August 16th. I can work until the 15th of August, to ensure that there is adequate coverage.

If you need me to train anyone to cover my position, or to wrap up some business matters, I would be more than willing.

I anticipate that my return will be December 21st, 2020. While this is just an estimate, I want you to be prepared. I hope to return before this time and to retain my rightful position.

I appreciate your consideration in this matter. You have always been great to work for through the years and I know you will understand that this is something that must be done. If you have any questions, please feel free to let me know.

Sincerely,

Tatum G. Clark

Sample 3 – Medical Leave Of Absence Letter

Sonny Hill
1400 Jackson Road
San Jose, CA, 94704

May 13, 2020

Sandy Jones
HR Manager
XYZ Company
2600 Lucky Street
San Jose, CA, 94704

RE: Requesting Medical Leave of Absence

Dear Ms. Jones, 

As you may already know, my young daughter is having some serious health problems. Although she’s seen a number of different health care providers and endured many tests to address the problem, she unfortunately needs surgery. 

She requires a serious neuro-based type of surgery and therefore I will need to be at her side and care for her for a number of weeks while she recovers. I am sorry to say that I need the full 12 weeks that are allowed under the FMLA policy. 

Her doctor has already filled out the request from that I obtained from the human resources department. Because I respect the company I work for and am trying to be as fair as possible, 

I am giving you a full month’s notice so you’ll have enough time to make adequate arrangements to cover my position while I’m away. My daughter’s surgery is scheduled for June 22, 2020. I intend to work up until the previous Friday on June 19 to ensure that my job is covered. 

I am more than willing to train someone to do my job or wrap up any business matters if you like. I expect to return on Monday, September 14, 2020. As of right now, these are the anticipated dates for her surgery and my time of leave. 

If anything changes I will let you know immediately. Hopefully I can return before September 14 if all goes better than expected and retain my current position in the company. 

I truly appreciate your consideration and understanding concerning this sensitive matter. I respect both you and the company and feel it’s been an honor to work here over the past 12 years. Again, thank you for understanding. If you have any questions or concerns, I intend to be here every day until June 19 to talk with you.

Sincerely,

Signature
Sonny Hill
List of enclosures

related posts

  1. Writing a Simple Maternity Leave Letter
  2. Writing a Compelling Request Letter for Paternity Leave
  3. Writing a Request Letter for Family Emergency Leave
  4. Writing a Formal Leave of Absence Request Letter
  5. Writing a Vacation Request Letter (with Sample)