I, Dr. _____________________, am a NYS licensed ___________________. During the year _________, JOHN SMITH was a patient of mine. He had approximatey ________ visits with me over ______ months. During that time, I treated JOHN SMITH for ___ (more details better)_________________. He was/was not placed on any perscription medicine as a result of this condition. He was fully functionaly at that time.
Based upon my examination and treatment of John Smith, the condition noted above has since been alleviated. I see no reason how this could affect John now, or affect his career or future in law enforcement. I have atatched a copy of any remaining patient records for your review. If you have questions, please do not hesitate to contact me.
Thank you,
_________________________
-In God we trust. All others, put your hands on the car and don't move.