[{"id":"087bc56e-a2bf-4d94-b985-a6eaa291c1c6","order":1,"text":"[Your full name]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"1248f8f4-64d2-4131-b79d-28ed4086cb61","order":2,"text":"[Your address]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"e80e2a88-2410-4021-a76c-469faff7c465","order":3,"text":"[Town and postcode]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"16c071f2-ce74-437f-b109-24dc87760c24","order":4,"text":"[Your email]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"0afd9530-c923-442c-8f1f-304356dcbaa2","order":5,"text":"[Your phone]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"5ab1cc31-6c27-49d4-9969-dd29b855f54b","order":6,"text":"[Date]","fontSize":"14","textAlign":"right","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"4c37175e-cd09-4764-9033-7ef19ef83432","order":7,"text":"[Recipient name]
[Recipient role]
[Employer / company name]
[Employer address]
[Town and postcode]","fontSize":"14","textAlign":"right-align","bold":false,"underline":false,"marginBottom":"30","cflou":false,"active":true},{"id":"9f50ace8-ecf5-404a-b445-9b0a1eec443e","order":8,"text":"Dear [Recipient name],","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"972fc308-a5a7-40c9-bde7-6f6ad8a3fade","order":9,"text":"Re: Sickness absence and fit note — confirmation of approved dates for payroll and planning","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"d6fedc32-f042-4ae3-9457-eee19af0275b","order":10,"text":"I am writing to formally notify you of my continued sickness absence (payroll reference [Payroll/employee reference]) and to provide the medical evidence now required, following the end of the self-certification period. I should be grateful if you would confirm the matters set out below in writing, so that my pay, handover and return-to-work arrangements are recorded accurately and consistently.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true},{"id":"a8f2e6d0-f207-4382-aabd-6ab83800dfa9","order":11,"text":"My absence began on [First day of absence]. In accordance with the position confirmed by GOV.UK and Acas, the first seven calendar days of absence (including weekends and any non-working days) are covered by self-certification, and no fit note is required for that period. The self-certified period therefore ran to and including [Last day of self-certified period].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true},{"id":"cf068b84-a13d-4695-89e3-ca8c67b1a0c3","order":12,"text":"As my absence has continued beyond seven calendar days, I enclose a fit note (Statement of Fitness for Work) issued by [Issuing clinician / practice]. The fit note covers the period from [Fit note start date] to [Fit note end date] inclusive. I confirm that this is the medical evidence my employer is entitled to request once an absence extends into day eight and beyond.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true},{"id":"fa00019d-a5c1-43fc-8f41-56ed1adff09b","order":13,"text":"In keeping with my right to medical confidentiality, I am not obliged to disclose the underlying diagnosis, and the fit note need not state it. I trust this will be treated in confidence.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"5434e203-0b48-4004-9520-56727c1949f2","value":"disclose","type":"remove","operator":"="}]},{"id":"7792f3d9-fdfa-426f-bb52-4dd7499e7030","order":14,"text":"For your records, my absence relates to [brief reason / condition]. I ask that this information be treated as confidential and shared only on a need-to-know basis.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"5434e203-0b48-4004-9520-56727c1949f2","value":"disclose","type":"add","operator":"="}]},{"id":"1d2d5116-1c33-4fd8-84fc-525d1cd56092","order":15,"text":"My fit note advises that I am not fit for work for the period stated. I will remain absent for the duration of the fit note and will keep you updated should my circumstances change.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"42f9ce63-dda4-4bc4-bac3-06e8135ef77c","value":"notfit","type":"add","operator":"="}]},{"id":"426bfde4-8bf1-4704-8cff-8ad4f8eb359f","order":16,"text":"My fit note advises that I may be fit for work subject to the adjustments noted by the issuing clinician, namely: [adjustments noted on the fit note]. I should welcome a discussion about how these adjustments might be accommodated. Where they cannot reasonably be put in place, I understand the fit note should be treated as advising that I am not fit for work for the period stated.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"42f9ce63-dda4-4bc4-bac3-06e8135ef77c","value":"mayfit","type":"add","operator":"="}]},{"id":"d5edbf65-6b71-49a4-950d-0a538ae6419c","order":17,"text":"I currently expect to be fit to return to work on [expected return date], subject to any further medical advice. I will confirm my return in good time and am happy to take part in a return-to-work discussion.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"a9b15dd5-4fba-4b95-9b2f-6c88ba93124c","value":"known","type":"add","operator":"="}]},{"id":"6900c2e8-7c30-4c9e-8b0b-f8edf0d80045","order":18,"text":"A return date is not yet fixed, as my fitness for work will be reviewed before the current fit note expires. I will provide any further fit note promptly and keep you informed of the position.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"a9b15dd5-4fba-4b95-9b2f-6c88ba93124c","value":"review","type":"add","operator":"="}]},{"id":"386c5d83-ab05-487d-9965-4b2b2cefe351","order":19,"text":"To support continuity in my absence, I am willing to assist with a reasonable handover of urgent matters by email, so far as my health permits. Please let me know who will be covering my responsibilities so that I can direct any time-sensitive items appropriately.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true},{"id":"8d63a72d-ecb6-4c76-bcce-3fb99b6b8e10","order":20,"text":"So that there is no later dispute about what was agreed, I should be grateful if you would confirm in writing: (a) the dates of absence [employer] has recorded as authorised; (b) how this absence is treated for Statutory Sick Pay, which is paid through payroll, and for any contractual sick pay to which I am entitled under my contract of employment; and (c) the date on which any sick pay is expected to be paid.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"a978accf-ffe0-4d52-84bf-7cffed1b0374","value":"yes","type":"add","operator":"="}]},{"id":"e7aa7d53-7263-4728-a0d4-cd60281c7b13","order":21,"text":"More generally, and to avoid any reliance on conversations held informally, I ask that the approved absence dates and the arrangements above be confirmed to me in writing by email. A short written acknowledgement recording the agreed dates will be sufficient for payroll, handover and planning purposes.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true},{"id":"1e31239d-96d6-4f53-ba37-10188c65ac7e","order":22,"text":"I have kept this request proportionate and limited to what is necessary. Any health information I have provided is supplied solely to evidence my absence and to manage my return, and I would ask that [employer] processes it in accordance with its obligations under data protection law.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true},{"id":"b41aacd6-e385-4043-953a-a654b449f721","order":23,"text":"Nothing in this letter is intended to waive any of my rights, all of which are expressly reserved.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"0445c083-8582-45ad-abb6-11af55e81ad1","order":24,"text":"Please do not hesitate to contact me on the details above if you require anything further. I look forward to your written confirmation.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"11e28eb0-1d37-41b4-b053-4b8b83e523d7","order":25,"text":"Yours sincerely,","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"40","cflou":false,"active":true},{"id":"1b58beeb-24d2-4921-81be-7b7c79254c5b","order":26,"text":"[Your full name]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"d99f86fe-08f6-42ca-a63d-fec54272c2a3","order":27,"text":"[your job title]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"e3570134-77ec-4b9a-bb9a-ba68528fb694","order":28,"text":"Enclosure: Fit note (Statement of Fitness for Work) dated as above.","fontSize":"12","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true}]