Ouch. Okay, there are a bunch of tell-tale errors. The redo on the signature is pretty glaring, and doctors don't usually prescribe medicine to cure people of "spreading germs." But you'd probably let a few things slide too if you were busy with the backbreaking task of trying to correctly spell "gastroenteritis." He could have gone with stomach flu, but nope, "gastroenteritis." This is an employee who is willing to give 110% to not work for you, and you should at least reward him a half-day for the effort.