Thanks for the advice everyone. Here is the letter I sent:

Dear Program Director,

I am writing to request a brief medical leave of absence from the program, approximately 2 weeks' duration. Attached is a note from my physician stating his recommendation for the LOA.

My goal is to create as little educational interruption as possible while still taking care of my needs. The requested LOA would begin immediately and end on September 2nd. This timing will both allow me the recovery time I need, and permit me to take the overdue orthopedics exam and make-up CSPs with the current second year students on September 3rd, then resume my future clinical rotations as presently scheduled.

I understand that taking this LOA will mean that I will have to repeat my pediatrics rotation in January/February, and I accept this as a natural consequence of taking the leave. At present, my recovery must take priority, or I will be risking further decompensation and complete disaster. I will take it upon myself to look into pediatrics clinics in Utah which may be willing to accommodate me for my pediatrics rotation in January.

Please let me know the status of my LOA request as soon as possible.

Thank you,

Medicated

I felt it necessary to include the stuff about repeating the rotation and taking exams because I want them to know that I am thinking and planning ahead this time. My last LOA happened on an emergency basis and it created a lot of trouble in the program. I want it to be easier for everyone this time.

Unfortunately, my program director is out of town until the 30th, and he's the one who is supposed to make the recommendation to the dean regarding whether or not I should be granted the leave of absence, but I copied half the faculty AND the dean on this email, so hopefully it won't be too much of a problem.

I think I've about expended all of my energy for one day getting the doctor's note and composing emails and such. I'm tired.

Cross your fingers for me that this all works out.

And again, I sincerely thank all of you for the wonderful support that you have given me since I first started this thread. It really does mean a lot to me. You all have so much wisdom to offer... I only hope that some day I can be as supportive and encouraging as you. Thanks.