I have drafted a leave letter for you below, I really hope your mother's operation goes well but I am sure she is in good hands with you looking after her.
Your full name, job title
Home Address
City, State, Zip code
Date
Mr./Mr. Last Name:
I am writing to you to submit a formal request for a medical leave of
absence due to my own serious health condition that requires surgery. My
doctor has scheduled a surgical procedure for (insert date) and expects
that I will need (insert number) of weeks for recovery before being
released to return to work. My physician will be happy to provide a
formal medical certification document on my behalf.
Please let me know the next steps I should take to secure approval for
this request. Thank you in advance for your consideration.
Sincerely,
Your signature
Your typed name