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Medical certificate format for leave and fitness

The format from Appendix 2 of the Indian Medical Council Regulations, 2002, which clause 1.3.3 of the same Regulations says a medical certificate shall follow. Print it blank and fill it in by hand for the patient in front of you.

FORM OF CERTIFICATE RECOMMENDED FOR LEAVE OR EXTENSION OR COMMUNICATION OF LEAVE AND FOR FITNESS

Signature of patient or thumb impression

To be filled in by the applicant in the presence of the Government Medical Attendant, or Medical Practitioner.

Identification marks:

1.

2.

I, Dr. after careful examination of the case certify hereby that whose signature is given above is suffering from and I consider that a period of absence from duty of with effect from is absolutely necessary for the restoration of his health.

I, Dr. after careful examination of the case certify hereby that on restoration of health is now fit to join service.

Place

Date

Signature of Medical attendant

Registration No.

(Medical Council of India / State Medical Council of ______ State)

Note: The nature and probable duration of the illness should also be specified. This certificate must be accompanied by a brief resume of the case giving the nature of the illness, its symptoms, causes and duration.

Before you sign

Clause 1.3.3 asks for three things beyond the form: a register of the certificates you issue, a copy of each certificate, and the patient’s signature or thumb mark, address and at least one identification mark on it. The Appendix 2 note also asks for a brief resume of the case with the certificate. The wording above is reproduced from the Regulations, which the National Medical Commission lists on its rules page.

Questions

Is there an official medical certificate format in India?

Yes. Clause 1.3.3 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 says “The medical certificate shall be prepared as in Appendix 2”. Appendix 2 is the form reproduced on this page, for leave, extension of leave and fitness.

What must a doctor record when issuing a medical certificate?

Clause 1.3.3 requires the doctor to keep a register of medical certificates issued, keep a copy of each one, and record the patient’s signature or thumb mark, address and at least one identification mark on the certificate. The doctor’s registration number goes on every certificate under clause 1.4.1.

Does the format apply to dentists?

Yes. Clause 3.3.3 of the Dental Council of India’s Revised Dentists (Code of Ethics) Regulations, 2014 carries the same rule for dental certificates.

Keep the case notes behind every certificate

MyClinicDesk keeps each patient’s visits, diagnosis and notes on one record, so the case behind a certificate is a search away.

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