9+ Medical Certificate From Doctor Sample Templates

MEDICAL CERTIFICATE FROM DOCTOR TEMPLATES

TABLE OF CONTENTS  

What is a Medical Certificate?
What are the various purposes of a Medical Certificate?
What are the contents of Medical Certificates?
Things all doctors should consider before signing Medical Certificates
Template Sample 1 for Leave
Template Sample 2 to Compete in Sports
Template Sample 3 for Fitness Certification
Template Sample 4 for Job Application
Template Sample 5 for Fit To Fly
Template Sample 6 to Resume Duties
Template Sample 7 for Boxing Competition
Template Sample 8 for Travel After Testing Covid-19 Negative
Template Sample 9 for the use of Prescribed Restraint
Template Sample 10 for the Identification of the Disease

What is a Medical Certificate?

A medical certificate is a written confirmation from a certified doctor or physician about an individual’s physical health. It is seen that the certificate also mentions the number of days a patient was admitted within the hospital (with the name of the hospital) for the treatment. It is basically proof of the person’s current physical condition after the medical checkup from the assigned doctor with their signature. 

Medical Certificates will be required for many different reasons, such as for faculty students to induce a medical leave or rest, or perhaps for a working person to assert certain health benefits from the corporate, and so on. Also, Medical Certificates should be considered as human confidentiality. It contains an individual’s workplace, identifying diseases, and other information. Therefore, without one’s consent, the certificates must not be made public.

Also, there are a number of factors to consider as a doctor while filling the Medical Certificates. Take a look at some of the mentioned below:

Things All Doctors Should Consider Before Signing a Medical Certificate

The doctors must keep in mind their legal and professional responsibilities when issuing the Medical Certificates. Also, when issuing a Medical Certificate of sickness, it is the doctor’s responsibility to test whether the patient is truly able to attend the work or not. If not so, then the number of days should be mentioned within the certificate for the patient to take a leave for recovery. It should also be considered that the leave must not exceed over 15 days unless the patient’s condition is kind of worse. And if that’s the case, the fresh Medical Certificate must be issued.

Before signing the Medical Certificates, doctors must reconsider the form and see if it is actually accurate or not. They must be sincere when filling the form and not be misleading. That would be considered misconduct. If the medical practitioner feels no need for the absence from the work or school after examining the patient, they should decline to sign the Medical Certificate. Doctors must be frank with their range of knowledge and should not give an opinion beyond those limits when providing evidence because this might result in the health consequences of the patient.

What are the various purposes of a Medical Certificate?

Now, Medical Certificates have become very crucial in varied departments. There are literally so many events in one’s life wherever physical health matters the foremost, and for the same purpose, Medical Certificates are considered in need. The most common purpose for the requirement of a Medical Certificate is considered sick leave from the faculties and colleges and, in fact, from work.

Some of the common applications for the Medical Certificates are mentioned below:

  • To obtain health benefits from a corporation or government as an employer
  • To allow traveling around the globe (fit to fly)
  • To claim insurance
  • To kindle leave from school or work on medical terms
  • For some job application procedures
  • To be applicable for legal procedures
  • To claim taxes
  • For the eligibility of the various activities (such as disabled parking)
  • To certify that the candidate is free from sickness (such as free from COVID-19 when infected from it)
  • Application for an eye fixed examination for drivers license
  • To get a pilot’s license stating the candidate is fit to fly a plane under different circumstances
  • To describe medical conditions like eye blindness
  • To certify the person is free from drug addiction, mental disease, and other contagions

Doctor’s Medical Certificates Should Contain the Following Information

This is a guide to create a Medical Certificate from a doctor’s perspective. Follow the guidelines about what should be mentioned within the Medical Certificate.

  • Name and address of the patient/ candidate
  • The exact period of leave/ day off that is medically excusable
  • Nature of injury/ sickness
  • Date of issue of the certificate and date of medical diagnosing
  • The assigned doctor should conjointly possess medical records that support the contents of the certificate
  • The approximate date the condition commences 
  • Signature of the assigned doctor with a name 
  • Stamp of the Clinic/ Hospital
  • The contact number of the medical officer
  • Email address of the medical officer if possible
  • Signature of the patient

Medical Certificate From Doctor Sample:

The templates are just to grant you an idea of what information a Medical Certificate must contain and the way it should be in line with the necessity for it.

Template Sample 1 (For Leave)


Name Of The Hospital

Medical Certificate

………………………………………………………

Signature of the Candidate

I, the undersigned Dr……….(Name of the doctor)…………, Doctor of Medicine, certifies that Mr./Mrs…………(Name of a person)……… of……… (Address)………, who has the signature above, was examined and treated at the ………(Name Of The Hospital)……… on……… (Date) ……………………………

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According to the reports of the examination, for the patient’s full recovery, medical attention of………(No. Of Days)………would be considered mandatory.

…………………………..

Date

………………………………………………..                Signature of the doctor


Template Sample 2 ( Fit to compete)


Name Of The Hospital

Medical Certificate

Date:

I, the undersigned Dr………(Name Of The Doctor)……… Doctor of Medicine certifies that the examination of Mr./ Mrs…………. (Name of the Patient)……………………….. Of………(Age)………… years concludes the full fitness of the candidate to participate in the………………competition.

Signature of the doctor: ………………………………….

Doctor’s contact number: ……………………………..

Stamp of the clinic: 

 ………………………………………


Template Sample 3 (Fitness Certificate)


Name of the Hospital

Medical Fitness Certificate

Date: …………………

I, Doctor, …………(Name of the doctor)………… certify that I have carefully examined Mr./Mrs……………(Name of the Person)…………….. whose signature is given below. The examination reports reveal no physical and mental contradictions, and I, therefore, assure that he/she is in completely sensible mental and physical health to indulge in any physical activities or studies.

Signature of the candidate: ………………………….

Medical Certificate is issued in: ….(Place)…

……………………………………………………

Signature of the assigned 

Doctor 

……………………………………………

Stamp of the clinic


Template Sample 4 (For Job Application)


Name Of The Hospital

Medical Certificate

Name of the candidate: ………………………………….

Father’s Name: ……………………………………………………

Blood Group/Blood Count: ……………………………

Height: …………………… Weight: ……………………………

Vision: L: ……………………………R: ………………………………

Colour Vision: ……………………………………………………….

Hearing: ………………………………………………………………….

Hernia/ Piles/ Hydrocele: ………………………………..

Any other disease diagnosis in the past: …………………………………………………………………………………….

Allergies, if any: …………………………………………………..

List of prescribed medication, if any:

1…………………………………………………….

2……………………………………………………

3……………………………………………………

Any other remarks……………………………………..

I, Doctor………(Name of the Doctor) ………certifies that, after carefully examining the patient, Mr./Mrs…………(Name of the Candidate)………. assures that he/she has no physical and mental defects and is therefore fit.

Date: ………………………

Place: ……………………..

……………………………………………………….

Signature of the candidate      

…………………………………………………………………..                                    

Signature of the assigned doctor

…………………………………………………………………

Doctor’s Contact Number/ 

Email address

 ……………………………………..

Stamp of the clinic


Template Sample 5 (Fit to Fly)


Medical Certificate for Air Travel

Name of the passenger: …………………………………

Gender: …………………………………………………………………..

Age: ………………………………………………………………………….

Nationality: ………………… Passport Number/ ID Number: …………………………………………………………..

Airline: ……………… Flight Number: …………………..

Departure/ Arrival/ Transit

Patient’s medical history: ………………………………

Any recent Infection: ……………………………………….

Recent Fever: ………………………………………………………

Being treated for any conditions. Yes/No. If yes, explain ………………………………………………………………………………………………………………………………………………………………………….

Diagnosis: ……………………………………………………………..

…………………………………………………………………………………….

Treatment: …………………………………………………………….

…………………………………………………………………………………….

Recommendation for Air Travel per the reports:

Fit for air travel:

Not fit for air travel:

……………………………………………………….

Name and signature of the 

assigned doctor

………………………………………………………

Signature of the passenger

………………………………………

Stamp of the clinic


Template Sample 6 (Fit to resume duties)


Name of the Hospital

Medical Certificate

Signature of the candidate: ………………………….

I, Dr……….(Name of the doctor)………hereby certify that I had fully examined Mr./Mrs………(Name of the candidate)………working in the………(Name of the company)…………………… whose signature is given above, and confirms that he/she has recovered from his/her sickness fully and is currently appropriate to resume duties at the mentioned service. 

Medical certificate is issued in: ……………………

…………………………………………………………………..

Signature of the assigned doctor

……………………………………..

Stamp of the clinic


Template Sample 7 (permit for boxing competition)


Name of the Hospital

Sports Medical Certificate

Surname of the candidate: ……………………………

Name of the candidate: ………………………………….

Date of Birth: ……………………………………………………….

Athlete’s Declaration:

1. I am fully aware that boxing is extremely demanding on the vascular system, the respiratory system and the articulations.

2. I am in a very psychological state.

3. I can train well for different boxing events throughout the year.

4. I do not suffer from any cardiac problems, chronic muscular, spiral or joint problems or any other medical conditions that might put me in danger within the competition.

I hereby certify that the above statements are completely true.

……………………………………………………..                                     

Signature of the candidate                       

…………………..

Date

I, Dr………(Name of the doctor)……………………… cardiologist/sports medicine doctor/ other, states that I have examined Mr,/Mrs………..(Name of the candidate)……… and from the reports available to me, I can state that he/ she is fit to take part in Boxing competition at a competitive level.

……………………………

Date

………………………………………………                       Signature of the doctor

……………………………………………………..

Doctor’s Contact Number/

Email Address

………………………………………

Stamp of the clinic


Template Sample 8 (Covid-19 free to travel)


Name of the Hospital

Medical Certificate for General Passenger

Date: ……………

I, …………………(Name of the Doctor)…………………. an authorized medical doctor, holding a medical registration number ……………………… …………………………..have carefully examined Mr/Mrs. ……..(Name of the candidate)………… on………(Date)………and have found out that he/she is free from the subsequent disease:

Coronavirus Disease- 2019 (covid-19)

In the past 14 days with evidence of negative testing for Covid-19 not more than 48 hours of departure (specify test and date…………..)

……………………………………………….

Signature of the doctor 

……………………………………………………..

Doctor’s Contact Number/

Email Address

……………………………………..

Stamp of the clinic


Template Sample 9 (for use of prescribed restraint)


Doctor’s Medical Certificate

Full name of the Client: …………………………………..

Date of Birth: ……………………………………………………….

Client’s Diagnosis:………………………………………………

Parent’s Full Name: …………………………………………..

Contact Number: ……………………………………………….

Address: …………………………………………………………………

…………………………………………………………………………………….

This letter certifies that Mr./Mrs………………….. (Name of the client)………has been diagnosed with the permanent disability of……………………………….. As a result, he/ she is unable to travel in his/ her standard vehicle seat and requires……….. (the restraint you are applying for)………for use in his/her family/ personal vehicle when traveling.

I was a certified doctor hereby recommend that the……..(restraint name) ……. issued by Mr/Mrs……..(Name of the client) ……….. should be provided……(whatever it is helping with the posture, behavior, safety, etc.) during travel.

Please consult with the advice on the parent’s form from the prescriber, 

…………………………………………………………………………………….

Date: ………………………..                  

Stamp of the clinic: …………………………………………..

Signature of the doctor: ………………………………….

Doctor’s Name: …………………………………………………..

Doctors Telephone number/ email ID: …………………………………………………………………………………….


Template Sample 10 (Identification of the disease)


Name of the Hospital

Medical Certificate

Date: ………………………………………………………………………..

To be filled by you, the participant: 

First Name: …………………………………………………………..

Last Name: ……………………………………………………………

Address: …………………………………………………………………

…………………………………………………………………………………….

Town: …………….City: …………….Country: ……………..

Telephone Number: ………………………………………… Emergency Contact Number: ……………………..

To be filled by your medical practitioner:

I the undersigned Dr………..(Name of the Doctor)………., Doctor of Medication have found him/her:

Free of the following illnessSuffering from the following illness
Illness name here
Illness name here
Illness name here
Illness name here
Illness name here

Place: ……………………                     

Date: ……………………..

……………………………………………….                              

Signature of the doctor   

……………………………………………….

Stamp of the clinic            


Note: 

  • We would never encourage anyone to create fake Medical Certificates from the doctor’s perspective because it is considered a fraud action. We are totally against any illegal activities carried out with such fake Medical Certificates. Students or even employees falsifying a Medical Certificate for acquiring a leave is misconduct. A candidate doing so must realize the very fact that there might be some health consequences for it.
  • The Medical Certificate should not begin with “to whomever it is going concerned” as this might possess a risk of being employed for different purposes (maybe illegal) than what you actually expect.
  • Please note that the Medical Certificates don’t seem to be backdated. However, exceptions are accepted where the patient is incredibly unwell and unable to go to a doctor straight.
  • The Medical Certificate should avoid medical jargon wherever possible.

Also read High School Diploma and Equivalent Certificates

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