Medical certificate format for doctors

A free, printable medical certificate for sick leave and fitness to resume. Print it, or save it as a PDF, and fill it in by hand.

What a medical certificate should include

  • The doctor’s name, qualification and medical council registration number.
  • The clinic or hospital name and address.
  • The patient’s name, age and address, and an identification mark where your council’s format asks for one.
  • The diagnosis, in words the reader of the certificate can act on.
  • The period of rest advised, with both dates.
  • The date the patient is fit to resume work or school.
  • The date and place of issue, the doctor’s signature and seal, and the patient’s signature.

The format

[Clinic / hospital name, address and phone]

MEDICAL CERTIFICATE

Certificate No.:  Date:  

I, Dr.  , Registration No.  , after careful personal examination, hereby certify that Mr. / Ms.  , aged   years, residing at  , is suffering from  .

I consider that a period of absence from duty / school of   days, from   to   (both days inclusive), is necessary for the restoration of his / her health.

He / She will be fit to resume duty / school from  .

Identification mark:  

Signature of patient (or thumb impression)

Place:  

Signature and seal of doctor

Name:  

Qualification:  

Registration No.:  

A general format for reference. Adapt it to your practice and to the laws and medical council rules that apply to you. It is not legal advice.

Skip the blanks

checkup.care fills medical certificates from the consultation: the patient, the diagnosis and your registration details are already in place. You set the dates and print.

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