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Medical Certificate

This medical certificate documents a government employee's sick leave request. It includes the employee's signature and identification, a diagnosis of their condition by a licensed medical professional, the recommended duration of leave for recovery, and authentication by the certifying doctor including their registration number and office seal. The certificate provides the essential information to justify and approve the employee's medical leave of absence from work duties.

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nandhanasanthosh04
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4K views1 page

Medical Certificate

This medical certificate documents a government employee's sick leave request. It includes the employee's signature and identification, a diagnosis of their condition by a licensed medical professional, the recommended duration of leave for recovery, and authentication by the certifying doctor including their registration number and office seal. The certificate provides the essential information to justify and approve the employee's medical leave of absence from work duties.

Uploaded by

nandhanasanthosh04
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MEDICAL CERTIFICATE

(Rule 117, Part I, KSRs)

Signature of the applicant .. .. .. .. .. .. .. .. .. .. ..

I (Name) …………………………………………….. .. .. ………….. after careful personal


examination of the case hereby certify that (Name and official address) ……………… ……
……….………………….………………………………………………………………… .. .. ..
…. .. .. .. .. .. .. .. .. .. .. … … … … .. .. … .. ..,, …… …… …… …… …… …… ……
…………whose signature is given above, is suffering from ……………………..
…………………………………………………………………….and that I consider that a
period of absence from duty of ………………………… with effect from …………………….
is absolutely necessary for the restoration of his / her health.

Signature of Government
Medical Officer / Civil Surgeon
/ Staff Surgeon/Authorized
Place Medical Attendant / Registered
Medical Practitioner

Date Reg No: .. .. .. .. .. .. .. ………….


Office seal Part of registration .. .. .. … .. ...
System of Medicine .. .. .. .. .. .. .

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