MEDICAL CERTIFICATE
ESSENTIALITY CERTIFICATE - 'B'
(To be completed in the case of patients who are admitted to hospital for treatment)
Certificate granted to Mrs./Mr./Miss _________ wife/son/daughter of Mr_____________ employed in the _________________
__________________________________________________________
Part A
I, Dr.__________________________________________________________ hereby certify.
(a) that the patient was admitted to hospital on the advice of _____________________________________ (name of medical
officer)/on my advice.
(b) that the patient has been under treatment at _____________________________________ and that the under mentioned
medicines prescribed by me in this connection were essential for the recovery/prevention of serious deterioration in the
condition of the patient. The medicines are not stocked in the _____________________________________ (name of the
Hospital) for supply to private patients and do not include proprietary preparations for which cheaper substances of equal
therapeutic value are available nor preparations which are primarily foods, toilets or disinfections.
Price
S. No. Name of medicines
Rs. P.
1.
2.
3.
4.
5.
6.
(c) that the injection administered was/were not for immunising or prophylactic purposes.
(d) that the patient is/was suffering from _____________________________________ and is/was under treatment from
_____________________________________ to _____________________________________
(e) that the X-ray, laboratory tests, etc. for which an expenditure of Rs. _____________________________________ was
incurred were necessary and were undertaken on my advice at _____________________________________ (Name of the
Hospital or Laboratory)
(f) that I called on Dr. _____________________________________ for specialist consultation and that the necessary
approval of the _____________________________________ (Name of the Chief Administrative Medical Officer of the
State) as required under the rules, was obtained.
Signature and Designation of the
Medical Officer in charge of the
Case at the hospital
PART B
I certify that the patient has been under treatment at the _____________________________________ hospital and that
the service of the special nurses for which an expenditure of Rs. _____________________________________ was
incurred, vide bills and receipts attached, were essential for the recovery/prevention of serious deterioration in the
condition of the patient.
Signature of the Medical Officer
In charge of the case at the hospital
Countersigned
Medical Superintendent
...................................................................Hospital
*I certify that the patient has been under treatment at the _____________________________________ hospital and that
the facilities provided were the minimum which were essential for the patient's treatment.
Medical Superintendent
...................................................................Hospital
Date : _____________
Place : ________________
Note: Certificates not applicable should be struck off. Certificate (d) is compulsory and must be filled in by the Medical
Officer in all cases.
