Certificates

CERTIFICATESCERTIFICATESININ

GENERAL PRACTICEGENERAL PRACTICE

DR. ANAND NIGUDKARDR. ANAND NIGUDKAR

DEFINITIONDEFINITION

THIS IS THE SIMPLEST FORM OF THIS IS THE SIMPLEST FORM OF DOCUMENTARY EVIDENCE & MAY DOCUMENTARY EVIDENCE & MAY PERTAIN TO SUCH FACTS AS –PERTAIN TO SUCH FACTS AS –

BIRTHBIRTH SICKNESSSICKNESS COMPENSATIONCOMPENSATION VACCINATIONVACCINATION DEATHDEATH

LEGAL IMPORTANCELEGAL IMPORTANCE

1.1. COURT OF LAWCOURT OF LAW

2.2. I.P.C.- SEC.-197I.P.C.- SEC.-197

- SEC.- 463- SEC.- 463

3.3. I.M.C.I.M.C.

4.4. CIVIL SUIT FOR COMPENSATION CIVIL SUIT FOR COMPENSATION

REQUIREMENTSREQUIREMENTS

1.1. LETTER HEADLETTER HEAD

2.2. RELEVANT INFORMATIONRELEVANT INFORMATION

3.3. TRUE STATEMENTSTRUE STATEMENTS

4.4. DATE & TIME OF ISSUING CERTIFICATESDATE & TIME OF ISSUING CERTIFICATES

5.5. IDENTIFICATION MARKS OF PATIENTIDENTIFICATION MARKS OF PATIENT

6.6. SIGNATURE & /OR LT. HAND THUMB SIGNATURE & /OR LT. HAND THUMB IMPRESSIONIMPRESSION

7.7. CARBON COPYCARBON COPY

8.8. CAN CHARGE EXCEPT DEATH CERTCAN CHARGE EXCEPT DEATH CERT

TYPES OF CERTIFICATESTYPES OF CERTIFICATES

1.1. BIRTH CERTIFICATEBIRTH CERTIFICATE2.2. SICKNESS CERTIFICATESICKNESS CERTIFICATE3.3. FITNESS CERTIFICATEFITNESS CERTIFICATE4.4. VACCINATION CERTIFICATEVACCINATION CERTIFICATE5.5. CERTIFICATE ON WILLCERTIFICATE ON WILL6.6. MENTAL FITNESS CERTIFICATEMENTAL FITNESS CERTIFICATE7.7. DOMICILLIARY TREATMENT CERT.DOMICILLIARY TREATMENT CERT.8.8. LIFE CERTIFICATELIFE CERTIFICATE

TYPES OF CERTIFICATESTYPES OF CERTIFICATES

9. CERTIFYING LT. HAND THUMB 9. CERTIFYING LT. HAND THUMB IMPRESSIONIMPRESSION10. CERT. FOR OPINION IN CASE THE 10. CERT. FOR OPINION IN CASE THE PATIENT IS REFERRED FOR MEDICAL PATIENT IS REFERRED FOR MEDICAL OPINIONOPINION11. CERTIFICATE OF INJURY11. CERTIFICATE OF INJURY12. CERT. FOR L.I.C. POLICY12. CERT. FOR L.I.C. POLICY13. CERTIFICATE FOR WITHDRAWING 13. CERTIFICATE FOR WITHDRAWING MONEY FROM PROVIDENT FUNDMONEY FROM PROVIDENT FUND14. DEATH CERIFICATE14. DEATH CERIFICATE

BIRTH CERTIFICATEBIRTH CERTIFICATE

1.1. RESPONSIBILITY OF DOCTORS/ RESPONSIBILITY OF DOCTORS/ HOSPITALHOSPITAL

2.2. INFORMATION IN WRITING FROM INFORMATION IN WRITING FROM FATHER & MOTHER OF THE CHILD FATHER & MOTHER OF THE CHILD WITH THEIR SIGNATURES.WITH THEIR SIGNATURES.

3.3. OFFENCE IF NOT REGISTERED.OFFENCE IF NOT REGISTERED.

SICKNESS CERTIFICATESICKNESS CERTIFICATE

1.1. NO BACKDATED CERTIFICATENO BACKDATED CERTIFICATE

2.2. PREPARE A CASE PAPERPREPARE A CASE PAPER

3.3. CERTIFY ONLY WHEN UNDER YOUR CARECERTIFY ONLY WHEN UNDER YOUR CARE

4.4. SHOULD INCLUDE-SHOULD INCLUDE-

a. Nature of Illnessa. Nature of Illness

b. Approximate Period for b. Approximate Period for

TreatmentTreatment

5.5. IDENTIFICATION MARKSIDENTIFICATION MARKS

6.6. SIGNATURE OR LT. HAND THUMB SIGNATURE OR LT. HAND THUMB IMPRESSION OF THE PATIENTIMPRESSION OF THE PATIENT

SICKNESS CERTIFICATESICKNESS CERTIFICATE

7. DOCTOR’S SIGNATURE,DATE & TIME7. DOCTOR’S SIGNATURE,DATE & TIME

8. Carbon Copy8. Carbon Copy

9. TREATMENT PERIOD PROPORTIONATE 9. TREATMENT PERIOD PROPORTIONATE TO THE ILLNESSTO THE ILLNESS

FORMAT OF SICKNESS CERTIFICATEFORMAT OF SICKNESS CERTIFICATE

I, Dr. ------ after careful personal examination, do hereby I, Dr. ------ after careful personal examination, do hereby certify that Mr./Mrs./Ms……………….( whose certify that Mr./Mrs./Ms……………….( whose signature is given below is suffering from -----------signature is given below is suffering from -----------

and I consider that a period of absence from duty of and I consider that a period of absence from duty of about -----days/weeks is necessary for the restoration of about -----days/weeks is necessary for the restoration of his/her health with effect from -------.his/her health with effect from -------.

Identification marks-(i) -------Identification marks-(i) -------

(ii)------- (ii)-------

Signature of Mr./Mrs./Ms. Signature of Mr./Mrs./Ms. Signature of DoctorSignature of DoctorDate-Date- Time- Time-

FITNESS CERIFICATEFITNESS CERIFICATE

Recovery after IllnessRecovery after Illness Consider the purpose for which Consider the purpose for which

fitness is requiredfitness is required Pay Attention to COLOUR VISIONPay Attention to COLOUR VISION Identification Marks of the PatientIdentification Marks of the Patient Signature/ Lt. Hand Thumb Signature/ Lt. Hand Thumb

Impression of the Patient Impression of the Patient Signature of Doctor with Date & TimeSignature of Doctor with Date & Time


Record Your Observation of Medical Record Your Observation of Medical ExaminationExamination

Keep a Carbon CopyKeep a Carbon Copy


This is to Certify that, I have This is to Certify that, I have examined Mr./Mrs./Ms. -----------today, (Whose examined Mr./Mrs./Ms. -----------today, (Whose signature is given below) & find that he/she has signature is given below) & find that he/she has recovered from his/ her illness and in my recovered from his/ her illness and in my opinion, is physically fit to resume his/ her opinion, is physically fit to resume his/ her duties from today/tomorrow i.e.-----duties from today/tomorrow i.e.-----

Identification marks-(i) -------Identification marks-(i) ------- (ii)------- (ii)-------

Signature of Mr./Mrs./Ms. Signature of Mr./Mrs./Ms. Signature of DoctorSignature of Doctor Date-Date- Time- Time-

VACCINATION CERIFICATEVACCINATION CERIFICATE

CERTIFY ONLY WHEN YOU HAVE CERTIFY ONLY WHEN YOU HAVE VACCINATEDVACCINATED

NO FALSE CERTIFICATENO FALSE CERTIFICATE MENTION :-MENTION :-

1.1. Name of Vaccine AdministeredName of Vaccine Administered

2.2. Name of the Manufacturing Pharma Co.Name of the Manufacturing Pharma Co.

3.3. Batch No.Batch No.

4.4. Mfg. DateMfg. Date

5.5. Exp. DateExp. Date

6.6. Date & time of AdministrationDate & time of Administration

VACCINATION CERIFICATEVACCINATION CERIFICATE

Case PaperCase Paper Identification Marks of the Person Identification Marks of the Person

VaccinatedVaccinated Signature/ Lt. Hand Thumb Impression Signature/ Lt. Hand Thumb Impression

of the Person Vaccinatedof the Person Vaccinated Doctor’s Signature with Date & TimeDoctor’s Signature with Date & Time Carbon CopyCarbon Copy

Certificate of WillCertificate of Will Examination of the PersonExamination of the Person Case PaperCase Paper Records in Diary:-Records in Diary:-1.1. Name of the PersonName of the Person2.2. AgeAge3.3. AddressAddress4.4. Place Where the Cert. is IssuedPlace Where the Cert. is Issued5.5. Date & TimeDate & Time6.6. Case Paper No.Case Paper No.7.7. Findings in DiaryFindings in Diary

Certificate of WillCertificate of Will

Preserve the Diary FOREVERPreserve the Diary FOREVER Signature of the PersonSignature of the Person Signature of the Doctor, Date, Time Signature of the Doctor, Date, Time

& Seal& Seal

FORMAT OF THE WILL CERT.FORMAT OF THE WILL CERT.This is to Certify that, I have examined This is to Certify that, I have examined

Mr./Mrs. --------- today. In my opinion, at the time of Mr./Mrs. --------- today. In my opinion, at the time of the examination he/ she is mentally competent to the examination he/ she is mentally competent to depose his/her assets and for executing this depose his/her assets and for executing this document. document.


Signature of Mr./Mrs./Ms. Signature of Mr./Mrs./Ms. Signature of DoctorSignature of Doctor/Lt. Hand Thumb Impression/Lt. Hand Thumb Impression Date- Date- Time- Time-

SealSeal

MENTAL FITNESS CERTIFICATE MENTAL FITNESS CERTIFICATE FOR REVOLVER LICENCEFOR REVOLVER LICENCE

This is to Certify that, I have examined Mr./Mrs. This is to Certify that, I have examined Mr./Mrs. --------- today. In my opinion, at the time of the --------- today. In my opinion, at the time of the examination he/ she is mentally in a sound examination he/ she is mentally in a sound condition of health.condition of health.



SealSeal

DOMICILIARY TREATMENT DOMICILIARY TREATMENT CERTIFICATECERTIFICATE

EXAMINATIONEXAMINATION CHECKING & VARIFYING OF CHECKING & VARIFYING OF

DOCUMENTSDOCUMENTS XEROX COPIES OF THE DOCUMENTSXEROX COPIES OF THE DOCUMENTS SATISFY ABOUT SATISFY ABOUT

i. DIAGNOSISi. DIAGNOSIS

ii. TREATMENTii. TREATMENT

Format of CERTIFICATEFormat of CERTIFICATEThis to certify that I have examined Mr./Mrs. -------- This to certify that I have examined Mr./Mrs. --------

today. After going through the records of the today. After going through the records of the investigations, other records & the clinical investigations, other records & the clinical examination, I am of the opinion Mr./Mrs.------- is examination, I am of the opinion Mr./Mrs.------- is suffering from ------- . He/ She needs domiciliary suffering from ------- . He/ She needs domiciliary Treatment for this condition.Treatment for this condition.

At present, he/she is taking following At present, he/she is taking following medicines-------------.medicines-------------.

Drugs & doses may change as per the condition that Drugs & doses may change as per the condition that time. time.



LIFE CERTIFICATELIFE CERTIFICATE

Why is it required?Why is it required? Examination of the personExamination of the person Carbon CopyCarbon Copy

FORMATFORMAT

This to certify that, I have examined Mr. This to certify that, I have examined Mr. Mrs.-------- today. He/She is alive today on ------- at Mrs.-------- today. He/She is alive today on ------- at ----------a.m./p. m. ----------a.m./p. m.



CERTIFYING CERTIFYING LT. HAND THUMB IMPRESSIONLT. HAND THUMB IMPRESSION

Why is it Required?Why is it Required? To Known person onlyTo Known person only Taken on the Bank’s withdrawal Slip- filled in completelyTaken on the Bank’s withdrawal Slip- filled in completely Thumb Impression in Your PresenceThumb Impression in Your Presence Record in a Diary Record in a Diary FORMAT:FORMAT: Lt. Hand Thumb Impression of Mr./Mrs. ----------is taken in My Lt. Hand Thumb Impression of Mr./Mrs. ----------is taken in My

Presence. Presence.

Signature of DoctorSignature of Doctor Date-Date- Time- Time-

SealSeal

CERTIFICATE OF CERTIFICATE OF MEDICAL OPINIONMEDICAL OPINION

GIVEN IN CASE THE PATIENT IS REFERRED GIVEN IN CASE THE PATIENT IS REFERRED FOR MEDICAL OPINIONFOR MEDICAL OPINION..

Why is it required?Why is it required? Who is expected to do this Medical Who is expected to do this Medical

Examination?Examination? Examine the PatientExamine the Patient Check reports of the InvestigationsCheck reports of the Investigations Check other recordsCheck other records Reports- ConfidentialReports- Confidential No Doctor-Patient relationship establishedNo Doctor-Patient relationship established

FORMATFORMAT(1(1stst Page) Page)To,To, ------------,------------,Dear Sir,Dear Sir,

Mr./ Mrs. ------- attended my clinic Mr./ Mrs. ------- attended my clinic on-------- at --------a.m./ p.m. for the medical on-------- at --------a.m./ p.m. for the medical examination & opinion, as per your letter dated examination & opinion, as per your letter dated -------. His/ Her report is attached here with.-------. His/ Her report is attached here with.



FORMATFORMAT

22ndnd ( Page) ( Page)

Your Report ( Confidential)Your Report ( Confidential) Refer Textbooks/ Consultants in the Refer Textbooks/ Consultants in the

field, if in doubtfield, if in doubt Carbon CopyCarbon Copy

CERTIFICATE OF INJURYCERTIFICATE OF INJURY Supreme Court JudgmentSupreme Court Judgment Record all injuries SitesRecord all injuries Sites

TypeTypeLength etcLength etc

Do not Omit any injury/ See Back of the Do not Omit any injury/ See Back of the patient alsopatient also

Treat – First AidTreat – First Aid Record the Treatment GivenRecord the Treatment Given If asked to give a letter / Cert. mention all If asked to give a letter / Cert. mention all

injuriesinjuries

CERTIFICATE OF INJURYCERTIFICATE OF INJURY

Identification Marks of the PatientIdentification Marks of the Patient Signature/ Lt. Hand Thumb ImpressionSignature/ Lt. Hand Thumb Impression Case PaperCase Paper Record- Name address of the person bringing the Record- Name address of the person bringing the

patientpatient Refer to hospital if requiredRefer to hospital if required Take signature/ Lt. Hand thumb Impression of Take signature/ Lt. Hand thumb Impression of

the patient on the referral letterthe patient on the referral letter Put the Date and Time on the referral LetterPut the Date and Time on the referral Letter If Ref. to the Hospital on Phone : If Ref. to the Hospital on Phone : *Record Name of the Person with whom *Record Name of the Person with whom you talkedyou talked

*Time & Date*Time & Date

CERTIFICATE FOR L.I.C.POLICYCERTIFICATE FOR L.I.C.POLICY

SPECIFIC FORMS – L.I.C.SPECIFIC FORMS – L.I.C. NO DOCTOR-PATIENT RELATIONSHIPNO DOCTOR-PATIENT RELATIONSHIP

CERTIFICATE FOR CERTIFICATE FOR DRAWING MONEY FROMDRAWING MONEY FROM PROVIDENT FUNDPROVIDENT FUND

Only on Medical GroundOnly on Medical Ground Never issue False CertificateNever issue False Certificate Only in Legitimate CasesOnly in Legitimate Cases Mention a Provisional Diagnosis & expected Mention a Provisional Diagnosis & expected

Investigations and approximate cost of Investigations and approximate cost of Investigations & treatmentInvestigations & treatment

Identification Marks of the PatientIdentification Marks of the Patient Signature & Lt. Hand thumb impression of the Signature & Lt. Hand thumb impression of the

PatientPatient Doctor’s Signature with Date & TimeDoctor’s Signature with Date & Time Carbon CopyCarbon Copy

DEATH CERTIFICATEDEATH CERTIFICATE

Examine the person. See the back Examine the person. See the back side of the personside of the person

Confirm DeathConfirm Death Standard Forms supplied by P.M.C.Standard Forms supplied by P.M.C. Single CopySingle Copy Get necessary information from near Get necessary information from near

relative or responsible person in relative or responsible person in writingwriting


The dead person must be under care The dead person must be under care for at least 14 days prior to the for at least 14 days prior to the Death.Death.

Give the Certificate to near relative Give the Certificate to near relative or close person & take his signature.or close person & take his signature.

Do not Issue D.C. if the Death is due Do not Issue D.C. if the Death is due to unnatural case. Inform Police.to unnatural case. Inform Police.

No FeesNo Fees Xerox Copy of the Certificate Xerox Copy of the Certificate


REFUSE D.C. WHEN—REFUSE D.C. WHEN— M.L.C.M.L.C. Unknown PersonUnknown Person Person not under your CarePerson not under your Care Sudden death in a married lady, within 7 Sudden death in a married lady, within 7

years from the date of her marriageyears from the date of her marriage Death due to administration of Death due to administration of

Injection--- AnaphylaxisInjection--- Anaphylaxis

Certificates

Documents

hand thumb

hand thumb

mental fitness

referral letter

fitness cerificate

identification

provident

carbon copy