Professional Documents
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MEDICAL CERTIFICATE
This is to certify that Sri/Smt/Kumari/Master……………………………………………………………………
……………………………………………………………………………………………………………………………………………………………
(Name&Address)aged……… is completely bedridden due to
……………………………………………………………………………………………(Name of disease), hence needs a fulltime
caregiver/ is 100% blind hence needs a full time caregiver/ is moderately/ severely mentally challenged,
hence needs a full time caregiver/ suffering from Cerebral Palsy /Autism, hence needs a full time caregiver/
suffering from severe mental illness (Schizophrenia/ Severe Mood disorder) hence needs a full time caregiver.
Strike out which is not applicable.
Identification marks of the Patient
Signature:
Name & Designation of the Doctor……………………………………..
Registration No:
Name of the Hospital
Office Seal
Place:
Date:
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(Designation Seal)
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