Professional Documents
Culture Documents
BEGUMPET
Name - ________________________________
BONAFIDE CERTIFICATE
Registration No.______________________________
SICK CERTIFICATE
I, ............................................................................................................... after careful personal
examination of the case hereby certify that Shri / Smt. / Kumari
………………………………….
…………………………………………………, is suffering from and I consider that a period
of absence from duty of ………………….. day (s) with effect from is absolutely necessary
for the restoration of his / her health.
……………………………………………………………………………………………………..
MEDICAL CERTIFICATE O F F I T N E S S F O R
RETURN TO DUTY
I .................................................................................................... member of Medical Board /
Civil Surgeon / Staff Surgeon / Authorized Medical Attendant / Registered Medical
Practitioner of………………………………………………… Hereby certify that I / We have
carefully examined Shri / Smt. / Kumari ………………………………………………………
whose signature is given above and found that he / she has recovered from his / her illness
and now fit to resume duties. I / We also certify that before arriving at this decision, I / we
have examined the original medical certificate (s) and statement (s) of the case (or certified
copies thereof) on which leave was granted or extended.
Members of the Medical Board / Civil Surgeon /
Staff Surgeon / Authorised Medical Attendant /
Dated………………... Registered Medical Practitioner
SIGNATURE
NAME -
AGE -
SEX -
ADRESS -
DISCHARGE SUMMARY
Name of Patient:
Tel No. Mobile No.
IPD No. Admission No.
Treating Consultant/s Name, contact
numbers
and Department/Specialty
Date of Admission Time of
Admission
Date of Discharge Time of
Discharge
MLC No. / FIR No.
Provisional Diagnosis at the time of Admission
Final Diagnosis at the time of Discharge
ICD-10 code(s) or any other codes, as
recommended by the Authority, for Final
diagnosis
Presenting Complaints with Duration and
Reason for Admission
Summary of Presenting Illness
Key findings, on physical examination at the
time of admission
History of alcoholism, tobacco or substance
abuse if any
Significant Past Medical and Surgical History, if
any
Family History if significant/relevant to
diagnosis or treatment
Summary of key investigations during
Hospitalization
Course in the Hospital including complications,
if any
Advice on Discharge
Name of treating Signature of
Consultant/ treating
Authorized Team Consultant/
Doctor Authorized
Team Doctor
Name of Patient / Signature of
Attendant Patient /
Attendant
Total: Rs_________________
Signature