All India Institute of Medical Sciences Raebareli
Munshiganj, Raebareli - 229405, UP, India
No: - Dated:-
Medical Certificate
This is to certify that Shri/Smt………………..………..…………………... Whose Signature is
given below is/was Suffering from……………………….………………and is/was undergoing
treatment in this hospital and I consider that a period of absence from duty
of………………………. days w.e.f……………..……..…………to……………..……………..….is
absolutely necessary for the restoration of his/her health.
…………………………………..
Signature of the patient/Left thumb impression.
Signature with stamp
Doctor's full Name-
Designation-
Department-
All India Institute of Medical Sciences Raebareli
Munshiganj, Raebareli - 229405, UP, India
No: - Dated:-
Form of Fitness to Return to duty
I Dr………………………………….……….…do hereby Certify that I have carefully
examined Shri/Smt. …..………………………………………………………………..………of
……………………………………..….Ministry/office whose Signature is given
below and find that he/she has recovered from his/her illness and is
now fit to resume duties in his/her office (I also certify that before
arriving at this decision, I have examined that original Medical
Certificate(s) and statement(s) of the care (or certified Copies thereof)
on which leave was granted or extended and taken there into
consideration in arriving at my decision.)
Date: -
…………………………………..
Patient Signature /Left thumb impression Signature with
stamp
Doctor's full Name-
Designation-
Department-