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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
FITNESS CERIFICATEFITNESS CERIFICATE
Record Your Observation of Medical Record Your Observation of Medical ExaminationExamination
Keep a Carbon CopyKeep a Carbon Copy
FITNESS CERIFICATEFITNESS CERIFICATE
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.
Identification marks-(i) -------Identification marks-(i) ------- (ii)------- (ii)-------
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.
Identification marks-(i) -------Identification marks-(i) ------- (ii)------- (ii)-------
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
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.
Identification marks-(i) -------Identification marks-(i) ------- (ii)------- (ii)-------
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-
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.
Identification marks-(i) -------Identification marks-(i) ------- (ii)------- (ii)-------
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-
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.
Identification marks-(i) -------Identification marks-(i) ------- (ii)------- (ii)-------
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-
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
DEATH CERTIFICATEDEATH CERTIFICATE
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
DEATH CERTIFICATEDEATH 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