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General Practitioner Template

First Certificate of Capacity

A professional General Practitioner template for healthcare professionals.
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About this template

Need a clear and concise way to document a worker's capacity for work? This First Certificate of Capacity template is perfect for General Practitioners. It helps you record essential details like the date of assessment, job title, injury details, and work restrictions. This template, when used with Heidi, ensures all necessary information is captured accurately and efficiently, streamlining the process of creating medical documentation. This template is ideal for GPs assessing a patient's ability to return to work after an injury or illness, ensuring compliance with workplace health and safety regulations.

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**First Certificate of Capacity** **Date of Assessment:** 01/11/2024 **Job Title:** Construction worker **Roster:** Monday to Friday, 8 am to 4 pm **During R&R:** The worker reported resting at home and avoiding any strenuous activities. **DOI (Date of Injury):** 20/10/2024 **MOI (Mechanism of Injury):** The worker sustained a lower back injury while lifting a heavy object on the construction site. **PMHx (Past Medical History):** * Nil known **Medications:** * Ibuprofen 400mg as needed for pain **Allergies:** * No known allergies **Previous Injuries:** * Nil known **Current Symptoms/Treatment:** The worker is experiencing lower back pain, which is exacerbated by movement. He has been using over-the-counter pain relief and applying heat packs. He has been advised to rest and avoid heavy lifting. **Medical Assessment:** **Examination:** On examination, there was tenderness to palpation in the lumbar region. Range of motion was limited due to pain. No neurological deficits were noted. **Diagnosis:** Acute lower back strain. **Work Capacity:** **Plan with Work Restrictions:** Some capacity for work. * Avoid heavy lifting (over 5kg). * Avoid prolonged sitting or standing. * Frequent breaks to change position. **Injury Management Plan:** * Continue with over-the-counter pain relief as needed. * Apply heat packs to the affected area. * Follow-up appointment in two weeks. * Referral to a physiotherapist for further assessment and management.
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Specialty

General Practitioner

Used

7 times

Type

Note

Last edited

23/10/2025

Created by

Dr M Moeen Ahmed

Heidi AI

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