PPS Claim for Sickness Benefit Covid-19

PPS Claim for Sickness Benefit Covid-19 Patient Details: Name: John Smith Date of Birth: 15/03/1985 PPS Number: 1234567AB Address: 123 Main Street, Dublin 1, Ireland Contact Number: 087 123 4567 Medical Practitioner Details: Name: Dr. Eleanor Vance Medical Council Registration Number: 12345 Address: Elmwood Medical Centre, 45 Oak Avenue, Dublin 7, Ireland Contact Number: 01 876 5432 Declaration of Medical Practitioner: I, Dr. Eleanor Vance, confirm that I have personally examined the above-named patient. Diagnosis: COVID-19 (ICD-10 code: U07.1) Date of first symptoms: 28/10/2024 Date patient became unfit for work: 29/10/2024 Expected date patient will be fit for work: 08/11/2024 Patient was advised to self-isolate due to positive COVID-19 test result and symptomatic presentation. Symptoms included fever, cough, fatigue, and loss of taste/smell. Patient advised to rest, hydrate, and monitor symptoms. No hospitalisation required. Patient is recovering well and is expected to return to work on the specified date. Date of Examination: 01/11/2024 Signature of Medical Practitioner: (electronic signature) Dr. Eleanor Vance Official Stamp/Seal of Medical Practitioner (if applicable): (Image of practice stamp)