General Practitioner Template
PPS Claim for Sickness Benefit Declaration
A professional General Practitioner template for healthcare professionals.
About this template
Streamline your administrative tasks with our "PPS Claim for Sickness Benefit Declaration" template, perfect for general practitioners. This essential form simplifies the process of certifying a patient's inability to work due to illness, a common requirement for insurance claims and sickness benefits. Designed to capture all necessary details efficiently, including dates of disability and return-to-work recommendations, it ensures accurate and complete documentation. When used with Heidi, our AI medical scribe, this template will intelligently populate key information directly from your patient consultations, drastically reducing manual data entry and freeing up valuable time for patient care. Optimise your practice's workflow with this indispensable GP medical certificate.
Preview template
PPS Claim for Sickness Benefit Declaration
Declaration for Sickness Benefit:
1. I, Dr. Emily Clarke, confirm that I saw [Patient's Full Name]: Mr. John Smith on [Date of Visit]: 1 November 2024.
2. The patient's condition for which a claim is being submitted for sickness benefit is [Condition for which claim is being submitted]: Acute bronchitis.
3. The patient has been continuously disabled by this condition and unable to work from [Date condition began]: 28 October 2024 to [Date condition ended or is expected to end]: 15 November 2024.
4. I have advised the patient that they should not work during this period.
5. The patient can return to work on [Date patient can return to work]: 16 November 2024.
6. I further declare that all the information provided above is true and correct to the best of my knowledge and belief.
7. Doctor's Full Name: Dr. Emily Clarke
8. Practice Number: 1234567
9. Contact Number: 020 7946 0000
10. Date of Completion: 1 November 2024
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Specialty
General Practitioner
Used
15 times
Type
Form Template
Last edited
1/22/2026
Created by
Heidi Team