Medical Certificate (for sick leave of employee)

Practice Name: [Enter Practice or Clinic Name] (only include if explicitly mentioned) Contact Number: [Enter Contact Number] (only include if explicitly provided) Date of Certificate Issue: [Enter Date of Issue] (only include if explicitly mentioned) To Whom It May Concern, This is to certify that [Enter Patient’s Full Name] (only include if explicitly mentioned) attended a medical consultation at this practice on [Enter Date of Assessment] (only include if explicitly mentioned). After thorough clinical evaluation, it is my professional opinion that the patient is unwell due to an acute medical condition and is currently not fit to attend work or engage in regular occupational duties. The period of medical leave recommended spans from [Enter Start Date of Leave] to [Enter End Date of Leave] (only include if leave dates are explicitly provided; ensure this reflects the duration needed for adequate rest and recovery based on the presenting condition). This recommendation is based solely on clinical findings and is provided to support the patient’s recovery and prevent worsening of their current health status. Nature of Illness (if consented): [Enter general description of illness only if the patient has given explicit consent to disclose] (only include if permission has been granted; otherwise omit this paragraph entirely to preserve patient confidentiality. If included, write in full sentences using general non-specific terms unless a more specific diagnosis has been shared with consent.) Additional Notes or Considerations: [Enter any additional remarks that may be clinically relevant to the employer or the patient's return, such as the need for gradual reintroduction to work, recommendation for light duties, or referral for further treatment] (only include if relevant and explicitly mentioned. Write this section in full sentences.) Provider Verification: Healthcare Provider Name & Signature: [Enter Provider’s Full Name] (only include if explicitly mentioned) Qualifications: [Enter Medical Qualifications] (only include if explicitly mentioned) Provider Number: [Enter Provider Number] (only include if applicable or required for documentation) Email Address: [Enter Provider Email] (only include if explicitly provided) Disclaimer: This certificate is issued for the purpose of verifying a medical condition that renders the individual temporarily unfit for work. It is based on clinical judgment at the time of examination. Reproduction or modification of this document without authorisation is not permitted. Disclosure of the specific nature of the illness is subject to patient consent and may be withheld. (Never come up with your own patient details, diagnosis, medical history, or return-to-work plan – use only the transcript, contextual notes, or clinical note as a reference for the information included in your note. If any information related to a placeholder has not been explicitly mentioned in the transcript, contextual notes, or clinical note, you must not state that the information has not been mentioned – just leave the relevant placeholder or omit the paragraph completely. Use one paragraph per section and write in full sentences unless otherwise structured in the original note.)