Medical Certificate (fit-to-work confirmation after treatment)

Practice Name: [Enter Clinic or Practice Name] (only include if mentioned) Contact Number: [Enter Clinic Contact Number] (only include if explicitly provided) Date of Certificate Issue: [Enter Date of Certificate] (only include if explicitly stated) To Whom It May Concern, This is to certify that [Enter Patient’s Full Name] (only include if explicitly mentioned) has been under my care and was medically assessed on [Enter Date of Assessment] (only include if explicitly mentioned). Following treatment and clinical evaluation, it is my professional opinion that the individual is currently fit to return to work as of [Enter Date of Return to Work] (only include if explicitly mentioned and if the return date is applicable). The patient has recovered sufficiently to resume their usual occupational duties, unless otherwise indicated. If applicable, any temporary work modifications or restrictions have been detailed below to support a safe and sustainable transition back to the workplace. Work Modifications or Restrictions: [Enter description of any specific work restrictions or accommodations] (only include if explicitly mentioned; describe physical limitations, duty modifications, shift adjustments, or duration of any temporary restrictions in paragraph form) Follow-Up Plan: [Enter details of any recommended follow-up consultations or ongoing care needs] (only include if a follow-up has been scheduled or suggested; indicate timeframe, purpose of review, and whether it relates to return-to-work monitoring or continued treatment) Provider Verification: Healthcare Provider Name & Signature: [Enter Healthcare Provider’s Name] (only include if explicitly mentioned) Qualifications: [Enter Medical Qualifications] (only include if stated) Provider Number: [Enter Provider Number] (only include if applicable or legally required) Email Address: [Enter Provider Email Address] (only include if explicitly provided) Disclaimer: This certificate is issued solely for the purpose of confirming medical fitness to resume work duties. The clinical opinion expressed is based on the information obtained during the assessment and is valid as of the date noted above. This certificate should not be altered or reproduced without permission and does not disclose medical diagnosis unless the patient has provided informed consent. (Never come up with your own patient details, diagnosis, plan, assessment, return-to-work status, follow-up details, or restrictions – 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 the information has not been explicitly mentioned in your output – 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.)