FORM OF CERTIFICATE RECOMMENDED FOR LEAVE OR EXTENSION OR COMMUNICATION OF LEAVE AND FOR FITNESS.
Signature of patient
or thumb impression ___________________________________________
To be filled in by the applicant in the presence of the Government Medical Attendant, or Medical Practitioner.
Identification marks: -
_____________
_____________
I, Dr. _____________________________________ after careful examination of the case certify hereby that _______________whose signature is given above is suffering from ________________ and I consider that a period of absence from duty of ____________________ with effect from ______________________________ is absolutely necessary for the restoration of his health.
I, Dr. ______________________after careful examination of the case certify hereby that ______________________ on restoration of health is now fit to join service.
Place_______________ Signature of Medical attendant.
Date ________________ Registration No._______________________
(Medical Council of India/State
Medical Council of ………….State)
Note:- The nature and probable duration of the illness should also be specified . This certificate must be accompanied by a brief resume of the case giving the nature of the illness, its symptoms, causes and duration.
FORM OF CERTIFICATE RECOMMENDED FOR LEAVE OR EXTENSION OR COMMUNICATION OF LEAVE AND FOR FITNESS.
Signature of patient
or thumb impression ___________________________________________
To be filled in by the applicant in the presence of the Government Medical Attendant, or Medical Practitioner.
Identification marks: -
_____________
_____________
I, Dr. _____________________________________ after careful examination of the case certify hereby that _______________whose signature is given above is suffering from ________________ and I consider that a period of absence from duty of ____________________ with effect from ______________________________ is absolutely necessary for the restoration of his health.
I, Dr. ______________________after careful examination of the case certify hereby that ______________________ on restoration of health is now fit to join service.
Place_______________ Signature of Medical attendant.
Date ________________ Registration No._______________________
(Medical Council of India/State
Medical Council of ………….State)
Note:- The nature and probable duration of the illness should also be specified . This certificate must be accompanied by a brief resume of the case giving the nature of the illness, its symptoms, causes and duration.
