Here’s A Medical Certificate Sample You May Use as Guide
MEDICAL CERTIFICATE SAMPLE – Here is a guide on the format templates that you may follow in writing a Medical Certificate.
Most schools and companies require a medical certificate from students or employees who were absent from their school or work for a check-up. It is often the requirement so one could be excused from his/her work or class.
Often times, the Medical Certificate is issued along with an additional fee. Even city health centers issue it but on a strict basis that the patient really went for a medical check-up.
In the case of doctors and doctors’ secretaries who have to draft the said certificate, you may refer to a medical certificate sample in drafting one. You can check on the sample formats below.
Here are three (3) formats that you may choose from. The important details that must be reflected on the certificate includes the name of the patient, his/her address, the date of check-up, and the diagnosis.
Sample #1
Republic of the Philippines
Province of _____________
MUNICIPAL HEALTH UNIT
______ City, (Province)
MEDICAL CERTIFICATE
___(Date)____
To whom it may concern,
This is to certify that ____(name of patient)____ of ______(address of patient)______ was examined and treated at the Municipal Health Office on (date of check-up) with the following diagnoses:
__________________(In this part, write the diagnosis of the patient)___________ and would need medical attention for ___(number of days)____ days barring complication.
_________________________
(Attending Physician)
Sample #2
MEDICAL CERTIFICATE
I, the undersigned Dr. __________________, Doctor of Medicine, certify that the examination of _____(name of patient)_____ on ___(date of check-up)____.
Diagnosis: (Write the diagnosis of the patient)
_____(name of patient)_____ is able to return to work / school on ______________.
Restrictions/Limitations: (Write the restrictions for the patient based on the diagnosis)
_________________________
(Attending Physician)
Sample #3
MEDICAL CERTIFICATE
Date: ___________
TO WHOMSOEVER IT MAY CONCERN
This is to certify that Mr/Mrs. ________________________________
Male/Female ______ Age ___, residing at _____________________
was under my treatment since _____________________________.
The patient is suffering from __________________. He/She is/was
adviced treatment or rest for this period ____________________
_________________________
(Attending Physician)
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