Medical Certificate Sample — A Guide on Format Templates You May Follow

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.

Medical Certificate Sample
Photo Credit: Rev

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.

Medical Certificate Sample Format
Photo Credit: Pexels

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 _____________
______ City, (Province)



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


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


Date: ___________


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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