Free tool
Medical certificate format for sick leave. The Appendix 2 form, on your letterhead.
Free medical certificate maker for doctors in India, built on Appendix 2 of the 2002 ethics regulations: identification marks, patient signature, period of absence, registration number. Print or save as PDF.
Certificate
Patient
Illness and leave
Clinic
Logo
PNG or JPG. Stays in this browser.
Doctor
Layout
Everything you type stays in this browser. Nothing is uploaded to Vitels. In the print window choose “Save as PDF” for a file.
Clinic name
Dr. Name
Medical certificate
Sl. No. Date
Identification marks of the patient
1.
2.
I, , after careful examination of the case, certify hereby that , , of , whose signature is given above, is suffering from and I consider that a period of absence from duty of with effect from to is absolutely necessary for the restoration of his / her health.
Nature and probable duration of the illness:
Place
Date
Issued under the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, clause 1.3.3 and Appendix 2. A copy is kept and the certificate is entered in the Register of Medical Certificates at the serial number above.
Preview at reduced size. Prints at full A4.
What the rules say
What the regulations ask for on a medical certificate
The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 treat a certificate as a legal document and say what it must carry.
A recommended form exists
Clause 1.3.3 says the medical certificate shall be prepared as in Appendix 2 of the regulations: the form of certificate recommended for leave, extension or commutation of leave, and for fitness. This tool follows that wording.
2002 Regulations, clause 1.3.3 and Appendix 2
Signature, address and an identification mark
The practitioner shall not omit to record the signature and/or thumb mark, address and at least one identification mark of the patient on the certificate. The form asks for the patient to sign in the practitioner's presence.
2002 Regulations, clause 1.3.3
Keep a copy and a register
A registered medical practitioner shall maintain a Register of Medical Certificates giving full details of certificates issued, and shall keep a copy of each certificate. The serial number on this form is the register entry.
2002 Regulations, clause 1.3.3
Registration number on the certificate
Every physician shall display the registration number accorded by the State Medical Council or the Medical Council of India on all prescriptions, certificates and money receipts given to patients.
2002 Regulations, clause 1.4.1
Nature and probable duration
The note under Appendix 2 says the nature and probable duration of the illness should also be specified, and that the certificate must be accompanied by a brief résumé of the case: nature, symptoms, causes and duration.
2002 Regulations, Appendix 2, note
An untrue certificate can cost the registration
Any registered practitioner shown to have signed or given a certificate, notification, report or document that is untrue, misleading or improper is liable to have their name deleted from the Register.
2002 Regulations, clause 7.7
What a complete sick leave certificate carries
Appendix 2 plus the register requirements in clause 1.3.3, in the order they appear on the printed form.
- Serial number from the Register of Medical Certificates
- Date and place of issue
- Patient's name, age, sex and address
- Signature or thumb impression of the patient, taken in your presence
- At least one identification mark; the form has space for two
- What the patient is suffering from, in plain words
- Period of absence from duty, with the start and end dates
- The statement that the absence is absolutely necessary for the restoration of health
- Nature and probable duration of the illness, as the Appendix 2 note asks
- Your name, qualifications, registration number and council
- Your signature
- A copy filed and the register entry made
The register, kept for you
Vitels keeps every patient's visits, prescriptions and receipts in one record with the registration number on every print. Certificates on the clinic letterhead are on the roadmap; the letterhead, history and printing are live today.
Questions
Straight answers
01Who can issue a medical certificate in India?
A registered medical practitioner: a doctor whose name is on a State Medical Register or the Indian Medical Register, now maintained by the National Medical Commission. Some employers and institutions require a government medical officer or a specific form; when they do, their rule applies on top of the regulations.
02Is there a fixed format for a sick leave certificate?
The 2002 regulations recommend the Appendix 2 form and require the contents listed above. Central and state government employees are usually asked for their employer's own form under the leave rules, so when an employee brings a form, fill that one and keep a copy.
03Must the patient sign the certificate?
Clause 1.3.3 says the practitioner shall not omit to record the signature and/or thumb mark, address and at least one identification mark of the patient. Appendix 2 has the signature taken at the top, in the presence of the practitioner.
04Do I have to write the diagnosis?
Appendix 2 asks what the patient is suffering from, and the note asks for the nature and probable duration of the illness. The regulations do not provide for leaving it blank. Write it in words the employer can read without a medical dictionary.
05How long should I keep the copy?
Clause 1.3.3 requires a copy and a register entry but fixes no period for certificates. Clause 1.3.1 fixes three years for indoor patient records. The regulations give no shorter period for certificates.
06Can I type the certificate instead of writing it by hand?
Nothing in the 2002 regulations requires handwriting. The certificate needs your signature, the patient's signature or thumb impression, and the contents in clause 1.3.3. Print this form, sign it, and have the patient sign it.
07Does the tool store patient details?
Only in this browser, so an interrupted form is not lost. Nothing is sent to Vitels. Use Clear after printing if the device is shared.
This page summarises the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 as amended. It is general information for registered practitioners, not legal advice. Employers, courts and state medical councils may ask for more.
Keep going
Related tools and pages
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- Prescription pad makerYour letterhead with the registration number and a generic-name medicine table.Open
- Security and privacyHow Vitels isolates clinic records and who can and cannot see them.Open
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