Code of Ethics Regulations, 2002

APPENDIX – 2

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:-

1. __________________________
   
2. __________________________

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.

Chapter 1, Chapter 2, Chapter 3, Chapter 4, Chapter 5, Chapter 6, Chapter 7, Chapter 8,
Appendix 1, Appendix 2, Appendix 3, Appendix 4