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Medical Sick Certificate Template for England and Wales

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Key Requirements PROMPT example:

Medical Sick Certificate

"I need a Medical Sick Certificate for an employee who has been diagnosed with stress-related illness, requiring a phased return to work over three months starting from January 2025, with specific workplace adjustments to be detailed in the certificate."

Document background
A Medical Sick Certificate (commonly known as a 'Fit Note' in the UK) is required when an employee needs to provide formal evidence of their medical condition to their employer. Operating under the jurisdiction of England and Wales, this document is essential for statutory sick pay claims after seven days of illness. The certificate must include specific information about the patient's condition, working capacity, and recommended duration of absence, while adhering to data protection requirements and medical confidentiality standards.
Suggested Sections

1. Patient Details: Full name, date of birth, NHS number, address and other identifying information of the patient

2. Medical Practitioner Details: Name, GMC number, practice details and contact information of the certifying medical professional

3. Condition Assessment: Nature of illness/condition (within confidentiality limits) and its impact on work capability

4. Duration of Incapacity: Specific period for which the patient is certified as unfit for work or requires workplace adjustments

5. Certification: Date of assessment, doctor's signature, and official practice stamp

Optional Sections

1. Work Recommendations: Specific suggestions for workplace adjustments or modified duties, used when patient may return to work with modifications

2. Referral Information: Details of any specialist referrals or ongoing treatment plans, included when relevant to work capacity

3. Follow-up Requirements: Information about necessary follow-up appointments or reassessment schedule

Suggested Schedules

1. Additional Medical Evidence: Supporting documentation from specialists or test results that substantiate the certification

2. Workplace Assessment Report: Detailed evaluation and recommendations for workplace modifications or accommodations

3. Treatment Plan: Detailed schedule of planned treatments or interventions that may affect work capacity

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok³ÉÈ˰æ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions




















Clauses













Industries

Medical Act 1983: Primary legislation governing medical practitioners and their responsibilities in issuing medical certificates

Health and Social Care Act 2012: Framework legislation for healthcare delivery and documentation in England and Wales

Equality Act 2010: Legislation protecting against disability discrimination and requiring reasonable adjustments in medical documentation

Data Protection Act 2018 and UK GDPR: Regulations governing the handling and protection of personal medical data in certificates

GMC Guidance on Medical Certificates: Professional guidelines from the General Medical Council on proper documentation and certification practices

Social Security (Medical Evidence) Regulations 1976: Regulations specifying requirements for medical evidence in social security claims

Social Security (Medical Evidence) Amendment Regulations 2010: Updated regulations on medical evidence requirements for social security purposes

Statutory Sick Pay (Medical Evidence) Regulations 1985: Specific requirements for medical evidence supporting statutory sick pay claims

Social Security Contributions and Benefits Act 1992: Framework legislation for sick pay and medical evidence requirements

DWP Fit Note Guidance: Department for Work and Pensions guidelines on completing fit notes and medical certificates

NHS Guidelines on Medical Certification: National Health Service standards and procedures for issuing medical certificates

Clinical Record Keeping Standards: Professional standards for maintaining accurate and complete medical records and certificates

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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