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Sick leave certificate format

A sick leave format records that a clinician assessed you and found your health affects your ability to work or study for a period. It is the most common type people search for. The preview labels the fitness statement, the advice box and the period covered.

Annotated preview

Notes
Medical certificate for sick leavePatient[Patient name]Date of assessment[Date of assessment]Condition[Condition]Fitness statement[Fitness statement]Period covered[Period covered]Advice or comments[Advice or comments]Follow up[Follow up]Date of issue[Date of issue]Issuer detailsIssuer details appear here on a real certificateSAMPLE. NOT A VALID MEDICAL CERTIFICATE · SAMPLE. NOT A VALID MEDICAL CERTIFICATESAMPLE. NOT A VALID MEDICAL CERTIFICATE · SAMPLE. NOT A VALID MEDICAL CERTIFICATESAMPLE. NOT A VALID MEDICAL CERTIFICATE · SAMPLE. NOT A VALID MEDICAL CERTIFICATESAMPLE. NOT A VALID MEDICAL CERTIFICATE · SAMPLE. NOT A VALID MEDICAL CERTIFICATESAMPLE. NOT A VALID MEDICAL CERTIFICATE · SAMPLE. NOT A VALID MEDICAL CERTIFICATESAMPLE. NOT A VALID MEDICAL CERTIFICATE · SAMPLE. NOT A VALID MEDICAL CERTIFICATESAMPLE. NOT A VALID MEDICAL CERTIFICATE · SAMPLE. NOT A VALID MEDICAL CERTIFICATESAMPLE. NOT A VALID MEDICAL CERTIFICATE · SAMPLE. NOT A VALID MEDICAL CERTIFICATESAMPLE. NOT A VALID MEDICAL CERTIFICATE · SAMPLE. NOT A VALID MEDICAL CERTIFICATESAMPLE. NOT A VALID MEDICAL CERTIFICATE

Sample sick leave certificate format, watermarked SAMPLE. NOT A VALID MEDICAL CERTIFICATE, with 9 numbered fields explained in the notes and in the field table.

Field notes9 fields

1 Patient identity

What it means: Usually a name and sometimes a date of birth.

Why it is there: This links the certificate to one person.

2 Date of assessment

What it means: When the clinician actually assessed you.

Why it is there: The opinion rests on that assessment. It can differ from the date the certificate was written.

3 Condition or reason

What it means: The health problem, in words the reader can act on.

Why it is there: It explains why your fitness is affected. Some forms allow a less specific description to protect the patient.

4 Fitness statement

What it means: The core opinion. For work, it might be "not fit for work" or "may be fit for work" with changes.

Why it is there: It is the clinician's conclusion, the part the reader acts on.

5 Period covered

What it means: The dates the opinion applies to.

Why it is there: It tells the reader how long the opinion lasts. In the UK, the maximum is 3 months during the first 6 months of a condition.

6 Advice or comments

What it means: What the person can do, or what changes would help.

Why it is there: It helps the employer plan changes. On a UK fit note these comments are mandatory when "may be fit for work" is ticked.

7 Follow up

What it means: Whether the clinician needs to see you again before the end date.

Why it is there: It tells the reader whether to expect a further certificate.

8 Date of issue

What it means: When the certificate was produced.

Why it is there: The assessment date, issue date and period covered should form a logical order.

9 Issuer details

What it means: On a real certificate, the name, profession and practice address of the person who issued it, plus a signature or an equivalent digital authorisation.

Why it is there: These details make a certificate genuine. Official UK guidance says a fit note without the issuer's name, profession and practice address is not valid.

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What does each field mean?

Sick leave certificate format: field glossary
FieldWhat it meansWhy it is thereUK fit note
1 Patient identityUsually a name and sometimes a date of birth.This links the certificate to one person.Not a numbered box
2 Date of assessmentWhen the clinician actually assessed you.The opinion rests on that assessment. It can differ from the date the certificate was written.Box 1
3 Condition or reasonThe health problem, in words the reader can act on.It explains why your fitness is affected. Some forms allow a less specific description to protect the patient.Box 2
4 Fitness statementThe core opinion. For work, it might be "not fit for work" or "may be fit for work" with changes.It is the clinician's conclusion, the part the reader acts on.Box 3
5 Period coveredThe dates the opinion applies to.It tells the reader how long the opinion lasts. In the UK, the maximum is 3 months during the first 6 months of a condition.Box 5
6 Advice or commentsWhat the person can do, or what changes would help.It helps the employer plan changes. On a UK fit note these comments are mandatory when "may be fit for work" is ticked.Box 4
7 Follow upWhether the clinician needs to see you again before the end date.It tells the reader whether to expect a further certificate.Box 6
8 Date of issueWhen the certificate was produced.The assessment date, issue date and period covered should form a logical order.Box 9
9 Issuer detailsOn a real certificate, the name, profession and practice address of the person who issued it, plus a signature or an equivalent digital authorisation.These details make a certificate genuine. Official UK guidance says a fit note without the issuer's name, profession and practice address is not valid.Boxes 7, 8, 9 and 10

Format version 1. Last checked .

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What else should you know about this format?

In the UK, the period box has a maximum of 3 months during the first 6 months of a condition.

In Ireland, a GP issues a "Certificate of incapacity for work" for an Illness Benefit claim. Citizens Information says some GPs can complete it online. The doctor must mark the last certificate as final before you return to work.

For statutory sick pay in Ireland, Citizens Information says you must be certified by a medical practitioner as unable to work.

This page is general information about certificate layouts. It is not medical or legal advice and does not replace a clinician's assessment or the official rules of your country, employer, school, airline or consulate.

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