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This document is used by employees in the State of Connecticut to request family leave to care for a family member with a serious health condition. It includes information to be filled out by a physician
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How to fill out Medical Certificate

01
Start by obtaining a blank medical certificate form from a medical professional or authorized source.
02
Fill in the patient's name, date of birth, and other identifying information at the top of the form.
03
Include the date of the examination.
04
Indicate the reason for the medical examination, such as illness or injury.
05
The physician should provide a diagnosis, if applicable, detailing any medical conditions.
06
State any medical treatments or recommendations if necessary.
07
Fill in the duration of time the patient needs to recover or the period they are unable to work, if required.
08
The physician should then sign the certificate and include their medical license number and contact information.
09
Make a copy for your records before giving the original to the patient.

Who needs Medical Certificate?

01
Individuals who are ill or injured and require documentation for work or school.
02
Employees needing to provide proof of medical leave to their employers.
03
Students who are required to submit a medical certificate for absence due to illness.
04
Athletes needing to confirm fitness to participate in sports activities.
05
Individuals applying for insurance claims that require proof of medical conditions.
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What is the purpose of issuing a medical certificate? A medical certificate is certified documentation of an individual's health status. It certifies illness or injury, assisting individuals in obtaining leave from work or school. It can also confirm recovery, allowing you to continue your job or hobbies.
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A Medical Certificate is an official document issued by a qualified medical professional that confirms a person's health status, medical condition, or fitness for a specific activity.
Individuals may be required to file a Medical Certificate for various reasons, including employees needing to provide proof of illness for sick leave, students requiring documentation for school attendance, or athletes needing clearance for participation in sports.
To fill out a Medical Certificate, a medical professional must include patient details, diagnosis, date of examination, recommended restrictions or limitations, and their signature along with relevant medical credentials.
The purpose of a Medical Certificate is to provide legal proof of an individual's health status or medical condition, which can be used for employment, educational, or legal purposes.
A Medical Certificate must report the patient's name, date of birth, date of examination, medical findings, the diagnosis, any required treatment or recommendations, and the issuing doctor's name and credentials.
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