SICKNESS & FITNESS

CERTIFICATE
Introduction:
Objectives:
Rules:
1. Only RMP.
2. In prescribed format &
preferably on letterhead.
3. Issued to patient himself or legal
guardian.
4. Statements should be best of
his/her knowledge & based on
current clinical information.
5. Doctor should have complete
understanding & information of
patient’s employment
requirements.
6. Patient should be actually under
care of the concerned doctor for
the said period.
7. Doctor should preserve a copy of
the certificate issued & also
should maintain register.
8. Doctor can demand fees.
9. The certificate should pertain to
the illness that is actually
treated by the practitioner
10. Separate consent is not
necessary.
11. Two identification marks should
be mentioned in detail.
12. Any use of short forms or
abbreviations should be
avoided.
13. The expected duration in
number of days to be
mentioned in the sickness
certificate.
14. If the RMP is of the opinion
that any further increase in
duration of treatment is
anticipated, then such a
comment can be made.
15. The duration of illness in the
sickness certificate will be from
the date on which the patient
visited the doctor.
16. It’s a twin certificate. When
sickness certificate is issued,
fitness certificate must be
issued.
17. Doctor should not mix both
certificates.
18. Do not issue blank certificates.
19. Purpose of issuing sickness &
fitness certificate should be
asked.
LIABILITIES:
1. Issuing of a false certificate is
ethically wrong
2.
Sec. 197 IPC:
Whoever issues or signs any certificate
relating to any fact knowing or
believing that such certificate is false
in any material point, shall be
punished in the same manner as if, he
gave ‘false evidence’.
3. Issuing of false certificate by a
RMP may lead to penal erasure
of the name of the practitioner
from the medical register.
4. Physicians can be summoned as
witnesses in legal proceedings
5. Professional Secrecy.
PHYSICAL FITNESS
CERTIFICATE:
Introduction:
Objectives:
Rules:
1. Only RMP
2. Patient’s consent for
examination must.
3. Patient’s consent for disclosing
the information to third party is
must.
4. Doctor should have complete
understanding & accurate
information regarding patient’s
job requirement.
5. Doctor should limit himself to
the required information.
6. The authority of the third party
should be ascertained.
7. Some organizations have their
own format.
8. The post/ job/ course for which
the individual is being examined
should be enquired and
mentioned in detail.
9.
The RMP should obtain a thorough
personal, family, past history of any
illness, occupational history, perform a
thorough clinical examination and
advise necessary investigations as he
deems fit before issuing the certificate.
10.
If the RMP is of the opinion that
the individual is not fit for the said
assignment, he should clearly state
the reason for his such opinion in
unambiguous terms.
CONSENT:
Definition:
It is voluntary agreement,
permission or approval without
any compulsion, given freely,
willingly & truly.
Definition:
As per Section 13 of Indian
Contracts Act,
“ Two or more persons are said to
consent when they agree upon the
same thing in same sense.”
Medico legal importance:
1. Civil cases – contracts, marriage
etc.
2. Criminal cases – Rape,
abduction, kidnapping etc.
3. Medical practice – examination
& treatment of patient.
Types of Consent:
A] Implied consent
B] Expressed consent
1. Verbal
2. Written
Informed Consent:
Full Disclosure & Therapeutic
privilege:
Informed refusal:
Extension Doctrine:
Rules of Consent in medical
practice:
1. Expressed consent is not
necessary for each & every
medical examination.
2. Oral consent should be obtained
in front of a disinterested third
party.
3. Regarding written consent,
‘Blanket Consent’ is not valid.
4. Any procedure beyond routine
physical examination, requires
express consent.
5. Examination of an accused.
6. Examination of a victim
7. Section 87 IPC-
> 18 years – can give valid
consent to suffer any harm
8. Section 89 of IPC –
< 12 years can’t give valid consent.
9. Section 90 IPC –
Consent given under fear of
injury or misunderstandings of the
fact is not valid.
10. Section 92 IPC –
Any harm caused to the patient
in good faith even without his
consent is not an offence.
11. Inmates of the hostel-

LOCO PARENTIS
12. Compulsory operations/
vaccinations.
13. Prisoner
14. Consent for illegal act is not
valid.
15. Contraceptive sterilization
16. Abortion
17. Organ & body donation after
death
18. Insurance
19. Research
20. Clinical autopsy
21. Emergency situations
22. How long consent is valid
23. Can patients withdraw consent
during a procedure?
24. What should be done where a
patient’s relative asks the doctor
to withhold information from
the patient?
25. If a patient gives consent for
blood to be taken during an
examination, is it necessary to
specify what tests are to
be performed?
26. Are adults presumed to be
competent to give consent?
27. Where a patient lacks capacity
to consent to treatment and
has no relatives or friends who
should be consulted?
28. Can a patient who lacks
capacity be sterilised if the
health care team and relatives
agree it is necessary?
29. Who has parental
responsibility?
30. Advance decision
A 35 year old male patient named, Ramesh Ravindra
Bansode, resident of Vadgaon(Bk), Pune, working as a
clerk in Collector Office, Pune attended Medicine O.P.D.
of Smt. Kashibai Navale Medical College & General
Hospital, Pune with complaints of fever with chills &
rigor since last one day. His blood was preserved for lab
investigations.
Prepare sickness & fitness certificate. (Other necessary
data should be written hypothetically.)
A 32 year old male patient named, Muralidhar Subhash
Mahajan, resident of Narhe, Pune, working as a
Teacher in Springdale School, Pune attended Medicine
O.P.D. of Smt. Kashibai Navale Medical College &
General Hospital, Pune with complaints of fever,
headache, backache, diarrohea, pain in abdomen, loss
of appetite since last two days. His blood was
preserved for lab investigations.
Prepare sickness & fitness certificate. (Other necessary
data should be written hypothetically.)