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FORM : 4 [See Rule 19] MEDICAL CERTIFICATE FOR LEAVE OR EXTENSION OF LEAVE OR COMMUTATION OF LEAVE & FORM : 5 [See Rule 24 (3)] MEDICAL CERTIFICATE OF FITNESS TO RETURN TO DUTY...
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FORM 5
MEDICAL CERTIFICATE OF FITNESS TO RETURN TO DUTY
Signature of the Govt. servant ……………………………………………………………..
I, Dr. …………………………………….……………...…… do hereby certify that I have
carefully examined Sh./Smt./Km. ………………….………………………………………
whose signature is given above, and find that he/she recovered from his/her illness and is
now fit to resume duties in Govt. Service. I also certify that before arriving at this
decision I have examined the original medical certificate (s) and statement (s) of the case
(or certified copies thereof) on which leave was granted or extended and have taken these
into consideration in arriving at my decision.
Civil Surgeon/Staff Surgeon
Authorized Medical Attendant
Registered Medical Practitioner
MEDICAL CERTIFICATE FOR LEAVE OR EXTENTION OF LEAVE OR COMMUTATION OF LEAVE
Signature of the Govt. servant ……………………………………………………………..
I, Dr. …………………………………………...…… after careful personal examination
of the case, hereby certify that Sh. /Smt. /Km. ………………….……………………….
whose signature is given above, is suffering from ………………………………………
and I consider that a period of absence from duty of ………..…………….. days with
effect from ……………….… is absolutely necessary for the restoration of his/her health.
Authorized Medical Attendant
…………………………… Hospital/Dispensary
or other Registered Medical Practitioner
Dated…………….
MEDICAL CERTIFICATE OF FITNESS TO RETURN TO DUTY
Signature of the Govt. servant ……………………………………………………………..
I, Dr. …………………………………….……………...…… do hereby certify that I have
carefully examined Sh./Smt./Km. ………………….………………………………………
whose signature is given above, and find that he/she recovered from his/her illness and is
now fit to resume duties in Govt. Service. I also certify that before arriving at this
decision I have examined the original medical certificate (s) and statement (s) of the case
(or certified copies thereof) on which leave was granted or extended and have taken these
into consideration in arriving at my decision.
Civil Surgeon/Staff Surgeon
Authorized Medical Attendant
Registered Medical Practitioner
