A certificate of incapacity for work is a document confirming temporary release from work. The social insurance fund pays for it. If inaccurate data is entered, then such a document will not be paid.
Instructions
Step 1
The stamp of the medical institution with its name and address is placed in the upper right corner. Additionally, the title can be typed or handwritten.
Step 2
In the upper right and lower right corners, the stamp for sick leaves is also affixed.
Step 3
In some cases, additional seals must be affixed. In the first case, when a person does not have registration at the place of the disease (for visitors, business travelers, who are on vacation in a given area). In the second case, when examining citizens who were sent for a medical examination. The seal is placed next to the signature of the head confirming the conclusion.
Step 4
Mismatching of the seal in the upper corner and in the lower one is allowed when a patient is redirected to another medical institution. All seals should be clear without smears and streaks. Some types of seals may be without the name of the institution. These are psychiatric clinics, narcological, infectious diseases, AIDS centers.
Step 5
The certificate of incapacity for work must be filled out without blots with a pen or printing device.
Step 6
On the front side it is indicated whether the sick leave was issued initially, or this is a continuation of the previously issued, date, month (in words), year of issue, last name, first name, patronymic of the patient, age (number of full years), gender, full name of the organization where the patient works. It is also indicated whether a sick leave was issued at the main place of work, or at a part-time place of work.
Step 7
The corresponding columns indicate the disease or other reason (for pregnancy and childbirth), the treatment regimen, notes on the violation of the regimen, from which and by what date the regimen was violated.
Step 8
In the column "Exemption from work", the date of issue or (if necessary) the date of the next extension is entered in Arabic numerals. The doctor puts a personal signature and seal.
Step 9
If the decision is made by the medical commission, then the signature of the chairman of the commission is additionally put.
Step 10
In the line "Get started" the date is written in words.
Step 11
If the patient continues to be ill, a corresponding entry is made. In the old sheet, they write that a new one has been issued, and put its number, date of issue and the doctor's signature.
Step 12
If a disability is established, the sick leave is closed and an appropriate entry is made.
Step 13
If the sick leave is lost, a duplicate is issued.
