The Centrelink Medical Certificate Template – Australia is offered in multiple formats, including PDF, Word, and Google Docs. Each version is both modifiable and ready for printing, ensuring they cater to your requirements efficiently.
Centrelink Medical Certificate Template – Australia Editable | PrintableSample
1. Patient Information 2. Medical Practitioner Information 3. Medical Condition 4. Recommended Treatment Plan 5. Duration of Incapacity 6. Follow-up Appointments 7. Declaration 8. Signature and Date
PDF
WORD
Examples
[Patient’s Name]
[Patient’s Address]
[Patient’s Date of Birth]
[Patient’s Medicare Number]
[Practitioner’s Name]
[Practitioner’s Registration Number]
[Practitioner’s Practice Address]
[Practitioner’s Phone Number]
This Medical Certificate is issued for the purpose of providing documentation to Centrelink regarding the patient’s medical condition and ability to work.
The patient has been diagnosed with [specific medical condition] on [Date of Diagnosis].
The patient exhibits symptoms including [list of symptoms], affecting their daily activities and capacity to engage in work-related tasks.
It is recommended that the patient [specific recommendations, e.g., rest, certain treatments, reduced hours of work].
The patient is expected to require [number of weeks/days] off work, from [Start Date] to [End Date].
Please consider this certificate for any assistance or benefits through Centrelink that may be available to the patient based on their current medical condition.
[Practitioner’s Signature]
[Practitioner’s Name]
[Practice Stamp]
[Patient’s Name]
[Patient’s Address]
[Patient’s Date of Birth]
[Patient’s Medicare Number]
[Practitioner’s Name]
[Practitioner’s Registration Number]
[Practitioner’s Practice Address]
[Practitioner’s Phone Number]
This Medical Certificate serves as a formal acknowledgment of the patient’s medical condition and the necessity for leave from their employment as required by Centrelink.
The patient is diagnosed with [specific medical condition] as of [Date of Diagnosis].
The patient experiences [list of symptoms], impacting their ability to work effectively.
Following the examination, the patient is advised to undergo [details of treatment or therapy] and to avoid non-essential activities.
I recommend that the patient take a leave of absence from work for [number of weeks/days], specifically from [Start Date] to [End Date].
This certificate should be submitted to Centrelink to support the patient’s application for benefits or assistance related to their medical condition.
[Practitioner’s Signature]
[Practitioner’s Name]
[Practice Stamp]
Printable
