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Medical Certificate Form B

This document is a certificate for a patient admitted to the hospital. It contains information about the patient, their treatment, and costs. It summarizes that the patient, [name redacted], was admitted to the hospital on the advice of their doctor and was treated for an illness from [dates redacted]. It details the medicines prescribed and their prices, as well as costs for tests and facilities. The certifying doctor and medical superintendent confirm the treatment and costs were necessary for the patient's recovery.

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ayodhya prasad Baghel
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5K views2 pages

Medical Certificate Form B

This document is a certificate for a patient admitted to the hospital. It contains information about the patient, their treatment, and costs. It summarizes that the patient, [name redacted], was admitted to the hospital on the advice of their doctor and was treated for an illness from [dates redacted]. It details the medicines prescribed and their prices, as well as costs for tests and facilities. The certifying doctor and medical superintendent confirm the treatment and costs were necessary for the patient's recovery.

Uploaded by

ayodhya prasad Baghel
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CERTIFICATE “B”

(To be filled in the case of patients who are admitted to hospital for treatment)
Certificate granted to Mr./Ms/___________________________________
wife/son/daughter of Mr._______________________________________ employed in the -
___________________ _______________________.

PART “A”
I, Dr. _________________________________ hereby certify :-
(a) That the patient was admitted to hospital on my advice
of________________________________________________________________
(Name of Medical Officer)

(b) That the patient has been under treatment at ___________________________and that the
undermentioned medicines prescribed by me in this connection ware essential for the
recovery/prevention of serious deterioration in the condition of the patient. The medicines are not
stocked in the _____________________________________________.
(Name of the Hospital)
preparation for which cheaper substances of equal therapeutic value are available nor preparation
which are primarily food, toilets or disinfectants.
S.# Name of Medicines Price S.# Name of Medicines Price
Rs. Ps. Rs. Ps.
1. 8.
2. 9.
3. 10.
4. 11.
5. 12.
6. 13.
7. 14.

(c) That the injections administered were/were not for immunising or prophylactic purposes.
(d) The the patient is/was suffering from _____________________ and is/was under my treatment from
________________ to __________________.
(e) That the X-Ray, Laboratory test, etc. for which an expenditure Rs. _________was incurred were
necessary and were undertaken on my advice
at ________________________________________________.
(Name of the Hospital or Laboratory)

(e) That I reffered the patient to Dr. ______________________________ for specialist consultation
and that the necessary approval of the ________________________________ as required under
the rules was obtained.
(Name of the Chief Administrative Medical Officer of the State)

Signature and Designation of the Medical


Officer–in-Charge of the case at the Hospital

PART “B”
I certified that the patient has been under treatment at the __________________________hospital
and that the services of the special nurses, for which an expenditure of Rs. ___________________ was
incurred vide bills and vouchers attached, were essential for the recovery/prevention of serious
deterioration in the condition of the patient.

Signature and Designation of the Medical


Officer–in-Charge of the case at the Hospital

COUNTERSIGNED

__________________________
Medical Superintendent
___________________Hospital

I Certify that the patient has been under treatment at the ____________________ hospital and
that the facilities provided were the minimum which were essential for the patient’s treatment.

__________________________
Medical Superintendent
___________________Hospital

N.B.:- Certificate not applicable should be struck off, Certificate “B” is compulsory and must be filled by
the Medical Officer in all cases.

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