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Certificate: (To Be Filled by The Hospital/ Nursing Home/ Clinic Authority)

This certificate summarizes a patient's hospital admission and treatment. It provides details such as the name and registration status of the admitting hospital, the patient's admission and discharge dates and times, a history of their present illness including symptoms and duration, and their past medical history related to the condition. The certificate is signed by a doctor or hospital authority and includes the hospital seal.

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Darbha Shalini
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187 views1 page

Certificate: (To Be Filled by The Hospital/ Nursing Home/ Clinic Authority)

This certificate summarizes a patient's hospital admission and treatment. It provides details such as the name and registration status of the admitting hospital, the patient's admission and discharge dates and times, a history of their present illness including symptoms and duration, and their past medical history related to the condition. The certificate is signed by a doctor or hospital authority and includes the hospital seal.

Uploaded by

Darbha Shalini
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 

(TO BE FILLED BY THE HOSPITAL/ NURSING HOME/ CLINIC AUTHORITY) 

This is to certify that____________________________________________________________________ 
was  admitted  under  my  treatment  from  ___________at  ___________to  ___________at  ___________ 
and detail information is as under:‐ 

1. Name of Hospital/ Nursing Home ___________________________________________________ 
2. Whether the same is registered with the local authority or not ___________________________ 
3. If so, Registration No _____________________________________________________________ 
4. If not answer the following queries:‐ 
A. No of inpatient beds in the Hospital/ Nursing Home: ________________________________ 
B. Whether you have fully equipped Operation Theater of your own.       Yes/ No 
C. Whether you have fully qualified Nursing Staff  
in your employment round the clock.             Yes/ No 
D. Whether you have qualified Doctor in Charge round the clock.       Yes/ No 
5. Date/ Time of Admission __________________________________________________________ 
6. Date/ Time of Discharge __________________________________________________________ 
7. History of present illness with duration of the presenting complaints: 
(a) What  is  the  exact  nature  of  complaint  with  which  the  patient  first  presented  (seen) 
___________________________________________________________________________ 
(b) Since  how  long  he/  she  has  been  suffering  for  the  same 
___________________________________________________________________________ 
8. Past History of the disease ________________________________________________________ 

Signature of Doctor 
             Or 
Hospital Authorities 
(Seal of Hospital) 

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