Certificate of ill health

Another type of medical certificate is the certificate of ill health which is required by the
employers as a proper medical cum legal document which provides with the heath and the
medical opinion of the doctor. Such medical certificates are to be given on a recommended
format according to the Indian medical Council (professional Conduct, Etiquette and Ethics)
Regulations 2002.it should contain identification marks of the patient, nature of illness,
period of expected absence. Further the patients medical record shall be kept confidential ad
strict patient doctor confidentiality and relation of trust is to be maintained. 1 besides the
above mentioned medical certificates there are various other medical certificates.

Authenticity of a medical certificate

Due to the increase of the number of the issuance of the Authentication of a medical cerficate can
be determined only on fulfilling after the following aspects:-

Medical Certificates must be made only on the letterhead of the doctor, if not, with complete
address and qualifications.

Date, time and place of issue of the certificate are to be mentioned in the Medical Certificate.

Medical Certificates should be made for legitimate purposes and only when necessary.

Medical Certificates must be true, clear, unambiguous, clearly worded according to specific
purpose for which it is issued.

Medical Certificates must be limited to the actual period when a person has been under
doctors observation.

1 Anil aggarwal, APC Essentials of Forensic Medicine and Toxicology ed 5 p11

 Medical Certificates must not disclose the diagnosis without the patients express consent
unless required by law.

A duplicate copy of every Medical Certificate issued must be with the doctor in his/her records2

What are a doctors obligations when it comes to medical certificates?

Medical practitioners have important legal and professional responsibilities when issuing
medical certificates. Specifically they must:

be honest and not misleading when issuing medical certificates

only sign medical certificates they believe, or reasonably believe, to be accurate.

This means the medical certificate must be based on facts known to the doctor including the
practitioners own observations as well as information provided by the patient. Any medical
statements in the certificate must have a factual basis . The medical professional in
responsible and bound by various laws such as the Indian Penal Code
registration of birth and deaths act 1969 etc. further the medical professional are also bound by
the rules and regulations issued by the medical council of Indian to issue proper and legal
3
medical certificates.

Guidelines

The medical council of India which is the governing and the regulatory body for medical science
in India, it is the prerogative of the MCI to provide various guidelines for the regulation of
medical certificates in India. In exercise of the powers conferred under section 20A read with
2 http://chai-india.org/wp-content/uploads/2013/10/Medical-certificates.pdf visited on 3/10/17 at 5:30am
3 ibid
section 33(m) of the Indian Medical Council Act, 1956. Medical Council of India, with the
previous approval of the Central Government, it made the following regulations relating to the
Professional Conduct, Etiquette and Ethics for registered medical practitioners, further by
various circulars provide for the following guidelines namely:-

Every physician shall maintain the medical records pertaining to his / her indoor patients
for a period of 3 years from the date of commencement of the treatment in a standard
proforma laid down by the Medical Council of India and attached as Appendix 3.

If any request is made for medical records either by the patients / authorised attendant or
legal authorities involved, the same may be duly acknowledged and documents shall be
issued within the period of 72 hours.

A Registered medical practitioner shall maintain a Register of Medical Certificates giving

full details of certificates issued. When issuing a medical certificate he / she shall always
enter the identification marks of the patient and keep a copy of the certificate. He / She
shall not omit to record the signature and/or thumb mark, address and at least one
identification mark of the patient on the medical certificates or report.

The medical certificate shall be prepared as in Appendix 2. And Efforts shall be made to
computerize medical records for quick retrieval.

Registered medical practitioners are in certain cases bound by law to give, or may from
time to time be called upon or requested to give certificates, notification, reports and
other documents of similar character signed by them in their professional capacity for
subsequent use in the courts or for administrative purposes etc.4 Such documents, among
others, include the ones given at Appendix 4. Any registered practitioner who is shown
to have signed or given under his name and authority any such certificate, notification,
report or document of a similar character which is untrue, misleading or improper, is
liable to have his name deleted from the Register.5

4 Infra4
 The certificate should be legible, written on the medical practitioners letterhead and should not
contain abbreviations or medical jargon. The certificate should be issued on the facts known to
the doctor. The certificate may include information provided by the patients but any medical
statements must be based upon the doctors own observations or must indicate the factual basis
of those statements. The certificate should only be issued in respect of an illness of injury
observed by the doctor or reported by the patient and deemed to be true by the doctor.

The certificate should:

(a) indicate the name and address of the medical practitioner issuing the certificate
(b) indicate the name of the patient
(c) indicate the date on which the examination took place
(d) indicate the degree of incapacity of the patient as appropriate
(e) indicate the date on which the medical practitioner considers the patient is likely to be able
to return to work
(f) be addressed to the party requiring the certificate as evidence of illness, for example,
employer, insurer, magistrate
(g) Include the nature and probable duration of the illness. This certificate must be accompanied
with a brief resume of the case giving the nature of illness, its symptoms, causes and duration.

An official serially numbered certificate should be utilized. The original medical certificate is
given to the patient to provide the documentary evidence. The duplicate copy will remain in the
medical certificate books for the records. The record of the medical certificate are to be retained
with the doctor for a total period of 3 years from the date of the issue. 6
Record of issuing medical certificate documentation should include the patients sign,
identification marks for proper and easy identification of the paient.

Legal liability

The medical professional who has issued the medical certificate is bound by law to issue a
correct and true certificate as per his professional opinion without any malice. However in
case an illegal and incorrect with an intention to deceive then both the professional and any
person who uses the same in the court of law shall be held criminally liable for the same.
Legal liability of inaccurate/ Fake Certificate is as follows :

5 https://mciindia.org/ActivitiWebClient/rulesnregulations/codeofMedicalEthicsRegulations2002 visited on
5/10/17 at 5:15am
6 Ibid
 When a certificate is submitted in a court of law as evidence, and proved to be false, the
one who has issued it is liable for the same punishment as giving false evidence (ranging
from three years imprisonment and fine/ imprisonment for life).

Willfully and recklessly issuing a false or fake certificate is a professional misconduct as

per Indian Medical Council, punishable by striking the name off the Medical Register.

Alternations/ additions in certificate with the intention to deceive is punishable by charge

of forgery where punishment is of two years imprisonment and fine.

A person who suffers damage while acting upon a false Medical Certificate can charge the
issuing authority of civil or criminal negligence. 7

Further issuing a false, fictions or a certificate in a backdate is made a criminal offence under
the Indian penal code which provides for punishment of imprisonment of seven years and
fine. In case a patient to whom a fake medical certificate has been issued and is used by him
then he is liable for the same punishment. 8

Medical certificates in court

The courts of justice works only on the evidences submitted by the parties to the proceedings
. Evidence according to section 3 of the Indian evidence act means and includes all
statements which the court permits or requires to made before it by witnesses, in relation to
the mattes of fact under inquiry; all documents including electronic records produced for the
inspection of the court.
An evidence tendered by a medical personnel is known as medical evidence.

7 https://www.gla.ac.uk/forensic science medicalcertificate /media_2722538_en.pdf visited on 8-10-17 at 5:40pm

8 ibid
In case of Bhoopram V state of Uttar Pradesh 9there was variance in the Proof of Age of
the accused medical certificate and School certificate at variance with regard to age of
accused there. The complainant contended that the accused was much elder than started in
his school certificate. There was no material on record to doubt School certificate School
certificate cannot brushed aside on the surmise that parents usually understate the age for
securing benefits to their children in their future years. The court held that the medical
certificate was credible enough to consider that the age in the school record and the medical
certificate were correct thus the accused was liable to go to juvenile home rather than to jail
in accordance with the U.P. children act 1951.

10
In an English case R. v Ealing the court while setting up a precedent for medical
certificates gave the following guidelines

The court held that the circumstances where a court may find a medical certificate to be
unsatisfactory include the following:

1. Where the certificate indicates that the defendant is unfit to work (rather than to
attend court);

2. Where the nature of the defendant's ailment (e.g. a broken arm) does not appear to be
capable of preventing his attendance at court;

3. Where the defendant is certified as suffering from stress/anxiety/depression and there

is no indication of the defendant recovering within a realistic timescale.

It therefore follows that as a minimum standard a medical certificate should set out:

1. The date on which the medical practitioner examined the defendant;

2. The exact nature of the defendant's ailment;

3. If it is not self-evident, why the ailment prevents the defendant from attending court;

9 1989 Cri. L.R. 360

10 Magistrates Court Ex p. Burgess (2001) 165 J.P. 82.
 4. An indication as to when the defendant is likely to be able to attend court, or a date
when the current certificate expires.

Medical practitioners should be aware that when issuing a certificate to a defendant in

criminal proceedings they make themselves liable to being summonsed to court to give
evidence about the content of the certificate, and may be asked to justify their statements. 11

In case of Raj kumar v/s State NCT Delhi 12is one of the recent cases where the supreme
court reduced the punishment of the appellant on the basis of the medical certificate
produced by appellant showing, that appellant is suffering from effective psychosis, which is
stated to be a brain disorder

The court held that this aspect was not considered by High Court while imposing sentence
and recording concurrent finding of conviction and sentence that the appellant had already
undergone eight months' imprisonment thus held the sentence of appellant reduced to period
of sentence already undergone and the appeal was allowed.

Conclusion

Medical certificates form an important document for forensic experts as well as for proper
adjudication. It is a legal document which until rebutted with evidences may be presumed by
law to be correct and true to the knowledge of the medical professional issuing the
11 http://www.cps.gov.uk/legal/l_to_o/medical_certificates/ visited on 9/9/17at 5:30 am

12 2016(3) AICLR 526

certificate. Though medical certificates are not a conclusive proof in the eyes of courts but
they can still have persuasive value if they are corroborated with other material evidences. 13

In countries such as Quatar various systems have been developed in the for providing
medical certification such as the Medical Certification System (MediC) is an integrated
Workflow Management Software System exclusive for the use of Medical Commissions
Management that manages medical and administrative data of the organization for the issue
of Medical Fitness Certificate and automates workflow between different roles and
departments wherever these are located.

In line with the rules of the country of Qatar, any visitor seeking extension of stay beyond a
month say, expatriate seeking resident permit for employment / family joining or visa
extensions, has to necessarily undergo Medical Examination at the Department before
applying for the Immigration to the Ministry of Interior, Qatar. In addition, the department
also issues medical fitness certificates to both Qatari and Non-Qatari nationals who require
medical assessment tests for other requirements such as, those applying for citizenship,
Qatari Males getting married to Non-Qatari Females, Pilots, Firemen, Air Hostesses. With
such a system there has been a speedy and automated results and issuance of the medical
certificates as per the governmental directions.14

India should also, with the change in time bring changes in the guidelines in the formation
and acceptance of the medical certificates. More stringent reforms should be brought and the
medical professionals should issue the medical certificates in accordance with their ethical
code.

It should be born in mind by the medical professionals who issue these certificates that these
certificates are a legal document, they should be made with proper medical advice and with
full care and regard to medical ethics. In case of a forged medical certificate the professional
is liable for imprisonment.

13 Infra 12
14https://books.google.co.in/books?
id=jDEyDwAAQBAJ&pg=PA121&dq=medical+certificate+forensic+science&hl=en&sa=X&ved=0ahUKEwivpIuui-
TWAhWMgI8KHdIwAVYQ6AEIQTAF#v=onepage&q=medical%20certificate%20forensic%20science&f=false visited
on 5-10-17 at 6:50pm
As a general rule, a medical license is needed for the forensic expertise involving
postmortem examination with or without autopsy and issuing the death certificate .other
qualifications are not essential legally. For investigations, involving forensic toxicology,
DNA analysis by forensic scientists are needed15

Bibliography

https://en.wikipedia.org/wiki/Medical_certificate

http://www.cps.gov.uk/legal/l_to_o/medical_certificates/

15Rajesh Bardale, Principles of Forensic Medicine & Toxicology 2011 jaypee 3rd edition 112
http://chai-india.org/wp-content/uploads/2013/10/Medical-certificates.pdf

https://mciindia.org/ActivitiWebClient/rulesnregulations/codeofMedicalEthicsReg
ulations2002

https://ama.com.au/system/tdf/documents/AMA%20Guidelines%20on%20Medical
%20Certificates%202011.%20Revised%202016_0.pdf?
file=1&type=node&id=44819

https://books.google.co.in/books?
id=jDEyDwAAQBAJ&pg=PA121&dq=medical+certificate+forensic+science&hl=
en&sa=X&ved=0ahUKEwivpIuui-
TWAhWMgI8KHdIwAVYQ6AEIQTAF#v=onepage&q=medical%20certificate
%20forensic%20science&f=false

Anil aggarwal, APC Essentials of Forensic Medicine and Toxicology 4th edition

Rajesh Bardale, Principles of Forensic Medicine & Toxicology 2011 jaypee 3rd
edition