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    Form 8 (Confidential) Special Intermediate Certificater Employees' State Insurance Corporation (Regulations 61 & 89-B)

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    hdpanchal86
    This document is a Form 8 confidential special intermediate certificate from the Employees' State Insurance Corporation. It certifies that the patient has continued to need medical treatment and has remained incapable of working through the date of examination due to their sickness. The medical officer further certifies that based on the current condition, the patient will remain incapable of working for at least [number of] weeks from this date. The medical officer will continue to issue certificates at the stated intervals as long as the patient's condition does not require more frequent attendance. In the medical officer's opinion, the patient should now/need not be referred to a medical board to determine if they are permanently disabled.

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    Form 8 (Confidential) Special Intermediate Certificater Employees' State Insurance Corporation (Regulations 61 & 89-B)

    Uploaded by

    hdpanchal86
    1K views3 pages
    This document is a Form 8 confidential special intermediate certificate from the Employees' State Insurance Corporation. It certifies that the patient has continued to need medical treatment and has remained incapable of working through the date of examination due to their sickness. The medical officer further certifies that based on the current condition, the patient will remain incapable of working for at least [number of] weeks from this date. The medical officer will continue to issue certificates at the stated intervals as long as the patient's condition does not require more frequent attendance. In the medical officer's opinion, the patient should now/need not be referred to a medical board to determine if they are permanently disabled.

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    Form 8

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    This document is a Form 8 confidential special intermediate certificate from the Employees' State Insurance Corporation. It certifies that the patient has continued to need medical treatment and has remained incapable of working through the date of examination due to their sickness. The medical officer further certifies that based on the current condition, the patient will remain incapable of working for at least [number of] weeks from this date. The medical officer will continue to issue certificates at the stated intervals as long as the patient's condition does not require more frequent attendance. In the medical officer's opinion, the patient should now/need not be referred to a medical board to determine if they are permanently disabled.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    1K views3 pages

    Form 8 (Confidential) Special Intermediate Certificater Employees' State Insurance Corporation (Regulations 61 & 89-B)

    Uploaded by

    hdpanchal86
    This document is a Form 8 confidential special intermediate certificate from the Employees' State Insurance Corporation. It certifies that the patient has continued to need medical treatment and has remained incapable of working through the date of examination due to their sickness. The medical officer further certifies that based on the current condition, the patient will remain incapable of working for at least [number of] weeks from this date. The medical officer will continue to issue certificates at the stated intervals as long as the patient's condition does not require more frequent attendance. In the medical officer's opinion, the patient should now/need not be referred to a medical board to determine if they are permanently disabled.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
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    FORM 8 (CONFIDENTIAL) SPECIAL INTERMEDIATE CERTIFICATER EMPLOYEES STATE INSURANCE CORPORATION (Regulations 61 & 89-B)

    Book No. .. S. No. .. Impression of the IP Stamp of Dispensary Signature or Thumb

    Date of First Certificate of spell of Sickness or Disablement

    Employers

    Code

    No.

    Branch Office

    To..s/w/d/..Ins.

    No.

    Any other remarks by the Medical Officer ... .... ....

    Certified that I have examined you. Today and that in my opinion you have continued to need medical treatment and have remained in capable to work upto and including this day by reason of .further certify that by judging your present condition it is found that your sickness is of such a character that it will be unnecessary to see you for the purpose of treatment and will remain incapable to work at least upto the end of . Weeks from this date.. I propose to issue certificates in this form at the interval stated above so long as your condition does not require more frequent attendance. In my opinion you should now/need not be

    referred to a Medical Board to determine if you are permanently disabled.

    Date.. Signature.. Ins. Medical Officer with Rubber Stamp Name in Block letters

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