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1. Certificate Header: Contains the physician's details, practice information, and professional credentials
2. Patient Information: Employee's full name, date of birth, and address
3. Employer Information: Name and address of the employer
4. Incapacity Declaration: Clear statement of work incapacity (full or partial) and its duration
5. Period of Absence: Specific dates for which the employee is certified as unable to work, including start and expected end date
6. Degree of Incapacity: Percentage of work incapacity if partial capacity exists
7. Date and Authentication: Date of examination, physician's signature, and official stamp
1. Work Restrictions: Specific limitations or modifications needed when returning to work, used when partial work capacity exists
2. Follow-up Requirements: Information about necessary follow-up appointments or re-evaluation dates, included for longer-term illnesses
3. Causation Statement: Statement whether the incapacity is due to illness, accident, or occupational illness - included when required for insurance purposes
4. Pregnancy Notation: Special section for pregnancy-related absence, used when applicable
5. Previous Consultations: References to previous related consultations, included for chronic or recurring conditions
1. Medical History Summary: Optional attachment for complex cases requiring detailed medical history, only included when specifically requested and with patient consent
2. Treatment Plan: Attached in cases of long-term illness or when graduated return to work is planned
3. Workplace Modification Requirements: Detailed recommendations for workplace adaptations, attached when specific modifications are needed for return to work
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