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CMDRF Medical Certificate Template

This medical certificate is intended to provide information to help a patient avail financial assistance for treatment. It requests details about the patient such as name and address as well as information about their treatment including the type of disease, treatments undergone and recommended, expenditures incurred so far, and anticipated future expenses. The certificate is to be signed by the head of the hospital where the patient is receiving treatment.

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Zakariya Pk
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822 views1 page

CMDRF Medical Certificate Template

This medical certificate is intended to provide information to help a patient avail financial assistance for treatment. It requests details about the patient such as name and address as well as information about their treatment including the type of disease, treatments undergone and recommended, expenditures incurred so far, and anticipated future expenses. The certificate is to be signed by the head of the hospital where the patient is receiving treatment.

Uploaded by

Zakariya Pk
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

MEDICAL CERTIFICATE FOR AVILING FINANCIAL ASSISTANCE FOR

TRATMENT
(To be issued by the head of hospital where the patient undergoes treatment)

1. Name and Address of the patient :

2. OP/IP with date of registration/

Admission :

3. Description of disease :

4. Treatment recommendation :

5. Expenditure already incurred, if any :

6. Anticipated expenditure of the treatment :


Undergoing/recommendation

7. Remarks

Date:
(Signature and name of the issuing
authority and name and address of the
hospital)

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