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Treating Doctor Certificate

This document is a medical certificate template from Even Healthcare, certifying a patient's visit and detailing their medical history, diagnosis, and treatment. It includes sections for patient information, symptoms, diagnosis, and doctor details, along with declarations and signatures for authenticity. The certificate is intended for medico-legal purposes.

Uploaded by

d.gahlot454545
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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4K views2 pages

Treating Doctor Certificate

This document is a medical certificate template from Even Healthcare, certifying a patient's visit and detailing their medical history, diagnosis, and treatment. It includes sections for patient information, symptoms, diagnosis, and doctor details, along with declarations and signatures for authenticity. The certificate is intended for medico-legal purposes.

Uploaded by

d.gahlot454545
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

Even Healthcare

1335, 11th Cross Rd, Stage 3, Indiranagar,


Bengaluru, Karnataka 560038

Tel +919643667399 | Email [email protected]

Date:

To whomsoever concerned 

This is to certify that Mr/Mrs _____________________ son/daughter of _________________________


aged ______ years, of village/town __________ PO _________________ district ________________ state
__________________ visited very first time on date ___________________ with a chief complaint of
______________ and exact duration and etiology of __________________ days/months/year.

Medical details of member

Date of first 
 Date of commencement 
 History provided & 



Symptoms/Complaints
consultation/admission of symptoms/complaints Recorded by

Details of diagnosis

Date of discharge/

Exact Illness diagnosed Date of diagnosis Treatment given
treatment given
Even Healthcare

1335, 11th Cross Rd, Stage 3, Indiranagar,


Bengaluru, Karnataka 560038

Tel +919643667399 | Email [email protected]

Details of Doctor/ Clinic

Name of the Clinic /
 Address of the Clinic/
 Contact number 



Name of the Doctor Mobile number
Hospital Hospital (STD Code)

Declarations

I Undersigned do hereby declare that I was the doctor in attendance during the illness of

______________________ and I hereby declare that whatever is stated herein above is true to the 

best of my knowledge, belief & information.

Name of the Doctor____________________________________________________________________


Date _________________________________________________________________________________ 


Place _________________________________________________________________________________ 


Address _______________________________________________________________________________


_______________________________________________________________________________________

Contact No. ___________________________________________________________________________

Registration No _______________________________________________________________________

Doctor signature & stamp To be used by Medico Legal purpose

Regards,

Even Healthcare Private Limited

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