Guidelines Medical Certificates Reports

iii

Table of Contents

A. Background...................................................................................1

1. ThePreliminary:................................................................1

2. TheRelevantLaws/Statutes...............................................1

3. PurposeofthisGuideline...................................................2

4. Definition............................................................................. 2

B. PurposeofMedicalCertificates.....................................................4

C. PowertoCertify............................................................................5

D. ImplicationsforHealthandMedicalProfessionals......................5

7. Limitations........................................................................... 5

8. Noobligations.....................................................................6

9. Liabilities............................................................................. 7

E. GeneralConsiderations.................................................................8

10. ConflictofInterest...............................................................8

11. ReferraltoaMedicalPractitioner/MedicalBoardofDoctors............................................................................... 8

12. PrivacyandConfidentiality..................................................8

13. RecordKeeping...................................................................9

14. FeeforService....................................................................9

15. GeneralProceduresandContentsofMedicalCertificatesandReports......................................................................9

F. SpecificConsiderations...............................................................11

16 Medical/SickLeave..........................................................11

17. MedicalFitnessforEmployment......................................12

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18. MedicalCertificationforExemptionfromattendanceinCourtsofLaw....................................................................13

19. MedicalFitnessforDetention/FitnesstoStandTrialorPlead................................................................................. 13

20. InjuryorDisabilityorOccupationalDiseaseCertification14

21. MedicalCertificatesforInsurancePurposes.....................14

22. BirthCertificates..............................................................15

23. Miscellaneous...................................................................15

24. RevisionofGuideline........................................................15

AppendixI.......................................................................................... 16

AppendixII......................................................................................... 19

AppendixIII....................................................................................... 23

AppendixIV...................................................................................... 24

AppendixV....................................................................................... 25

AppendixVI....................................................................................... 26

AppendixVII...................................................................................... 27

AppendixVIII..................................................................................... 30

AppendixIX........................................................................................ 31

1Bhutan Medical and Health Council Guidelines for Writing Medical Certificates and Reports -2009

A. Background

1. The Preliminary:

1.1 This guideline shall be called the Bhutan Medical andHealthCouncilGuidelinesforWritingMedicalCertificatesandMedicalReports,2009.

1.2 This guideline outlines the medico-legal obligations ofthemedicalandhealthprofessionals,registeredwiththeBhutanMedicalandHealthCouncil, inrelationtowritingmedicalcertificatesandreports.

1.3 ThisguidelineshallcomeintoforcefromMarch13,2009correspondingto18thdayofthe1stmonthofEarthFemaleOxYear.

2. The Relevant Laws/Statutes

2.1 Themedicalandhealthprofessionalsarerequiredtosignavarietyofmedicalcertificatesandreportsthatrangeinpurposesfromconfirmingsicknesstocertifyingdeathandarerequiredbyagenciesincludingemployers,governmentdepartments, insurance agencies, police, courts, schools,scholarshipawardinginstitutions,etc.

2.2 TheMedicalandHealthCouncilAct-2002oftheKingdomofBhutanbestowsupontheregisteredmembersaprivilegeofissuingmedicalcertificatesandgivingoraltestimonyinthecourtoflawasanexpertwitnessdependinguponthequalification of the member concerned and the existinggovernmentpolicies.

2.3 Thereareseverallaws,aslistedinAppendix-I,underorforthepurposeofwhichmedicalcertificateormedicalreportsincluding death certificates are required. Therefore,

2medicalcertificatesarelegaldocumentscontaininghealthand disability related information including medicalinterventionsandrecommendationsaboutapersonfromamedicalandhealthpersonnel.

3. Purpose of this Guideline

3.1 Thisguidelineshallbethebasisforthemedicalandhealthcare professionals registered under the Bhutan MedicalandHealthCouncilinmeetingtheirlegalandprofessionalobligations when writing medical reports and issuingcertificatesthatarecompliantwithall relevant laws,andminimisetheriskofmedicalnegligence.

3.2 Theprivilegeofwritingorissuingmedicalcertificatesandreportsshallbedelegatedtovarious levelsofhealthandmedical professionals as outlined in section C of thisguideline. Accruing privilege entails responsibility andaccountability. Therefore, the ultimate responsibility forissuingmedicalcertificatesandanyconsequencesresultingthereof shall rest solely with each medical and healthprofessional.

4. Definition

Forthepurposeofthisguideline, theterminologiesaredefinedaccording to the applicable statutes and rules and regulationsgoverningmedicalcertificatesandreportsinthecountry.

4.1 Accident means any unintended or unforeseen eventormishap arising from any activity that results in injury,disabilityordeathtoanindividual.

4.2 CouncilmeanstheBhutanMedicalandHealthCouncil

4.3 Death means the end of life following permanentcessationofallbodilyfunctions.

4.4 Dependent means an individuals familymemberwhowaswhollyorpartlydependentonanindividualsearningsat the time of the individuals death, and includes thespouse,childrenandparentofanindividual.

34.5 Disability means the inability to perform a range oftasks to a reasonable standard considered normal for aparticularjoborworkactivityduetosomephysical,mentalorsensoryimpairment.

4.6 Family means the spouse, children and parents of anindividual.

4.7 Immediate Family Members meansthespouse,childrenandparentsofanindividual.

4.8 Injury means any physical, mental, or emotionaldeprivation or damage to a person resulting from anaccidentorexposuretoriskoveraperiodoftime.

4.9 Medical Certificate means a certificate signed bya registered medical and /or health professional inaccordancewith the BhutanMedical andHealth CouncilActandRegulations.

4.10 Occupational disease means any illness or sickness orailmentcontractedasaresultofanexposuretoriskfactorsarisingfromworkactivity.

4.11 Professional meansanymedicalorhealthprofessionalwhoholdsavalidregistrationundertheCouncil.

4.12 Registered Health Professional means all thoseprofessionals in the field of health and healthcare whoarenotcoveredundermedicalprofessionalsandincludessuch fields as nursing, pharmacy, physiotherapy,medicalandhealth technologyand techniciansandwhoaredulyregisteredwiththeCouncil.

4.13 Registered Medical Professional means practitioneroftheartandscienceofmedicine includingdentistsandpractitioners of traditional medicine and who are dulyauthorisedtodosobytheCouncil.

4B. Purpose of Medical Certificates

5. Medicalcertificateorreportsareusedforvariouspurposes.A personmay require amedical certificate or report forpurposessuchas

5.1 Medicalleaveabsencefromplaceofworkorschoolduetoillnessorinjury.

5.2 CertificatesofMedicalFitness

a. For employment, scholarship in-and/or ex-country,drivinglicence.

b. To Courts of law to be excused from attendingcourtsduetoillnessorinjury(tobeissuedonCourtorderwhen a person does not attend court citingmedicalreasons).

c. Tobeexemptedfromperformingcertainfunctions,suchassittingforanexamination,engaginginworkthatrequiresmuchexertion,disabilityduetoillnessor injury thatpreventsaperson fromattending tosomeaspectsofhisjobrequirements,etc.

d. To perform duties after a person rejoins his/herdutiesafteravailingmedical leave formore than3months.

e. Tobeinterviewed/ortopleadand/orstandtrialinthecourtoflaw.

f. Tobedetainedorimprisonedongroundsofmentalill-healthorothermedicalconditions.

5.3 Maternity-Certificationofpregnancyand/orchildbirth.

5.4 Insurancepurposes:

a. On the request of the Insurer to assess thesuitabilityofacceptanceforinsurance.

b. Ontherequestoftheinsuredpersontoapplyforaclaimtorecoveraninsuranceaward.

55.5 Disability certificates for certification of disability of anindividual.

5.6 PaternityLeave-Certificationofchildbirthbytheindividualsspouse.

5.7 Medical condemnation certificate for provident fund,whenan individual ismedicallycondemnedor retiresonmedicalgrounds.

5.8 Death Certificates related to medical cause of deathof a person for legal proof of death, insurance claims,bereavementleave,welfareschemes,etc.

5.9 Miscellaneous:

a. Certification of testamentary capacity true mentalstateofapersonatthetimeofmakingawill.

b. Vaccinationcertificates.

c. Changeofoccupation/workplaceonmedicalgrounds.

C. Power to Certify

6. Amedicalcertificateorreport,asspecifiedunderthisguideline,can only be completed by a registered medical and/or healthprofessional,whoareregisteredwiththeCouncilandpractisingallopathic medicine in the government medical institutions.Thevarioustypesofmedicalcertificatesorreportsthatmaybecompleted/issuedbytheprofessionalareoutlinedinappendixII.

D. Implications for Health and Medical Professionals

7. Limitations

7.1 The medical and health professionals in general shouldlimit issuingmedicalcertificateorreportsonly inrespectoftheareaofpracticeinwhichtheyareregistered.

6Forexample;

a. Thepharmacistswill limit theprovisionofmedicalcertificates primarily in relation to the supply,compoundingordispensingofmedicine,andtotheprovisionofprofessionalpharmacyservicesincludingadviceonsafeandeffectiveuseofmedicines;

b. Dentists can complete a medical certificate if theoriginoftheinjuryordisabilityisdental-related;

c. Midwives can complete the medical certificaterelatedtopregnancyandchild-birth;

8. No obligations

8.1 Thehealthprofessionalsother thanmedical doctors andspecialists, in general, are not obliged to issue medicalcertificateswhenrequested. Theprerogativeofwhetherornottoissuemedicalcertificatesinagivencircumstanceliesentirelywiththemedicalandhealthprofessionals.

8.2 Wheretherequestformedicalcertificateorreportismadethroughcourtorderorbyanyauthorizedgovernmentornon-governmentalofficialandthedocumentsorequestedpertainstotheillnessordeathofapersonthatwasattendedtobytheprofessionalconcerned,thentheprofessionalisobligedtosubmitthemedicalcertificateorreport.

8.3 In instances where a medical or health professional issubjected to pressure, or feel uncomfortable or unsureabout issuing amedical certificate at any time, then theconcerned medical or health professional shall declinefromissuingacertificate.

8.4 Whereamedicalorhealthprofessionaldecidesnottoissuea medical certificate or report (following a consultationwithaspecialistorduetotheadoptedpolicyofnottoissuecertificates),appropriateguidanceshallbeprovidedtotheperson applying for such documents on other availableavenues.

79. Liabilities

9.1 Themedical andhealthprofessionalmustbeaware thatcompletingandissuingamedicalcertificateorreporthasimplicationsforthepatients,aswellasthemselves,andtheagencyreceivingthecertificate.Certificates, for instance,may have financial implications for the patient and therecipientthroughbenefits,employmentandcompensationpayments or insurance claims and the failure to issuea certificate or include certain information may impactnegativelyonthepatientorthepatientsfamily.

9.2 Completingacertificatemaydirectlyaffectthesafetyandsecurityofothers.Certifyingapatienttoundertakeworkwhenheorsheisunfitmayplacethepatientorpatientscolleaguesatrisk.

9.3 Providing misleading or untrue information, bothdeliberately or negligently, constitute professionalmisconductandmayresultindisciplinaryactionundertheprovisionsofMedicalandHealthCouncilAct2002.

9.4 Medicalandhealthprofessionalsmaybelegallychallengedandcanbesummonedinthecourtstojustifytheirclinicalcertification.

9.5 Someoftherisksinvolvedinissuingmedicalcertificatesorreportsinclude

a. Allegationsofnegligence;

b. Allegationsofprofessionalmisconduct;

c. Disciplinary actions following professionalmisconduct/negligence;

d. Breach of legal requirements including issuingmedicalcertificatesoutsideonesareaofpractice;

e. Insurancecomplications.

8E. General Considerations

10. Conflict of Interest

10.1 Themedicalandhealthprofessionalsshallnotissuemedicalcertificatesorreportstothemselvesormembersoftheirimmediatefamilyortoarelative,wherecertificationbearsfinancialbenefits to thepersoncertified.Further, for thecertificationfor insurancepolicies,themedicalcertificateshallnotbe issued if the requesting insuranceagencyorthe potential client is related to the medical or healthprofessional.

10.2 Themedical and health professionals obligations are tohisorherpatient,andtothelaw.Issuessuchasthetypeof certificates requested, or who initiated or pays forthe consultation shall have no bearings on the medicalassessmentandfindings.

11. Referral to a Medical Practitioner/ Medical Board of Doctors

11.1 Themedicalandhealthprofessionalsshallseekconsultationwithaspecialistforinjuriesandillnesseswhicharebeyondhis/herexpertise(referAppendix-II).

11.2 Medicalcertificationfor thepurposeofmedical leaveupto6monthsorbeyondandfordisabilityorcompensationclaimsmustbecompletedbyamedicalboardofdoctorswhoareappointedbytheheadoftheinstitutionoragency.

12. Privacy and Confidentiality

12.1 The medical and health professionals are ethically andlegally obliged to respect and safeguard the patientsprivacy and confidentiality of patient information in thecourseofissuingmedicalcertificatesandreports.

12.2 Medicalcertificateorreportsshallbehandedovertotheapplicantpersonallyordeliveredtotherelevantauthoritythathadrequestedforsuchadocument.

912.3 Themedicalandhealthprofessionalshallprovideadditionalinformationregardingtheindividualsillnessordisability if required by the law and relevant government policies.

13. Record Keeping

13.1 Themedical and health professionals shall maintain thefollowingrecords:

a. Acopyoftherecordoftheconsultation(interview,examinationandinvestigationfindings);

b. Acopy(photocopy,carboncopy,orsecondprintedcopy)ofthemedicalcertificatethatisissuedtotherequestingparty.

13.2 The above records shall be stored in a secure andconfidential manner and accessible only to authorisedhealthstaff.

13.3 Allrecordsshallbemaintainedforatleast5yearsfromthedateofinitialissuanceofthecertificateorreport.

14. Fee for Service

14.1 The Council shall monitor the implementation of theregulations on the service fee as determined by acompetentauthority.

15. General Procedures and Contents of Medical Certificates and Reports

15.1 The general procedures involved in issuing a medicalcertificateorreportshallbeasfollows:

a. Receiveawrittenrequestforamedicalcertificateorreport.

b. Provide the person with information about theservice.

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c. Conduct a consultation interview, examination,laboratory investigations, reference to medicaldocuments(e.g.,birthregister,patientcasesheets)and consultations with relevant specialists whererequired.

d. Documentthefindingsandassesswhetherornottoissuemedicalcertificateorreport.

e. Completeamedicalcertificateorreportifoneistobeissued.

f. Receivepaymentfortheservice,whereapplicable.

g. Storethedocumentsinanappropriatemanner.

15.2 A medical certificate or report is a legal document andthereforethemedicalcertificatesandreportsshall:

a. Bewrittenlegibly;

b. Be written on letterhead or on forms designedspecifically for thispurpose (templatesprovided inappendixesIIIVII);

c. BeinplainEnglish/Dzongkha,minimisingtheuseoftechnicalormedicalterms;

d. Bebasedonthefactsknowntothepractitionersandbasedontheirownobservationsmade;

e. Containthedateoftheconsultation;

f. Containthedateofthecertification;

g. Be issued only once where a certificate is lostandtherequestforaduplicatecopyismadebythepatient, only the practitioner who had issued theoriginal certificate can issue the duplicate, and itshouldbeclearlymarkedasduplicate.

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h. Containthename,age,gender,andaddressofthepersonexamined.

i. Be completed by a registered medical or healthpractitionerwhoisauthorizedtodoso;

j Contain the name, designation and BMHCRegistrationnumberandsealofthecertifier.

k. Notbe backdatedorpre-dated;butwheretheneedis genuinely established, retrospective certificatesshouldbeclearlyidentifiedassuch.

F. Specific Considerations

16 Medical / Sick Leave

a. A treating practitioner only, as specified in appendix- II,shallissuemedicalorsickleavecertificates.

b. Aprovisionaldiagnosisisgenerallyrequiredforshorttermleavelessthan1month.

c. Themedical and health professional is obliged to obtainsufficient factual information through history andexaminationandlaboratoryinvestigationswherenecessarytocertifyunfitnessforwork.

d. Themedicalandhealthprofessionalshallnotinadvertentlyrevealconfidentialpatientinformation.

e. Thecertificateshallcontainthenatureofillnessorinjury,whetherfit fordutyornot,andrecommendedperiodofleave.

f. Amedicalorsickleaveupto2weekscanberecommendedby a treating ACO, medical doctors and specialists. Theperiod of leave granted shall not exceed threedays at atimewithfurtherextensionofleaveifindicatedonreviewofthepatient.

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g. Amedicalorsick leaveexceeding2weeksandextendinguptoonemonthshallonlybeissuedbyamedicaldoctor,whomayormaynotbeaspecialist.Theperiodof leavegrantedshallnotexceed2weeksatatimewithpossibilityforfurtherextensionofleave,ifindicatedonreviewofthepatient.

h. Except in cases ofmaternity leave,medical or sick leaveexceedingonemonthandextendingupto6monthsshallonly be recommended by a Medical Board of Doctorsinstituted for this purpose. Except in cases of maternityleave, the period of leave granted shall not exceed onemonthatatime,uptofirstthreemonths,andthereafterfortwoweeksatatimeforthenextthreemonths.

i. Medicalleaveexceeding6monthscanbesanctionedonlybytheheadoftheDepartmentofMedicalServicesontherecommendationoftheMedicalBoardofDoctors.

j. A personwhowas onmedical leave for 3monthsmustproduce a medical certification of fitness to work onresuming his duties. Such certification should be carriedoutbythetreatingmedicalofficerorthespecialist.

k. Backdating and change of date should not be allowed,exceptinthecaseofindoorpatientswherethecertifyingmedicalorhealthprofessionalmustjustifysuchleaveafterconsideringthenatureoftheillness.

17. Medical Fitness for Employment

a. Themedical and health professional shall collect factualinformation through history and clinical examination todetect signs and/or symptoms of infectious diseases,defectivesensoryorganfunctions,oranyobviousdeformityordisability.

b. Themedicalandhealthprofessionalshallassessthenatureofthejobthepersonisapplyingforandwhetherornotthepatientspresentconditionswouldenablehim/hertocarryouttherequirementsofthework.

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c. Thecertificateshallbevalidforaperiodof6monthsfromthedateofissuanceofthecertificate.

18. Medical Certification for Exemption from attendance in Courts of Law

a. Themedicalprofessionalshallexerciseutmostcaution inissuingsuchacertificate.

b. Themedical professionalmust be fully aware of his/herresponsibilities to the patient on one side and his legalobligations to facilitate the administration of naturaljustice.

c. Themedicalprofessionalshallactonhisownconvictionsand base the certification on the objective observationsmadefromthepatientconsultation.Thecourtmayrequestasecondopinionfromanothermedicalprofessional.

d. Theperiodforwhichthepersonisnotfittoattendcourtandthe likelyperiodonwhichhe/she is likely torecoverandbefittoattendcourtsmustbestated.

e. Ifthecertifyingmedicalprofessionalisoftheopinionthatthepersonistryingtoavoidattendingcourtsbyresortingtovariousmeansand later requestsamedicalcertificatetoevadetheattendanceincourts,nocertificationshallbeissuedandsuchfactsshallbedisclosedtothecourt.

19. Medical Fitness for Detention / Fitness to Stand Trial or Plead

a. The treating specialist or a Psychiatrist shall base thecertification process on the objective assessment ofthe presence or absence of illness, injury or othermedical conditions that endangers the persons life orseverely impairs the persons judgment, reasoning andunderstandingpower,whenproducedbypoliceoroncourtorder.

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b. An allegation of negligence may follow against theprofessionalifthepersonproducedformedicalevaluationis allowed by the treating medical professional to bedetained and where the patient subsequently dies indetention. Therefore, the certifying doctor shall exerciseutmostcautionindealingwithsuchcase.

20. Injury or Disability or Occupational Disease Certification

a. TheMedicalBoardofDoctorsshallwritetheactualnatureofinjuryordisabilityoroccupationaldiseasecontractedbythepatient.

b. Iftheinjury,disabilityordiseasewasaggravatedbycertainhabitsorbehavioursofthepatient,suchas,(i)consumptionof substance of abuse, (ii) failure to comply with safetymeasures,and(iii)notfollowingmedicaladvice,etc.,thensuch information shall be divulged even if it affects theclaimmadebythebeneficiaries.

21. Medical Certificates for Insurance Purposes

a. Certification for insuranceschemesmaybe requestedbythe insuringagency inwritingonbehalfof the individual(insured) to assess his/her suitability to be accepted forinsurance. In such cases, the medical professional shalldivulgethecorrectandaccurate informationeven if thatpersonmaynotbebenefittedasaresult.Withholdingofpertinent patient informationmay result in legal actionsagainstthecertifyingmedicalprofessionalbytheinsuringagency.

b. Certificatesfor insuranceclaimsmayberequestedeitherforrecoveryofhealthcareexpensesoftheinsuredpersonorforinsurancebenefitstothefamilymembersupondeathoftheinsuredperson.Thecertifyingmedicalprofessionalshallexercisecautioninissuingsuchcertificatesandinthecase of death benefits, the certificates must be handedovertotheproperlegalclaimant.

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c. Ifthecertifyingmedicalprofessionalisoftheopinionthatthe injury, disability, diseaseordeathwasaggravatedbythe insured persons habits/actions/behaviours, thensuchfactsshallbeclearlymentionedinthecertificatesorreports.

22. Birth Certificates

a. Birth certificates shall be issued only to those wherechild birth was attended to by the medical or healthprofessionals.Thecertifiershall issuethebirthcertificateafteraffixinghis/hername,signature,designation,BHMCRegistrationNo.,andnameofthehealthcentre.

b. Requestsforduplicatebirthcertificatesmaybeentertainedonlyafter the facts tochildbirthhavebeenverified fromthe Birth Register maintained in the respective healthcentres.Thenursein-chargeofMaternityWardorLabourRoom,MCHclinic,andWardmaycompletethecertificate.ThecertificateshallbemarkedDuplicate.

23. Miscellaneous

a. Anyblankorunfilledcertificatesorreport forms instockshallbestoredinasecureplacetoavoidmisuse.

b. The receiving agency has the right to accept or reject acertificate or request for second opinion from anothermedicalorhealthprofessional.

24. Revision of Guideline

This guideline shall be revised from time to time to suit therequirementsofthechangingtimesandevolvinglaws.

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Appendix I

List of Prescribed Medical Certificates and Reports including DeathCertificates

Description of Medical Certificates/Reports

Laws / Regulations under or for the purpose of which Certificates are

required

1. Tosecureregistrationofbirth,admissioninschools,dateofbirthforemploymentanddecidingdateofretirementBirthCertificate

i. Birth&DeathRegistration,CivilRegistrationsAct(currently no enactment)

ii. Educationpolicy

iii. BCSR2006,

iv. Labour&EmploymentActofBhutan2007;section174

v. MCHHandbook2008

2.Medicalcertificateoffitnessforemployment

i. BhutanCivilServiceRules&regulations2006,chapter3,subsection7.1.3.

ii. BhutanCivilServiceRules&regulations2006,chapter4:Contractappointment.

3.Toestablishpregnancyand/orrecentchildbirthforthepurposeofMaternityLeave

i. BhutanCivilServiceRules&regulations2006,chapter10,section2.4;subsection2.4.1.

ii. Labour&EmploymentActofBhutan2007;section106

iii. LeaveRegulation-2007(Draft);section52

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4.Toestablishpregnancyand/orrecentterminationofpregnancyforthepurposeofMaternityLeave

i. BhutanCivilServiceRules&Regulations2006;chapter10,section2.5.

ii. LeaveRegulation-2007(Draft);section54

5. ToestablishrecentchildbirthbythespouseofacivilservantforthepurposeofPaternityLeave

Note:applicationtobeattachedwithbirthcertificate.


ii.Labour&EmploymentActofBhutan2007;section106

6.ToproveincapacitytoworkduetoillnessorinjurytoapplyforMedicalLeave/SickLeave


ii. Labour&EmploymentActofBhutan2007;section106

iii. LeaveRegulation-2007(Draft);section28

7.Toresumeofficeafterhavingbeenonmedicalleaveformorethan3monthsmedicalfitnesstoperformduties


8.ToapplyforMedicalleaveforattendantofapatientreferredoutsideBhutan

i.BhutanCivilServiceRules&regulations2006,chapter10,section2.6;subsection2.6.4.

9.Toassessthevalidity/invalidityofwillsongroundsofmentalincapacity

InheritanceAct1980;sectionGA7-6

10.Medicalcertificateoffitnesstodrive

RoadSafetyandTransportAct1997

11.Accidentcompensation i. Labour&EmploymentActofBhutan2007;section96,142,143SS-f(v)

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12.Disabilitycompensation i. Labour&EmploymentActofBhutan2007;section96,142,143SS-f(v)

ii. NationalPension&ProvidentFundRules&regulations2002;sections44-46

13.Occupationaldiseases i. Labour&EmploymentActofBhutan2007;sections96,143:SS-(g)

14.Questionsastoageofachild i Labour&EmploymentActofBhutan2007;section174

ii. AcceptableformsofChildLabourRegulations2007(Draft);section25

iii. Penaloffenceschildrape,childprostitution,etc.

15 Toenablethefamilymembersofacivilservant/employeetoclaimbenefitsuponhis/herdeaths

MedicalcauseofdeathDeathcertificates

i BhutanCivilServiceRules&regulations2006,chapter20,section4.9.

ii. NationalPension&ProvidentFundRules&regulations2002;sections47-66

iii. Labour&EmploymentActofBhutan2007;section96,

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Appendix II

CategoriesofCertifiersaccordingtothenature/purposeofthemedicalcertificateorreports

Certificate Who may Certify Remarks

1.BirthCertificate(BC)

1.Mid-wives/nurses/healthworkerswhoattendedthebirth

2.Doctorwhoattendedthebirth

3.Gynaecologist/Obstetrician

Foralldeliveriesattendedbymedicalandhealthprofessional

(QuotethepatientsReg.No.intheBirthRegisterontheBC)

2.Pregnancy/recentchildbirth/terminationofpregnancy

1.Mid-wives/nurses/healthworkerswhoattendedthebirth

2.Doctorwhoattendedthebirth

3.Gynaecologist/Obstetrician

4.In-chargeofMaternityWard/LabourRoom/MCHclinic

Foralldeliveriesattendedbymedicalandhealthprofessional

(QuotethepatientsMCHReg.No.andtheserialNo.intheBirthRegister)

3.Sick/MedicalLeave

1.TreatingDoctors/ACO/HA/Drungtshos/sMenpa

Maximumleaveupto2weeks;

(1-5daysleaveatatimewithreviewandfurtherextension,ifrequired).

2.TreatingMedicalOfficer

3.TreatingSpecialists

Maximumupto1month

(Twoweeksleaveatatimewithfurtherextension,ifrequired,onreview).

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4.MedicalBoardofDoctors,includingatreatingphysician

Leaveexceeding1month,maximumupto6months

(Onemonthatatime,uptofirstthreemonths,andthereafterfortwoweeksatatimeforthenextthreemonths).

5.HeadofDepartmentofMedicalServices,MoH

Leaveexceeding6months,

(OntherecommendationoftheMedicalBoardofDoctors).

4.Disabilitycertification

1.MedicalBoardofDoctorsincludingatreatingdoctor

ThreedoctorstoformtheMBD

5.Occupationaldiseasecertification

1.MedicalBoardofDoctorsincludingatreatingdoctor

ThreedoctorstoformtheMBD

6.MedicalFitnessforemployment

1.Medicaldoctor -

2.Specialist -

7.Aviationindustry

1.MedicalBoardofDoctors

5-memberMBDcomprisedofMedicalSpecialist,Ophthalmologist,ENTSurgeon,Psychiatrist,&Medicalofficer

8.MedicalfitnesstoWork(resumingworkafter>3monthsmedicalleave)

Treatingdoctor/relevantspecialty

-

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9.Medicalfitnessforscholarship/trainingabroad

Medicaldoctor-

10.Medicalfitnessforsuitabilityforinsuranceschemes

MedicalBoardofDoctors ThreedoctorstoformtheMBD

11.Medicalfitnesstoobtainadrivinglicence

1.ACO

2.Medicaldoctor

Referraltoaspecialistwhenthereisdebilitatingmedicalconditionorwhenindoubt

12.Medicalfitnesstostandtrial/detention

MedicalBoardofDoctor,includingatreatingSpecialist

InvolvementofPsychiatristorForensicSpecialisttoadviseonmedico-legalissuesispreferable

13.Certificationfortestamentarycapacity

Psychiatrist -

14.CertificatesforVaccination

1.Medicaldoctor

2.Pharmacist

3.In-chargeofBHUs/MCHClinic

ReferencetoHealthCard,Records,Vaccinationcard

15.Certificationofageofaperson

1.Radiologist,or

2.DentalSurgeon,or

3.ForensicSpecialist

Agemaybeanissueincasesofchildlabour,childsexualassault,prostitution,trafficking,sports,etc.

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16.Medicalreport

1.Healthprofessionalswhoattendedtothepatient,or

-Injury

-Rape/SexualAssaults

(Incentreswherenoforensicmedicineunitexistsornotavailable)

2.TreatingMedicaldoctor,or

3.TreatingSpecialist,or

4.ForensicMedicineDept. AttheJDWNRH

17.Certificationforexemptionfromcertainaspects/activitiesofapersonsjobrequirements

1.TreatingMedicaldoctors

ExampleexemptionfromstrenuousphysicalactivityinapatientwithRHD2.TreatingSpecialist

18.Certificationofchangeofwork/workplaceonmedicalgrounds

Specialists(MedicalBoardofDoctors)

Threedoctors

19.Deathcertificationprocesses:*

a.Declarationofdeath

1.Healthprofessionalswhohaveattendedthedeath.

2.Medicaldoctors

Deathsinhealthcentres(tocertifythefactthatthepersonisdead;notthecauseofdeath)

b.Causeofdeath

Note:*guidelinestobedevelopedafternationalstakeholdersconsultation

1.Healthprofessionalswhohaveattendedthedeath.

2.Medicaldoctors

3.Specialists

4.ForensicMedicineteam

Deathsinhealthcentres&

out-of-hospitaldeathswhichareinvestigatedalongwiththepolice

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Appendix III

Royal Government of Bhutan

Ministry of Health

Medical/Sick Leave Certificate

Icertifythat...........................................CIDNo..................................

Employee/student/residentof...........................................................

.............................................................................................................

Wasunabletoattendwork/school Willbeunabletoattendwork/schoolfrom..................................to...................................

Additional comments:

Signature of Certifier: .........................................................................

Name: .................................................................................................

Designation: .......................................................................................

BMHC Reg. No.:.................................................................................. Health Centre: .....................................................................................

Date(certificate is signed): ..............................................................

Official Seal: ...............................................................................

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Appendix IV

Royal Government of Bhutan

Ministry of Health

Fitness to Resume Work

(requiredforemployeeswhohavebeenonsickleavefor3months)

Ihaveexamined.................................................................................(patientsname)

on ...................................................................... and can certify that

she/heisfullyabletoresumeworkingon/from...................................................................



Name: .................................................................................................

Designation: ........................................................................................

BMHC Reg. No.:........................ Health Centre: ..................................

Date(certificate is signed): ................................................................

Official Seal:.........................................................................................

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Appendix V

Royal Government of BhutanMinistry of Health

Medical or Sick Leave Certificate

Medical Board of Doctors (up to 6 months medical leave)

Ihaveexamined..............................................................................................(patientsname)on....................................................................................................................

Thenatureofillnessandmedicalinterventionswouldmakethepatientunabletoworkfrom.................................................until...........................................


Signature of Treating Practitioner :...............................................................

Name:..............................................................................................................

Designation: .........................................BMHC Reg. No.:........................... Health Centre: ................................................................................................

Date(certificate is signed): .............................................................................

Official Seal:....................................................................................................

Medical Endorsement

Afterhavingdiscussedthepatients illnessandmedical interventionswiththetreatingpractitioner,weherebyendorsetheperiodofmedicalleaveasrecommendedbythetreatingpractitioner.

..................................................................................................................

..................................................................................................................

..................................................................................................................

1. Signature of Medical Practitioner 2. Signature of Medical Practitioner

Name/Designation/ BMHC Reg. No. Name/Designation/ BMHC Reg. No.

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Appendix VI


Medical Fitness Certificate

IcertifythatIhaveexamined(personsname),.............

........ age/gender ................................................ and

bearingcitizenshipIDNo..................................on................asa

candidateapplyingfor..........................................................................

Inmyopinion,thepersonexaminedisinastateofgoodphysicalandmentalhealthandthereisnothingtodisqualifyhim/heronmedicalgroundsfromthepurposeforwhichthiscertificateisissued.



Name:...................................................................................................

Designation: ......................................BMHC Reg. No.:.....................Health Centre: ..................................................................................... Date(certificate is signed): ..................................................................

Official Seal:.........................................................................................

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Appendix VII


Medical Certificate (Workmans Compensation)

I. WORKER DETAILS:

1. Name: 2. Age: 3. Gender

CID No.:

4. Occupation: 5. Contact No.:

6. Address:

II. EMPLOYER DETAILS:

7. Name of workers Employer:

8. Employers address:

III. INJURY DETAILS (from the worker):

9. Date of Injury / disease first noticed:

10. Workplace location where injury/disease occurred:

11. Workers description of the injury or disease:

12. Workers description of how the injury or disease occurred:

IV. MEDICAL ASSESSMENT:

13. Date & Time of Examination: 14. Place of Examination:

15. History of current condition:

16. Past Medical History (relevant to the current condition):

17. Examination Findings:

18. Laboratory /Diagnostic Investigations:

19. Diagnosis:

20. Opinion: In my opinion, the injury or disease is [tick appropriate cage(s)]:

(a)Consistentwiththestatedcause

(b)Inconsistentwiththestatedcause

(c)Ofuncertaincause(comment):

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V. FITNESS FOR WORK (Tick those boxes which apply):

21. I am of the opinion that as from the date of this certificate the worker is:

(a)Fittoreturntopre-injuryduties,nofurthertreatmentrequired;

(b)Fittoreturntopre-injuryduties,butrequiresfurthertreatment;

(c)Fittoreturntoworkforrestrictedhours/daysfrom:

........................................to.........................................

(d).Fittoreturntoworkonrestricteddutiesfrom: i.Avoidprolongedstanding/walking/sitting;

ii.Avoidsquatting/kneeling/ladders/steps;

iii.Noliftingofheavyofobjects;

iv.Avoidrepetitiveuseofaffectedbodypart;

v.Avoidrepetitivebending/lifting;

vi.Other:

(e)Unfittoworkfor.

(f)UnfitforpresentworkVI. MEDICAL MANAGEMENT PLAN:

22. Treatment:

23. Medication:

24. Referral to Hospital:

25. Referral to Specialist (specialty/ name):

26. Referral to Allied Health Professionals:

(a) Physiotherapist

(b) Vocational rehabilitation

(c) Others:

27. Review Date:Worker to be reviewed on

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VII. MEDICAL BOARD OF DOCTORS:

28. Signature of Treating Practitioner: ..........................................................

Name:..............................................................................................................

Designation: .........................................BMHC Reg. No.:.............................. Health Centre: ................................................................................................

Date(certificate is signed): .............................................................................

Official Seal:....................................................................................................

Medical Endorsement

Afterhavingdiscussedthepatients illnessandmedical interventionswiththetreatingpractitioner,weherebyendorsetheperiodofmedicalleaveasrecommendedbythetreatingpractitioner.

.................................................................................................................

.................................................................................................................

.................................................................................................................

29. Signature of Medical Practitioner 30. Signature of Medical Practitioner

Name/Designation/ BMHC Reg. No. Name/Designation/ BMHC Reg. No.

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Appendix VIII


Certificate for Maternity Leave

IcertifythatMrs..............................................................................................

CitizenshipIDNo............................................................................andwife/ex-wife/widow/partnerof(name):.................................................................

(a)Is/waspregnantwithestimateddateofdeliveryon..................................

(b)Hasdeliveredababyboy/girlon................................................

(c)Hadspontaneousmiscarriageon...............................................Andsheisduefor/wishestotakematernityleavefrom*:............................................................to.....................................................................................

[Note:*maternity leave must commence at the latest from the day ofdeliveryofthechildaspertheBCSR2006).]

TheMCH/HospitalReg.No.............................................................................

Signature of Certifier:.....................................................................................

Name:..............................................................................................................

Designation:....................................................................................................BMHC Reg. No..........................Date (certificate is signed): ........................

Health Centre: ...............................................................................................

Official Seal:....................................................................................................

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Appendix IX


Birth Certificate

I certify that:

Ababyboy/girlweighing......................................................................grams

wasborn/deliveredthroughnaturalprocess/caesareansectionon(dd/mm/yy)to(mothersname),whois/wasthewife/ex-wife/widow/partnerof(name)..atthe(NameoftheHealthCentre),.....................

Further, I certify that this certificate is completed by me in my capacity as:

(a)Healthworkerwhohadattendedtotheabovechildbirth

(b)In-chargeoftheMaternity/LabourUnit*

(c)HeadofDepartmentofObstetrics&Gynaecology*

(d)HeadoftheHealthCentre/Hospital*

[Note*: in case of (b) to (d) above, the certifier must confirm the above facts from the Birth Register maintained at the respective centres/units.]

(i).MCHReg.No.:.........................................Dated:.............................

(ii).BirthRegisterSerialNo.:............................Dated:...........................

Signature of Certifier:....................................................................................

Name: ............................................................................................................Designation:................................................................................................... BMHC Reg. No...........................Date(certificate is signed): .....................

Health Centre:...............................................................................................

Official seal:.............................................................

Guidelines Medical Certificates Reports

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Transcript of Guidelines Medical Certificates Reports