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Medical Certificate

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Date,_____________________

MEDICAL CERTIFICATE

TO WHOM IT MAY CONCERN,

This is to certify that M________________________________________, of


______________________________, was examined and treated in this hospital by the
undersigned Diagnosis of __________________________________________.

It is further certified that he/she is fit to resume to his/her duties at work.

This Medical Certificate is issued upon the request of


___________________________________ for whatever purpose it may serve him/her.
__________________________ M.D.
Attending Physician

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