Clinical template
Medical Certificate Template
A medical certificate is a formal opinion on fitness, restrictions, or duration of disability, usually for work, school, occupational health, or a named third party. It is longer than a sick note and it is still based on an assessment you actually did. Use the blank below, then three fictional Canadian certificates.
Blank medical certificate template
Copy this onto letterhead or into a Scribeberry letter template. If the employer, school, or insurer sent a form, complete that form and keep a copy. Do not invent capacity you did not assess. Issuing a false certificate is professional misconduct.
Medical certificate
[Clinic letterhead: name, address, phone, fax] Date of certificate: Date(s) of assessment: To: [occupational health / registrar / insurer / employer] File or student number: Re: [patient full name], DOB, job title or program if relevant I assessed this patient on [dates]. This certificate is based on that assessment [and review of (imaging, specialist note)]. Opinion (pick what you were asked): - Fit for full duties from [date] - Unfit for all work / school from [date] to [date] - Fit for modified duties from [date], restrictions below, review on [date] Functional restrictions (be specific): lifting, standing, sitting, driving, shift work, patient-facing, screens, PPE, sport Hours: full / reduced (state hours) / graded return (week-by-week) Diagnosis: omitted / included with patient's consent: Prognosis / expected duration (if you can support it): Reassessment date: I have not assessed fitness for [items you did not test: commercial driving, aviation, safety-sensitive work unless you did]. Sincerely, [Signature, printed name, designation, college number] [Contact for occupational health, with patient consent]
Fictional patients
Every example on this page uses made-up names and findings. They are teaching material for clinicians who have assessed the person. They are not a kit for forging certificates. Review every generated letter before it leaves the clinic.
Certificate vs doctor's note
A doctor's note is usually a short absence letter (a few days off work or school, or simple modified duties). A medical certificate answers a fitness question: can they return, with what restrictions, for how long, and when you will look again. EI sickness, occupational health, return-to-sport, and registrar deferrals often want a certificate or their own form, not a three-line sick note.
| Document | Typical use | What it must rest on |
|---|---|---|
| Doctor's note | Short work or school absence, simple modified duties | An assessment covering those dates |
| Medical certificate | Fitness, graded return, duration of disability, third-party forms | An assessment plus, when needed, function you actually tested |
| Workers' compensation form | WSIB, WorkSafeBC, WCB, CNESST | The provincial form, not a substitute letter |
| Specialist / ministry form | Aviation, commercial driving, some licences | The designated examiner pathway; do not freelance |
Several Canadian colleges and the CMA have discouraged routine sick notes for brief viral absences. Certificates for fitness and return-to-work are a different job: occupational health still needs a defensible opinion. Confirm your college's current advice. CPSO-style guidance treats honesty of the certificate as an integrity issue. So do other provincial colleges.
False certificates
Certifying fitness or unfitness you did not assess, back-dating disability, or signing a blank insurer form is professional misconduct. It can cost a licence. This page is for legitimate certificates after a real assessment. Do not use it to fake paperwork.
What to put on a certificate
Dates of assessment, the opinion, specific restrictions, hours, and a review date. Function beats diagnosis. Occupational health can roster a cashier who cannot lift more than 2 kg and cannot stand more than 20 minutes. They cannot roster 'ankle issues.' Ask the patient before you name a diagnosis; PHIPA still applies when the letter will sit in an HR or insurer file.
Stay inside what you examined. A family physician can certify a graded return after pneumonia based on a clinic visit. They should not certify a commercial Class 1 driver as fit without the CCMTA medical process, or a pilot without the aviation medical examiner pathway. Write the limit on the page: 'I have not assessed commercial driving fitness.' Prognosis should be cautious. If you do not know when a concussion will clear, give a short window and a review, not a six-month guess.
Example 1 — fitness to return after pneumonia
Family medicine, graded return to work
52-year-old teacher, Ottawa. Follow-up 10 days after hospital discharge. Fictional.
Byward Family Practice Ottawa ON | 613-555-0144 Date of certificate: 21 March 2026 Dates of assessment: 11 March 2026 (hospital discharge summary reviewed) and 21 March 2026 (clinic) To: Occupational Health, Ottawa-Carleton District School Board Re: Nadia El-Sayed, DOB 1973-08-16, secondary teacher I assessed this patient in clinic on 21 March 2026 following hospitalization for community-acquired pneumonia (discharged 11 March 2026). She is afebrile, saturating 97% on room air at rest, and walking on the flat without stopping. She still becomes dyspneic climbing two flights. Opinion: Unfit for full classroom duties until 4 April 2026. Fit for modified duties from 24 March 2026 as below. Restrictions until review 4 April 2026: - No full-day teaching. Maximum 4 hours/day, non-consecutive if possible - No yard duty, no stair supervision - May do lesson planning, marking, and small-group work seated - Not fit for high-intensity physical-education coverage Diagnosis included with the patient's consent: resolving community-acquired pneumonia. Prognosis: expected return to full duties on 7 April 2026 if the 4 April review is satisfactory. I have not assessed fitness for any role other than her teaching position. Sincerely, Dr. P. Nguyen, CCFP CPSO # 445566
Example 2 — school, exam deferral after confirmed influenza
Student health, registrar certificate
19-year-old undergraduate, Edmonton. In-person visit, PCR positive. Fictional.
University Health Centre Edmonton AB | 780-555-0121 Date of certificate: 14 January 2026 Date of assessment: 14 January 2026 To: Faculty of Engineering, deferred-exam office Student ID: on file with the student Re: Alexei Morozov, DOB 2006-05-02 I assessed this student in clinic today. They have laboratory-confirmed influenza A with fever, myalgias, and inability to concentrate. They are medically unfit to sit timed examinations from 14 January 2026 to 18 January 2026 inclusive. They should be fit to sit a deferred examination on or after 20 January 2026 if fever-free for 24 hours without antipyretics. No ongoing academic restrictions are recommended after that date. This certificate does not address accommodation for a chronic condition. Diagnosis included with the student's consent: influenza A. I have not assessed disability for the purposes of a long-term academic accommodation file. Sincerely, Dr. F. Okeke, CCFP CPSA # 112233
Example 3 — return to sport after ankle sprain
Family medicine / sport, modified training
17-year-old soccer player, parent present, Burnaby. Fictional.
Hastings Community Clinic Burnaby BC | 604-555-0180 Date of certificate: 9 October 2026 Date of assessment: 9 October 2026 (injury 2 October 2026) To: Club athletic therapist / coach Re: Samira Kadri, DOB 2009-03-21 Parent/guardian present and agrees to this certificate being shared with the club. I assessed this patient today. Examination is consistent with a left lateral ankle sprain (able to weight-bear, no bony tenderness at Ottawa ankle points, drawer mildly positive). X-ray 2 October 2026: no fracture (report reviewed). Opinion: Unfit for match play and for cutting/pivoting drills until review on 23 October 2026. Fit for modified training from 10 October 2026. Restrictions: - Weight-bearing as tolerated in a lace-up brace - Stationary bike, swimming, upper-body weights: allowed - No running until pain-free walk and single-leg stance 10 s - No heading drills that require jump-and-land until the 23 October review - School: no gym running; may attend class (this is not a school-absence note) I have not cleared this athlete for full competition. Clearance for match play will require a further assessment. Diagnosis included with patient and parent consent. Sincerely, Dr. C. Huang, CCFP CPSID 55667
Mistakes that show up on certificates
- Signing an insurer's blank or pre-ticked form without an assessment that matches the boxes.
- Permanent restrictions with no exam and no occupational-health pathway.
- Certifying commercial driving, aviation, or diving fitness without the designated process.
- Open-ended 'unfit until further notice' with no review date.
- Putting a mental-health or infectious diagnosis on an HR certificate the patient did not agree to share.
- Using a certificate as a substitute for a WSIB / WorkSafe / CNESST form.
- Back-dating weeks of disability you first heard about today.
- Issuing a certificate for someone you never assessed.
CMPA files on medical certificates usually turn on whether the opinion matches the assessment and whether the physician stayed inside their role. Colleges treat false or undocumented certificates as professional misconduct, not as a paperwork error. If a third party wants more than you can support, say so on the page and offer a review date.
Third-party forms and who you work for
The patient is still the patient when occupational health or an insurer is paying for the letter. Record who requested the certificate, what you disclosed, and the consent. If you cannot complete a section (functional capacity evaluation, treadmill, specialist imaging), write that you did not perform it rather than guessing.
Draft the certificate from the visit
Scribeberry listens to the encounter, or takes dictation, and drafts a medical certificate in your letterhead template. You check dates, restrictions, and consent, then send. Smart Push into Accuro, OSCAR, Jane, or any web EMR. Pro is $99/month after the free trial.
Frequently asked questions
How is a medical certificate different from a doctor's note?
A doctor's note is usually a short absence or simple modified-duties letter. A medical certificate is a formal fitness opinion: return-to-work, graded hours, duration of disability, or a school/sport clearance, often for a named third party. Both require a real assessment.
Do I have to put the diagnosis on a medical certificate?
Only if the patient consents or a specific form requires it. Functional restrictions and dates are usually enough for occupational health. Record consent in the chart if you name a diagnosis.
Can I certify someone I have not seen?
No. Issuing a false certificate, or a certificate without an assessment, is professional misconduct in Canadian jurisdictions. Do not back-date or invent fitness. Use the designated examiner process for aviation and many commercial-driving decisions.
Can Scribeberry write medical certificates?
Yes. After a real visit, generate into your certificate template, then edit restrictions, dates, and consent before the letter leaves the clinic. Scribeberry does not create certificates for people who were not assessed.
Templates
