Medical Facilities - ESSENTIALLY CERTIFICATE

ESSENTIALITY CERTIFICATE
I Certify that Mrs. /ESSENTIALITY CERTIFICATE
I Certify that Mrs. / Mr. / Miss ……………………………… … Wife / Son /Daughter
of Mr/Mrs……………………………………………………… employed in the
………………………………………… has been under my treatment for ……………………..
diseases from ……………………………….to …………… at
…………………………………..Hospital / my consulting room and that the under mentioned
medicine prescribed by me in this connection were essential for the recovery / prevention of
serious deterioration the condition of the patient . The Medicines are not stocked in the
……………………………Hospital ( for supply to patients) and do not include proprietary
preparations for which cheaper substance of equal therapeutic value are available or
preparations which are primarily foods, toilets of disinfectants.
Name of Medicines Price
……………………………. …………………………
…………………………… ……………………………
…………………………… ……………………………
Signature and Designation of Authorized Medical Attendant
Signature of the Medical Officer in charge in the case of the hospital Mr. / Miss ……………………………… … Wife / Son /Daughter
of Mr/Mrs……………………………………………………… employed in the
………………………………………… has been under my treatment for ……………………..
diseases from ……………………………….to …………… at
…………………………………..Hospital / my consulting room and that the under mentioned
medicine prescribed by me in this connection were essential for the recovery / prevention of
serious deterioration the condition of the patient . The Medicines are not stocked in the
……………………………Hospital ( for supply to patients) and do not include proprietary
preparations for which cheaper substance of equal therapeutic value are available or
preparations which are primarily foods, toilets of disinfectants.
Name of Medicines Price
……………………………. …………………………
…………………………… ……………………………
…………………………… ……………………………
Signature and Designation of Authorized Medical Attendant
Signature of the Medical Officer in charge in the case of the hospital