[F1[F2PART IIFORM OF CERTIFICATE
Textual Amendments
F1Sch. 2 substituted (6.4.1987) by The Social Security (Medical Evidence) Amendment Regulations 1987 (S.I. 1987/409), regs. 1(1), 4
F2Sch. 2 Pt. II substituted (1.11.1991) by The Social Security (Miscellaneous Provisions) Amendment Regulations 1991 (S.I. 1991/2284), regs. 1, 22
MATERNITY CERTIFICATE
Please fill in this form in ink Name of patient _________________________________ | |
Fill in this part if you are giving the certificate before the confinement. | Fill in this part if you are giving the certificate after the confinement. |
Do not fill this in more [F3than 20 weeks] before the week the baby is expected. | I certify that I attended you in connection with the birth which took place on ......./........../....... when you were delivered of a child [__] children. |
I certify that I examined you on the date given below. In my opinion you can expect to have your baby in the week that includes ......./........../........ | In my opinion your baby was expected in the week that includes ......./........../........ |
"Week": This means the 7 days beginning on a Sunday. | |
Date of examination ......../........../........ | Registered midwives: |
Please give your [F4NMC] Personal Identification Number and the expiry date of your registration with the [F4NMC]. | |
Date of signing ......./........../........ | ___________________________________ |
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Signature: | Doctors: Please stamp your name and address here [F5(unless the form has been stamped, in Wales, by the Local Health Board in whose medical performers list you are included or, in Scotland,] F6[F7 by the Health Board in whose primary medical performers list you are included)]]] |
Textual Amendments
F3Words in Sch. 2 Pt. II substituted (28.9.2001) by The Social Security (Medical Evidence) and Statutory Maternity Pay (Medical Evidence) (Amendment) Regulations 2001 (S.I. 2001/2931), regs. 1, 2(3)(a)
F4Word in Sch. 2 Pt. II substituted (1.8.2004) by The Health Act 1999 (Consequential Amendments) (Nursing and Midwifery) Order 2004 (S.I. 2004/1771), art. 1(1), Sch. para. 56(b)
F5Words in Sch. 2 Pt. II substituted (1.4.2013) by The National Treatment Agency (Abolition) and the Health and Social Care Act 2012 (Consequential, Transitional and Saving Provisions) Order 2013 (S.I. 2013/235), art. 1(2), Sch. 2 para. 6(3)
F6Words in Sch. 2 Pt. II substituted (1.4.2004) (W.) by The General Medical Services and Personal Medical Services Transitional and Consequential Provisions Order 2004 (S.I. 2004/865), art. 1(1), Sch. 1 para. 1(3)
F7Words in Sch. 2 Pt. II substituted (1.4.2004) (E+S+NI.) by The General Medical Services Transitional and Consequential Provisions (Wales) (No. 2) Order 2004 (S.I. 2004/1016), art. 1(1), Sch. 1 para. 1(3) (with art. 83)