SCHEDULE 1

Regulation 2(1)

PART IRULES

1

In these rules, unless the context otherwise requires—

  • “claimant” means the person in respect of whom a statement is given in accordance with these rules;

  • “doctor” means a registered medical practitioner not being the claimant;

  • “doctor's statement” means a statement given in accordance with these rules;

  • “2 weeks” means any period of 14 consecutive days.

2

The doctor's statement shall be in the form set out in Part II of this Schedule.

3

Where the claimant is on the list of a doctor providing general medical services under the National Health Service Act 1946, or the National Health Service (Scotland) Act 1947, F8or the list of a doctor, or a list held jointly by two or more doctors, performing personal medical services in connection with a pilot scheme under the National Health Service (Primary Care) Act 1997, and is being attended by such a doctor, the doctor's statement shall be on a form provided by the Secretary of State for the purpose and shall be signed by that doctor.

4

In any other case, the doctor's statement shall be either on a form provided by the Secretary of State for the purpose or in a form substantially to the like effect, and shall be signed by the doctor attending the claimant.

5

Every doctor's statement shall be completed in ink or other indelible substance, and shall contain the following particulars:—

a

the claimant's name;

b

the date of the examination on which the doctor's statement is based;

c

the diagnosis of the claimant's disorder in respect of which the doctor is advising the claimant to refrain from work or, as the case may be, which has caused the claimant's absence from work;

d

the date on which the doctor's statement is given;

e

the address of the doctor,

and shall bear, opposite the words “Doctor's signature”, the signature of the doctor making the statement written after there have been entered the claimant's name and the doctor's diagnosis.

6

Subject to rules 7 and 8 below, the diagnosis of the claimant's disorder in respect of which the doctor is advising the claimant to refrain from work or, as the case may be, which has caused the claimant's absence from work shall be specified as precisely as the doctor's knowledge of the claimant's condition at the time of the examination permits.

7

Where, in the doctor's opinion, a disclosure to the claimant of the precise disorder would be prejudicial to his well-being, the diagnosis may be specified less precisely.

8

In the case of an initial examination by a doctor in respect of a disorder stated by the claimant to have caused incapacity for work, where—

a

there are no clinical signs of that disorder, and

b

in the doctor's opinion, the claimant need not refrain from work,

instead of specifying a diagnosis “unspecified” may be entered.

9

A doctor's statement must be given on a date not later than one day after the date of the examination on which it is based, and no further doctor's statement based on the same examination shall be furnished other than a doctor's statement by way of replacement of an original which has been lost or mislaid, in which case it shall be clearly marked “duplicate”.

10

Where, in the doctor's opinion, the claimant will become fit to resume work on a day not later than 2 weeks after the date of the examination on which the doctor's statement is based, the doctor's statement shall specify that day.

11

Subject to rules 12 and 13 below, the doctor's statement shall specify the minimum period during which, in the doctor's opinion, the claimant should, by reason of his disorder, refrain from work.

12

The period specified shall begin on the date of the examination on which the doctor's statement is based and shall not exceed 6 months unless the claimant has, on the advice of a doctor, refrained from work for at least 6 months immediately preceding that date.

Where13

a

the claimant has, on the advice of a doctor, refrained from work for at least 6 months immediately preceding the date of the examination on which the doctor's statement is based, and

b

in the doctor's opinion, it will be necessary for the claimant to refrain from work for the foreseeable future,

instead of specifying a period, the doctor may, having regard to the circumstances of the particular case, enter the words “until further notice”.

14

The Notes set out in Part III of this Schedule shall accompany the form of doctor's statement provided by the Secretary of State.

15

A doctor may, having regard to the circumstances of the particular case, indicate on the doctor's statement that the claimant should be considered for vocational rehabilitation.

PART IIFORM OF DOCTOR'S STATEMENT

DOCTOR'S STATEMENT

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PART IIITHE NOTES

The following notes shall accompany the form of doctor's statement provided by the Secretary of State:—

On the doctor's statement:—

1

After the words “you should refrain from work for”, the period entered must not exceed 6 months unless the patient has, on the advice of a doctor, already refrained from work for a continuous period of 6 months.

2

After the words “you should refrain from work until”—

a

if the patient is being given a date when he can return to work the date entered should not be more than 2 weeks after the date of the examination;

b

if the patient has already been incapable of work for at least 6 months and recovery of capacity for work in the foreseeable future is not expected “further notice” may be entered.

F5SCHEDULE 1A

Regulation 2(1)

Annotations:
Amendments (Textual)

PART Irules

1

In these rules, unless the context otherwise requires—

  • “claimant” means the person in respect of whom a statement is given in accordance with these rules;

  • “doctor” means a registered medical practitioner not being the claimant;

  • “special statement” means the form prescribed in Part II of this Schedule.

2

Where a doctor advises a claimant to refrain from work on the basis of a written report which he has received from another doctor or where a doctor has not issued a statement since the claimant was examined and he wishes to issue a statement more than a day after the examination he shall use the special statement.

3

The special statement shall be completed in the manner described in paragraph 5 of Part I to Schedule 1.

4

Subject to rules 5 and 6 below, the diagnosis of the claimant’s disorder in respect of which the doctor is advising the claimant to refrain from work or as the case may be, which has caused the claimant’s absence from work shall be specified as precisely as the doctor’s knowledge of the claimant’s condition permits.

5

Where, in the doctor’s opinion, a disclosure to the claimant of the precise disorder would be prejudicial to his well being, the diagnosis may be specified less precisely.

6

In a case of a disorder stated by the claimant to have caused incapacity for work, where—

a

no clinical signs have been found of that disorder, and

b

in the doctor’s opinion, the claimant need not refrain from work, “unspecified” may be entered.

7

Part B of the special statement must only be given on a date not later than one month after the date of the written report on which the special statement is based and that part shall only be used where the claimant is being advised to refrain from work for a specified period of not more than one month.

PART IIform of special statement

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F6SCHEDULE 1B

Regulation 2(1)(c)

Annotations:
Amendments (Textual)

PART IRules

1

In these rules, unless the context otherwise requires—

  • “claimant” means the person in respect of whom a statement is given in accordance with these rules;

  • “doctor” means a registered medical practitioner not being the claimant;

  • “F9personal capability assessment statement” means a statement given by a doctor in accordance with these rules.

2

Where the Secretary of State has requested that the claimant provide an F9personal capability assessment statement, that statement shall be provided in the form prescribed in Part II of this Schedule notwithstanding that the claimant has already provided a statement in accordance with Schedule 1 or 1A.

3

The F9personal capability assessment statement shall be completed in accordance with rules 3, 4, 5 F7and 9 to 13 of Part I to Schedule 1.

4

Subject to rule 5 below, the diagnosis of—

a

the disorder in respect of which the doctor is advising the claimant to refrain from work or, as the case may be, which has caused the claimant’s absence from work; and

b

any other condition which could affect the claimant’s capacity for work,

shall be specified as precisely as the doctor’s knowledge of the claimant’s condition at the time of the examination permits.

5

Where, in the doctor’s opinion, a disclosure to the claimant of the precise disorder would be prejudicial to his well being, the diagnosis may be specified less precisely.

6

The notes set out in Part III of this Schedule shall accompany the form of doctor’s statement provided by the Secretary of State.

PART II

Annotations:
Amendments (Textual)

FORM OF DOCTOR'S STATEMENT

THIS FORM SHOULD NOT BE USED FOR PEOPLE CLAIMING STATUTORY SICK PAY FROM THEIR EMPLOYER

Doctor's Statement

In confidence to Mr/Mrs/Miss/Ms

__________________________________________________________

Note for Doctor - we are making an assessment of your patients eligibility for Incapacity Benefit and other state benefits under the terms of the F10personal capability assessment. Please complete the following boxes

Main diagnosis (be as precise as possible)__________________________________

Other diagnosis ___________________________________________________________________________

Doctor's remarks

(Including comments on the disabling effects of the condition, treatment and progress - accuracy and detail will avoid requests for completion of a medical report).

Note for Doctor - While the F10personal capability assessment is being carried out, we need evidence that your patient should refrain from his usual occupation. Please provide the following information (which will not be part of the F11personal capability assessment ).

I am issuing the following statement based upon the current guidance to certifying medical practitioners. I examined you today / yesterday and advised you that:

(a) You need not refrain from your usual occupation

(b) You should refrain from your usual occupation

For (Insert period) _________________

Or until ___________________________

Doctor's

Signature

Date of

signing

Form Med 4

PART IIIThe Notes

The following notes shall accompany the form of doctor’s statement provided by the Secretary of State:

1

After the words on the doctor’s statement “you should refrain from your usual occupation”—

i

if the patient is being given a date when he can return to work, the date entered should not be more than 2 weeks after the date on which the statement is issued;

ii

if recovery of capacity for work in the foreseeable future is not expected, “further notice” may be entered.

2

The “remarks” box should be used to provide additional information; including further details of diagnosed conditions, the disabling effect of such conditions, and notes on the patient’s treatment and progress. Accuracy and detail will avoid requests for completion of a medical report.

3

The “remarks” box should also be used to state whether or not the patient is able to travel a reasonable distance to a medical examination as a result of his condition. If no entry is made, it will be assumed that the patient can travel.

4

This form of doctor’s statement should not be used where the patient is claiming statutory sick pay from their employer. Form Med 3 should be used for that purpose.

F1SCHEDULE 2

Regulation 2(3)

Annotations:
Amendments (Textual)

PART Irules

1

In these rules any reference to a woman is a reference to the woman in respect of whom a maternity certificate is given in accordance with these rules.

2

A maternity certificate shall be given by a doctor or registered midwife attending the woman and shall not be given by the woman herself.

3

The maternity certificate shall be on a form provided by the Secretary of State for the purpose and the wording shall be that set out in the appropriate part of the form specified in Part II of this Schedule.

4

Every maternity certificate shall be completed in ink or other indelible substance and shall contain the following particulars—

a

the woman’s name;

b

the week in which the woman is expected to be confined or, if the maternity certificate is given after confinement, the date of that confinement and the date the confinement was expected to take place F3...;

c

the date of the examination on which the maternity certificate is based;

d

the date on which the maternity certificate is signed; and

e

the address of the doctor or where the maternity certificate is signed by a F4registered midwife the personal identification number given to her by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (“UKCC”) on her registration in Part 10 of the register maintained under section 10 of the Nurses, Midwives and Health Visitors Act 1979 and the expiry date of that registration,

and shall bear opposite the word “Signature”, the signature of the person giving the maternity certificate written after there has been entered on the maternity certificate the woman’s name and the expected date or, as the case may be, the date of the confinement.

5

After a maternity certificate has been given, no further maternity certificate based on the same examination shall be furnished other than a maternity certificate by way of replacement of an original which has been lost or mislaid, in which case it shall be clearly marked “duplicate”.

F2PART IIFORM OF CERTIFICATE

Annotations:
Amendments (Textual)
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 F12than 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 UKCC Personal Identification Number and the expiry date of your registration with the UKCC.

Date of signing ......./........../........

___________________________________

Signature:

Doctors:

Please stamp your name and address here if the form has not been stamped by the F13Health AuthorityF14or Primary Care Trust in whose medical list you are included