Get Form 41

Filling out the Form 41 online is a straightforward process that allows individuals to submit a medical certification to the relevant authorities. This guide will walk you through each section of the form, ensuring that you understand what information is required and how to submit it effectively.

Follow the steps to complete the Form 41 online

1. Click the ‘Get Form’ button to obtain the form and open it in the browser.
2. Begin the form by having the patient sign in the specified area. Ensure that they understand they are waiving their rights to professional confidentiality regarding their medical information.
3. The attending physician should complete the section below the patient's signature by indicating the bureau the application is addressed to, and confirming the duration of their attendance as the physician from a specified start date to an end date.
4. Provide the name and nature of the disease or disability in the appropriate sections. It's essential to include thorough details about the condition, as these will be scrutinized for accuracy and completeness.
5. Complete the history section by detailing the patient's medical history relevant to this illness or disability, providing a comprehensive understanding of their health status leading up to the certification request.
6. In the description section, further elaborate on the condition, including any symptoms and the necessity of the medical leave from work.
7. If any laboratory tests were conducted, document them in the designated area. State the dates of hospitalization, if applicable, and ensure all details are correct and detailed.
8. The physician needs to certify that the statements made in the form are accurate and complete, confirming a specific period when the patient was unable to perform their duties due to the illness.
9. Finalize the form by adding the physician's signature, post office address, and the date of signing to validate the certification. Check for any additional requirements, such as a documentary stamp if executed in the Philippines.

Complete your documents online with ease and confidence.