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More specifically, however, capacity describes a patient's ability to make autonomous decisions regarding their care, as determined by a physician, whereas competence is a legal term that describes a person's ability to participate in legal processes, as determined by a judge.
A fit note must be issued by a healthcare professional, which could be a doctor, nurse, pharmacist, physiotherapist or occupational therapist. You do not always need to see them in person to get one.
Incapacity is the clinical state in which a patient is unable to participate in a meaningful way in medical decisions. Mentally incapacitated patients relinquish the authority, that is the competent patient's right, to choose among professionally acceptable alternative treatments.
This can be done by a telephone consultation with your own doctor who may be able to issue a certificate without you needing to be seen. Or, if it is a continuing problem, a telephone consultation from the doctor who you saw previously for the condition, again there may be no need for you to be seen in person.
Pennsylvania has at-will employment, which means that employers have the freedom to terminate someone for taking sick leave, even if they followed the company policy and provided a doctor's note. You may take legal action against the employer if you were unfairly terminated.