Mississippi Affidavit of Physician
What is this form?
The Affidavit of Physician is a sworn statement by a licensed medical doctor affirming the physical and mental condition of an individual, typically a minor or patient. This form differs from other affidavits as it specifically certifies medical fitness, making it essential for situations that require proof of health status, such as school admissions, sports participation, or legal matters regarding custody and care. It is important that this form is completed and signed in the presence of a notary public to ensure its validity.
Main sections of this form
- Affiant Details: Information about the physician, including their name and medical credentials.
- Patient Information: Identification of the individual being examined, including their name and date of birth.
- Examination Certification: A statement certifying the individual’s physical and mental condition.
- Signature of The Physician: The physician must sign the affidavit to affirm its accuracy.
- Notary Section: A space for the notary public's signature, seal, and commission expiration date.
State law considerations
This form is applicable in Mississippi, where it must conform to local notarization and certification standards. Ensure that all fields are appropriately filled, including the date of the notary's commission expiration and the physician's credentials, as dictated by state law.
When to use this document
This form is commonly used in various scenarios, including when a minor is participating in sports, enrolling in school, or undergoing activities that require proof of health. It may also be necessary in legal contexts, such as custody disputes or medical exemptions, where verifying a person's health status is vital. The affidavit serves as official documentation of an individual's well-being as assessed by a qualified physician.
Who should use this form
- Parents or guardians of minors needing health certification.
- Physicians who have performed examinations and require documentation of their findings.
- Individuals participating in activities where health verification is mandatory.
- Legal guardians or representatives involved in custody or care determinations.
How to prepare this document
- Identify the physician: Fill in the name and medical designation of the physician certifying the health status.
- Enter patient details: Provide the individual's name, date of birth, and any relevant medical history.
- Complete the certification section: The physician must describe the examination and affirm the individual's health status.
- Sign the affidavit: The physician must sign the document in front of the notary public.
- Notarize the document: Have a notary public witness the signature and complete the notary section with their seal.
Notarization guidance
To make this form legally binding, it must be notarized. Our online notarization service, powered by Notarize, lets you verify and sign documents remotely through an encrypted video session.
Mistakes to watch out for
- Failing to provide complete patient information, such as name and date of birth.
- Omitting the physician's signature or not having it notarized.
- Not including the notary public's seal or signature.
- Leaving blank fields that are required for completion.
What to keep in mind
- The Affidavit of Physician certifies the medical condition of an individual.
- This form is critical for situations where health verification is necessary.
- Completion in front of a notary is mandatory for legal validity.
- Accurate and complete information is essential to prevent issues with the document.
