Medical certificate 2018 Senior External Examination This certificate must be completed by a medical practitioner. I, registered medical practitioner, __________________________________________________________________, (name, professional qualification) of provider no. _______________________________________________________, ____________________________, (address of practice) examined _________________________________________________________________________________________ (patient’s name) on In my opinion, the person has ___________________________________________________. (date/s of consultations) ___________________________________________________________________________________________________ (name of medical condition) This person’s medical condition will affect them in the following ways when sitting examination/s: Name any prescribed medications this person is taking and list any side effects: Signature Date / /
Medical certificate 2018 Senior External Examination This certificate must be completed by a medical practitioner. I, __________________________________________________________________, registered medical practitioner, (name, professional qualification) of _______________________________________________________, provider no. ____________________________, (address of practice) examined _________________________________________________________________________________________ (patient’s name) on ___________________________________________________. In my opinion, the person has (date/s of consultations) ___________________________________________________________________________________________________ (name of medical condition) This person’s medical condition will affect them in the following ways when sitting examination/s: Name any prescribed medications this person is taking and list any side effects: Signature Date / /
see_app_special_provision_18.docx