Neftaly Medical Certificate

Patient Name: ____________________________
Date of Birth: ____________________________
Gender: _________________________________

Date of Examination: ______________________
Certificate Issued On: ______________________

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Medical Diagnosis:

Hypoglycemia (Low Blood Glucose Level)
ICD-10 Code: E16.2 – Hypoglycemia, unspecified

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Clinical Findings:

The patient presented with symptoms consistent with hypoglycemia, including:

• Shakiness and sweating
• Dizziness or light-headedness
• Palpitations
• Confusion or difficulty concentrating
• Irritability or sudden behavioral changes
• Recorded blood glucose level: ___________ mmol/L (below normal range)

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Treatment Provided:

• Immediate administration of fast-acting glucose
• Monitoring of blood glucose levels
• Dietary and lifestyle counseling
• Review and adjustment of medications (if applicable)
• Advised on strategies to prevent recurrence

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Prognosis:

The patient responded well to treatment and was stabilized. Rest and monitoring are advised for the next 24–72 hours, depending on symptom severity and underlying cause. Further investigation or follow-up may be required.

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Medical Certificate Statement:

This is to certify that the above-named patient was diagnosed and treated for Hypoglycemia at Neftaly Medical Center. As a result, the patient is temporarily unfit for work/school from:
_________________ to _________________
The patient may return to normal duties on: _________________, subject to clinical improvement and follow-up review.

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Attending Physician: _________________________
Medical License Number: _____________________
Signature & Official Stamp: ___________________