Neftaly Medical Certificate
Patient Name: ____________________________
Date of Birth: ____________________________
Gender: _________________________________
Date of Examination: ______________________
Certificate Issued On: ______________________
Medical Diagnosis:
Hip Fracture
ICD-10 Code: S72.0 – Fracture of Neck of Femur (or specify: S72.1/S72.2 for different types)
Clinical Findings:
The patient sustained a hip fracture as confirmed by physical examination and imaging studies (e.g., X-ray, CT scan). Clinical symptoms include:
- Severe hip and/or groin pain
- Inability to bear weight on the affected side
- Swelling, bruising, and visible deformity
- Restricted range of motion
Type of Fracture: _________________________ (e.g., displaced, non-displaced, intertrochanteric, subtrochanteric)
Treatment Administered:
- Initial pain management and immobilization
- Surgical intervention on: _______________ (e.g., open reduction and internal fixation, hip replacement)
- Post-operative care and physiotherapy initiated
- Anticoagulant therapy (if applicable)
- Rehabilitation plan in place for mobility recovery
Prognosis:
Hip fractures require extensive recovery time and rehabilitation. The patient is currently unable to walk independently and is not fit to resume regular work/school duties. The expected recovery period ranges from ______ to ______ weeks/months, depending on the patient’s response to treatment and rehabilitation.
Medical Certificate Statement:
This is to certify that the above-named patient has been diagnosed and treated for a Hip Fracture at Neftaly Medical Center. The patient is declared medically unfit for work/school from:
_________________ to _________________
A follow-up evaluation will determine the readiness to return to normal activities.
Attending Physician: _________________________
Medical License Number: _____________________
Signature & Official Stamp: ___________________
