Neftaly Medical Certificate
Patient Name: ____________________________
Date of Birth: ____________________________
Gender: _________________________________
Date of Examination: ______________________
Certificate Issued On: ______________________
Medical Diagnosis:
Guillain-Barré Syndrome (GBS)
ICD-10 Code: G61.0 – Guillain-Barré Syndrome
Clinical Summary:
The patient has been diagnosed with Guillain-Barré Syndrome (GBS), a rare neurological disorder in which the body’s immune system attacks the peripheral nervous system. Clinical symptoms observed include:
- Progressive muscle weakness (typically beginning in the lower limbs)
- Loss of reflexes
- Tingling or numbness
- Difficulty with walking, balance, or coordination
- In severe cases, respiratory involvement requiring medical intervention
Diagnostic Confirmation:
- Neurological examination
- Nerve conduction studies / Electromyography (EMG)
- Lumbar puncture (if applicable)
Treatment and Management:
- Hospitalization and close monitoring
- Administration of intravenous immunoglobulin (IVIG) or plasma exchange (plasmapheresis)
- Pain management and supportive care
- Physiotherapy and rehabilitation to restore mobility and strength
- Regular neurological follow-up
Prognosis:
Recovery may take weeks to several months, depending on the severity of the condition. Some patients may require prolonged rest, rehabilitation, and mobility support. The patient is currently not medically fit for work/school or strenuous activities.
Medical Certificate Statement:
This is to certify that the above-named patient has been diagnosed with Guillain-Barré Syndrome and is undergoing treatment at Neftaly Medical Center. Due to the nature of the illness, the patient is declared medically unfit for work/school from:
_________________ to _________________
A follow-up assessment will determine the readiness to return to normal activities, based on recovery progress.
Attending Physician: _________________________
Medical License Number: _____________________
Signature & Official Stamp: ___________________


