How to fill out a temporary disability certificate: sample form

Certificate 095 of temporary disability certifies the fact that the employee is unable to perform professional tasks at the enterprise. This document is issued by a competent medical institution. The form of a certificate of temporary incapacity for work confirms the valid reasons for absence from work, which allows one to avoid the application of disciplinary sanctions to the person. Let us next consider the design features of the document.

certificate of temporary incapacity for work

Form and content of the certificate

The certificate of incapacity for work must contain complete information about the patient and his diagnosis. The doctor fills out a medical certificate in form 095/у according to the following algorithm:

  • affixing OKPO and OKUD codes and a three-digit form number;
  • date of doctor's visit;
  • last name, first name and patronymic of the patient in full;
  • full name of the educational institution or enterprise to which the certificate will be provided;
  • indication of the patient's category;
  • patient's full date of birth;
  • disease identification code or indication of other causes;
  • the period for which the document is provided;
  • fact of contact with infectious patients (if any);
  • date of issue of the medical certificate;
  • doctor's recommendations (if necessary);
  • the doctor’s signature and two seals certifying the document.

The document is also accompanied by a control coupon, which is filled out in parallel with the certificate and remains with the institution that issued the form. It is used to maintain statistics and confirm the authenticity of the certificate.

The legislative framework

Disability of pupils and students is regulated by the following legislative acts:

  • Labor Code of the Russian Federation, in particular - Art. 183, 351.1 and .
  • Federal Law “On Education in the Russian Federation” dated December 29, 2012 N 273-FZ. The main thing in this act is clause 4 of Art. 43, stating that numerous absences without appropriate sick leave can cause the student to be expelled.

According to the legislative acts listed above, a number of standards are established in relation to minors or adult students:

  1. Absenteeism at work or systematic absences from classes at a technical school/university can lead to undesirable consequences - dismissal and expulsion, respectively. However, this rule does not apply to cases where the student or employee has provided a document certifying a valid reason for missing class.
  2. The only document confirming that a citizen really could not come to work or study may be a doctor’s certificate.
    As a rule, this means sick leave (temporary disability certificate). Moreover, the certificate must be prepared in the proper form, and it must bear the seal of the institution and the signature of an authorized employee. For students, the certificate form “095/u” is prescribed.
  3. If the total period of absences exceeded 24 days, then in addition to the certificate in form 095/y, a certificate in form 027/u must be provided.

Often, due to the excessive bureaucratization of the process, students “buy” certificates. However, this is strictly forbidden, since there may even be criminal liability if a forgery is discovered.

It is better to consider the standard algorithm for obtaining a certificate - it is not so difficult if you approach the procedure carefully and responsibly.

List of circumstances

A certificate of temporary disability is issued for the following list of valid reasons:

  • presence of illness or exacerbation of a chronic disease;
  • caring for a sick relative or small child;
  • the presence of an injury that interferes with normal work or study;
  • caring for a sick relative or small child;
  • going through the process of prosthetics in a stationary clinic;
  • deterioration of health during pregnancy;
  • the need for resort treatment or the process of restoring health;
  • going through the postoperative rehabilitation process;
  • announcement of quarantine at the enterprise;

Also, the reason for issuing this medical certificate may be to conduct a forensic examination or undergo a medical examination.

Functions

The form of a temporary disability certificate allows you to regulate your relationship with the employer. Absence from work without good reason, as is known, is a violation of discipline at the enterprise. For this, the Labor Code provides for certain sanctions. This means that the validity of the reasons must be documented.

In addition, the certificate in question is used for temporary disability benefits. In itself, it is not a basis for calculating amounts. However, for accounting, the information contained in the certificate is important. Temporary disability benefits are calculated taking into account the number of days missed. It is this information that specialists need.

Validity periods

The maximum validity period of a document exempting from study or work is 15 calendar days. If the certificate form is filled out by a paramedic or dentist, the validity period of the document is reduced to 10 days.

Additional Information! In some cases, it is possible to extend the certificate for up to 30 days (for students, the document includes a 1-month exemption from physical education classes).

To extend the standard validity period of the document, you must undergo an additional examination and obtain a certificate from a medical commission.

Registration online

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Important points

For military personnel and employees of the Ministry of Internal Affairs, a separate document is provided - a sheet of exemption from service duties due to prosthetics or illness. Its validity period is no more than four months per year and is necessarily accompanied by a referral for treatment under the supervision of a military medical commission. Based on the results of her work, a diagnosis and conclusion about suitability for military work will be made.

How to fill out a temporary disability certificate: sample form

But in some cases it can be replaced by a certificate of temporary disability, which for law enforcement officers is issued in the generally established manner.

Deciding on the type of certificate

If you are in doubt about which document you should order, our managers will be happy to advise you over the phone for free and help you choose a medical form that will cover the required number of passes at work:

  1. Certificate 027 is an extract from the medical history confirming the presence of a serious illness and the need for long-term release from professional activities. The form also states the exact diagnosis, nature and duration of treatment. Certificate 027 can be either inpatient or outpatient.
  2. Certificate 095 is a document similar to a sick leave certificate, confirming your temporary disability. Ideal if, for example, you work several jobs, and the document is required where the work book is.
  3. A free form from a specialized doctor (dentist, ophthalmologist, gynecologist, therapist, traumatologist, gastroenterologist, surgeon, etc.). In fact, you could just oversleep on your way to work, but in order not to get a reprimand, you will need such a one-day certificate.

What does the certificate look like?

The medical certificate is issued according to a single prescribed template. The form must be filled out in black or blue ink. The upper right corner of the certificate is indicated by the code of the form of the document and the medical institution that issues it. Below is the subheading “Help” and its registration number is indicated. The document must contain information about the patient and the enterprise or educational institution to which he is assigned.

How to fill out a temporary disability certificate: sample form

The form also indicates the date the certificate was issued and the patient’s diagnosis code. According to the new rules, to maintain confidentiality about the patient’s condition, each disease recorded on the temporary disability certificate has its own identification number. The period for which the certificate is issued is indicated at the bottom of the document. The certificate is certified by the doctor’s signature and two seals: the attending physician himself and a blue triangular stamp for certificates at the very bottom of the form.

Medical certificates of temporary disability

A medical certificate about a citizen’s temporary disability can certainly be called an expert document. Its main task is to confirm the fact that during a certain period of time an individual did not have a full opportunity to perform certain actions. In most cases, we are talking specifically about the fulfillment of professional obligations that were assigned to a person in accordance with his employment contract, as well as other staff documents of the company.

As you know, the authority of any employer includes imposing various types of disciplinary sanctions on its employees. Such penalties can only be applied for any violations committed by the employee. These violations include the most common:

As you can see, the first place in the most common disciplinary violations is occupied by absenteeism. From a legal point of view, they should be understood as certain time periods during which the employee was absent from his workplace. The fact of absenteeism must be recorded by the employer in documentary form. To do this, he draws up an official report on the absence of the employee from his workplace.

After compiling the above fact, the head of the organization actually has legal grounds for applying one of three types of disciplinary action. It should be noted that the specific choice of punishment is at the sole discretion of the employer. Therefore, if he wants, he can easily fire an employee unilaterally.

However, the above situation will change radically if the employee submits to his boss a certificate of temporary disability. In this situation, the employer will lose his right to apply one of the rules of disciplinary liability. Naturally, this rule will only work if the certificate itself is issued to an individual in full compliance with the established requirements regarding the form of the document and other important features.

Design specifics

For employees of enterprises, students in schools or higher educational institutions, registration occurs on equal terms. To do this, you should contact the nearest clinic or any other medical institution where the patient is undergoing examination or treatment. The certificate itself is issued after several visits to the attending physician, who makes a diagnosis, prescribes treatment and monitors the treatment process. To receive a document, you must appear in person at the medical institution with your identification card.

All patients who belong to the category of citizens affected by accidents with radioactive emissions, disabled people or suffering from radiation sickness have a number of individual benefits when obtaining a medical certificate.

When a certificate can be issued instead of a certificate of incapacity for work

There are not so many cases of issuing a certificate. For example, a certificate may be issued if:

  1. The employee fell ill and sought medical help in another city. Due to the fact that he was going to return home before the recovery period, he was not prescribed a PL; they gave him a certificate from a medical institution so that he could continue his treatment and discharge a PL at his place of residence.
  2. An employee fell ill while on a business trip abroad. In this case, there is simply no one to prescribe LN for him. The employee brings any documents that are issued to him by the medical institution where he sought help. In Russia, he will have to make an official translation of documents, then write out the LN at his place of residence.
  3. The employee received a minor injury, went to the trauma center, he was provided with medical assistance, the injury was considered minor, the patient was not discharged, he was advised to see a surgeon at his place of residence, and was issued a certificate of seeking medical assistance.
  4. In addition, in case of illness, children of school age are issued certificates for exemption from school.

Issue

The issuance of a certificate in form 095/у is carried out according to certain rules.

  1. The document can only be obtained upon a personal visit to the doctor.
  2. The patient is issued a certificate only upon presentation of an identification document (passport, student card or driver's license) to the attending physician.
  3. Only the specialist who examined and treated the patient has the right to issue a medical certificate.
  4. The seals of the medical institution issuing the certificate must be clear, easy to read and contain the full name of the organization and the name of the attending physician.
  5. The document certified by the doctor is registered in the accounting book under an individual serial number.
  6. All data about the examination, the treatment process and the issuance of a certificate are recorded in the patient’s outpatient record.
  7. The counterfoil of the form must always remain with the medical institution that issued the certificate.

The process of issuing a certificate of incapacity for work to a schoolchild or student follows the same procedure.

How to compose correctly

This document has a single unified form throughout the country. Therefore, the patient should not compile it independently. Moreover, forging a form is punishable by law. A certificate form is issued at medical institutions where the patient was treated, received follow-up treatment, or had a prosthesis installed.

It is important to note: organizations must have a special license. Institutions that issue certificate forms include city clinics, hospitals (including for military personnel), as well as sanatoriums and rehabilitation centers.

Duration of illness

The length of stay on sick leave due to disability depends on the duration of the disease, the absence or presence of complications or pathologies. The Ministry of Health has established a certain number of days allocated for the treatment of the most common diseases:

  • sore throat - from 6 to;
  • bronchitis - from 10 to;
  • exacerbation of gastritis and pancreatitis - up to 10 days;
  • otitis - from 5 to 7;
  • influenza and its various forms - from 6 to 10;
  • exacerbation of cardiovascular diseases - from 5 to 7;
  • ARVI - from 3 to 8;
  • exacerbation of vegetative-vascular dystonia - from 5 to 7.

Up to 29-30 days are allotted for the treatment of pneumonia; to extend the treatment period, the convening of a special medical commission is required.

Where can I get it?

A certificate of temporary disability is issued at the place where the patient seeks help, where he receives various types of medical services. Students can apply for it in a city or rural clinic (at their place of registration) if a disease occurs that does not require hospitalization.

Form 095/у can only be issued by doctors working in a medical institution that has licenses to carry out medical activities.

The license must necessarily specify the right of the healthcare institution to issue certificates of temporary disability.

Such legal entities include:

  • clinic;
  • inpatient hospital;
  • sanatorium;
  • rehabilitation center.

A certificate of temporary disability of a student in form 095/у is filled out by a doctor at a medical institution.

Issuance procedure for a student at a technical school or university

Letter of Rosobrnadzor No. 02-153 dated April 17, 2015 indicates the procedure for issuing certificates of temporary disability to students of universities and technical schools, observing the following algorithm of actions:

  • Form 095/у is issued only upon a personal visit to the doctor; ordering it by phone is unacceptable, as is receiving it by mail;
  • a document on the student’s temporary disability is issued upon presentation to the doctor of an identification document, in addition to which a student or travel card with a photograph is attached;
  • the certificate is written by the healthcare worker who examined the patient, prescribed a diagnosis and course of treatment; in exceptional cases, these functions can be taken over by a midwife or paramedic;
  • the stamp and seal of the medical institution must be clear, easy to read and include the full name of the institution;
  • the counterfoil of form 095/y always remains in the clinic or dispensary where the patient received medical services.

A certificate from a doctor during state scheduled exams allows the student to receive a deferment and is essential evidence of his legal absence due to temporary disability when passing the scheduled, final certification.

It is this form issued to the student that serves as the basis for rescheduling the required exams to reduce the student’s backlog from the educational program due to illness.

A certificate of temporary disability of a student at an institute is issued by clinics to representatives of full-time and part-time education.

Sometimes students who feel the first signs of a slight illness (flu, cold) are immediately sent to the hospital to avoid the infection causing serious harm. The document will also save those students who are unable to attend lectures and seminars due to accumulated fatigue.

Decor

Today, there are often cases of acquiring illegal certificates in order to maintain one’s place at the institute. But this act may lead to expulsion from the university and criminal prosecution.

To be sure of the authenticity of the document, you need to know the required fields of the certificate to fill out:

  1. three-digit form number;
  2. date of doctor’s visit (period of issue of form 095/у);
  3. Full name of the student (in full, legible handwriting);
  4. name of the educational institution (preschool, higher, secondary specialized), the use of abbreviations is allowed;
  5. student's date of birth;
  6. a diagnosis that allows you to stop attending a university, technical school, or school;
  7. the period of temporary incapacity for work of the student;
  8. the date allowing the student to begin classes;
  9. signature of the doctor who issued the form.

The regulations for document execution are determined by the Ministry of Health of the Russian Federation. If the exemption from classes lasts more than 10 calendar days, then the medical worker breaks the document into equal sections.

When issuing a certificate due to an acute viral infection, it is allowed to write down an abbreviated entry - ARVI.

If the certificate is issued to children who are students of secondary schools, gymnasiums, or kindergarten students, then form 095/u must contain information about the absence of contact with infectious patients for two or three weeks. Without this registration, the child is not allowed to attend classes.

The full period for granting temporary disability according to a medical certificate of form 095u should not exceed the deadlines stipulated by the Ministry of Health of the Russian Federation.

The document must be certified by 3 medical seals: a rectangular seal of the clinic, a triangular one for sick leave, and a round seal of the attending doctor.

Medical certificate 095 is issued for a limited time, but no more than 14. Exemption from physical education also cannot exceed 2 weeks.

Extension of the validity period of the document is formalized by another medical document - a certificate of form 027/u (medical extract). This form allows you to receive a 30-day exemption from physical education.

It is important to indicate the serial number and date of registration of the certificate in the journal of issued documents. This makes it possible to always clarify the details of the issued medical certificate.

and sample form 095/у

Form of certificate of temporary disability of a student 095/у – .

A sample form for a university student – ​​.

This is what a completed sample certificate of form 095/у looks like:

photo-4

Is it possible to punish an employee who, after illness, did not bring sick leave?


How to fill out a temporary disability certificate: sample formAngry executive pointing out his employee
By law, an employee is required to document a valid reason for missing or failing to perform work duties. To do this, the employee must provide a certificate of incapacity for work to the place of work. If such a document is missing or it is revealed that it is fictitious, the boss has the right to fine or dismiss the subordinate. An employee may face legal penalties for falsifying official documents. In the case of students, the dean's office has the right to expel a student for unjustified absences after several reprimands.

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