Medical certificates and reports


July 2004

Appendix 1
Schedule 4 - Regulation 21

List of prescribed medical certificates
Please note: We have inserted in bold references to the certificates commonly requested in relation to this schedule.

Description of medical certificate - Enactment under or for the purpose of which certificate required

Description of medical certificate

Enactment under or for the purpose of which certificate required

1. To support a claim or to obtain payment either personally or by proxy; to prove incapacity to work or for self-support for the purposes of an award by the Secretary of State; or to enable proxy to draw pensions etc.

Statutory sick pay and state incapacity benefits:
Med 3, Med 4, Med 5, Med 6

Statutory maternity pay and state maternity benefits:
MAT B1

Disability living allowance:
DLA 1, DLA 1A, DLA 1 Welsh, DLA 1 Child, DLA 434, DLA 580, DLA 581, DLA 582

Attendance allowance:
AA1, AA1A

Naval and Marine Pay and Pensions Act 1865

Air Force (Constitution) Act 1917

Pensions (Navy, Army, Air Force and Mercantile Marine) Act 1939

Personal Injuries (Emergency Provisions) Act 1939

Pensions (Mercantile Marine) Act 1942

Polish Resettlement Act 1947

Social Security Administration Act 1992

Social Security Contributions and Benefits Act 1992

Social Security Act 1998

2. To establish pregnancy for the purpose of obtaining welfare foods

Section 13 of the Social Security Act 1988 (schemes for distribution etc of welfare foods)

3. To secure registration of still-birth

Medical certificate of stillbirth – 34

Section 11 of the Births and Deaths Registration Act 1953 (special provision as to registration of still-birth)

4. To enable payment to be made to an institution or other person in case of mental disorder of persons entitled to payment from public funds

No prescribed certificate; this is usually produced as a letter with no fixed format

Section 142 of the Mental Health Act 1983 (pay, pensions etc of mentally disordered persons)

5. To establish unfitness for jury service

Juries Act 1974

6. To support late application for reinstatement in civil employment or notification of non-availability to take up employment owing to sickness

Reserve Forces (Safeguarding of Employment) Act 1985

7. To enable a person to be registered as an absent voter on grounds of physical incapacity

Representation of the People Act 1983

8. To support applications for certificates conferring exemption from charges in respect of drugs, medicines and appliances

FW8 and FP92A

National Health Service Act 1977

9. To support a claim by or on behalf of a severely mentally impaired person for exemption from liability to pay the Council Tax or eligibility for a discount in respect of the amount of Council Tax payable

Local Government Finance Act 1992


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