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I. TO BE COMPLETED BY STUDENT: STUDENT NUMBER: I, (please print) ____________________, hereby authorize this licensed practitioner to provide the following information to Western University and, if required, to supply additional information relating to my petition for special academic consideration. Signature Date II.
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Medical Certificate Templates & Examples Certification of Medical Records Template A Certification of Medical Records Template is a standardized format that provides an organized way to present and verify the accuracy of a patient's medical history, diagnosis, treatments, and other pertinent health information.
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CSU Student Medical Certificate Division of Student Student Medical form is to be used when
What Is a Medical Certificate? Alternatively referred to as a doctor's certificate, a medical certificate is a document that serves as a medical professional's sworn statement in regards to the examination of a specific patient. It attests in particular that the patient received a diagnosis or even a treatment.
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Click on New Document and select the form importing option: add Student medical certificate pdf from your device, the cloud, or a secure URL. Make adjustments to the sample. Use the top and left panel tools to redact Student medical certificate pdf. Insert and customize text, pictures, and fillable fields, whiteout unnecessary details.
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I also certify that before arriving at this decision, I have examined the original medical certificate(s) and statement(s) of the case (or certified copies thereof) on which leave was granted or extending, and have taken these into consideration in arriving at my decision. MEDICAL OFFICER Signature Station: Seal Date :