Med 3 Form PDF Details

The Med 3 form, known officially as the Statement of Fitness for Work, serves a crucial role in bridging the gap between health care professionals and employment obligations for individuals facing health challenges. This document, vital for patients who find themselves unable to perform their job duties due to physical or psychological conditions, creates a structured pathway for discussing and documenting an individual’s work capacity. Through a clear layout, including sections for the patient’s personal information, a detailed assessment date, and the specific condition(s) affecting their fitness for work, the form delineates whether a person is completely unfit for work or may return under adjusted conditions. It introduces the possibility of a tailored return to work through amended duties, altered hours, or workplace adaptations, directly engaging with the employer's capacity to accommodate these needs. Furthermore, the form includes a section for doctors to note the expected duration of the work impact and whether a follow-up assessment is necessary, offering a timeline for both the patient and employer. The form ends with mandatory fields for the doctor's signature, the date of the statement, and the doctor's address, ensuring the document’s validity and traceability. Designed with both the patient's welfare and the employer's operational requirements in mind, the Med 3 form is indispensable for managing health-related absences in the workforce.

QuestionAnswer
Form NameMed 3 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesmed3 form, med 3 form, fit note template uk pdf, unique id med 3 01 17

Form Preview Example

Statement of Fitness for Work

For social security or Statutory Sick Pay

Patient’s name

Mr, Mrs, Miss, Ms

 

 

 

 

 

 

 

 

 

 

I assessed your case on:

/

/

 

and, because of the

 

 

 

 

 

 

 

 

 

following condition(s):

 

 

 

 

 

 

 

I advise you that:

 

you are not fit for work.

 

 

 

 

you may be fit for work taking account

 

 

 

 

 

 

 

 

 

 

 

 

of the following advice:

 

 

 

 

 

 

 

 

 

 

 

 

 

If available, and with your employer’s agreement, you may benefit from:

 

 

a phased return to work

 

 

amended duties

 

 

 

 

 

 

altered hours

 

 

 

 

workplace adaptations

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comments, including functional effects of your condition(s):

 

 

 

 

 

 

 

 

This will be the case for

or from

/

/

to

/

/

 

 

 

 

 

 

I will/will not need to assess your fitness for work again at the end of this period. (Please delete as applicable)

Doctor’s signature

Date of statement Doctor’s address

//

Med 3 04/10