Do you need to provide medical evidence for a long-term health condition? In that case, the Med 3 Form is your go-to paperwork. This form is also known as the "Statement of Fitness for Work" and it's a document used in the UK by employers, government departments and pension providers. You will likely require a Med 3 Form if you are claiming benefits due to ill or disability related conditions or seeking an exemption from compulsory work activities accompanying some welfare entitlements. With this blog post, we’ll be walking you through what exactly is on a Med 3 Form – so read on if you want to learn more!
| Question | Answer |
|---|---|
| Form Name | Med 3 Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | med3 form, med 3 form, fit note template uk pdf, unique id med 3 01 17 |
Statement of Fitness for Work
For social security or Statutory Sick Pay
Patient’s name |
Mr, Mrs, Miss, Ms |
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I assessed your case on: |
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and, because of the |
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following condition(s): |
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I advise you that: |
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you are not fit for work. |
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you may be fit for work taking account |
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of the following advice: |
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If available, and with your employer’s agreement, you may benefit from: |
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a phased return to work |
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amended duties |
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altered hours |
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workplace adaptations |
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Comments, including functional effects of your condition(s): |
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This will be the case for
or from |
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to |
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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
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Med 3 04/10