राजपत्रित अधिकारियों को चिकित्सा के आधार पर अवकाशःनियम 70 के अनुसार राजपत्रित अधिकारियों को चिकित्सा प्रमाण-पत्र के आधार पर अवकाश या उसकी वृद्धि स्वीकृत करने से पहले वित्त विभाग, राजस्थान की अधिसूचना क्रमांक एफ.1(5) विवि(नियम)/2008 दिनांक 7 सितम्बर 2010 द्वारा निर्धारित प्रपत्र में चिकित्सा प्रमाण-पत्र प्राप्त करना आवश्यक है। नियम 70 एवं 76 में चिकित्सा प्रमाण-पत्र एवं नियम 83 में चिकित्या पूर्ण होने पर फिटनेस प्रमाण-पत्र का प्रारूप निर्धारित किया गया है।

Medical Certificate for Gazetted Officer

Statement of the case of..................Name (to be filled in by the applicant in the presence of the Civil Surgeon or Official Medical attendant). Appointment.............. Age.................. Total service................ Previous periods of leave if absence on medical certificate. Habits................ Disease................ Civil Surgeon of I........................................................after careful personal examination of the Medical Officer at or of case certify that..........................................is in a bad state of health and I solemnly and sincerely declare that according to the best of my judgment the period of absence from duty is essentially necessary for the recovery of his health and recommend that he may be granted.....................month's leave with effect from...................................* [In my opinion it is/it is not necessary for the officer to appear before a Medical Board}.

Dated................                                                                                                                                                                                                                                                    Civil Surgeon.or Official Medical Attendant.

The................

Note:—This sentence should either be modified by scoring out the irrelevant words or altogether scored out according as the period of leave recommended is upto 2 months or exceeds that period.

NOTES.

1. No recommendation contained in this certificate shall be evidence of a claim to any leave not admissible to the Government servant under the terms of his contract or of the rules to which he is subject.

2. This form should be adhered to as closely as possible and should be filled in after the signature of the applicant has been taken. The Certifying Officer is not at liberty to certify that the applicant requires a change from or to a particular Locality, or that he is not fit to proceed to a particular locality. Such Certificates should only be given at the explicit desire of the administrative authority concerned to whom it is open to decide, when an application on such grounds has been made to him, whether the applicant should go before a Madical Committee to decide the question of his fitness.

3. In a case, where the period of leave initially recommended or the period of leave initially recommended together with any extension thereof subsequently recommended, does not exceed [two months] the Medical Officer should invariably certify whether in his opinion it is or it is not necessary for the officer to appear before a Medical Committee.