Medical Certificate

To be granted leave on medical grounds, a student must submit a reduced certificate, such as described below:

THE UNIVERSITY OF PAPUA NEW GUINEA
PO BOX 320
UNIVERSITY
NCD

MEDICAL CERTIFICATE NO.....................

I ............................................................. , a legally qualified Medical Practitioner certify that on .................................................... (Date of Consultation)

I examined ......................................................................................

(Patients name in BLOCK LETTERS)

Please complete one of the categories below:

1. The patient is suffering from ........................................................

(Diagnosis to be provided with patient consent where possible) or

2. Is suffering from a Medical Condition of a confidential nature ( )

(Please tick)

3. States that he/she was ...................................................................

(Subjects Period of affliction)

The above patient will return on .............................................................. for
reassessment of the condition.

In my opinion this condition will affect the following:

(Please tick) In a Minor way Moderately Severely Lectures ( ) ( ) ( ) ` Assignments ( ) ( ) ( ) Practical Assignments ( ) ( ) ( ) Private Study ( ) ( ) ( )

For the period ..................................... to ............................................

Examinations - I certify that the student is medically unfit/fit to sit for the examinations on .......................................................................

DOCTOR’S NAME........................................................................

ADDRESS ...................................................................................

DATE STAMP

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IMPORTANT INFORMATION REGARDING THE STUDENT MEDICAL CERTIFICATE

(ON REVERSE)

The UPNG SENATE in 2001, adopted the following medical certificate and resolved that the following statements be included in the Guidelines for Academic Matters at UPNG Rules and Procedures For All Undergraduate Programs (Rules 03; 3.4)

(a) Students who are medically certified as unfit to sit for an examination are advised not to sit.

(b) Illness before or during an examination must be verified by a Doctor not later than the date of the examination.

(c) Medical certificates based solely on a student’s statement of illness are unlikely to result in special consideration of deferred examination

It is intended that this medical certificate be used by all students within the University in the following circumstances:

1. Where an appeal on medical grounds is lodged to sit a special examination; (the certificate should be submitted no later than 10 calendar days after the due date of assessment for the unit).

2. Where an assignment extension is being sought on medical grounds.

3. As supporting documentation with an “Application to Waive Academic Penalty”.

4. In all other circumstances relating to this University where documentary evidence is required of a medical condition.

Please note that in all cases above the Medical Certificate must contain your Medical Practitioner’s stamp where indicated. Students are advised to make copies of the Medical Certificate as required and to present this format to Doctors for completion and endorsement. (Only the original completed by the Doctor or a certified copy is acceptable).

This certificate is only relevant for use in UPNG related matters. The certificate should be submitted to the Executive Dean of School.

This section to be completed by the student in the presence of the Doctor:

_________________ ________________ _________________

NAME STUDENT NO. DATE

I agree to the University of Papua New Guinea requesting verification of this information on my medical condition if deemed necessary.

__________________________

Signature

Any other remarks: ......... ....................... ....................... .....................

________________________

Signature of Medical Practitioner