Medical certificates from the psychiatrist: leave, fitness for work, and how much to say

What these certificates are for

Two documents, two different jobs, one standard of care in writing them.

The leave certificate is evidence for the employer that the person was, or is, unfit for work for a stated period, so that personal leave can be taken and paid. Under the Fair Work Act, an employee asked for evidence must provide evidence that would satisfy a reasonable person, and a medical certificate is the accepted form. Its reader is payroll or HR; they check the name, the dates and that a registered practitioner signed it.

The fitness-for-work certificate is a statement of what the person can do now: fit, unfit, or fit with stated restrictions, for how long, with a review date. Its reader is a manager or return-to-work coordinator who has to roster around it, and who cannot act on anything vague.

Both are formal statements by a registered practitioner. The Medical Board's code of conduct expects them to be honest, accurate and not misleading, and they are held to that standard word by word: the dates, the date of consultation, the period certified, and what was actually assessed.

What the law requires, and what it does not

The Act requires evidence that would satisfy a reasonable person. It does not require the diagnosis, and an employer cannot insist on it. A certificate stating that the person was unfit for work due to a medical condition from one date to another, signed and dated by a registered practitioner, satisfies the requirement. Any more detail is the patient's confidential information, disclosed only with their agreement.

The professional conventions add the rest: the certificate states the date of consultation; a period certified before that date is possible where you are satisfied on the history and examination, and must be clearly shown as such; the period is defined, with an end date or a review date; and the certificate identifies you fully, with provider number and contact details, on letterhead.

The leave certificate: what it must contain

1. The patient's name. As known to the employer.
2. The date of consultation. The date you assessed the patient, stated plainly.
3. The statement. That in your opinion the person is, or was, unfit for work due to a medical condition.
4. The period. From a date to a date. If any of it precedes the consultation, say so and say it is certified on history and examination.
5. Nothing about the diagnosis, unless the patient has asked for it to be included.
6. Your identification. Name, qualifications, AHPRA registration, provider number, practice address and contact, signature, on letterhead.

A carer's leave certificate follows the same pattern, stating that the person was required to care for a family or household member who was unwell, without identifying the member's condition.

The fitness-for-work certificate: what it must contain

1. The patient's name and the date of consultation.
2. The capacity statement. Fit for full duties; unfit for all work until a date; or fit for work with restrictions.
3. The restrictions, specifically. Hours per day and days per week; duties that can and cannot be performed; environmental conditions (no night shifts, no lone working, no client-facing work); anything that must be avoided. A restriction the manager cannot roster is not a restriction.
4. The duration and the review date. How long the restrictions apply and when they will be reassessed.
5. The anticipated course, if you can give one: an expected date for full duties, or the next step.
6. A pointer to adjustments, where the workplace needs to change something. The detail belongs in a separate accommodation letter, not in the certificate.
7. Your identification and signature, on letterhead.

Mental health specifics

The stigma is real and the reader is not a clinician, so the vocabulary should be functional rather than clinical. What the person can and cannot do, for how long, in what conditions. "Medical condition" is the standard wording, and it is the patient's decision, taken with knowledge of who will read the document, whether the condition is named.

A return after a mental health absence is often graduated, and a manager needs it written as a plan: hours and duties by week, the review points, and who to contact. That is a separate document, the Employer - Graduated Return to Work preset, as are the Workplace Accommodation Letter for adjustments and the Employer - Medical Clearance to Return for the employer who requires clearance before the person resumes. The certificate should point to them, not try to be them.

Where certificates fall short

• The period has no end date, or "indefinitely", which invites an independent examination and leaves the employer unable to plan.
• The date of consultation is missing, or a retrospective period is not shown as retrospective.
• The diagnosis appears without the patient having chosen to disclose it.
• "Fit with restrictions" with no restrictions stated, or restrictions no roster can implement.
• No review date on a fitness-for-work certificate.
• Provider details, signature or letterhead missing, so payroll queries it.
• The certificate tries to be the return-to-work plan or the accommodation letter as well.

Two skeletons that work

The leave certificate:

The fitness-for-work certificate:

How PsychDispatch drafts these

The Medical Certificate - Fitness for Work and Medical Certificate - Leave / Absence presets draft each certificate from the consultation with the dates filled from the record rather than from memory, the capacity statement and restrictions in the functional vocabulary above, and nothing about the diagnosis unless you put it there. Every date is verified against the source before you sign, the certificate is rendered onto your letterhead, which is the part payroll actually checks, and it goes to the patient or, with their agreement, the employer by secure link.