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Medcert Centrelink

This medical certificate provides details about patient Jodie McQueen's medical conditions and capacity for work. Jodie has been diagnosed with PTSD since an unknown date and has symptoms of anxiety, decreased focus, and forgetfulness. Her doctor, Dr. Syed Adnan, has deemed her unfit for work or study from August 25, 2023 to June 25, 2023. No other work is recommended due to her condition and associated impacts on her participation.

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shane johnson
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1K views1 page

Medcert Centrelink

This medical certificate provides details about patient Jodie McQueen's medical conditions and capacity for work. Jodie has been diagnosed with PTSD since an unknown date and has symptoms of anxiety, decreased focus, and forgetfulness. Her doctor, Dr. Syed Adnan, has deemed her unfit for work or study from August 25, 2023 to June 25, 2023. No other work is recommended due to her condition and associated impacts on her participation.

Uploaded by

shane johnson
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Australian Government

Medical Certificate
centrelink
Department of Human Services (SU415)
Centrelink customers: did youknow? Youcan lodge this certificate with us using Online Services or one of our Express Plus Apps.
Go to servicesaustralia.gov.au/submitdocumentsonline
Patient's details CRN
Family name McQueen Home Address 3 Helen Street
First Name Jodie

Second Name CABOOLTURE Postcode 4510


Date of Birth 1/5/1974 This person has My patient since: 8/12/2020
been:
A patient of this practice since:

Primary condition Secondary/Related condition


Diagnosis List the main medical conditions which impact on the patient's capacity to work or study
(Primary condition should be the condition with the most impact).
PTSD

Date of onset (if known) Date of onset (if known)

Is this condition Is this condition


Temporary Exacerbation of aPermanent condition
Prognosis Estimate how longthe symptom(s) will affect the patient's capacity to Work or study.
Uncertain

Symptoms - List current symptoms for each condition.


Anxiety symptoms, Decreased focus concentration, forgetfulness
Treatment Describe the patient's treatment regime, including past, current and planned treatment.
Past: Psychology Past:

Curnent. Crent:

Planned:

Johnson
Planned:
Certification by Medical Practitioner
Give details of any other medical conditions which impact on
the patient's capacity to work or study. Doctor's name Dr Syed Adnan
Qualifications MBBS, FRACGP Provider no. 5845831Y
Capacity to work or study Surgery/Medical Bertha Street Medical &Dental Centre
In my opinion the patient is/has been unfit for work/study
from 25/8/2023 to 25/06/2023 Centre/Hospital
name

Can the patient do any other work for 8 No Address 21-25 Bertha St
|hours or more per week?
Phone number 07 5316 8222
In order to prepare your patient for return to work or study,
certain assistance may be offered. ldentify any factors which
may impact on participation.
Signature
Date 25 August 2023|

CLKOSU415 2003

SU415.2003

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