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The Statement Of Fitness For Work Form is a crucial document in the Irish employment landscape, particularly following the introduction of the Sick Leave Act 2022. This form serves as an official medical certification that bridges the communication between healthcare providers, employers, and social welfare services. It is required when an employee needs to take sick leave, claim statutory sick pay, or apply for illness benefit. The document includes essential information such as the nature of the illness (where appropriate to disclose), the duration of incapacity, and any recommended workplace adjustments. It must comply with Irish medical certification standards and data protection regulations, particularly regarding the handling of sensitive personal health information. The form is designed to support both employers and employees in managing health-related absences and facilitating appropriate return-to-work arrangements.

1. Patient Information: Essential identifying details including full name, date of birth, PPS number, and contact information

2. Medical Assessment: Doctor's clinical assessment of the patient's fitness for work, including diagnosis or symptoms (where appropriate to disclose)

3. Work Capacity Statement: Clear statement of whether the patient is 'not fit for work' or 'may be fit for work subject to adjustments'

4. Duration: Specific period for which the statement applies, including start and end dates

5. Workplace Recommendations: Specific advice about the patient's ability to work and any recommended workplace adjustments

6. Medical Practitioner Details: Doctor's information including name, medical council registration number, practice details, and contact information