Part II FORM OF CERTIFICATEF1 F2

MATERNITY CERTIFICATE

Please fill in this form in ink Name of patient _________________________________
Fill in this part if you are giving the certificate before the confinement.	Fill in this part if you are giving the certificate after the confinement.
Do not fill this in more F3than 20 weeks before the week the baby is expected.	I certify that I attended you in connection with the birth which took place on ......./........../....... when you were delivered of a child [__] children.
I certify that I examined you on the date given below. In my opinion you can expect to have your baby in the week that includes ......./........../........	In my opinion your baby was expected in the week that includes ......./........../........
"Week": This means the 7 days beginning on a Sunday.

Date of examination ......../........../........	Registered midwives:
	Please give your F4NMC Personal Identification Number and the expiry date of your registration with the NMC.
Date of signing ......./........../........	___________________________________


Signature:	Doctors: Please stamp your name and address here F5(unless the form has been stamped, in Wales, by the Local Health Board in whose medical performers list you are included or, in Scotland, F6F7 by the Health Board in whose primary medical performers list you are included)

Annotations

F1: Sch. 2 substituted (6.4.1987) by The Social Security (Medical Evidence) Amendment Regulations 1987 (S.I. 1987/409), regs. 1(1), 4
F2: Sch. 2 Pt. II substituted (1.11.1991) by The Social Security (Miscellaneous Provisions) Amendment Regulations 1991 (S.I. 1991/2284), regs. 1, 22
F3: Words in Sch. 2 Pt. II substituted (28.9.2001) by The Social Security (Medical Evidence) and Statutory Maternity Pay (Medical Evidence) (Amendment) Regulations 2001 (S.I. 2001/2931), regs. 1, 2(3)(a)
F4: Word in Sch. 2 Pt. II substituted (1.8.2004) by The Health Act 1999 (Consequential Amendments) (Nursing and Midwifery) Order 2004 (S.I. 2004/1771), art. 1(1), Sch. para. 56(b)
F5: Words in Sch. 2 Pt. II substituted (1.4.2013) by The National Treatment Agency (Abolition) and the Health and Social Care Act 2012 (Consequential, Transitional and Saving Provisions) Order 2013 (S.I. 2013/235), art. 1(2), Sch. 2 para. 6(3)
F6: Words in Sch. 2 Pt. II substituted (1.4.2004) (W.) by The General Medical Services and Personal Medical Services Transitional and Consequential Provisions Order 2004 (S.I. 2004/865), art. 1(1), Sch. 1 para. 1(3)
F7: Words in Sch. 2 Pt. II substituted (1.4.2004) (E+S+NI.) by The General Medical Services Transitional and Consequential Provisions (Wales) (No. 2) Order 2004 (S.I. 2004/1016), art. 1(1), Sch. 1 para. 1(3) (with art. 83)