Part II FORM OF CERTIFICATEF1
United Kingdom
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 F2than 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 means a period of 7 days starting on a Sunday and ending on a Saturday. | |
| Date of examination ......../........../........ | Registered midwives |
| Date of signing ......./........../........ | Please give your F3NMC Personal identification Number and the expiry date of your registration with the NMC . _________________ _________________ |
| ___________________________________ | |
|---|---|
| Signature: | |
Doctors Please stamp your name and address here F4(unless the form has been stamped, in Wales, by the Local Health Board in whose medical performers list you are included or, in Scotland, F5by the Health Board in whose primary medical services performers list you are included). | |
______________________________ | |
Annotations
Textual amendments
- F1
Sch. Pt. II substituted (1.11.1991) by The Social Security (Miscellaneous Provisions) Amendment Regulations 1991 (S.I. 1991/2284), regs. 1, 24
- F2
Words in Sch. 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, 3(3)(a)
- F3
Word in Sch. 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. 51(b)
- F4
Words in Sch. 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. 9(3)
- F5
Words in Sch. Pt. II substituted (E.S.N.I.) (1.4.2004, (further amended (W.) (S.I. 2004/1016)Sch. 1 para. 5)) 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. 5