Paragraph 5 F1

the patient’s name;

the date of the assessment (whether by consultation or consideration of a report as the case may be) on which the healthcare professional’s statement is based;

the condition in respect of which the F4healthcare professional advises the patient they are not fit for work;

a statement, where the healthcare professional considers it appropriate, that the patient may be fit for work;

a statement that the healthcare professional will or, as the case may be will not, need to assess the patient’s fitness for work again;

the date on which the healthcare professional’s statement is given;

the address of the doctorF5; F6and

the name of the healthcare professional (whether in the form of a signature or F8otherwise); and

the profession of the healthcare professional.