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Model Medical Certificates

The following model medical certificates and forms are available to download from this page (scroll down) as individual documents. Each document has a set of guidance notes on completion. The fire and rescue authority should take care to ensure that the certificates and forms most appropriate to the circumstances of each case are used.

The model documents provided are:

Certificate A
For use in the case of a serving regular firefighter where a medical opinion is required for consideration of eligibility for an ill-health pension (but not an injury award - in those circumstances Certificate B should be used instead).

Certificate B
For use in the case of a serving firefighter (regular, retained or volunteer) where a medical opinion is required for consideration of eligibility for an ill-health pension and/or an injury award.

Certificate C
For use in the case of a former regular firefighter who left with entitlement to a deferred pension and has requested early payment on grounds of permanent disablement (no question of an injury award - in those circumstances Certificate D should be used instead).

Certificate D
For use in the case of a former firefighter (regular, retained or volunteer) who claims an "after-appearing injury".

Certificate E
For use in the case of review of an ill-health award (but not an injury award - in those circumstances Certificate F should be used instead).

Certificate F
For use in the case of review of an ill-health award and/or injury award.

Certificate G
For use in the case of a serving retained or volunteer firefighter where a medical opinion is required for consideration of termination of employment on health grounds. This is not an opinion required under the Firefighters' Pension Scheme - no award would be payable in these circumstances regardless of medical opinion. The certificate is offered as a model which is consistent with other certificates should an authority wish to use it. If there are medical questions to be asked for consideration of an injury award, however, then there is a possibility of an award under the Firefighters' Pension Scheme and Certificate B should be used.

Certificate H
For use in cases where an IQMP's opinion that there is no injury award has been overturned by the Medical Appeal Board and the authority must seek the opinion of another IQMP as to degree of disablement. They will not need to seek an opinion as to whether or not there is a permanent disablement - that has been established by the Board. Consequently Certificate H asks questions about degree of disablement only.

Form: Assessment of Degree of Disablement
For use where an injury award is to be made, to assess degree of disablement.

Medical Review Questionnaire
For issue to a former firefighter in receipt of an ill-health and/or injury award where the authority proposes to review the award.

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