Emergency Department Attendance Certificate

 

To whom it may concern,
 
This is to certify that _______________________________ attended the Emergency Department
 
of the Flinders Medical Centre between     ____:____ on the ____ / ____ / ______
                           
                                                            and ____:____ on the ____ / ____ / ______
 
This attendance was for : (circle one)

        1. Medical treatment

        2. Medical treatment of _____________________________ - ______________________

                                                        (Patient's name)                                 (Relationship to patient)

 

Signed : _____________________________

 

Name: ______________________________

 

Position: ____________________________

 

____ / ____ / _______