EMERGENCY ADMISSION CERTIFICATE
This is to certify that Mr. / Mrs./Ms……………………………………… S/o. D/o/ W/o…………………………………………………………………aged about ……………………………………………….admitted in our hospital in ……………………………………………………Department under emergency on ……………………… at ……………………. am / pm.
The provisional diagnosis is …………………………………..
Signature and designation of the
attending medical authority