Establishing secure connection… Loading editor… Preparing document…
Navigation

Fill and Sign the Medical Certificate Fillable PDF Form Sample

Fill and Sign the Medical Certificate Fillable PDF Form Sample

How it works

Open the document and fill out all its fields.
Apply your legally-binding eSignature.
Save and invite other recipients to sign it.

Rate template

4.5
64 votes
Table 1. Health insurance coverage status, coverage type, and selected characteristics, for persons of all ages, January-June 2010 Total Number of persons in millions 303.4 Selected Characteristic Sex Male Female Poverty status4 Poor Near poor Not poor Race/ethnicity Hispanic or Latino Non-Hispanic White, single race Black, single race Other races and multiple races Current Health status Excellent or very good Good Fair or poor Place of residence5 Large MSA Small MSA Not in MSA Private1 Health insurance coverage status and type Medicaid/CHIP2 Medicare Uninsured3 Percent (standard error) of persons 60.8 (0.66) 15.1 (0.39) 14.0 (0.33) Percent distribution of characteristic (standard error) 16.2 (0.42) 49.0 (0.19) 51.0 (0.19) 48.7 (0.24) 51.3 (0.24) 43.9 (0.58) 56.1 (0.58) 43.1 (0.63) 56.9 (0.63) 55.6 (0.54) 44.4 (0.54) 15.1 (0.52) 18.7 (0.46) 66.2 (0.72) 3.9 (0.23) 10.5 (0.42) 85.6 (0.48) 48.4 (1.29) 31.7 (1.07) 20.0 (0.90) 12.8 (0.71) 22.7 (0.90) 64.5 (1.16) 27.2 (1.18) 33.8 (0.99) 39.0 (1.15) 16.1 (0.66) 9.6 (0.46) 28.7 (1.26) 7.1 (0.63) 30.8 (1.43) 64.6 (0.82) 12.2 (0.54) 74.7 (0.74) 8.8 (0.42) 42.0 (1.29) 22.6 (1.24) 78.7 (1.00) 9.9 (0.62) 46.5 (1.55) 14.6 (0.93) 7.0 (0.44) 6.9 (0.38) 6.7 (0.61) 4.3 (0.38) 8.2 (1.65) 66.0 (0.44) 24.1 (0.34) 9.9 (0.21) 72.7 (0.46) 21.0 (0.38) 6.4 (0.20) 58.1 (0.88) 26.4 (0.72) 15.5 (0.57) 38.8 (0.83) 33.4 (0.72) 27.7 (0.74) 58.7 (0.82) 30.1 (0.81) 11.3 (0.51) 53.9 (1.61) 30.6 (1.59) 15.4 (0.83) 55.8 (1.73) 29.9 (1.68) 14.2 (0.85) 49.1 (1.94) 31.3 (1.90) 19.6 (1.39) 46.8 (1.80) 32.9 (1.88) 20.3 (1.28) 52.1 (2.09) 31.3 (2.19) 16.6 (1.17) 1 “Private" health insurance coverage excludes plans that paid for only one type of service, such as accidents or dental care. A small number of persons were covered by both public and private plans and were included in both categories. 2 "Medicaid/CHIP" health insurance coverage also includes persons covered by other public programs. 3 A person was defined as uninsured if he or she did not have any private health insurance, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), state-sponsored or other government-sponsored health plan, or military plan. A person was also defined as uninsured if he or she had only Indian Health Service coverage or had only a private plan that paid for one type of service, such as accidents or dental care. 4 Poverty status is based on family income and family size, using the U.S. Census Bureau’s poverty thresholds. “Poor” persons are defined as those below the poverty threshold; “near poor” persons have incomes of 100% to less than 200% of the poverty threshold; and “not poor” persons have incomes of 200% of the poverty threshold or greater. The percentage of respondents with unknown poverty status was 12.0% in the first two quarters of 2010. 5 MSA is metropolitan statistical area. Large MSAs have a population size of 1,000,000 or more; small MSAs have a population size of less than 1,000,000. "Not in MSA" consists of persons not living in a metropolitan statistical area. NOTES: The Private, Medicaid/CHIP, and Medicare categories are not mutually exclusive, and a person may be counted in more than one category. These 2010 health insurance estimates are being released prior to final data editing and final weighting, to provide access to the most recent information from the National Health Interview Survey (NHIS). The resulting estimates for persons without health insurance are generally 0.1–0.3 percentage points lower than those based on the editing procedures used for the final data files. Occasionally, due to decisions made for the final data editing and weighting, estimates based on preliminary editing procedures may differ by more than 0.3 percentage points from estimates based on final files. The estimates for "Medicaid/CHIP" and "Medicare" are lower than estimates that will be produced from the final files. DATA SOURCE: CDC/NCHS, National Health Interview Survey, 2010, Family Core component. The estimates for 2010 are based on data collected from January through June. Data are based on household interviews of a sample of the civilian noninstitutionalized population. ACKNOWLEDGEMENTS: This publication is a product of the NHIS Early Release Program (http://www.cdc.gov/nchs/nhis/releases.htm). This table was produced by Robin A. Cohen of the Division of Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention. Table 2. Health insurance coverage status, coverage type, and selected characteristics, for persons aged 0-18, January-June 2010. Total Number of persons in millions 78.8 Selected Characteristic Sex Male Female Poverty status Poor Near poor Not poor Race/ethnicity Hispanic or Latino Non-Hispanic White, single race Black, single race Other races and multiple races Current Health status Excellent or very good Good Fair or poor Place of residence Large MSA Small MSA Not in MSA Private1 Health insurance coverage status and type Medicaid/CHIP2 Medicare Uninsured3 Percent (standard error) of persons 54.4 (0.95) 34.4 (0.87) 0.2 (0.06) Percent distribution of characteristic (standard error) 8.8 (0.49) 51.2 (0.52) 48.8 (0.52) 51.0 (0.77) 49.0 (0.77) 51.2 (0.82) 48.8 (0.82) 52.7 (8.26) 47.3 (8.26) 53.0 (1.63) 47.0 (1.63) 21.9 (0.89) 22.9 (0.76) 55.2 (1.06) 4.2 (0.42) 12.9 (0.79) 82.8 (0.87) 48.6 (1.50) 34.0 (1.31) 17.4 (0.99) 55.6 (12.01) 40.2 (11.72) † 29.8 (3.31) 38.0 (2.74) 32.2 (2.39) 22.6 (0.93) 12.4 (0.71) 35.0 (1.53) *27.4 (9.74) 36.3 (2.74) 54.9 (0.98) 14.1 (0.69) 69.9 (1.12) 9.1 (0.57) 36.1 (1.42) 21.8 (1.32) † 44.6 (12.98) 39.2 (2.69) 13.0 (1.55) 8.3 (0.56) 8.5 (0.59) 7.1 (0.74) † 11.5 (3.04) 82.3 (0.59) 15.6 (0.54) 2.1 (0.18) 89.3 (0.54) 9.9 (0.52) 0.8 (0.12) 72.2 (1.09) 23.7 (1.00) 4.1 (0.42) 44.9 (12.44) *35.8 (11.07) *19.3 (8.38) 78.0 (1.91) 20.0 (1.88) 2.0 (0.45) 53.7 (1.80) 31.0 (1.74) 15.3 (0.94) 58.0 (2.05) 28.4 (1.95) 13.6 (1.04) 47.6 (2.06) 32.8 (2.01) 19.6 (1.51) 68.4 (11.20) *31.6 (11.20) - 50.6 (3.45) 33.2 (3.63) 16.2 (2.02) †Estimates with a relative standard error of greater than 50% are indicated with a dagger, but are not shown. *Estimates preceded by an asterisk have a relative standard error of greater than 30% and less than or equal to 50% and should be used with caution as they do not meet the standard of reliability or precision. -Quantity zero 1 “Private" health insurance coverage excludes plans that paid for only one type of service, such as accidents or dental care. A small number of persons were covered by both public and private plans and were included in both categories. 2 "Medicaid/CHIP" health insurance coverage also includes persons covered by other public programs. 3 A person was defined as uninsured if he or she did not have any private health insurance, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), state-sponsored or other government-sponsored health plan, or military plan. A person was also defined as uninsured if he or she had only Indian Health Service coverage or had only a private plan that paid for one type of service, such as accidents or dental care. 4 Poverty status is based on family income and family size, using the U.S. Census Bureau’s poverty thresholds. “Poor” persons are defined as those below the poverty threshold; “near poor” persons have incomes of 100% to less than 200% of the poverty threshold; and “not poor” persons have incomes of 200% of the poverty threshold or greater. The percentage of respondents with unknown poverty status was 12.0% in the first two quarters of 2010. 5 MSA is metropolitan statistical area. Large MSAs have a population size of 1,000,000 or more; small MSAs have a population size of less than 1,000,000. "Not in MSA" consists of persons not living in a metropolitan statistical area. NOTES: The Private, Medicaid/CHIP, and Medicare categories are not mutually exclusive, and a person may be counted in more than one category. These 2010 health insurance estimates are being released prior to final data editing and final weighting, to provide access to the most recent information from the National Health Interview Survey (NHIS). The resulting estimates for persons without health insurance are generally 0.1–0.3 percentage points lower than those based on the editing procedures used for the final data files. Occasionally, due to decisions made for the final data editing and weighting, estimates based on preliminary editing procedures may differ by more than 0.3 percentage points from estimates based on final files. The estimates for "Medicaid/CHIP" and "Medicare" are lower than estimates that will be produced from the final files. DATA SOURCE: CDC/NCHS, National Health Interview Survey, 2010, Family Core component. The estimates for 2010 are based on data collected from January through June. Data are based on household interviews of a sample of the civilian noninstitutionalized population. ACKNOWLEDGEMENTS: This publication is a product of the NHIS Early Release Program (http://www.cdc.gov/nchs/nhis/releases.htm). This table was produced by Robin A. Cohen of the Division of Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention. Table 3. Health insurance coverage status, coverage type, and selected characteristics, for persons aged 19-64, January-June 2010. Total Number of persons in millions 186.1 Selected Characteristic Sex Male Female Poverty status4 Poor Near poor Not poor Race/ethnicity Hispanic or Latino Non-Hispanic White, single race Black, single race Other races and multiple races Current Health status Excellent or very good Good Fair or poor Place of residence5 Large MSA Small MSA Not in MSA Private1 Health insurance coverage status and type Medicaid/CHIP2 Medicare Uninsured3 Percent (standard error) of persons 64.9 (0.66) 8.5 (0.29) 3.1 (0.13) Percent distribution of characteristic (standard error) 22.5 (0.54) 49.2 (0.22) 50.8 (0.22) 48.7 (0.25) 51.3 (0.25) 33.4 (0.85) 66.6 (0.85) 45.5 (1.94) 54.5 (1.94) 56.2 (0.56) 43.8 (0.56) 13.2 (0.46) 16.3 (0.43) 70.5 (0.68) 3.7 (0.26) 8.7 (0.36) 87.6 (0.46) 49.5 (1.58) 28.1 (1.23) 22.5 (1.20) 30.3 (2.12) 30.4 (2.05) 39.3 (2.10) 26.8 (1.00) 33.0 (0.89) 40.2 (1.08) 15.2 (0.63) 9.7 (0.47) 19.7 (1.22) 9.2 (1.02) 29.7 (1.34) 65.7 (0.83) 12.2 (0.56) 74.1 (0.72) 9.3 (0.44) 50.1 (1.64) 24.3 (1.50) 68.3 (1.79) 18.7 (1.51) 47.8 (1.48) 14.9 (0.93) 7.0 (0.46) 6.9 (0.38) 5.9 (0.65) 3.9 (0.65) 7.5 (1.44) 63.9 (0.49) 25.7 (0.38) 10.4 (0.27) 71.2 (0.51) 22.6 (0.45) 6.1 (0.22) 40.7 (1.22) 30.5 (1.05) 28.8 (1.01) 15.8 (1.44) 29.6 (1.69) 54.5 (2.04) 55.6 (0.80) 31.7 (0.77) 12.6 (0.60) 55.1 (1.62) 30.2 (1.59) 14.7 (0.81) 57.2 (1.73) 29.6 (1.68) 13.2 (0.79) 50.5 (2.17) 29.5 (2.12) 20.0 (1.69) 40.4 (2.39) 34.9 (2.60) 24.7 (2.11) 52.3 (2.00) 31.0 (2.07) 16.7 (1.15) 1 “Private" health insurance coverage excludes plans that paid for only one type of service, such as accidents or dental care. A small number of persons were covered by both public and private plans and were included in both categories. 2 "Medicaid/CHIP" health insurance coverage also includes persons covered by other public programs. 3 A person was defined as uninsured if he or she did not have any private health insurance, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), state-sponsored or other government-sponsored health plan, or military plan. A person was also defined as uninsured if he or she had only Indian Health Service coverage or had only a private plan that paid for one type of service, such as accidents or dental care. 4 Poverty status is based on family income and family size, using the U.S. Census Bureau’s poverty thresholds. “Poor” persons are defined as those below the poverty threshold; “near poor” persons have incomes of 100% to less than 200% of the poverty threshold; and “not poor” persons have incomes of 200% of the poverty threshold or greater. The percentage of respondents with unknown poverty status was 12.0% in the first two quarters of 2010. 5 MSA is metropolitan statistical area. Large MSAs have a population size of 1,000,000 or more; small MSAs have a population size of less than 1,000,000. "Not in MSA" consists of persons not living in a metropolitan statistical area. NOTES: The Private, Medicaid/CHIP, and Medicare categories are not mutually exclusive, and a person may be counted in more than one category. These 2010 health insurance estimates are being released prior to final data editing and final weighting, to provide access to the most recent information from the National Health Interview Survey (NHIS). The resulting estimates for persons without health insurance are generally 0.1–0.3 percentage points lower than those based on the editing procedures used for the final data files. Occasionally, due to decisions made for the final data editing and weighting, estimates based on preliminary editing procedures may differ by more than 0.3 percentage points from estimates based on final files. The estimates for "Medicaid/CHIP" and "Medicare" are lower than estimates that will be produced from the final files. DATA SOURCE: CDC/NCHS, National Health Interview Survey, 2010, Family Core component. The estimates for 2010 are based on data collected from January through June. Data are based on household interviews of a sample of the civilian noninstitutionalized population. ACKNOWLEDGEMENTS: This publication is a product of the NHIS Early Release Program (http://www.cdc.gov/nchs/nhis/releases.htm). This table was produced by Robin A. Cohen of the Division of Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention. Table 4. Health insurance coverage status, coverage type, and selected characteristics, for persons aged 65 and over, January-June 2010. Total Number of persons in millions 38.5 Selected Characteristic Sex Male Female Poverty status4 Poor Near poor Not poor Race/ethnicity Hispanic or Latino Non-Hispanic White, single race Black, single race Other races and multiple races Current Health status Excellent or very good Good Fair or poor Place of residence5 Large MSA Small MSA Not in MSA Private1 Health insurance coverage status and type Medicaid/CHIP2 Medicare Uninsured3 Percent (standard error) of persons 54.1 (1.17) 7.8 (0.54) 94.4 (0.37) Percent distribution of characteristic (standard error) 1.0 (0.14) 43.3 (0.61) 56.7 (0.61) 43.8 (0.76) 56.2 (0.76) 32.3 (2.08) 67.7 (2.08) 42.7 (0.61) 56.7 (0.61) 45.2 (6.46) 54.8 (6.46) 9.6 (0.61) 21.3 (0.92) 69.1 (1.16) 4.4 (0.52) 16.1 (1.08) 79.5 (1.20) 39.9 (3.13) 28.5 (2.88) 31.7 (3.30) 9.5 (0.62) 21.3 (0.95) 69.2 (1.19) 22.5 (4.90) 33.8 (6.65) 43.7 (7.50) 7.3 (0.67) 3.3 (0.39) 19.2 (2.68) 6.7 (0.65) 43.1 (6.34) 79.5 (1.00) 8.5 (0.57) 87.9 (0.88) 5.5 (0.60) 52.4 (3.25) 20.3 (2.20) 80.7 (0.99) 8.3 (0.56) 30.2 (6.97) *9.6 (3.13) 4.6 (0.43) 3.2 (0.46) 8.1 (1.32) 4.3 (0.42) 17.1 (4.40) 42.5 (0.87) 33.9 (0.76) 23.6 (0.72) 46.7 (1.24) 34.0 (1.05) 19.3 (0.88) 20.7 (2.33) 30.2 (2.52) 49.1 (2.57) 42.4 (0.91) 34.0 (0.79) 23.6 (0.74) 39.8 (6.27) 30.6 (5.14) 29.6 (5.58) 48.6 (1.87) 32.2 (1.91) 19.2 (1.29) 43.6 (2.22) 34.9 (2.24) 21.5 (1.79) 55.8 (3.68) 26.4 (3.21) 17.8 (2.59) 47.7 (1.88) 32.6 (1.93) 19.7 (1.33) 66.0 (7.13) 25.5 (5.78) † *Estimates preceded by an asterisk have a relative standard error of greater than 30% and less than or equal to 50% and should be used with caution as they do not meet the standard of reliability or precision. †Estimates with a relative standard error of greater than 50% are indicated with a dagger, but are not shown. 1 “Private" health insurance coverage excludes plans that paid for only one type of service, such as accidents or dental care. A small number of persons were covered by both public and private plans and were included in both categories. 2 "Medicaid/CHIP" health insurance coverage also includes persons covered by other public programs. 3 A person was defined as uninsured if he or she did not have any private health insurance, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), state-sponsored or other government-sponsored health plan, or military plan. A person was also defined as uninsured if he or she had only Indian Health Service coverage or had only a private plan that paid for one type of service, such as accidents or dental care. 4 Poverty status is based on family income and family size, using the U.S. Census Bureau’s poverty thresholds. “Poor” persons are defined as those below the poverty threshold; “near poor” persons have incomes of 100% to less than 200% of the poverty threshold; and “not poor” persons have incomes of 200% of the poverty threshold or greater. The percentage of respondents with unknown poverty status was 12.0% in the first two quarters of 2010. 5 MSA is metropolitan statistical area. Large MSAs have a population size of 1,000,000 or more; small MSAs have a population size of less than 1,000,000. "Not in MSA" consists of persons not living in a metropolitan statistical area. NOTES: The Private, Medicaid/CHIP, and Medicare categories are not mutually exclusive, and a person may be counted in more than one category. These 2010 health insurance estimates are being released prior to final data editing and final weighting, to provide access to the most recent information from the National Health Interview Survey (NHIS). The resulting estimates for persons without health insurance are generally 0.1–0.3 percentage points lower than those based on the editing procedures used for the final data files. Occasionally, due to decisions made for the final data editing and weighting, estimates based on preliminary editing procedures may differ by more than 0.3 percentage points from estimates based on final files. The estimates for "Medicaid/CHIP" and "Medicare" are lower than estimates that will be produced from the final files. DATA SOURCE: CDC/NCHS, National Health Interview Survey, 2010, Family Core component. The estimates for 2010 are based on data collected from January through June. Data are based on household interviews of a sample of the civilian noninstitutionalized population. ACKNOWLEDGEMENTS: This publication is a product of the NHIS Early Release Program (http://www.cdc.gov/nchs/nhis/releases.htm). This table was produced by Robin A. Cohen of the Division of Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention.

Useful suggestions for preparing your ‘Medical Certificate Fillable Pdf Form Sample’ online

Are you fatigued by the burden of handling paperwork? Look no further than airSlate SignNow, the top eSignature service for individuals and small to medium-sized businesses. Wave goodbye to the lengthy process of printing and scanning documents. With airSlate SignNow, you can smoothly complete and sign documents online. Utilize the extensive features integrated into this user-friendly and budget-friendly platform and transform your method of paperwork handling. Whether you need to sign documents or gather electronic signatures, airSlate SignNow simplifies the entire process, needing only a few clicks.

Follow this guided instruction:

  1. Sign in to your account or sign up for a complimentary trial with our service.
  2. Click +Create to upload a file from your device, cloud storage, or our form collection.
  3. Access your ‘Medical Certificate Fillable Pdf Form Sample’ in the editor.
  4. Click Me (Fill Out Now) to prepare the form on your end.
  5. Add and designate fillable fields for others (if necessary).
  6. Proceed with the Send Invite settings to solicit eSignatures from others.
  7. Save, print your version, or convert it into a multi-use template.

No need to worry if you need to work with your teammates on your Medical Certificate Fillable Pdf Form Sample or submit it for notarization—our solution delivers everything required to accomplish such tasks. Register for an account with airSlate SignNow today and enhance your document management to new levels!

Here is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

Need help? Contact Support
Medical certificate leave template
Medical certificate leave application
Medical certificate leave for work
Medical leave Certificate PDF download
Medical certificate for sick leave
Medical certificate format
Medical certificate FOR LEAVE from doctor PDF
Medical certificate for student leave PDF
Medical certificate leave pdf
FMLA medical certification form
Printable FMLA medical certification form
WH-380-E
Sign up and try Medical certificate fillable pdf form sample
  • Close deals faster
  • Improve productivity
  • Delight customers
  • Increase revenue
  • Save time & money
  • Reduce payment cycles