How to fill the hospital - sample

Hospital sheet is a formal document on temporary disability for health, pregnancy and childbirth or family member. Issued by a medical institution in which a citizen applied for medical care, and is provided to the employer to accrual the benefit.

Hospital sheet or disability sheet is a format of strict A4 reporting on special paper with watermarks and multistage protection. The blank consists of three parts:

fills the doctor of medical institution;
fills the employer;
fills the attending physician, cuts off and leaves in the clinic.

There are strict rules for filling the hospital:

in Russian, print-headed black letters, gel, capillary or feathers;
it is allowed to print on the computer;
letters must be inscribed strictly in the boundaries of the cells, there are gaps between words - empty cells;
an erroneous entry (only in the part only filled by an employer) is allowed to shift on the back side of the sheet to write correct, confirming the phrase "corrected to believe" and assuring the seal;
forbidden caulk error corrector or erase eraser;
not allowed to print from entering into cells with data.

Download sick leave Blank and Sample filling sick leave on our website.

Filling leaf disability physician. In this section the presence of patches is not allowed, so the hospital will not be paid by the employer:

Tick, is the primary document, a duplicate or a sequel.
When specifying the name of a medical institution and place of work it is allowed to use abbreviations and abbreviated name. Do not put the sign of «number», quotes, hyphens, commas, periods.
In the name of the doctor and the initials put a blank (empty cell), no space is needed between the initials.
Specify the cause of disability in the form of a two-digit code. Information about applicable codes is present on the back of the form.
Depending on the cause of disability, fill in the corresponding section of the form. The cells of the rest of the sections leave empty.
Be sure to fill the section "Exemption from work", based on the entered dates will be calculated.

Filling a blank employer. This section also needs to fill in carefully to Social insurance fund When verified, the benefits did not refuse:

Fill in the name of the organization by putting in 29 cells. It is allowed to use the abbreviated name, arbitrary abbreviations and abbreviation.
Registration number and subordination code Enter those that are specified in the notice of registration in the FSS.
Inn employee fill out only if it is presence.
Code for the "Conditions of Conditions" Field, look on the back of the sheet.
Field "Act forms" Fill if the employee's disease occurred due to an accident at work.
Specify the start of work if there is no employment contract with an employee.
Experience - put the number of full years, months. The non-trap period is the time of military service, law enforcement work.
Middle earnings and the amount of benefits at the expense of the employer and FSS, calculated by the accounting department, indicate excluding NDFL. Amount enter from the first cell.
The name of the head and accountant separate from the initials a space. Put initials without a space.