Course title: Responsibility and prescription: Medical documents Course objectives:

At the end of the course, the student should be able to:

1. Recognize the different types of medical certificates.
2. Define the general rules for any correct certification.
3. Describe the medico-legal implications of medical certificates.

Course outline:

1. Introduction :
2. Definition :
3. Different types of medical certificates: III-1- Mandatory certificates.

III-2- Optional certificates.

4. General rules:
   1. Who should request medical certificates?
   2. Is a medical certificate always required? IV-3- Who should be given the certificate to?

IV-4- Elements of form and substance.

5. Medical certificate and medical liability:
6. Conclusion.
7. Bibliographic references.
8. Introduction :

Writing medical certificates is part of a dentist’s daily practice.

Indeed, the task of a dentist is not only a matter of his clinical and therapeutic professional technique. It goes beyond the framework of the classic singular dentist-patient meeting to take on a real social dimension which is reflected in the establishment, in accordance with medical findings, of certificates, attestations and documents.

The multiplicity of situations in which a medical certificate must be produced has unfortunately trivialized its scope in the eyes of the public. It is too often seen as a simple formality that the dentist cannot refuse.

It should therefore be remembered that writing a certificate requires attention and rigour because it constitutes a form of proof which falls into the legal category of written testimony.

As a result, the criminal, civil and disciplinary liability of the dentist is incurred each time he agrees to write a medical certificate.

Please note that a certificate can only be written after an examination of the patient and in measured and objective terms.

2. Definition :

The definition of the Petit Robert states: “a writing which emanates from a competent authority and attests to a fact, a right.”

The medical certificate is a medical act intended to note, possibly interpret, a medical fact, attest to its reality and draw conclusions from it.

3. Different types of medical certificates:

Schematically, we distinguish:

1. Certificates which find their necessity in the application of legislation

“said to be of a mandatory nature”:

• Certificates subject to criminal legislation: Certificate of assault and battery; Initial descriptive certificate; Certificate of finding of deprivation and abuse of minors and disabled persons.
• Certificates subject to social legislation: Certificate of work stoppage; Extension of work stoppage; Declaration of occupational diseases, Declaration of a work accident.
• Certificates depending on health legislation: Diseases requiring mandatory notification.

2. Certificates intended to be used by the patient and which are the result of his own request “so-called optional”:
   • Certificate of good health; Certificate of fitness or unfitness.
   • Hospitalization certificate, etc.
3. General rules:
4. Who should request medical certificates?

• Usually, medical certificates respond to a request from the patient .

This request arises from a need, a necessity formulated by the patient in a specific context. According to article 6 of the code of ethics (CD) “the doctor and the dental surgeon are at the service of the individual and public health”. This call appears to be entirely justified on the part of the patient.

• Sometimes the request does not come from the patient, this is the case of a certificate established as part of a requisition, the requesting authority here replaces the patient;
• The request of parents (or legal guardians) for the benefit of a minor (or an incapacitated adult);
• The request of beneficiaries in the event of death.

2. Is a medical certificate always required?

• Yes , when it comes to mandatory certificates. On this point, there should be no hesitation.
• Yes , when the patient needs a medical certificate to support a justified request to an organization such as the CNAS for the provision of care.

According to article 57 of the CD: “(…) the doctor must facilitate (his patients) obtaining social benefits to which their state of health entitles them.”

• Yes , when the certificate responds to a requisition by the public authority (mayor, judicial police officer, public prosecutor, etc.).

Please note that the requisition constitutes an injunction which the practitioner cannot evade, except in exceptional circumstances in accordance with article 187 of the Algerian penal code (CPA) and article 178 of the law relating to health (LRS).

• But no , in all other cases.

A certificate will not be issued if the request made for it appears to be abusive, doubtful or if the facts to be certified are distorted.

Indeed, article 57 of the CD in its wording “without giving in to any abusive request from his patients (…)”, therefore leaves the possibility for the dentist to express his refusal, in a diplomatic but firm manner.

3. Who should the certificate be given to?

• Its delivery, in principle, must be made to the patient himself.
• There are legal exceptions: sending mandatory certificates directly to certain organizations. For example, for a mandatory declaration of contagious disease to the DSP
• To the requesting authority in the event of a requisition.
• To beneficiaries in the event of a deceased person.
• To the legal guardian in the case of a minor or an incapacitated adult.

4. Elements of form and substance:

These elements form the basis of any correct certification.

1. Elements of form : (articles 47, 56 of the CD)
   • Any certificate must be written clearly, legibly if handwritten.
   • Any certificate must follow a plan (preamble, allegations, medical findings, additional examinations, conclusion).
   • Any certificate must include two identities:
     • that of the dentist, with his qualification and professional address.
     • that of the applicant or the mention, in case of doubt, “declaring his/her name…”
   • All certificates must include a date and the handwritten signature of the dentist.
   • Every certificate must specify the reason for its issue and how and to whom it was issued.
2. Background elements :
   • The writing dentist must personally examine the patient; he must be competent with respect to the content of the certificate. He cannot ask a colleague to subcontract.
   • A medical certificate must transcribe the reality of the findings and the truth of the facts.
   • It must always be completed with complete accuracy, with the utmost neatness and precision.
   • It must not contain any omissions, especially not voluntary ones.
   • The certificate must be written with caution.
   • Any certificate must respect medical confidentiality (except in cases where the law requires or authorises overriding it). It is the patient who remains indisputably the master of the certificate and the secrets it contains; the dentist must only provide information that is strictly necessary for the intended use of the certificate (articles 36 to 41 of the CD, article 301 of the CPA, article 24 of the LRS).

An essential principle emerges from these main rules: the medical certificate is a personal document. In fact, only the dentist who is aware of the fact, who establishes observations in relation to it, can validly attest to it.

4. Medical certificate and medical liability:

The dentist is involved in carrying out this act on several levels; he incurs liability, both criminal and civil and disciplinary:

1. Criminal liability of the dentist

• Distortion of the truth in writing constitutes forgery: Pre-dating or post-dating a medical certificate constitutes a fault.

Articles 226 and 228 of the CPA severely punish the writing of false certificates or certificates of convenience (up to 3 years of imprisonment and a fine of 20,000 dinars).

• On the other hand, this can be considered as a scam or complicity in a scam.
• Violation of medical confidentiality in writing is an offence.

Article 39 of the CD: “the doctor must ensure protection against any indiscretion of the clinical records and documents that he holds concerning his patients”

2. Civil liability of the dentist:

In accordance with Article 124 of the Civil Code, damages may be claimed from a doctor by a person who considers themselves to have been harmed by the statements of a doctor.

3. Disciplinary responsibility of the dentist:

Article 58 of the CD: “the issuance of a biased report or a certificate of convenience is prohibited”.

Article 57 of the CD: “without giving in to any abusive request from its patients”

“any fraud, (…) inaccurate indication of fees or acts carried out are prohibited”

Article 24 of the CD: “any act likely to provide the patient with an unjustified material advantage is prohibited (…)”

5. Conclusion :

The medical certificate represents an important act of professional practice both in terms of its content and its frequency:

• an act of helping the patient;
• an act linking the sick individual to the community;
• a significant act of medical consciousness.

The main risk in the production of medical certificates concerns medical confidentiality and requires:

• to know the destination of the certificate;
• to certify only medical findings;
• to only mention the diagnosis in exceptions to medical confidentiality.

Most medical certificates are “optional”, and the dentist should only issue them when necessary, to avoid the multiplicity of unnecessary and often poorly written certificates.

Some “mandatory” certificates constitute an exemption from medical confidentiality and must be known.

The medical certificate, whatever it may be, is an important act and a commitment of the signatory’s responsibility, an act that frequency should not make trivial; a document whose every word carries weight.

6. Bibliographic references:
   1. Algerian Code of Medical Ethics. Executive Decree No. 92/276 of 06/07/1992.
   2. Algerian Civil Code. Ordinance No. 75-58 of September 26, 1975, establishing the amended and supplemented Civil Code. General Secretariat of the Government , year 2007.
   3. Algerian Penal Code. Ordinance No. 66-156 of June 8, 1966, establishing the amended and supplemented penal code. General Secretariat of the Government, year 2007.
   4. Law No. 18-11 of July 2, 2018 relating to health. JORADP No. 46 of July 29, 2018.

Course title: Responsibility and prescription: Medical documents

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Course title: Responsibility and prescription: Medical documents