Sick leave for pregnancy and childbirth: filling out a certificate of incapacity for work, sample, how to fill it out correctly?

Checking the contents of the application

When an employer receives an application for maternity leave, he needs to check the application itself for correctness.

First of all, you need to pay attention to the following:

the application must be signed directly by the employee herself,
the application must indicate the period of leave;
A sick leave certificate for pregnancy and childbirth must be attached to the application.

A sample application for maternity leave is at the end of the page.

Filling out sick leave for pregnancy and childbirth

It is necessary to pay attention to the fact that the certificate of incapacity for work must have the established form.

This form was approved by Order of the Ministry of Health and Social Development of Russia dated April 26, 2011 No. 347n. the front part must be completed by the medical professional and the employer.

The reverse part of the document contains information on the execution of the document.

In the line “at the expense of the Social Insurance Fund of the Russian Federation” the employer reflects the amount of the benefit, since it is paid at the expense of the Social Insurance Fund of the Russian Federation.

The line “at the expense of the employer” does not need to be filled out. The line where information about the TIN is indicated is not filled in.

The line is also not filled in if the citizen does not have a TIN.

Filling out the form by the employer

Like an employee of a medical institution, the employer fills out only his own column. However, he can check the correctness of filling out the sheet at the medical institution. If an error is detected, the employer must send the sheet back to the clinic and receive a corrected duplicate instead. The employer fills out his part of the form according to the following instructions:

The first line indicates the organization’s data: its name, registration number assigned by the Social Insurance Fund, subordination code. The same section indicates whether the main job is for a pregnant woman or a combined job.
The following lines indicate the pregnant woman’s TIN and her SNILS.
In the line “Calculation conditions” information is indicated only if there are special conditions: the pregnant woman is disabled, the pregnant woman works part-time, and so on. The information is encrypted with a special code.
The lines “Act N-1” and “Start date” are skipped.
The line “Insurance period” indicates the total time when contributions to the Social Insurance Fund were deducted from the pregnant woman’s income. In the line “Non-insurance periods” information is indicated only if the pregnant woman served (is) serving in the army, law enforcement agencies, or the Ministry of Emergency Situations.
The line “Benefits due” indicates the time actually spent by the employee on sick leave.
The following lines indicate the pregnant woman’s earnings for the previous 2 years and the average income for 1 day (this amount is calculated based on the employee’s earnings for the previous 2 years).
The line “Amount at the expense of the employer” indicates the amount of compensation for the first 3 days. In the line “Amount at the expense of the Social Insurance Fund” indicates the amount of compensation for the entire remaining period of sick leave. Next, the amounts are summed up and entered in the “Total to be accrued” line.
In the last lines you must enter the full name of the manager and chief accountant. The surname is written in full, the first and surname only with initials.

Unlike an employee of a medical organization, an employer has the right to make corrections in his part (defined by paragraph 65 of Order of the Ministry of Health and Social Development No. 624). To do this, he must carefully cross out the incorrect information and make the necessary entry on the back of the sheet. No more than 2 strikethroughs are allowed. Each correction is certified by the seal of the organization, and if there is none, by the signature of the head.

Issuance of an order on the provision of maternity leave

The order must be issued in accordance with the unified form No. T-6 (approved by Resolution of the State Statistics Committee of Russia dated January 5, 2004 No. 1).

The order must reflect the duration of the leave and the details of the certificate of incapacity for work.

After the order is issued, the employee must be familiarized with her signature.

If for some reason the employee cannot sign or refuses to sign, then the employer in the order states or “It is impossible to familiarize with signature due to ....”

This design of the document is specified in Art. 84.1 of the Labor Code of the Russian Federation upon termination of an employment contract, we believe that this also applies when reviewing the order for granting maternity leave.

How to correctly draw up a document on accounting

The sick leave is divided into 3 parts:

the first is completely filled out by a doctor from a medical institution;
the second is prescribed by the employer and accountant;
the third is necessary for medical reporting.

They are even graphically separated by black lines, where it is written which party should fill out the document.

The first part is traditionally prescribed by the medical institution . It is necessary to enter the information that is required by the document itself, that is, you cannot write anything superfluous, and also write out the medical history in full.

If an employee is pregnant, the form is filled out in the same way as in other medical cases, but with its own nuances.

The timing increases in the case of complicated and multiple pregnancies . As a general rule, an employee can go on labor and labor leave at the 30th week of pregnancy.

Article 255 of the Labor Code of the Russian Federation. Maternity leave

Women, upon their application and on the basis of a certificate of incapacity for work issued in accordance with the established procedure, are granted maternity leave of 70 (in the case of multiple pregnancies - 84) calendar days before childbirth and 70 (in the case of complicated childbirth - 86, for the birth of two or more children - 110) calendar days after childbirth with payment of state social insurance benefits in the amount established by federal laws.

Maternity leave is calculated cumulatively and is provided to a woman completely regardless of the number of days actually used by her before giving birth.

The first part of the form is filled out by special medical workers, and in the case of pregnancy, this is done solely by the obstetrician-gynecologist who is seeing the patient.

It is this doctor who issues a sick leave certificate and writes down all the necessary data there.

The gynecologist writes in a special column the timing of the pregnant woman’s release from work, counting 140 days according to the calendar. If for some reason the obstetrician-gynecologist cannot do this, then the bulletin is issued and filled out by a general practitioner or paramedic.

No longer do any medical workers have the right to issue and fill out sick leave.

The employer fills out the form after the doctor in the strictly designated part of the sick leave sheet. The management itself does not issue sick leave , since it does not have the right to do so.

It is worth immediately noting that the head of the organization does not deal with this issue alone, but delegates such powers to the human resources department or the chief accountant. It is entirely his discretion as to who exactly will be responsible for filling out the ballots.

Filling out a form at a medical institution

The sick leave must be written out without a single mistake, that is, this means that practically no one has the right to make a mistake. The first part of the document is filled out by the doctor, who is required to enter specific information in special fields. According to the requirements of the sick leave certificate, the obstetrician-gynecologist indicates the following information in the document :

full name and number of the medical institution;
address of the medical center organization issuing the newsletter;
OGRN number;
date of issue;
Patient's name;
date of birth of the patient;
floor;
disability code;
the patient’s place of work, where the name of the organization is written;
date of release from work (vacation start and end period);
position of a doctor;
surname and initials of the doctor;
date of return to work, which is indicated in the “start to work” paragraph.

In addition to filling out the above data, you must know exactly the requirements for document execution. If this is not done according to the rules, then the ballot will be invalid and the employee will have to take a duplicate. The ballot must be filled out as follows :

All data is accurately entered into the square fields specially designated for this purpose. Each letter and number must strictly fit into the square field and not go much beyond its limits.
The text of the sick note is entered in block letters either on a computer or using a black gel pen. Blue ink is not allowed to fill out the document.
The data is entered together with spaces so that there is no hard-to-read continuous text.
The doctor's surname is indicated in full, and the first and patronymic names are indicated exclusively by initials without dots.
The doctor's position is indicated in full or in abbreviation. In this case, the word “gynecologist” or “obstetric gin” in abbreviated form is written in a special column.
The patient’s full name is indicated in full in special three columns.
The date of the patient’s absence from work is entered in a separate column “exemption from work” in DD format. MM. YYYY. The doctor needs to count 140 calendar days and write the final date of being on leave according to the BIR.
In the “get to work” paragraph, write a specific date following the end of the vacation according to the BIR.

The reason for disability in the document is always indicated in two-digit numbers. In order to maintain medical confidentiality, the exact diagnosis is never indicated on the bulletin. In case of pregnancy, doctors enter code 05 in a special column, which literally means “pregnancy and childbirth.”

No additional information on the patient's health status and diagnosis is required. All other information is written in the medical record , which is inaccessible to unauthorized persons, including the employer.

For example, 01 on the form is a disease, 02 is an injury, etc. No more specific information on the diagnosis is indicated on the form.

Next, in the photo you can see a sample of filling out a sick leave certificate for pregnancy and childbirth.

What should the employer specify?

The employer fills out his part of the document after the attending physician .
First, the HR department must make sure that there are no errors in the bulletin, and then begin their work. If the sick leave form is filled out with errors, the employee must bring a new form. The rules for filling out the document are practically the same for both the employer and the employees of the medical organization.

The chief accountant or personnel employee enters the following data in special square fields in block letters :

the name of the organization where the employee works;
form of work activity: main job or part-time;
registration number assigned by the Social Insurance Fund to the organization;
subordination code, which can be found in the reporting form No4-FSS;
TIN of the employee;
SNILS;
benefit accrual period in DD format. MM. YYYY;
insurance period, which is calculated from the moment of the first official work;
Wed earnings for calculating benefits;
average daily earnings;
the amount of money paid by management;
the amount of money paid to the Federal Social Insurance Fund of the Russian Federation;
the total amount, that is, it is necessary to sum up the accruals at the expense of the manager and the Social Insurance Fund of the Russian Federation;
surname, initials of the manager and chief. accountant, as well as their signature.

In the “calculation conditions” column, a two-digit code is usually entered, but it must be filled out only for certain categories of workers (employees of the Far North, persons exposed to radiation, disabled people, etc.). If the employee does not fit into any category, then this column is left empty.

The item “Act of form N-1” is not filled in upon pregnancy and childbirth , since it is written in case of industrial accidents.

Many managers are confused by the phrase “Employment start date,” but the employer fills it out only if the employment agreement with the employee is canceled. In all other situations, this column must be left empty.

A personnel employee or chief accountant should strive to fill out a sick leave certificate without errors. If the name of the organization or the name of the manager/chief accountant does not fit into the square fields, then in no case should you add anything to the side or top/bottom. The best option would be to leave everything unchanged .

Next, in the photo you can see a sample of filling out a sick leave form from an employer.

Watch a video about the rules for filling out sick leave by an employer: