Medical Leave Extension Request
मेडिकल अवकाश विस्तार अनुरोध
A request to extend previously approved medical leave, with revised dates and supporting document details.
Download Medical Leave Extension Request
What the medical leave extension request is used for
Use it to capture employee name, employee id, department, date, original leave from, original leave to and related details in one standard format. Send it before the original leave ends and attach an updated supporting document where required.
Who should use it
- Employees and students who need to apply for health-related leave
- HR and school offices who record such leave
- Qualified medical practitioners completing their own sections
Key features
- 6 labelled field groups covering Employee Name, Employee ID, Department, Date and more.
- Signature lines for the people who complete or approve it.
- Checklist boxes you can tick by hand.
- Clean A4 portrait layout designed to print on a standard office printer.
- Contains a medical-use disclaimer and blank sections for any medical details.
Frequently asked questions
What details does the Medical Leave Extension Request include?
It includes Employee Name, Employee ID, Department, Date, Original Leave From, Original Leave To, Extension From, Extension To and more, laid out so the form can be filled by hand or typed.
Can I edit the Medical Leave Extension Request before printing?
Yes. Download the Word (.docx) version, add your name, logo or extra fields and then print or save it as PDF. The PDF is best when you only need to print and write by hand.
Is the Medical Leave Extension Request available in Hindi?
Yes. Both an English and a Hindi version are provided in PDF, DOCX format where listed on this page.
Is the Medical Leave Extension Request an official medical document?
No. It is a general template for drafting or record-keeping. It does not certify that anyone is ill or fit, and any medical statement, signature, registration number and stamp must come from a qualified, authorised medical practitioner. Always give truthful information.
Last updated: 11 October 2026