Медицинская справка уже готова.

In the present tense, Russian usually omits the verb to be.

So:

• Медицинская справка уже готова. = The medical certificate is already ready / is already prepared.

There is no present-tense equivalent of English is/am/are in normal Russian sentences like this.

Compare:

• Справка готова. = The certificate is ready.
• Справка была готова. = The certificate was ready.
• Справка будет готова. = The certificate will be ready.

Only in the present tense is the verb normally left out.

Because готова agrees with справка, which is a feminine singular noun.

The short-form adjective готов changes to match the noun:

• готов = masculine singular
• готова = feminine singular
• готово = neuter singular
• готовы = plural

Examples:

• Документ готов. = The document is ready.
• Справка готова. = The certificate is ready.
• Письмо готово. = The letter is ready.
• Документы готовы. = The documents are ready.

Since справка is feminine, you need готова.

It is in the nominative case.

This phrase is the subject of the sentence:

• медицинская = medical
• справка = certificate / note / official document

In a sentence like this, the subject stays in the nominative:

• Медицинская справка уже готова.

The predicate adjective готова describes the subject, so the noun phrase is not being put into another case here.

Справка is a very common Russian word for an official note, certificate, or document confirming something.

In this sentence, медицинская справка usually means something like:

• a medical certificate
• a doctor’s note
• a medical document confirming health status

The exact English translation depends on context. In Russian, справка often refers to a practical bureaucratic document rather than just any general certificate.

Examples:

• справка с работы = a note/certificate from work
• медицинская справка = a medical certificate
• справка из школы = a note/certificate from school

Because it is an adjective modifying справка, and it must agree with it in gender, number, and case.

Since справка is:

• feminine
• singular
• nominative

the adjective must also be:

• feminine
• singular
• nominative

So you get:

• медицинская справка

Compare:

• медицинский документ = medical document
• медицинская справка = medical certificate
• медицинское заключение = medical conclusion/report
• медицинские документы = medical documents

In this sentence, готова is a short-form adjective, and that is the normal choice when saying that something is ready.

So:

• Справка готова. = The certificate is ready.

The form готовая is the long form, and it usually works differently. It is more natural when used before a noun or in contexts where it behaves more like a descriptive attribute:

• готовая справка = a ready/prepared certificate

But after the noun as the main predicate, Russian usually prefers the short form:

• Справка готова. ✔
• Справка готовая. usually sounds unnatural or means something different stylistically

This is an important pattern in Russian: many adjectives can have a short form when they function as the main statement about the subject.

Уже means already.

It shows that the action/state has been reached by now, often earlier than expected or in contrast to an earlier situation.

So:

• Справка готова. = The certificate is ready.
• Справка уже готова. = The certificate is already ready / is ready already.

It often gives the feeling of:

• now it is ready
• it has been completed
• you can get it now

Yes, Russian word order is fairly flexible, but the most neutral version here is:

• Медицинская справка уже готова.

This puts the subject first, then already, then the main new information ready.

Other word orders are possible, but they may shift emphasis:

• Уже готова медицинская справка. = more marked; emphasizes that it is already ready
• Медицинская справка готова уже. = possible, but sounds more conversational or contrastive
• Уже медицинская справка готова. = possible only in special contexts, with unusual emphasis

For learners, the safest neutral pattern is the original one.

It usually describes a state, not a permanent characteristic.

Here, готова means the certificate has been prepared, completed, and is now available.

So this is not like saying the certificate is beautiful or official as a permanent property. It is saying something more like:

• it is done
• it is ready now
• it can be picked up / used

That is one reason the short form is so natural here: it often expresses a current condition or state.

Because English does not always use ready the same way Russian uses готов.

Russian готов / готова can mean:

• ready
• prepared
• completed
• done

So depending on context, a more natural English translation might be:

• The medical certificate is ready.
• The medical certificate is already prepared.
• The medical certificate is done already.
• Your medical certificate is ready now.

The Russian sentence itself is perfectly natural. The slight awkwardness comes from English style, not from Russian grammar.

The usual stress is:

• медици́нская спра́вка уже́ гото́ва

A rough breakdown:

• медици́нская
• спра́вка
• уже́
• гото́ва

Stress matters in Russian, so it is worth learning words together with their stress pattern.

Yes, absolutely, if the context already makes it clear which certificate or document you mean.

• Справка уже готова. = The certificate is already ready.

Adding медицинская just makes it more specific:

• Медицинская справка уже готова. = The medical certificate is already ready.

Russian often omits information that is clear from context, just like English does.

Yes, very often.

In real-life Russian, Справка готова often implies more than just a technical state. It can also mean:

• the document has been completed
• it is available now
• you can pick it up
• it is no longer being processed

So in a clinic, office, or school context, this sentence may function almost like:

• Your medical certificate is ready now.
• You can collect the medical certificate.

The exact practical meaning depends on the situation.