Online Doctor Consultation · Health blog

Health & Wellness31 July 202616 min

Krankschreibung Online: How Sick Notes Work in Germany

It is 06:40 on a Monday and Lena is sitting on the edge of the bath with a thermometer, doing arithmetic. She has a fever of 38.9, a shift starting at eight, a team lead who is fine about illness and an HR system that is not. Her contract says something about a Bescheinigung. She half remembers a colleague saying you only need a sick note after three days. She also remembers someone else saying her company demands one from day one. Her Hausarzt's phone line opens at 08:00, by which time she is supposed to be at work, and the practice is a twenty-five minute tram ride away. She types Krankschreibung online into her phone and finds a dozen services promising a certificate in minutes, several of them clearly not designed for her situation.

This article is about what is genuinely true here, including the parts that are inconvenient. German sick leave documentation is one of the most tightly wired systems in European healthcare, and understanding the wiring tells you immediately what any given service can and cannot do for you. If you are searching for a Krankschreibung online ohne Versicherung, meaning a sick note online without German statutory insurance, the honest answer has several parts, and pretending otherwise would leave you worse off with your employer than you started.

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What a Krankschreibung actually is

The document Germans call a Krankschreibung has a formal name: the Arbeitsunfähigkeitsbescheinigung, usually shortened to AU. It is not a doctor's opinion that you feel unwell. It is a medical certification that you are unable to perform your specific work, issued by a doctor after assessing you, and it has legal consequences. It underpins your right to continued pay from your employer, the Entgeltfortzahlung im Krankheitsfall, which in the standard case runs for up to six weeks of the same illness, after which the Krankenkasse may pay Krankengeld instead.

Because money and employment law hang on it, the AU is not a form a doctor can simply improvise. It comes from a defined process, in a defined format, from a doctor working inside the German system.

The eAU: where the document actually goes

Germany has moved the AU onto electronic rails. Under the elektronische Arbeitsunfähigkeitsbescheinigung, the eAU, a German practice transmits the certification digitally to your gesetzliche Krankenkasse. Your employer then retrieves the data from the health fund rather than receiving a piece of paper from you. Employees are still required to report their absence to the employer, but the certificate itself travels through the health fund.

Read that sequence again, because it explains nearly everything else. The chain runs doctor to Krankenkasse to employer. Each link is a German institution. If you are not a member of a German statutory health fund, there is no Krankenkasse in the middle for the certificate to pass through. If your doctor is licensed in another country, they are not connected to the system that starts the chain. This is not a policy someone could relax for a good reason. It is plumbing.

Privately insured employees sit slightly outside the eAU flow and usually still receive a paper certificate from their doctor to give to the employer, which is one reason people compare notes at work and end up with contradictory information. Both colleagues are describing their own reality accurately.

The three-day rule, and why your colleagues disagree about it

German law sets a default: an employee must present a certificate of incapacity if the illness lasts longer than three calendar days, with the certificate required from the fourth day. That is the statutory baseline, and it is where the widely repeated three-day rule comes from.

The part people forget is that the same law permits the employer to require the certificate earlier, including from the very first day of absence. Many employers do exactly that, and it may appear in your contract, your works agreement or your staff handbook rather than being announced to you. So one colleague genuinely never needs a note for a two-day absence, and another genuinely needs one every time, and both are following the rules that apply to them.

Three calendar days means calendar days, not working days, so a weekend counts. And employers can also ask for a follow-up certificate, the Folgebescheinigung, when an absence continues beyond the period first certified.

The practical instruction here is unglamorous but valuable: find out your employer's rule while you are healthy. Search your contract for Arbeitsunfähigkeit, or ask HR a one-line question by email. Doing this in advance takes two minutes. Doing it at 06:40 with a fever takes considerably longer and produces worse decisions.

Telefonische Krankschreibung: what Germany does allow

Germany does permit sick certification without an in-person visit in defined circumstances. The telephone sick note, the telefonische Krankschreibung, became a permanent option after the pandemic-era arrangements. The conditions matter, though, and they are frequently misreported online. It applies where the patient is already known to the practice, where the symptoms are not severe, and it covers a limited period of a few days, with any extension requiring the patient to be seen. Video consultations within the German system can also be used for certification under professional rules that likewise depend on the doctor and patient relationship and on the doctor being registered here.

The common thread is that the certificate still originates from a German practice, usually one that already knows you. A telefonische Krankschreibung is not a shortcut around having a doctor. It is a convenience for people who already have one, which is precisely the resource most internationals in Germany lack.

So what can an international private online doctor do?

Here is the honest boundary, stated plainly because the honesty is what makes the rest of this useful.

A physician licensed in another European country, consulting you by video, cannot issue a German eAU, cannot transmit anything to your Krankenkasse, and cannot generate the record your German employer retrieves from the health fund. Any service suggesting otherwise is either describing a German-registered service or is being careless with the truth, and the person who bears the consequences is you, standing in front of HR with a document they will not accept.

What such a physician can do is conduct a proper clinical assessment and issue a private medical certificate or consultation report: a dated document from a named licensed doctor recording that a consultation took place, what was assessed, and what rest or restriction was advised. That is a legitimate medical document. Its power depends entirely on who is receiving it.

In practice these are accepted more often than people expect in specific situations: absences shorter than your employer's certificate threshold where you simply want documentation, illness while travelling or working abroad, universities and language schools with their own attendance rules, some flexible or international employers, and evidence for insurance or trip cancellation claims. They are accepted less often, and sometimes not at all, by large German employers with formal HR processes built around the eAU, and by public sector bodies.

Online Doctor Consultation is upfront about this distinction. The service works with licensed and registered physicians across Europe, with active markets in Spain, France, the United Kingdom and Italy and remote appointments elsewhere in Europe, and sick notes and medical certificates are part of the offering as described on the services page. What varies by country is the legal weight of the document, and the right time to check that is before you book rather than afterwards.

Which document fits which situation

The examples below are illustrative composites rather than real patients.

Document	Who can issue it	How it reaches the employer	Accepted for German statutory sick pay?	Typical use
eAU (electronic AU)	Doctor registered in the German system	Transmitted to your Krankenkasse, employer retrieves it	Yes, this is the standard route	Statutorily insured employees in Germany
Paper AU certificate	German doctor, typically for private patients	You hand or send it to the employer	Yes, in the private insurance context	Privately insured employees, and fallback situations
Telefonische Krankschreibung	German practice where you are already a patient	Same eAU route	Yes, within the defined conditions	Mild illness, short duration, patient known to the practice
Private medical certificate from an international online doctor	Physician licensed elsewhere in Europe	You receive it and pass it on yourself	No, it does not enter the German system	Short absences, study or travel contexts, flexible employers, insurance claims
Self-declaration to the employer	You	Email, phone call or HR portal	Only where the employer permits it below the threshold	One or two day absences where no certificate is required

Two scenarios that show the difference

These are fictional examples, written to show how remote and in-person care differ.

Nadia, permanent contract, statutorily insured, Stuttgart. She wakes with gastroenteritis on a Wednesday. Her contract requires a certificate from the first day. Her only valid route is a German doctor: her Hausarzt if she has one, a telefonische Krankschreibung if she is already a patient there and the case fits, otherwise 116117 or a Bereitschaftspraxis. An international online consultation could give her clinical advice on hydration, warning signs and when this stops being ordinary, and that has real value, but it cannot produce the document her employer requires. Knowing that at 07:00 saves her from wasting a booking on the wrong thing.

Rafael, freelance developer, no German employer, insured privately, Cologne. He is contracted to deliver work for a client in another country and is genuinely too ill to work for three days. There is no eAU relevant to him because there is no German employer and no statutory sick pay involved. What he needs is documentation for a client and possibly an insurer. A private medical certificate from a licensed online physician, with the date, the assessment and the advised period of rest, fits his situation properly. Same illness, entirely different document.

How to handle a German sick day competently

Tell your employer immediately, before your shift starts, by whatever method your company specifies. This duty is separate from the certificate and applies even on day one.
Say how long you expect to be absent, as best you can estimate.
Check whether a certificate is required from day one or from day four in your case.
If you need one, contact your Hausarzt early; practices hold acute morning slots and they go quickly. Outside opening hours, use 116117.
If the illness lasts longer than certified, arrange a Folgebescheinigung before the first one expires. Gaps cause problems with pay.
Keep your own record of dates, symptoms and contacts. Administrative disputes are far easier to resolve with notes.

Honest limitations of any online sick note

A remote consultation cannot examine you, so a doctor cannot certify what they cannot assess. Some conditions require an in-person examination before any certificate is appropriate.
No doctor, online or in person, is obliged to issue a certificate. Certification is a clinical judgement, not a purchase. A service guaranteeing a sick note before assessing you is not practising medicine.
An international online physician cannot issue an eAU, a German E-Rezept or a referral to a German Facharzt.
Backdating is generally not appropriate. Certificates normally start from the day of the consultation, so contact a doctor early rather than after the fact.
Video consultation cannot provide blood tests, imaging, swabs or emergency care.
Long-term or complex incapacity, occupational health assessments and rehabilitation processes belong with a local doctor who can examine you and coordinate with German institutions.

The physicians who conduct these consultations are introduced on the doctors page, background on the service is on the about us page, and specific questions about certificates by country are covered on the FAQ page. If your employer is strict, read those before booking.

Red flags: illness that needs more than a certificate

Call 112 in Germany and across the European Union for a medical emergency. A sick note is irrelevant in the following situations, and seeking one instead of help would be a serious mistake:

Chest pain or pressure, especially with sweating, nausea, breathlessness or pain spreading to the arm, jaw or back.
Sudden weakness or numbness on one side, facial droop, slurred speech, sudden confusion, sudden vision loss, or the sudden worst headache of your life.
Severe breathlessness, blue lips, or inability to complete a sentence.
Fever with a stiff neck, severe light sensitivity, or a rash that does not fade under pressure.
Uncontrolled bleeding, a serious injury, a seizure or any loss of consciousness.
Severe abdominal pain, persistent vomiting with no fluid tolerance, or signs of significant dehydration.
An infant under three months with a fever, or a child who is very drowsy, breathing hard or refusing to drink.
Suicidal thoughts or a mental health crisis. This is an emergency and deserves the same urgency as any physical one.

For urgent but non-emergency problems outside practice hours, particularly at weekends and on public holidays, call 116117. Elsewhere in Europe 112 also works, alongside 15 for the SAMU in France, 118 for ambulances in Italy and 999 in the United Kingdom. If you need medication overnight, the Apotheken-Notdienst rota shows the duty pharmacy for your postcode and is displayed in the window of any closed Apotheke.

Mental health and sick leave, briefly

Psychological illness is a legitimate reason for incapacity for work in Germany, and burnout, depression and anxiety disorders are certified in the same way as physical illness. The route is the same as any other: a German doctor for a German employer's documentation. An online mental health consultation can provide assessment, guidance, coping strategies and a documented history while you wait for a therapy place, and waiting lists for psychotherapy in German cities are long enough that this interim period matters. Anyone in crisis should contact emergency services rather than waiting for any appointment.

Data protection

Health information is a special category of personal data under the GDPR, and sick leave data is unusually sensitive because it touches your employment. Your employer is entitled to know that you are unable to work and for how long. They are not entitled to your diagnosis, and the AU does not tell them what is wrong with you. Any telemedicine provider handling your data should be able to say where it is stored, who can access it and how you obtain a copy.

If you work across borders or spend part of the year in another country, the rules on sick leave documentation change with the border. Where your question is really about a country we do not serve clinically, the Online Doctor Consultation network is a reasonable starting point, alongside European resource pages and Spanish-language material. Treat all three as reference material. They are independent resources within a wider network rather than the same brand, and useful when you need to compare one country's rules with another.

Frequently asked questions

Can I get a Krankschreibung online without German insurance?

You can obtain a private medical certificate from a licensed physician online without being in a German Krankenkasse. You cannot obtain an eAU that way, because the electronic certificate travels through the statutory health fund and is issued by doctors registered in the German system. If your employer requires the eAU, only a German doctor can produce it.

After how many days do I need a sick note in Germany?

The statutory default requires a certificate when the illness lasts longer than three calendar days, so from the fourth day. Employers are permitted to demand one earlier, including from day one, and many do. Your contract or works agreement is the place to check, and weekends count as calendar days.

Does my employer receive my diagnosis?

No. Your employer learns that you are unable to work and for how long. The diagnosis goes to the Krankenkasse, not to your manager. You are not required to explain what is wrong with you.

Is a telefonische Krankschreibung the same as an online sick note from a foreign doctor?

No, and conflating the two causes real problems. The telephone sick note is a German arrangement, available through a practice where you are already a patient, for non-severe symptoms and a limited number of days. A certificate from an internationally licensed online doctor is a private document that does not enter the German system.

My employer refused a certificate from an online doctor. What now?

Contact a German doctor for the required documentation as quickly as possible, since certificates are not normally backdated. Then ask HR in writing exactly what they accept, so the situation does not repeat. If the illness is ongoing, your Hausarzt can usually issue a follow-up certificate covering the continuing period.

Can I be sick-listed while on holiday?

If you fall ill during annual leave and obtain a certificate of incapacity, German law generally allows those days to be credited back rather than counted as holiday. You must notify your employer and provide documentation, and if you are abroad additional notification rules can apply. Check the specifics with your employer or health fund.

Can an online doctor certify me for longer than a few days?

Short certification for self-limiting illness is one thing; longer incapacity is a different clinical matter that usually requires examination and follow-up. A responsible physician will decline to certify a long absence remotely and will refer you to in-person care. Treat that refusal as a sign of good practice.

What if I have no Hausarzt at all?

This is the situation many internationals in Germany are in. Practically, use 116117 outside opening hours or on the day if you cannot reach a practice, try Bereitschaftspraxen, and keep working on registering with a Hausarzt when you are well. In the meantime an online consultation can still give you clinical assessment and advice, even where it cannot give you the German document.

Medical disclaimer

This article provides general information about sick leave documentation in Germany and does not constitute medical or legal advice. Employment law, insurance rules and digital certification processes change, and the requirements that apply to you depend on your contract, your insurer and your employer. Confirm current rules with your Krankenkasse, your employer or a qualified adviser. Consult a physician about your own health, and seek emergency care immediately if your symptoms are severe or worsening.

Patient stories and examples in this article are illustrative composites, not real patients. Medically reviewed by the Online Doctor Consultation Medical Team.

The short version worth remembering

If you have a German employer and statutory insurance, the eAU from a German doctor is the document that counts, and nothing bought online from abroad substitutes for it. If your situation sits outside that, as a freelancer, a student, someone working for a foreign client or someone who fell ill while travelling, a private medical certificate from a licensed physician may be exactly the right document. The skill is knowing which category you are in, and finding that out before you are ill rather than during. If you need a clinical assessment quickly and want to check first whether documentation from a remote consultation would work for your circumstances, ask through the contact page, book a time that suits you on the main site, or read the other country guides in the health blog. Being ill is enough to deal with without also losing a day's pay to a paperwork misunderstanding.

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