Sick Certificate Online for Work in Europe: Country-by-Country Rules

Monday, 06:40, a flat in Gràcia. Nadia has been awake since four with a fever and a cough that sounds like furniture moving. She works for a Barcelona company on a Spanish contract, her line manager is German, her payroll is handled by an agency in Madrid, and the staff handbook says only that absence must be "properly certified". She has no idea what properly certified means here, whether she can get whatever it is without dragging herself to the centro de salud, and whether the English-language telemedicine service she used last year in Amsterdam would produce anything her employer will accept.

If you have ever searched for a sick certificate online for work Europe at six in the morning, you already know the results are unhelpfully vague. That is partly because the honest answer is complicated: sick leave certification is one of the most nationally specific parts of European healthcare. There is no European sick note. There are five or twenty-seven different systems, each with its own document, its own issuing rules, and its own opinion about the first day.

Need to speak to a doctor today? Choose an appointment time that suits you and a licensed physician joins at that exact slot — no queue, no waiting on hold. Book a consultation or see which consultation fits your situation.

What follows is a practical explanation of how it works in Spain, France, the UK, Italy and Germany, where an online consultation genuinely helps, and where it will leave you holding a document your payroll department cannot use.

Two different objects that both look like sick notes

Almost every problem in this area comes from confusing two things.

The first is a statutory certificate. This is a national administrative instrument that triggers legal consequences: protected absence, statutory sick pay, social insurance benefits. It usually has a specific name, a specific form or electronic transmission route, and rules about who may issue it — nearly always a clinician registered and authorised inside that country's system.

The second is a private medical certificate. This is a signed statement from a licensed doctor describing your condition, the date of assessment, and a recommendation about fitness for work and duration. It is a genuine medical document. It is not the statutory instrument, and it does not enter the national social security system by itself.

Many employers accept a private certificate perfectly happily, particularly for short absences, and particularly for salaried staff whose employer pays the first days of sickness directly. Many others, especially where statutory benefit is involved, will require the national document and nothing else. Any telemedicine service that blurs this line is doing you harm, which is why our description of the sick note and medical certificate service states plainly which of the two you receive.

Spain: the parte de baja médica

In Spain, sickness absence for an employed person is handled through incapacidad temporal, and the document is the parte de baja médica. It is normally issued by your médico de atención primaria in the public system, or by the mutua colaboradora where the cause is work-related.

The baja is generally issued from the first day the doctor certifies you unfit, and there is a follow-up process with partes de confirmación at intervals depending on the expected duration, then a parte de alta when you return. Since the administrative reform that removed the patient's obligation to hand a copy to the employer, transmission to the employer and the INSS happens through official channels rather than through you, which reduces the paperwork but also means the document has to originate inside that system to travel at all.

What this means practically: a private international certificate does not create a baja. It can be a useful supporting document for a short absence with an understanding employer, and it is useful evidence that you sought medical assessment, but it will not produce statutory incapacidad temporal. If you need a baja, you need a doctor inside the Spanish public or mutua system.

France: the arrêt de travail

The French document is the arrêt de travail, issued by a physician and now largely transmitted electronically. The classic obligation is to get it to your CPAM and inform your employer within 48 hours, and delay can affect your indemnités journalières.

Two French specifics catch people out. The first is the délai de carence: social security daily allowances usually begin after a waiting period of a few days, though many collective agreements and employers top up or cover that gap. The second is that the arrêt has a section on authorised hours of absence from home, which the CPAM can in principle verify.

An arrêt de travail is a French instrument issued by a practitioner in the French system. A téléconsultation with a French-registered doctor can produce one, subject to the rules that apply to remote issuance and duration. A consultation with an international private doctor produces a medical certificate that some employers accept, but it is not an arrêt de travail and will not on its own generate indemnités journalières.

United Kingdom: self-certification, then the fit note

The UK is the outlier, and in a way that helps employees. For the first seven calendar days of sickness, you normally do not need a doctor at all. You self-certify, often on your employer's own form or the equivalent of the SC2, and that is sufficient for statutory sick pay purposes.

From the eighth day, you need a fit note — formally the Statement of Fitness for Work. It is worth knowing that the range of professionals who can issue one was widened beyond doctors to include registered nurses, occupational therapists, pharmacists and physiotherapists, which has made them easier to obtain. It is also worth knowing that a fit note is not simply "off sick": it distinguishes between not fit for work and may be fit for work with adjustments, which is the part employers most often overlook.

Because UK employers may accept a note from any suitably registered clinician, private certificates are more often usable here than elsewhere, though an employer is entitled to have a policy about what it accepts and some insist on NHS documentation. Ask HR rather than assume.

Italy: the certificato di malattia and its protocol number

Italy runs one of the most digitised systems, and also one of the least forgiving of documents from outside it. The certificato di malattia is issued by your medico di famiglia or a hospital doctor and transmitted telematically to INPS, which generates a numero di protocollo. You give that number to your employer, who retrieves the certificate directly.

The certificate is generally expected from the first day of absence, and there is a real enforcement dimension: fasce di reperibilità are the hours during which you must be at your registered address in case of a home visit by an INPS medical inspector.

The critical point for anyone considering a remote route is that transmission to INPS is done by clinicians authorised within the national system. A private international doctor cannot generate a protocol number, so a private certificate cannot substitute for the certificato di malattia even if the clinical assessment behind it was excellent.

Germany: the Arbeitsunfähigkeitsbescheinigung

The German document is the Arbeitsunfähigkeitsbescheinigung, universally shortened to AU or Krankschreibung. Statutory law has traditionally required it from the fourth day of absence, but employment contracts very frequently require it from the first day, so the practical answer is whatever your contract says.

Germany moved to the elektronische Arbeitsunfähigkeitsbescheinigung, the eAU, under which doctors transmit the certificate to the gesetzliche Krankenkasse electronically and employers retrieve it from there. That removed the yellow paper slip for most statutory-insured employees, but it also means the certificate has to be issued by a practice connected to that infrastructure. Out-of-hours, the 116117 service is the route to a non-emergency doctor.

Remote issuance has been permitted in defined circumstances in Germany, including telephone certification for known patients with familiar conditions, with limits on duration. Those rules have been adjusted repeatedly, so check the current position rather than relying on what a colleague did two years ago. A private international certificate will not enter the eAU system.

Country comparison

Country	Official document	Who normally issues it	Typically required from	Private international certificate?
Spain	Parte de baja médica (incapacidad temporal)	Médico de atención primaria in the SNS, or the mutua for work-related cases	Day one of certified incapacity, with partes de confirmación after	Not accepted for statutory IT; may support a short absence if the employer agrees
France	Arrêt de travail	A physician registered in France; sent to CPAM and employer, usually within 48 hours	Day one, with a waiting period before daily allowances start	Not an arrêt de travail; some employers accept it as supporting evidence only
United Kingdom	Self-certification, then the fit note (Statement of Fitness for Work)	Self for the first 7 days; then a doctor, nurse, pharmacist, occupational therapist or physiotherapist	Day 8 for the fit note	More often acceptable here, but employer policy decides
Italy	Certificato di malattia with numero di protocollo	Medico di famiglia or hospital doctor, transmitted telematically to INPS	Day one, with fasce di reperibilità for home checks	Cannot generate a protocol number, so it does not substitute
Germany	Arbeitsunfähigkeitsbescheinigung (eAU)	A doctor in Germany transmitting to the gesetzliche Krankenkasse	Legally day four; very often day one under the contract	Does not enter the eAU system; acceptance is at the employer's discretion

Treat this table as orientation rather than gospel. Rules in this area change, regional practice varies, collective agreements override defaults, and your own contract may be stricter than the law. Confirm with your employer and your national health insurer before relying on any route.

Where an online consultation genuinely helps

Given all that, it is fair to ask what a remote consultation is actually for in this context. Four things, mostly.

It gets you assessed on the day rather than on the day a surgery has capacity, which matters most where the certificate is expected from day one. It produces a written, dated clinical record of your illness — useful even where the statutory form must come from elsewhere, because it evidences that you sought care promptly. It gives you a consultation in a language you can be precise in, which reduces the risk of an absence being certified for the wrong duration. And in the UK, and in cases elsewhere where an employer accepts private documentation, it can produce the document itself.

The other underrated function is advice about duration. People routinely certify themselves back to work too early with respiratory infections and then relapse. A doctor who has actually assessed you gives you a defensible answer about how long to rest.

Two realistic situations

The examples below are illustrative composites rather than real patients.

Nadia in Barcelona, from the opening. The right sequence for her is to notify her manager immediately, book an online consultation that morning to get assessed and get written advice on duration, and simultaneously request an appointment at her centro de salud for the baja if the absence looks likely to run beyond a couple of days. The private consultation buys her a same-morning assessment and documentation; the public route produces the instrument her payroll needs. Neither substitutes for the other.

Tom, 31, a contractor in Manchester, has flu-like illness on a Tuesday. For the first seven days he self-certifies and needs no doctor at all — a fact that saves a surprising number of people an unnecessary appointment. If he is still unwell on day eight, he needs a fit note, and because UK employers may accept notes from any appropriately registered clinician, a remote consultation is a realistic route for him in a way it is not for his colleague in Milan. He still checks his contract first, because his agency may have its own policy.

Red flags: when a certificate is not the priority

Sick leave paperwork is never the first concern in a genuine emergency. Seek urgent care immediately for chest pain or tightness, especially with sweating, breathlessness or pain spreading to the arm or jaw; sudden weakness or numbness on one side, facial droop or slurred speech; severe difficulty breathing or blue lips; coughing up significant blood; a stiff neck with high fever and a rash that does not fade under pressure; confusion or a very drowsy state; severe dehydration; a first seizure; or any thought of harming yourself.

Call 112 anywhere in the EU, 999 in the UK, 15 for SAMU in France, 118 in Italy. In Germany, 116117 connects you to non-urgent out-of-hours care while 112 remains the emergency number. Employers, payroll and INPS protocol numbers can all be dealt with afterwards; every European system has a mechanism for retrospective certification after emergency treatment.

Honest limitations

A video consultation cannot examine you physically, cannot listen to your chest, cannot take a blood test or swab, and cannot perform imaging. It cannot prescribe controlled medicines. It cannot issue a Spanish baja, a French arrêt de travail, an Italian certificato di malattia with a protocol number, or a German eAU, because those instruments belong to national systems and require a clinician registered inside them. It cannot make an employer accept a document their policy excludes. And it cannot certify an illness that a doctor has not actually assessed — no responsible service issues a certificate without a consultation, and any that does is a service you should avoid, because a certificate obtained that way is worth nothing and may create a disciplinary problem.

Frequently asked questions

Can I get a sick note online that my employer in Europe will accept?

Sometimes, and it depends on the country and the employer. In the UK a fit note from an appropriately registered clinician is often acceptable. In Spain, France, Italy and Germany the statutory instrument must come from a clinician inside the national system, though many employers will accept a private medical certificate for a short absence. Ask HR before you pay.

Do I need a doctor's note from day one?

It varies. Spain, France and Italy generally expect certification from the first day of certified incapacity. Germany requires it legally from the fourth day but many contracts demand day one. The UK allows self-certification for the first seven days. Your own contract can be stricter than the law in every one of these countries.

Can an online doctor issue a Spanish baja médica?

Not a private international one. The parte de baja is issued through the SNS or the relevant mutua. A private consultation can assess you the same day and document your illness, which is useful, but the baja itself has to come from inside the system.

Puis-je obtenir un arrêt de travail en téléconsultation?

Yes, from a physician registered in France consulting remotely, within the rules that apply to remote issuance and duration. An international private provider can give you a medical certificate, but not the arrêt de travail that generates indemnités journalières.

Is a fit note the same as being signed off work in the UK?

Not exactly. A fit note either says you are not fit for work or that you may be fit with adjustments such as altered hours, amended duties or a phased return. The second option is frequently ignored by both employees and employers, and it is often the more useful one.

What happens if I fall ill abroad while employed in another EU country?

Most systems have a procedure for illness during a stay abroad, usually involving prompt notification and a certificate from the treating doctor, sometimes with translation or additional formalities. Notify your employer and your insurer immediately rather than waiting until you return, since deadlines are the part that catches people out.

Can I be checked up on while off sick?

In Italy, yes — the fasce di reperibilità are set hours during which an INPS inspector may visit. France has an equivalent concept of authorised hours of absence, and other systems have their own control mechanisms. Read what your certificate actually says about leaving home.

Where can I find more detail for my country?

Our library of country guides covers sick leave and certification market by market, the questions page explains what our own certificates contain, and our clinical background page sets out who reviews them. Background reading, if you want it: Online Doctor Consultation publishes general health information, European resource pages looks at other European systems, and Spanish-language material covers the same ground in Spanish. None of them issue prescriptions.

Medical disclaimer

This article summarises general rules on sickness certification and employment in several European countries. It is not medical advice and it is not legal or employment advice. Rules change and are applied differently by region, sector and employer. Confirm your position with your employer, your national health insurer and a qualified physician, and seek urgent care immediately if you are seriously unwell.

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

What to do this morning

If you are reading this while ill, the order that works almost everywhere is simple. Tell your employer now, in writing, before anything else — late notification causes more problems than late paperwork. Find out which document your country and your contract actually require. Get assessed the same day, remotely if that is faster, because a doctor who has seen you early can advise properly on how long you need. Then obtain the statutory document through the correct national channel if your absence is going to run.

Booking an assessment for a chosen time rather than waiting for a callback matters more when you are feverish than it does on paper, which is why our consultations run to a slot you select and a doctor joins at it. If you are unsure whether a certificate from us would be usable where you work, ask before booking — and if you would rather see who would be assessing you, the physician profiles list registrations and languages.

Continue reading

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