Sick Notes and Medical Certificates in Spain: A Complete Guide (2026)
Eight distinct types of medical certificate exist in Spain, each with its own legal basis, issuing authority, validity period, and cost. Asking for the wrong one is the single most common reason claims, visa applications, and licence renewals fail. Here is the complete map.
Spanish medical documentation looks chaotic from the outside because the same words mean different things depending on context. Justificante, certificado, informe, parte, certificado oficial, certificado de aptitud — these are not synonyms. Each is a legally distinct document with its own regulation, its own issuing authority, its own validity period, and its own cost. The price of getting it wrong is rejected claims, refused boarding passes, delayed visa applications, and forfeited holiday deposits.
This guide is the complete English-language reference. It covers every certificate type a tourist, expat, or resident in Spain is likely to need: the simple sick note, the formal social security baja, the official yellow paper from the Consejo General de Colegios Oficiales de Médicos, the sector-specific fitness certificates for driving, weapons, sports, occupational health, diving and aviation, the fit-to-fly letter for airlines, the medical documentation required by every major travel insurance company for cancellation claims, and the certificates needed for immigration, adoption, disability recognition, and international vaccination.
Spanish law defines the term in Article 3 of Ley 41/2002, de 14 de noviembre: a medical certificate is "the written declaration of a doctor attesting to a person's state of health at a determined moment." Article 22 of the same law gives every patient the right to obtain certificates of their own health status — free when statute provides for it, paid otherwise. The Consejo General de Colegios Oficiales de Médicos (CGCOM) has separately codified the distinction between the certificado (formal, dated, signed on official paper, criminally protected against falsification under Article 397 of the Penal Code) and the informe médico (a clinical report with no formalism, no expiry, used to convey diagnosis and treatment narratively).
The Eight Types of Medical Certificate in Spain
Spanish medical documentation collapses into a small number of legally distinct categories. Identifying which type your situation falls into is the first and most important decision — it determines who can sign the document, what it must contain, where to go, and how much you will pay.
| Certificate type | Who issues it | Typical use |
|---|---|---|
| Justificante médicoAttendance certificate | Any colegiado physician (public, private, telemedicine) | Work absence, school, gym, exam deferral, event cancellation, most insurance claims |
| Parte médico de bajaIncapacidad temporal | Only public-system, mutua or empresa colaboradora physicians | Paid sick leave through Seguridad Social |
| Certificado médico oficialCGCOM yellow paper | Any colegiado physician on official numbered form | Adoption, weapons licence, dangerous-dog ownership, certain visas, life insurance |
| Certificados de aptitudDriving, weapons, sports, occupational, diving, aviation | Sector-specific authorised centres or specialists | Activity-specific fitness verification |
| Fit-to-fly letterAirline MEDIF | Treating physician, signed for airline acceptance | Late pregnancy, post-surgery, chronic conditions, oxygen needs |
| Certificado para extranjeríaImmigration medical | Any colegiado, with country-specific overlays | Visa applications, residence permits, certain student visas |
| Trip cancellation medicalInsurer documentation | Treating physician (not family member) | Travel insurance cancellation claims |
| Niche certificatesAdoption, disability, care home, international vaccination | Specialist or regional valoración centres | Sector-specific legal procedures |
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Justificante vs Parte de Baja: The Single Most Important Distinction
A justificante médico is a justification of attendance. It confirms the patient was seen on a given day, often adds a recommendation of one to three days' rest, and carries no legal force to open incapacidad temporal (IT) or generate a social security subsidy. Any colegiado physician — primary care doctor, hospital emergency physician, private GP, telemedicine doctor — can issue one. It is what schools, universities, gyms, event organisers, employers (for short absences under collective agreements), and most travel insurers will accept.
Employers in Spain are bound by Article 20.4 of the Estatuto de los Trabajadores (RDL 2/2015), which permits them to verify illness through their own medical exam but does not allow them to demand the diagnosis. Article 22 of Ley 31/1995 (Prevención de Riesgos Laborales), reinforced by Article 9 of the GDPR and LOPDGDD 3/2018, confines what an employer learns to the apto / no apto / apto con restricciones verdict.
A parte médico de baja is a different document entirely. Governed by Real Decreto 625/2014 and substantially reformed by Real Decreto 1060/2022 (in force 1 April 2023), it is the document that opens incapacidad temporal and triggers paid sick leave. Article 2.1 of RD 625/2014 reserves issuance for "the doctor of the public health service who has performed the examination" for common contingencies (illness, non-work accident). For occupational contingencies, the mutua colaboradora or empresa colaboradora doctor issues it.
The 2023 reform was the most important change to Spanish sick leave administration in a generation. Workers no longer have to deliver paper partes to their employers — the Servicio Público de Salud transmits data telematically to the INSS by the next business day, and the INSS forwards identifying data to the employer via the RED system. The worker now receives a single copy for personal records.
How sick leave payment works in 2026
Payment during IT for common contingencies follows a layered schedule. Days 1 to 3 produce nothing from Social Security (some collective agreements add a top-up). Days 4 to 15 are paid by the employer at 60% of the regulatory base. From day 16, the INSS or mutua pays via pago delegado — 60% until day 20, then 75% from day 21. Occupational contingencies pay 75% from day 1, charged to the mutua. Self-employed workers (autónomos) generally collect from the mutua directly via pago directo, with the TGSS exonerating the cuota from day 61 of continuous baja under Article 308 of the General Social Security Law.
Confirmation intervals after the 2023 reform
| Estimated duration | Confirmation schedule |
|---|---|
| Under 5 days | Simultaneous baja and alta on same date |
| 5–30 days | Confirmations no more than 14 days apart |
| 31–60 days | Confirmations 28 days apart |
| 61+ days | Confirmations 35 days apart |
| After 365 days | Exclusive INSS Inspección Médica competence (RD-Ley 2/2023) |
Common use cases for a justificante médico in Spain
The same legal document covers a wide range of situations. The justificante does not change based on the recipient — it states the medical fact and the period of recommended rest, and the recipient decides what to do with it. Below is the practical map of who typically asks for one and what they accept.
| Use case | Who accepts it | Notes |
|---|---|---|
| Sick note for work | Employers under collective agreements; HR for short absences | Employer cannot demand the diagnosis (Art. 22 Ley 31/1995, Art. 9 RGPD) |
| Sick note for school | Primary and secondary schools across all autonomous communities | Parents formally justify the absence; the medical note supports it |
| Sick note for university or college | All Spanish universities | Used for exam deferral, class absence, late assignment justification |
| Exam deferral | Universities, professional certification bodies, language schools | Specific date of consultation and dates of incapacity required |
| Gym or class cancellation | Most gyms, fitness studios, recurring class memberships | Check membership terms for required wording |
| Event ticket refund | Concert promoters, theatres, sporting events | Cancellation insurance typically attached to the ticket determines wording |
| Travel insurance cancellation | Iati, Allianz, AXA, Mapfre, Heymondo, Chapka and 14+ major insurers | Must state condition makes travel impossible; issued after policy purchase |
| Hotel or trip cancellation | Hotels with cancellation policies; tour operators | Discretionary — depends on the property's terms |
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The Certificado Médico Oficial: The Yellow Paper
The certificado médico oficial ordinario is a serially numbered form printed exclusively by the CGCOM under Real Decreto 1018/1980 and Real Decreto 757/2006. Provincial Colegios de Médicos and authorised pharmacies sell the blank impreso. The price is fixed nationally — current 2026 confirmations from Colegios in Cantabria, Las Palmas and Madrid pharmacies place it at €3.00–€3.63 for the paper alone.
This is a documento público with reinforced evidentiary weight. A false certification on this paper triggers Article 397 of the Penal Code (fine of three to twelve months for the physician). When the falsification touches Social Security or Hacienda, the much heavier Article 390 applies (three to six years' prison and professional inhabilitation).
The yellow paper is legally required, not merely preferred, for:
| Procedure | Legal basis |
|---|---|
| National and international adoption | Ley 54/2007, RD 165/2019 |
| Oppositions to security forces | Specific bases of each convocatoria |
| Certain visa applications | Reglamento LOEX (RD 557/2011) |
| Dangerous dog ownership licence | Ley 50/1999, RD 287/2002 |
| Certain life insurance contracts | Underwriting requirement |
| Federation registration (specific sports) | Federation-specific rules |
The total cost including the medical examination typically ranges from €22 at the cheapest centres (Delphos Madrid, Correos rate) to roughly €80 at premium private clinics, with a typical median of €40 all-in.
The certificate must rest on a real clinical act. The 2022 CGCOM Code of Medical Deontology is explicit: "the physician can only certify what he or she knows of the patient through the clinical history or through the examination performed." Article 17 prohibits certificados de complacencia outright. For international use, the CGCOM operates a legalización de firmas service for provincial Colegios' stamps, which precedes the Hague Apostille route to acceptance abroad.
Certificados de Aptitud: A Separate Decree for Each Activity
Spain regulates fitness-to-do-X certificates through a patchwork of sector-specific decrees. Each activity has its own authorised centre, its own examination protocol, its own validity period and its own pricing.
Driving fitness (psicotécnico)
Governed by Real Decreto 818/2009 (Reglamento General de Conductores), with the medical baremo in Annex IV, last amended by Orden PCM/518/2023. Only Centros de Reconocimiento de Conductores (CRCs), authorised under Real Decreto 170/2010, can issue the psicofísico for the DGT. The CRC is a sanitary centre registered with both the autonomous community's Consejería de Sanidad and the DGT.
| Licence class | Validity (under 65) | Validity (over 65) |
|---|---|---|
| AM, A, B | 10 years | 5 years |
| C, D, BTP (professional) | 5 years | 3 years |
The 2026 DGT tasa 4.3 stands at €24.58 (free for over-70s, with a sliding scale 4.31–4.34 for reduced-period prórrogas). The CRC itself charges between €22 (Psicotécnicos Alcobendas) and €54 all-in (Te Renovamos Valencia). The exam takes 15–20 minutes; a provisional permit is issued the same day and the definitive card arrives within 4–6 weeks.
Weapons licence fitness
Sits under RD 137/1993 (Reglamento de Armas) as amended by RD 726/2020, with the medical procedure detailed in RD 2487/1998. The informe has a procedural validity of three months from issue.
| Licence type | Coverage | Validity |
|---|---|---|
| Licence B | Handguns | 3 years |
| Licence D | Rifled long arms (big-game hunting) | 5 years; biennial visado after 60, annual after 70 |
| Licence E | Shotguns and sporting arms | 5 years |
| Licence F | Target shooting in galleries | 3 years; forfeited after 1 year without competition |
Authorised centres charge €30–€45 typically. Federated hunters in Andalucía can access a €25 rate under a Mutuasport scheme. Over-70s often pay €5 less.
Sports fitness
Moved under Ley 39/2022, de 30 de diciembre, del Deporte (replacing Ley 10/1990) in January 2023. Article 30 introduces progressive mandatory medical reconocimientos for federation licences, with AEPSAD and the Consejo Superior de Deportes defining which modalities require certification and on what schedule. Any colegiado physician can sign, though sports-medicine specialists are best practice.
| Examination depth | Typical price (2026) |
|---|---|
| Basic exam with resting ECG | €30–60 |
| With stress ergometry | €110–170 |
| Full battery (VO₂max, gas analysis) | €170–295 |
Occupational health (vigilancia de la salud)
Flows from Article 22 of Ley 31/1995 and the Reglamento de los Servicios de Prevención (RD 39/1997). The Servicio de Prevención Propio or Ajeno performs the vigilancia de la salud. It is voluntary except where the worker's condition could endanger themselves, others, or third parties; where a statute mandates it for a specific risk; or where the examination is the only way to evaluate the effects of working conditions on health.
The employer receives only the apto / no apto / apto con restricciones verdict — never the diagnosis. Tribunal Supremo case law (STS 25 January 2018, rec. 62/2018) confirms that the worker's refusal can suspend non-statutory economic improvements but cannot trigger dismissal. The employer bears the entire cost.
Diving fitness
Comes from the Orden de 14 de octubre de 1997 (Ministerio de Fomento), amended in 2000 to include scientific diving. Recreational divers need a certificate every two years; professional divers, annually. The exam must be performed by a physician with a specific underwater-medicine credential. Pricing runs €60–€150 recreational and substantially higher for professional buceo with hyperbaric medicine specialists.
Aviation medicals
Follow EU Regulation 1178/2011 (Part-MED), with AESA as Spain's competent authority. Initial Class 1 (commercial pilots) must be performed at an Aeromedical Centre (AeMC); renewals can be done by an Aeromedical Examiner (AME). Spain layers a national psychiatric interview onto every initial Class 1 — a domestic add-on to Part-MED.
| Class | Validity | 2026 price range |
|---|---|---|
| Class 1 (commercial) | 12 months under 40; 6 months at 60 or in single-pilot commercial ops after 40 | €350–600 initial |
| Class 2 (private) | 60 / 24 / 12 months by age band | €80–200 |
| LAPL (light aircraft) | 60 then 24 months | €80–150 |
Fit-to-Fly: What Each Airline Actually Demands
The IATA Medical Manual sets the global framework. The Medical Information Form (MEDIF) is the airline's clearance instrument under IATA Resolution 700, Attachment A. The form has two parts — passenger declaration and physician assessment — and the carrier, not the doctor, decides whether to accept the passenger. Submission windows cluster around 48–72 hours pre-flight, with the medical assessment dated no more than 10–14 days before travel. For chronic stable conditions, the FREMEC card (Frequent Traveller Medical Card), operated by Iberia, KLM and others, eliminates the need for repeat MEDIFs.
Pregnancy thresholds by airline
Variation here is not academic. Booking the wrong flight in late pregnancy without the right letter results in denied boarding.
| Airline | Singleton cut-off | Certificate requirement |
|---|---|---|
| Iberia, British Airways, Ryanair, Air Europa | 36 weeks (32 weeks for multiples) | IATA standard letter from 28 weeks |
| Vueling | 36 weeks | Medical letter required from 28–35 weeks |
| easyJet | 35 weeks single, 32 weeks multiple | Letter from 28 weeks |
| Lufthansa | Case-by-case via Medical Operation Center | Medical clearance through medicaloperation@dlh.de |
| KLM | No formal cut-off | Letter advised but not strictly required |
| Delta | No formal cut-off | No certificate required at any stage |
| United | 36 weeks | Obstetrician's certificate dated within 72 hours of departure |
| American Airlines | Within 4 weeks of due date (international) | Physician examination within 48 hours |
Post-surgical waiting periods
Derived from UK CAA Aviation Health Unit guidance, broadly accepted across European carriers:
| Procedure | Typical waiting period |
|---|---|
| Laparoscopic abdominal surgery (no retained gas) | 24 hours |
| Simple abdominal procedures | 4–5 days |
| Major chest, abdominal, cranial or cardiac surgery | 10 days (British Airways prefers 4 weeks post-MI) |
| Neurosurgery | ~7 days |
| Retinal surgery | 2–6 weeks (depending on intraocular gas used) |
| Plaster cast (flight under 2h) | 24 hours, unless bivalved |
| Plaster cast (flight over 2h) | 48 hours, unless bivalved |
Infectious disease clearance has its own rules: chickenpox requires all lesions to scab over; measles requires five days after rash appearance plus a non-contagiousness letter; mumps requires eight days after swelling resolves.
For a tourist already in Spain, in-person fit-to-fly letters at private clinics cost roughly €30–80. Telemedicine providers undercut this, with prices from €20 to €55. The important caveat: for MEDIF-mandatory cases — recent surgery, oxygen needs, stretcher requirements — airlines frequently require a physician who has performed an in-person examination, and a telemedicine letter may be rejected. For straightforward late-pregnancy letters, a properly drafted telemedicine certificate (colegiado number, signature, gestation weeks, expected delivery date, fit-to-fly statement, validity dates) is generally accepted in practice.
Trip Cancellation: What 14 Travel Insurers Actually Want to See
Spanish insurance law sets the floor. Ley 50/1980 de Contrato de Seguro Article 16 obliges the insured to notify the loss within seven days unless the policy fixes a longer period — most reduce this to 72 hours for non-hospitalisation illness. Article 18 puts the burden of proof on the insured. Article 38 establishes the peritaje mechanism by which insurers can deploy their own peritos médicos. Ley 20/2015 (LOSSEAR) Article 96 makes Spanish law applicable to policies issued to Spanish-domiciled tomadores.
Across the 14 insurers surveyed, the documentation requirements cluster around four invariant features. Every insurer requires a medical certificate from a treating physician who is not a family member, stating the diagnosis, the gravity of the condition, and that the condition makes travel impossible. None of the insurers reviewed demanded an ICD-10 code — Spanish practice relies on the narrative informe médico rather than coded diagnoses. Originals are reserved-right but scans are universally accepted to open a file. Telemedicine certificate acceptance is not explicitly addressed in any insurer's wording reviewed — a silence likely indicating preference for in-person assessment.
| Insurer | Notification window | Documentation requirements |
|---|---|---|
| Iati (Inter Partner / AXA) | 72h if no hospitalisation | Informe médico; insurer reserves visita médica; pre-existing exclusions for treatment within 30 days of contracting |
| Allianz Assistance ES | 7 days | Certificado médico via online portal; varies by Bronze/Silver/Gold tier |
| AXA Assistance / Inter Partner ES | 7 days | Full informe with antecedents, symptoms, tests, diagnosis, treatment |
| World Nomads | 30 days | Proprietary Medical Certificate + Medical Authority release; usual GP must complete |
| SafetyWing | 90 days from incident | No pre-departure cancellation cover — only post-departure interruption with physician letter |
| Mapfre España | Immediate; 7-day grace | Document acreditando anulación + informe médico; event must postdate policy purchase |
| True Traveller (AXA UK) | As soon as possible | Excess doubled if no medical certificate confirming cancellation medically necessary |
| Insure&Go | 31 days | Signed GP certificate + Access to Medical Records consent |
| Staysure | 48 hours | Proprietary Davies claim form; "all other certificates are unacceptable"; usual practitioner must complete at claimant's expense |
| Chapka | 5 business days | Medical certificate or hospitalisation report stating origin, nature, severity, foreseeable consequences |
| Heymondo | 7 days | Documentation via siniestros.imaiberica.es; ~47 named causes |
| Generali / Europ Assistance ES | 7 days | Most explicit content list: antecedents, symptoms, tests, diagnosis, treatment; 72-hour cooling-off |
| AmEx Platinum ES | As soon as possible | Certificate from non-related physician confirming diagnosis necessitates cancellation |
| Travel Guard (AIG) | Proof of loss within 90 days | Proprietary Medical Certificate + Authorization for Release of Information |
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Immigration, Adoption, Disability, Vaccination
Certificado médico para extranjería
Confirms the applicant does not suffer "any disease with grave repercussions for public health under the International Health Regulations 2005." Rests on Article 10 of RD 557/2011 (Reglamento LOEX) and Ley Orgánica 4/2000.
A significant 2025 change deserves emphasis. The Dirección General de Gestión Migratoria Criterio 5/2025 establishes that the medical certificate is no longer required when the application is filed from within Spain (long-stay, residence). It remains required at consulates abroad for entry visas — residencia no lucrativa, family reunion, student visas — and must be apostilled and sworn-translated into Spanish when issued outside Spain.
Certificado médico para adopción
Closer to an extended informe than a certificate. Ley 54/2007 and RD 165/2019 structure international adoption. Each autonomous community's protective entity issues the Certificado de Idoneidad after psychosocial and medical valoración. The medical document must cover the absence of contagious chronic, grave, invalidating or degenerative diseases or incapacitating addictions — and must extend to all persons living in the household. Country-of-origin overlays (India, Vietnam, Bolivia among them) require ECAI processing with additional documentation.
Certificado de discapacidad
Runs under the Texto Refundido de la Ley General de derechos de las personas con discapacidad (RDL 1/2013) and was substantively reformed by RD 888/2022, in force since 20 April 2023. This replaced the 1999 baremo with a CIF-WHO biopsychosocial model. Each autonomous community's Centro de Valoración y Orientación performs the assessment. The 33% threshold unlocks tax benefits under Article 60 IRPF, the parking card, employment quota positions and similar entitlements. Existing recognitions of 33% or more do not need re-evaluation. The EU Disability Card is being rolled out under Directive (EU) 2024/2841, with full transposition due in 2028.
International Certificate of Vaccination (yellow book)
Runs under the International Health Regulations 2005 and Article 29 of Ley 13/1996. The relevant Tasa 058 stands at €19.46 per vaccine (model 790-058 autoliquidación). Yellow fever is the only vaccine legally exigible at international borders under IHR-2005 — the booster dose requirement was eliminated in 2016. Spain operates a network of Centros de Vacunación Internacional dependent on the Subdelegaciones del Gobierno, listed by the Ministerio de Sanidad.
Telemedicine and Electronic Signatures: What Is Actually Legal
Spain has no integral telemedicine statute. The legal scaffolding combines Directive 2011/24/EU on cross-border healthcare (transposed by RD 81/2014), RD 1718/2010 on electronic prescription, the eIDAS Regulation (EU) 910/2014, Ley 6/2020 on electronic confidence services (which replaced the old Ley 59/2003), LOPDGDD 3/2018, and Chapter XXIII of the 2022 CGCOM Code of Medical Deontology.
Article 80.4 of the Code explicitly accepts telemedicine for "second opinions and medical reviews, provided mutual identification is clear and intimacy is secured." Article 80.5 frames telephone or video consultation as orientation aids that respect deontology when used as decision support.
The CGCOM has publicly and repeatedly warned against "uberised" commercial telemedicine — issuing alerts that platforms must keep registries of identified colegiados, that each medical act must be recorded in the clinical history, and that electronic signature is mandatory on every prescription.
Electronic signatures on private medical certificates are fully valid. Spain participates in the EU's eIDAS trust framework. Qualified electronic signatures by colegiado physicians, issued through accredited services like AC-CGCOM (psc.cgcom.es), FNMT, ACCV or Firmaprofesional, carry the same legal weight as handwritten signatures. Private electronic prescriptions are operational nationally — ICOMEM in Madrid activated a free platform with Chip Card-Redsys Salud on 17 July 2025.
The 2026 Cost Map
Pricing in 2026 reflects a layered system. The public option is free, telemedicine is cheap, private in-person is mid-range, and specialised certificates (driving, aviation, sports with stress testing) climb steeply.
| Certificate | Typical 2026 range | Median |
|---|---|---|
| PrescribeMe online justificanteIssued by licensed Spanish physician | €20 | €20 |
| Public-system attendance slip | Free | €0 |
| Subscription-bundled telemedicineAdeslas Salud y Tú, Sanitas Salud Digital, included in policy | Included in policy | — |
| Pay-as-you-go telemedicine consultation + informeDoctorGo, MediQuo, Top Doctors (Spanish-language, typically) | €35–50 | €40 |
| Private in-person justificante | €30–100 | €50 |
| CGCOM yellow paper alone | €3–4 (fixed) | €3.63 |
| Certificado médico oficial (paper + exam) | €30–80 | €40 |
| Driving fitness (non-professional) | €22–50 + €24.58 tasa | ~€55 all-in |
| Driving fitness (professional C/D/E) | €50–80 + tasa | ~€90 all-in |
| Weapons fitness | €20–70 | €30–35 |
| Sports (basic, no ergometry) | €30–60 | €40 |
| Sports with stress ECG | €70–170 | €110–170 |
| Sports complete (VO₂max) | €170–295 | €200 |
| Extranjería certificate | €40–80 | €50 |
| Fit-to-fly (in person) | €30–80 | €45 |
| Fit-to-fly (telemedicine) | €20–55 | €35 |
| International vaccination (Tasa 058 per dose) | €19.46 fixed | €19.46 |
| Aviation Class 1 initial | €350–600 | €450 |
| Aviation Class 2 | €80–200 | €120 |
| Apostille of La Haya | €10–15 | €12 |
| Sworn translation per page (to English) | €30–80 | €50 |
The VAT trap
Article 20.Uno.3º of Ley 37/1992 LIVA exempts medical services with diagnostic, preventive or therapeutic purpose. Non-therapeutic certificates carry 21% IVA. The Court of Justice of the European Union fixed this in the 2003 D'Ambrumenil (C-307/01) and Unterpertinger (C-212/01) judgments, and the Dirección General de Tributos has applied it through binding consultations. Driving psicotécnicos, weapons certificates, sports fitness, life insurance certificates and judicial peritation are all subject to 21%. Certificates issued incidentally to a therapeutic consultation remain exempt. In practice, many clinics bundle the certificate into the consultation invoice and the line is not always itemised.
Regional Variations Across Spain
The state framework leaves room for meaningful variation at the autonomous community level in three areas: regional health-service portals and apps, school absence justification, and disability certification mechanics.
| Region | Digital health portal | Notable feature |
|---|---|---|
| Catalonia | La Meva Salut | Most mature integration; stores partes de baja, comunicats, vaccination, medication plan; explicit eConsulta for IT renewal |
| Madrid | Mi Carpeta de Salud | 5-year historical access to incapacities; SERMAS explicitly excludes sports, weapons, driving and insurance certificates from primary care |
| Andalusia | ClicSalud+ | Electronically signed attendance receipts with QR verification since December 2022 |
| Valencian Community | GVA+Salut | Employer/school verification portal where authenticity is checked by code |
| Basque Country | Carpeta de Salud | BakQ authentication, accepts external PDF reports, integrates Mi Diario |
| Galicia | É-Saúde / Sergas Móbil | Bilingual gallego/castellano standard; explicit asistencia justificante in app |
| Balearic Islands | Portal del Paciente | Integrated with national IT framework |
| Canary Islands | miSCS | Mobile-first access to public-system records |
The single rule that aligns every autonomous community is school absence: parents, not pediatricians, justify school absences. Article 154 of the Código Civil places this duty on patria potestad. SCS Canarias, SAS Andalucía, CatSalut, SERMAS and Conselleria Valenciana have all explicitly stated that primary care doctors are not obliged to issue specific school justificantes. They will issue an asistencia certificate confirming the consultation took place, without clinical content.
Disability certification follows the state baremo of RD 888/2022, but every autonomous community runs its own Centros de Valoración y Orientación. IMSERSO retains competence only for Ceuta and Melilla.
Myths and FAQ
Can I get a sick note over the phone or by video call?
Yes, conditionally, for the everyday justificante; the parte de baja IT depends on regional protocol. Telemedicine consultation that produces a properly signed informe is legal in Spain under the LOPS, eIDAS and the CGCOM Code. The IT parte is more contested — Catalonia recognises it explicitly, others have not formalised the position. Avoid platforms that cannot identify the issuing colegiado.
Does a UK, US, or Irish doctor's note work in Spain?
For private employer, school or insurance purposes, generally yes — ideally translated into Spanish. For Seguridad Social IT it does not work; only an SNS, mutua, MUFACE or ISM physician can issue the parte. EU social security coordination forms (S-series under Regulation 883/2004) handle cross-border IT in formal cases, but a generic British or American GP letter does not generate Spanish IT automatically.
Can a pharmacist issue a sick note?
No. Ley 16/1997 confines pharmacy practice to dispensing and pharmaceutical care. Article 6 of LOPS 44/2003 reserves medical certification to physicians. Pharmacist-signed notes have no probative value.
Do I need a Seguridad Social doctor, or can it be private?
Depends entirely on the certificate. For IT/baja médica, only public-system or mutua physicians. For everything else — justificantes, certificates of attendance, fitness certificates for non-statutory purposes, the CGCOM yellow paper, fit-to-fly, insurance claims — a private colegiado is fully valid.
Will school or university accept a private justificante?
Generally yes. No regulation prohibits it, and the CGCOM has repeatedly affirmed that any colegiado's certificate enjoys the same legal value. Schools must accept the asistencia certificate. Universities typically accept any colegiado's signed informe for exam rescheduling.
Can I get a sick note for university in Spain?
Yes. Spanish universities accept a justificante médico from any colegiado physician — public, private or telemedicine — for class absence, exam deferral, and late assignment justification. Each university has its own internal procedure (some require submission through the student portal, others through the faculty secretary), but the medical document itself does not need to come from the public system. The justificante must state the date of consultation and the dates the student was unable to attend. For exam-related deferrals, submit the document as soon as possible — most universities have time limits (often 5 working days) for retroactive justification.
Can I get a justificante backdated to a past date?
No, not as a certification of unwitnessed illness. The CGCOM Code requires the physician to certify only what has been personally verified. Articles 397–399 of the Penal Code criminalise complacency certificates, with a separate offence for the patient who knowingly uses one. A retrospective informe de valoración sanitaria based on existing clinical records, however, is permissible — and Madrid's primary care system explicitly allows it.
Can my employer demand to see my diagnosis?
No. Article 22.4 of Ley 31/1995 limits employer access to the apto / no apto verdict. Article 9 of the GDPR and LOPDGDD 3/2018 treat health data as a special category. Madrid's official guidance even requires that, if a justificante inadvertently contains diagnostic data, the centre director must issue a substitute diligencia and not retain the original.
Does my employer in Spain have to accept a private doctor's sick note?
Yes, for the purpose of justifying absence. A justificante médico from any colegiado physician — including a private or telemedicine doctor — has full legal validity. The employer can verify illness independently through their own medical examination under Article 20.4 of the Estatuto de los Trabajadores, but cannot reject a valid justificante outright. What changes by source is the financial consequence: a private justificante alone does not trigger paid sick leave through Seguridad Social. Only a parte médico de baja issued by a public-system, mutua or empresa colaboradora physician opens incapacidad temporal and its associated payment. For absences covered under a collective agreement's permitted-absence clauses (typical short illness), the private justificante is sufficient.
Does the public system issue certificates for gym cancellation or travel insurance?
No, for non-therapeutic purposes. The public system issues attendance certificates (which are usable for many administrative purposes) and clinical informes under Article 18 of Ley 41/2002. Certificates specifically for sports, weapons, driving, insurance contracts, or recreational purposes are excluded from the public-system cartera and must be obtained privately.
Is the digital signature on a Spanish medical certificate accepted abroad?
Within the EU, yes — under the eIDAS Regulation, qualified electronic signatures by Spanish colegiados carry equivalent legal weight to handwritten ones across all Member States. For non-EU use, an apostille of the Hague Convention on a paper version is the standard route.
What Is Genuinely Ambiguous, Recently Changed, or Contested
Several points warrant epistemic honesty rather than overconfidence.
The legality of issuing the parte de baja IT entirely by teleconsulta has no clear national rule. Regional practice ranges from formal eConsulta integration (Catalonia) to studied silence elsewhere.
Telemedicine certificates for travel insurance claims are not explicitly addressed in any insurer wording reviewed — a silence that implies a preference for in-person assessment but does not formally prohibit the alternative.
The VAT treatment of fit-to-fly and immigration certificates is not settled by a single Dirección General de Tributos binding consultation. Argument by analogy from the D'Ambrumenil case law suggests 21% but clinics often bundle the cost into a therapeutic consultation, where it falls within the exemption.
The DGGM Criterio 5/2025 exempting the immigration medical certificate for in-Spain residence applications is recent and not yet reflected in much consular guidance abroad.
Sports medical certification under Ley 39/2022 is progressively obligatory, not blanket-mandatory. AEPSAD has not finished defining which federation modalities require it.
The EU Disability Card is in pilot rollout in some autonomous communities but not universally available before the 2028 transposition deadline of Directive 2024/2841.
Lufthansa's exact pregnancy week thresholds are not stated on its consumer pages — they are delegated to the Medical Operation Center on a case-by-case basis.
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