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Sick note

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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On 6 April 2010, the Forms Med 3 and Med 5 were replaced with a single revised Statement of Fitness for Work

General points:

  • NHS General Practitioners are required to issue, free of charge, a Statement of Fitness for Work to patients for whom they provide clinical care
  • other doctors are also required to issue Statements where appropriate to patients for whom they provide clinical care
  • you do not need to issue a Statement to a patient until they have been off work for more than 7 calendar days
  • the Statement may be issued:
    • on the day that you assessed your patient;
    • on a date after you assessed your patient if you consider that it would have been reasonable to issue a Statement on the day of the assessment; or
    • after consideration of a written report from another doctor or registered health care professional

Also forms Med 4 has been withdrawn (in addition to Med 6 and RM 7).

To claim Statutory Sick Pay for illness of 7 days or less, the patient may self certify using the appropriate form.

The Department for Work and Pensions (DWP) amended legislation, with effect from 1 July 2022 to enable nurses, occupational therapists, pharmacists and physiotherapists to certify fit notes in addition to doctors (these five professions are referred to in this guidance as healthcare professionals - HCPs). The legislation is permissive, meaning that all these HCPs can legally certify a fit note, but they are not required to do so. Individuals should consider their scope of practice and ensure they have the relevant skills, knowledge and experience before undertaking health and work conversations and making decisions around certifying fit notes.


  • A statement of fitness for work, commonly known as a fit note or'med 3', is a form of medical evidence that can enable an individual to access health-related benefits or evidence eligibility for statutory sick pay (SSP). Its purpose, format and requirements are set out in regulations which cover England, Wales and Scotland. The fit note contains options to assess a person as 'not fit for work' or'may be fit for work taking account of the following advice'.
  • The legislation requires the HCP to undertake an assessment to complete a fit note. An assessment is defined as a consultation between the patient and HCP or consideration of a written report by another health professional. The fit note provides advice about the functional effects of a patient's condition on their fitness for work but it does not require the HCP to have specialist knowledge of workplaces or occupational health or to suggest possible changes to a patient's workplace or job.
  • Where patients are required to evidence eligibility for SSP, provided their employer is content, they can provide alternate forms of evidence[footnote 15]. One example of this is the'AHP Health and Work Report' [footnote 16] which can be completed by all Allied Health Professions, including those that are not legally able to certify fit notes.

Two legislative amendments were then made to improve the fit note and its use.

  • Removal of the requirement for signatures in ink (April 2022). This amendment removed the barriers to fit notes being completed and certified digitally so that relevant systems could be updated to simplify the processes for completing fit notes. (Wet signature fit notes continue to be accepted.)
  • Extension of certification of fit notes to a wider group of HCPs - nurses, occupational therapists, pharmacists and physiotherapists. This change legally enabled any statutorily registered member of these professions, to certify a legally valid fit note

An online training module hosted on elfh (Elearning for Health) has been developed to support HCPs in preparing to certify fit notes as part of their practice if it is an agreed part of their role.


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