It is written by one doctor for another, but the person who pays for anything missing from it is you.
The scrisoare medicală — the medical letter — is the document through which a specialist or a hospital tells your family doctor the diagnosis, the investigations done and the treatment recommendations. Within the social health insurance system it has a single standard form published by CNAS, and that form opens with «Stimate(ă) coleg(ă)» precisely because it is a communication between doctors. On the strength of it, your family doctor can carry on prescribing chronic treatment. A medical letter is also asked for in the file for the disability assessment commission, when enrolling a child in a school or nursery, and for certain insurance files — with content adapted to the purpose.
Starting point
What the medical letter actually is
It is not a certificate and it is not an attestation. It is a letter from one doctor to another, with you as its subject.
Its purpose is continuity of care. Your family doctor follows you over time but is not present at the specialist appointment and has no automatic access to what was discussed there. The medical letter carries that information back: what was found, what was ruled out, what treatment was decided and what comes next.
Within the social health insurance system the form is standardised, with a single approved model, and the annexed model states that the document is drawn up in two copies, one of which stays with the issuing doctor. That is a useful detail: if you lose your copy, the practice or hospital that issued it should, in principle, still have a record of it.
- It is a medical document, not an administrative one — the doctor decides the content, not the patient.
- It travels between doctors, but it is handed to you.
- It underpins the continuation of treatment by your family doctor.
- A similar document with different content is required by the assessment commission for adults with disabilities.
Standard model published by CNAS.
The pathway
Who issues the medical letter
The short answer: the doctor who assessed you. The useful answer depends on why you need it.
- The outpatient specialist — after the specialist consultation, for your family doctor.
- The hospital, on discharge — together with the discharge note, so treatment can continue.
- Your family doctor — when the document is required by a commission, a school or an employer, in the form suited to that purpose.
- A doctor in the private system — may issue a medical letter or a medical report for private use; documents reimbursed from the insurance fund are, however, reserved for doctors in a contractual relationship with the health insurance house.
That last distinction explains most wasted journeys. A private doctor can assess you, write up the findings and recommendations and direct you onwards, but the bilet de trimitere (referral note) and the subsidised prescription belong to the insurance pathway. If you need a reimbursed document, ask at the outset whether the doctor is contracted to the insurance house.
Content
What it must contain to be accepted
Most rejected letters are not wrong. They are incomplete.
Whatever the model, a useful medical letter carries the patient's identifying details, the date of issue, the issuing unit and doctor with stamp and signature, the reason for the assessment, the relevant history, the diagnosis, the investigations performed with their results, and the recommendations — treatment, doses, duration and the date of the next review.
- The full diagnosis, not merely an abbreviation or a code.
- The investigations the diagnosis rests on, with dates and results.
- The recommended treatment, with name, dose and duration — without these your family doctor has nothing on which to continue prescribing.
- The review date or the reassessment interval.
- The stamp, signature and seal of the issuing unit.
- For commission files, exactly the fields of the annex requested, filled in completely.
Check the document before you leave the consulting room. Filling in a field on the spot is far easier than coming back a week later, and if a result is missing the doctor can attach it immediately.
The common question
How long a medical letter stays valid
This is the question the internet answers most contradictorily, and the reason is simple: it depends.
Validity is not a property of the paper but of the purpose. For continuing chronic treatment it follows the therapeutic protocol for the condition and the norms in force. For a commission file or an institution, the deadline is set by whoever is asking for the document. Because both change, you will not find a number of days or months in this article: you confirm it with CNAS, or with the institution requesting it.
- Validity runs from the date of issue — check that the date has been filled in.
- For chronic treatment the reference is the therapeutic protocol, not a general rule.
- For files, the reference is the institution's requirement, which may be stricter.
- If your condition has changed in the meantime, the old document no longer describes reality, whatever the deadline says.
Norms in force and therapeutic protocols: CNAS · Ministry of Health.
Transparency
What a private online consultation can and cannot do
We say this at the outset, because it is the first question and because an honest answer saves time.
A private online consultation does not issue documents reimbursed from the insurance fund — no referral note, no subsidised prescription. Those belong to doctors in a contractual relationship with the health insurance house. Any private service promising otherwise is promising something it cannot deliver.
What an online consultation does handle well is the part that most often gets stuck:
- Clinical assessment without a waiting list, and a written document describing what was found.
- Interpreting results you already have and clarifying what they mean.
- Putting the file in order: which documents you are missing, in what order to obtain them and from whom.
- Recommending the right investigations, so you do not pay for tests that change nothing.
- A second opinion before an important decision.
- Monitoring between specialist reviews.
You can check any doctor's registration with the Romanian College of Physicians — ours as readily as anyone else's.
Practical
What to do when the letter is not good enough
Three situations cover almost every case in which the document is refused.
- A field is missing — go back to the issuing doctor to have it completed. Another doctor cannot fill in someone else's document.
- It is on the wrong model — ask the institution for the exact model, in writing, and take it to the appointment.
- It has expired for that purpose — what is needed is a reassessment, not simply a new date. A doctor who re-dates a document without seeing you is not doing you a favour.
And one situation that has nothing to do with paperwork: if your condition has worsened since the last assessment, the priority is the consultation, not the document. Signs such as chest pain, breathlessness at rest, sudden weakness on one side of the body, difficulty speaking, or fever with neck stiffness or confusion mean 112, not an appointment.
Global Health Romania
Next steps
Our doctors in Romania assess online, write up their conclusions and tell you plainly what can be settled privately and what stays within the insurance pathway.
Not sure which document you need?
A short consultation clarifies what is being asked of you, what can be issued privately and what must come from a doctor contracted to the insurance house — before you lose a day travelling.
Official sources
Where to check the rules
The form, its validity and the norms change. Always check at source.
Links open the competent bodies' own websites. Global Health is a private provider and does not issue documents reimbursed from the national health insurance fund.
FAQ
Common questions
What is the scrisoare medicală?
It is the document through which a specialist or hospital tells your family doctor the diagnosis, the investigations performed and the treatment recommendations. Within the insurance system it has a single standard form published by CNAS and is drawn up in two copies, one of which stays with the issuing doctor.
Who issues the medical letter?
The doctor who assessed you: the outpatient specialist, the hospital on discharge, or your family doctor, depending on the purpose. A private doctor may issue a medical letter for private use, but documents reimbursed from the insurance fund belong to doctors contracted to the health insurance house.
How long is a medical letter valid?
It depends on the purpose. For continuing chronic treatment the reference is the therapeutic protocol for the condition and the norms in force; for a file, the deadline is set by the institution requesting it. Both change, so confirm with CNAS and with the requesting institution.
What must it contain to be accepted?
The patient's details, the date of issue, the issuing unit and doctor with stamp and signature, the full diagnosis, the investigations with their results, the recommended treatment with dose and duration, and the review date. Check the document before leaving the consulting room — a field is far easier to complete on the spot than a week later.
I need a medical letter for the disability commission. Is it the same document?
It is the same type of document, but the commission uses its own model with specific fields. Ask the institution for the exact model, in writing, and take it to the appointment; otherwise the document risks being refused on form rather than on content.
Can I obtain a medical letter online?
A private online consultation can issue a medical letter or report for private use, interpret the results you already have and put your file in order. The referral note and the subsidised prescription, however, remain within the health insurance pathway.
