Sick Leave Certificates for Employees in Rome: What to Do from Day One
Fell ill and not sure how to handle the paperwork? Here's the step-by-step: your doctor, INPS, your employer, and the hours you must stay home for inspection.
In a nutshell
If you are an employee and you fall ill, simply calling your boss is not enough. Your doctor must issue a digital sick-leave certificate and transmit it directly to INPS (Italy's social-security agency — pensions, unemployment, family benefits). Your employer receives it automatically. Your only job is to pass on the protocol number (PUC) the same day and to stay home during the inspection windows.
At a glance
| Cost | Free (public health service) |
| Timeline | Certificate issued on the day of the visit; transmitted to INPS instantly |
| Where in Rome | Your GP, the out-of-hours medical service (116 117), or A&E |
| Documents needed | Tessera Sanitaria (Italian health-insurance card) or Codice Fiscale (Italian tax ID), photo ID |
How the system works
Since 2010, sick-leave certificates are mandatory digital documents (DL 78/2010 art. 55-septies). Your doctor sends the certificate to INPS in real time from their computer, and your employer receives it automatically through the system. You do not hand a piece of paper to anyone.
What your doctor gives you is the unique protocol number (PUC): a sixteen-digit code identifying your certificate. That number — together with a message saying you are unwell — is the only thing you need to send to your employer.
The certificate contains your prognosis (how many days off work) and a diagnosis coded under ICD-9. Important: the diagnosis is visible only to the doctor and INPS — your employer cannot see it.
What to do from the first day
If you fall ill on a weekday, call your GP as soon as you realise you cannot go to work. Most GPs in Rome work by appointment; many also do home visits the same day if you cannot leave the house.
After the visit, you have three things to do:
- Write down the PUC number your doctor gives you (16 digits).
- Notify your employer the same day (or within the deadline set by your employment contract — usually up to 2 hours after your shift was due to start) and give them the PUC together with the address where you can be reached.
- Stay home during the inspection hours set by INPS (see below).
If you fall ill in the evening, overnight or at the weekend, your GP is unavailable. In that case, call the out-of-hours service (Continuità Assistenziale, formerly the Guardia Medica) on 116 117 — free, available 24/7 on public holidays and from 20:00 to 08:00 on weekdays. The doctor can visit you at home or see you at the surgery and issue a certificate for up to three days. After that, your own GP must issue any extension.
Pronto Soccorso (Italian A&E / emergency room) can also issue a digital sick-leave certificate.
Inspection hours: stay home during these windows
INPS can send a medical inspector (medico fiscale) to your home to verify that you are genuinely ill. These windows apply every day, including Saturdays, Sundays and public holidays:
| Worker category | Inspection windows |
|---|---|
| Private sector | 10:00–12:00 and 17:00–19:00 |
| Public sector | 09:00–13:00 and 15:00–18:00 |
If the inspector calls and you are not home without a valid reason, you risk losing your sickness benefit. A first unexplained absence costs you 100% of the benefit for the first 10 days; a second costs 50% for the remaining period; a third means you lose it entirely.
If you need to go out during these windows for a medical appointment or treatment, notify INPS in advance through their online portal or by calling 803 164 (free from a landline).
Exemptions from the inspection requirement include: hospitalised workers, those undergoing oncology treatment, those with certified occupational diseases or serious diagnosed conditions. In any case, always notify your employer.
If the illness goes on longer, or you are hospitalised
If you are still unwell when the original prognosis expires, your doctor must issue a continuation certificate before the end date. The procedure is identical to the first one.
If you are hospitalised, the hospital sends the certificate to INPS automatically. When you are discharged you receive a letter that serves as a certificate covering your convalescence period. You are not subject to home inspections while in hospital.
Major public hospitals in Rome — Policlinico Umberto I, Gemelli, San Camillo, Sant'Andrea, San Giovanni, Pertini, Tor Vergata, San Filippo Neri, Bambino Gesù — all transmit certificates digitally.
When your child is ill: parental sick leave
Employed parents have the right to take leave when a child is sick:
| Child's age | Entitlement |
|---|---|
| 0–3 years | Unlimited days, unpaid (unless your collective contract is more generous) |
| 3–8 years | Up to 5 days per year per parent, unpaid |
| Over 8 years | No specific entitlement (use annual leave or other permitted absence) |
Take the child to the pediatra di libera scelta (your child's assigned NHS paediatrician), or outside surgery hours to the 116 117 out-of-hours service. The paediatrician issues a digital certificate and you pass the PUC to your employer. Home inspections do not apply in this case.
Mistakes to avoid
- Not telling your employer the PUC number. Even though INPS already has the certificate, your employer has no idea you are sick until you contact them with the protocol code.
- Leaving home during inspection hours. The medical inspector typically calls only once. Even a brief unexplained absence can cost you the entire benefit for the first ten days.
- Thinking a paper certificate is enough. Since 2010, a paper document has no legal standing unless it has been transmitted digitally to INPS. Without a PUC, your absence is not legally covered.
Special cases
Non-EU citizen without a GP yet assigned. Go to A&E or call 116 117 — the doctor there can issue the certificate using your Codice Fiscale. If you do not yet have one, you will be assigned an STP or ENI code (temporary codes for unregistered foreign nationals), and the certificate is still valid.
Falling ill during annual leave. Illness interrupts your holiday: sick days do not count as annual leave. Get a certificate and send the PUC to your employer straight away.
Falling ill abroad. Get a certificate from the local doctor, have it officially translated into Italian (traduzione asseverata — a certified translation) and send it to INPS and your employer within 2 days. For EU/EEA countries the process is streamlined under EU Regulations 883/2004 and 987/2009.
Being dismissed while on sick leave. Dismissal during the protected absence period (comporto) is void unless there is just cause. Contact a patronato (free union-run office helping with social-security and immigration paperwork) — such as ACLI, INCA-CGIL, ITAL-UIL or INAS-CISL — or an employment lawyer.
Official sources
- INPS — Sickness benefit (full overview)
- INPS — Sick-leave certificates
- INPS — View your certificates
- INPS — Medical inspections
- Ministry of Health — Essential health services: sickness
- SaluteLazio — GP and paediatrician
- ASL Roma 1 — ASL Roma 2 — ASL Roma 3
Legal references: DL 663/1979 conv. L. 33/1980; DM 18/04/1996; DM 206/2009; DL 78/2010 art. 55-septies; DLgs 151/2001; Circolare INPS 79/2017.