Hospital sheet as issued: instruction, sample

No one, no one is immune fromillnesses, all are sick: both leaders and ordinary workers, therefore, in order not to leave people without means of livelihood, the sick make out a sick leave sheet, confirming the good cause of absence at work and guaranteeing payment of cash benefits. In this article, we will consider what a hospital sheet is, how to make this document.

In order to avoid mistakes in the preparation of the document, as well as facilitating the process of registration in the FSS, the Ministry of Health developed and introduced a single document.

Brief description of the form

hospital sheet as make out

The uniform form of registration of the sick leave forterritory of the Russian Federation was introduced four years ago. The document form consists of two sheets, two-sided colored forms, adapted for reading special. machine.

To help those filling in on the back of the form, there are information about the codes that determine the degree of incapacity for work, as well as tips for filling out.

On the front of the document are subsections that are filled by the employer and employees of the honey. institutions.

About the form of the sick-list

We have dealt with the concept of a sick leave. How to draw up this document?

According to new requirements, now in the hospitalthe number of the medical card is indicated, many columns are filled with codes (for example, the cause of the disease and the conditions under which benefits are calculated). A list of codes can be found on the back of the sick leave sheet. TIN and pension card number are also mandatory. And the hospital is certified by the signature of the chief accountant and must be signed by the general director.

Forms in Russian are filled with blackink and printed capital letters. Helium, capillary or pen pens are suitable for filling in the form; they will make it not machine-readable.

Despite the availability of explanations from the Ministry of Health and the FSS, many doctors still do not know how to issue a sick leave sheet.


According to the general rules, it is mandatory to put spaces between words, and the way out of the allocated fields is not permissible.

Company name (department code) or nameThe physical person-insured enter in the line "the place of work - the name of the organization". The name of the organization that provided medical assistance and issued the sick list is entered in the line "name of the medical organization". The string is designed for 29 characters, and if the name does not fit, an abbreviation, consistent with the constituent documents, is allowed.

how to make a sick leave

"Name and initials of the doctor or indicationnumber "are written in the following order: first a surname, then initials through a space. In the event that the name of the doctor (more than 14 letters), you can transfer to the second row. If the last name contains more than 28 characters, you can shorten it. Since the medical sheet must, in the first place, be prescribed by a doctor, we will consider several rules.

The name of the doctor's position in the line "Doctor's position" in the table "Exemption from work", in case of lack of space, can also be reduced.
If the hospital is issued on the basis of a decisionmedical commission, the initials and surname of the attending physician, then the chairman, are first recorded. Only a last name can be recorded. If it does not fit into 14 cells, it is cut.

In a specially designated place, a medical organization is stamped. It can protrude a little beyond, but do not layer on the information cells of the form.

A citizen who received a sick leave is indicated in the appropriate box on the back of the sheet of the disability sheet.

As the sick leave sheet is drawn up, including inconnection with pregnancy and childbirth, the new rules provide for mandatory attachment to the document - a sheet on which the calculation of temporary disability benefits on a separate sheet.


If there are errors in the section "filled in by a doctor", the sick-list is considered to be spoiled. It is necessary to issue a new document. Please note, the date of receipt of the form remains the same.

The section "filled with the employer" is intended forfor the head or the responsible employee, authorized by the director of the enterprise. The rules of registration of the section are explained by the letter of the FSS of the Russian Federation of September 8, 2011. № 14-03-14 / 15-10022. The line "TOTALIZED" should contain the amount of the benefit without taking into account the amount of personal income tax. And the full amount of the benefit reflects the lines: "The amount of the benefit: at the expense of the employer ... from the funds of the FSS of the Russian Federation ..."whether it is possible to issue a sick leave sheet


By general rules, hospital sheets can not be bent or crumpled. However, the FSS of the Russian Federation gave explanations that the documents bent several times are not spoiled and do not require re-registration.

It should also be said that the seals and signatures that have passed beyond the boundaries that are set aside do not render the hospital invalid.

Note! Admitted defects in the course of filling out give no reason to re-register the sick-list and refuse to pay benefits if all entries are read well.

Counterfeit protection

Hospital sheets, like any official documents, are protected against forgery:

  • Numerous mesh backgrounds.
  • Water marks.
  • Binary pin code.
  • A unique bar code.

What does the instruction say?

In order not to think about how to properly arrange a sick leave sheet, you can make a brief instruction. It can include the following items:

  • Strictly in the special cells are written in capital letters of the employee's data.
  • It is forbidden to use a ballpoint pen to fill.
  • You can not go beyond the cells.
  • You can not use uppercase letters.
  • The form is filled only with black paste.

The instructions may contain other rules.

how to apply for a sick leave

Failure to comply with the conditions for the completion of forms of disability sheets may lead to a delay in the payment of benefits.

Required Information

On the front side there are several sections,which are filled in by the employees of the registry. How to make out the sick leave these employees of the medical institution? They also developed rules. So, we make out the sick leave sheet on the sample presented to issue a sick leave to an accountant

An employee of a medical institution should mark the primary document or a duplicate. If this is a duplicate, the number of the hospital number that is duplicated is indicated next.

The name of the medical institution, its exact address and the date of issue of the form are written below.

Then follows the date of the commencement of incapacity for work. On the back of the form, the disability code is shown, which consists of two numbers and an additional three-digit code.

The OGRN of the hospital is necessarily indicated. If the number is written incorrectly, the hospital will have to be changed.

Next, you must specify the date of birth and sex of the patient.

The cell "date 1" is intended for the day of the changecauses of the disease, in these graphs you can enter, for example: the date of the voucher or the estimated day of birth. And in the cell "date 2" the date of the end of the tour, and its number is indicated.

What other sick leave happens?

Canto issue a sick leave sheet for the care of a child or other disabled relative.

There are 2 lines in the corresponding block. They are provided for in case care is taken care of by two relatives. It is necessary to enter their age, indicate a related relationship and name.

Below there are cells for medical data. Here is the time of stay in the hospital, whether there were violations, if there is a disability. In addition, the data of the ITU bureau are also included.

Indicates the duration of the disease, its outcome and the data of the treating doctor who diagnosed. It is mandatory to specify the number of hours for going to work.

Registration of the blank of the form of the hospital isdoctor. This part of the sheet contains a brief description of each subsection with the addition of a case history number, the date of issue and the patient's signature about the receipt of the sick leave sheet.

make out a sick leave sheet sample

How to make out a sick-list for pregnancy?

An important document for a future mother is apregnancy and childbirth. This is the only reason for receiving benefits for a working woman. Often, future mothers fill the block on their employer themselves. The leaflet of incapacity for work is issued, as a rule, for a period of 30 weeks. Duration of the hospital - 70 days before childbirth and as many after them.

Is it possible to issue a sick-leave sheet retroactively?Yes, if documents confirming the fact of illness start are provided. This can happen when a person was on a business trip abroad and became ill, went to a health center instead of a polyclinic or he needed to get to a medical facility for a long time.

Recommendations for Employers

The employer himself completes the second section. Please follow the instructions below:

  • Specify the full name of the organization.
  • There is a basic or additional type of activity.
  • It is necessary to inscribe the TIN and SNILS.
  • In the event of an industrial injury, the date of registration of the certificate is filled out. H-1.
  • Indicates the length of insurance and all non-insurance periods. In the case of an incomplete working month, zeros are put in the graph (non-insurance periods include service in firefighters, law enforcement agencies or in the army).
  • when the employment contract is canceled, the date of commencement of work is entered.
  • The average or average daily wage is indicated without taxes. This information is needed to calculate the vacation compensation.
  • The seal and signature of the chief accountant or the head of the enterprise are put and the name and surname. (if the latter is not in the enterprise - the data of the manager in 2 lines).make sick leave for child care

Advice to the accountant

Above, we considered in some detail howissue a sick leave sheet. The accountant responsible for the correct calculation of benefits, too, must know these rules, because he will have to check the correctness of the document. In addition, when calculating cash compensation for incapacity for work, a specialist should consider the following nuances:

  • An employee can be called to work with a sick-lister only with his consent.
  • The consent of the employer is not required for the extension of the sick-list.
  • Compensation is paid only after the disability sheet is provided to the accounting department.
  • The calculation period is 10 days from the date of receipt by the hospital accountant, but, as a rule, payment of compensation is carried out together with an advance or a salary.

Disease Periods

Whether it is possible to issue a sick-list forlong period? The doctor independently determines the duration of the sick leave, depending on the patient's condition. It can be a few days or even months. But there are definite terms:

  • 15 days are spent on caring for sick children;
  • the period of care for sick relatives is 15 days, of which only 3 are paid;
  • care for a child with a disability up to 15 years - for the entire period of treatment (maximum 120 calendar days per year);
  • treatment by illness and after injuries no more than 30 days;
  • registration of maternity leave is carried out for 140 days, in case of any complications, it can be extended.

The records in the hospital sheet do not allow corrections and should be read well. If there are any inaccuracies in the design, you need to ask for a re-registration of the sick-list or make a duplicate.

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