The sick note submitted this week by former president Jacob Zuma’s legal team to the High Court in Pietermaritzburg,  again raised questions on what should be included to ensure the validity and legality of the certificate. In this article, Wendy Massaingaie, legal advisor, SAMA Governance and Legal Department explains what is required.


There has been a steady increase in the number of fraudulent sick notes being investigated by the HPCSA, and those medical practitioners found guilty of issuing them are liable to pay a fine and will be criminally charged. Therefore, it is important for medical practitioners to remain vigilant, and be aware of what is legally and ethically required from them when completing and issuing sick notes.

The Basic Conditions of Employment Act No. 75 of 1997 addresses sick notes in section 23 as follows:

“(1) An employer is not required to pay an employee in terms of section 22 if the employee has been absent from work for more than 2 consecutive days or on more than two occasions during an 8-week period and, on request by the employer, does not produce a medical certificate stating that the employee was unable to work for the duration of the employee’s absence on account of sickness or injury.

(2) The medical certificate must be issued and signed by a medical practitioner or any other person who is certified to diagnose and treat patients and who is registered with a professional council established by an Act of Parliament.”

Therefore, a valid sick note will be accepted by an employer if, in the medical practitioner’s professional opinion, the employee was unable to perform their duties due to an illness or injury.

In addition to the above, the Ethical Rules of Conduct for Practitioners Registered under the Health Professions Act [No. 56 of] 1974 specifies the requirements for a valid certificate of illness. Rule 16 of the Act reads:

“16. Certificates and reports
(1) A practitioner shall grant a certificate of illness only if such certificate contains the following information: (a) the name, address and qualification of such practitioner; (b) the name of the patient; (c) the employment number of the patient (if applicable); (d) the date and time of the examination; (e) whether the certificate is being issued as a result of personal observations by such practitioner during an examination, or as a result of information which has been received from the patient and which is based on acceptable medical grounds; (f) a description of the illness, disorder or malady in layman’s terminology, with the informed consent of the patient – provided that if such patient is not prepared to give such consent, the practitioner shall merely specify that, in his or her opinion based on an examination of such patient, such patient is unfit to work; (g) whether the patient is totally indisposed for duty or whether such patient is able to perform less strenuous duties in the work situation; (h) the exact period of recommended sick leave; (i) the date of issue of the certificate of illness; and (j) the initial and surname in block letters and the registration number of the practitioner who issued the certificate.

(2) A certificate of illness referred to in subrule (1) shall be signed by a practitioner next to his or her initials and surname printed in block letters.
(3) If preprinted stationery is used, a practitioner shall delete words which are not applicable. (4) A practitioner shall issue a brief factual report to a patient, where such patient requires information concerning himself or herself.”

A valid sick note must meet the requirements above in order for it to be legally acceptable. It is important to note that sick notes can be backdated, where the patient only consults the medical practitioner at a later stage, as long as it is the medical practitioner’s professional opinion that the patient was unfit for duty during the stated period. Furthermore, the diagnosis does not need to be disclosed unless the patient specifically consents to the nature of the illness or injury being stated in the sick note. This is based on the patient’s right to confidentiality as well as the doctor-patient relationship, which upholds the respect of privacy.

In conclusion, it is important to remember that a medical practitioner is not obliged to issue a sick note where there is no legitimate reason for one. The medical practitioner has to comply with the law, and bear in mind that their professional reputation will be at stake should they be found to have issued a fraudulent sick note. Always ensure that the sick note is completed accurately and honestly, and personally signed by the medical practitioner. Furthermore, all medical stationary containing professional or personal information must be kept safe, as loss of a medical certificate pad may be seen as professional misconduct. Lastly, should a medical practitioner become aware that their medical certificate pad has been lost, or is being used fraudulently, this must be reported to the SA Police Services.