Fit note builder — the right wording, every time
The Med3 "comments" box is where most fit notes go wrong. Pick the scenario and the adjustments and this builds clear, employer-ready wording you can copy straight into the statement — plus the duration and eligibility rules that catch people out.
📋 Statement preview
Who can sign
Doctors, nurses, pharmacists, physiotherapists and occupational therapists (since July 2022) can legally certify a fit note, based on an assessment of the patient.
First 6 months rule
In the first 6 months of a condition, a fit note can't be for more than 3 months at a time. After 6 months, you can issue for any clinically appropriate period — including "until further notice".
First 7 days
No fit note is needed for the first 7 calendar days of sickness — patients self-certify (SC2). Don't issue one for this period.
No "fit for work" box
There is no option to declare someone fit. If they're fit, they simply don't need a note. You only choose "not fit" or "may be fit with adjustments".
Can't be backdated wrongly
You can base a note on a past assessment date, but date the statement the day you write it. Retrospective notes are allowed if based on a previous assessment.
Hospital & A&E
A fit note can be issued by hospital doctors too. If a patient was an inpatient, the hospital can cover that period.
Legal basis, limits & when you must not issue one
A fit note (form Med3 — "Statement of Fitness for Work") is a statutory medical statement under the Social Security (Medical Evidence) Regulations 1976 (as amended). It is medical advice about a patient's fitness for work — not an instruction to the employer, and not a gateway to any specific benefit. Know the limits before you sign.
⛔ When you should NOT (or cannot) issue a fit note
- ✕The first 7 calendar days of sickness. These are covered by self-certification (form SC2 or the employer's own form). A Med3 is not required and should not normally be issued for this period — the 7 days include weekends and bank holidays.
- ✕To declare a patient "fit for work". There is no legal option to certify fitness. If someone is fit, they simply do not need a note. You may only state "not fit for work" or "may be fit for work with adjustments".
- ✕Without a genuine assessment. You must have assessed the patient — in person, by phone/video, or by considering a written report from another healthcare professional (e.g. hospital, OT, physio). No assessment ⇒ no note.
- ✕For a date before you (or another clinician) assessed the patient. Retrospective notes are permitted, but only when based on an assessment that genuinely took place on or before that date. Never certify a period you have no assessment basis for.
- ✕For purposes other than fitness for work. A fit note is not evidence for housing, exam mitigation, benefit appeals, court, travel/holiday cancellation, gym cancellation, ESA/PIP capability, or "to whom it may concern" letters. These are private, non-NHS requests and a separate (often chargeable) letter — never a Med3.
- ✕Where another clinician is better placed. If the patient was a hospital inpatient, the hospital should issue the note covering that admission. Don't certify a period you didn't manage.
- ✕Maternity: normal pregnancy is not an illness — use MATB1 for maternity pay, not a fit note. A fit note is only appropriate for a pregnancy-related illness (e.g. hyperemesis, SPD). In the last 6 weeks before the due date, pregnancy-related absence may trigger maternity leave instead.
- ✕Terminal illness / DS1500: use the SR1 (formerly DS1500) for fast-tracked benefits under the Special Rules for End of Life — that is a different form, not a Med3.
- !Avoid issuing to yourself, family or close friends where it can be avoided (GMC Good Medical Practice — conflict of interest and lack of objectivity).
⏱ Duration — maximum & recommended limits
| Situation | Limit / rule |
|---|---|
| First 7 days | Self-certification — no fit note. The clock for a fit note starts on day 8. |
| First 6 months of a condition | Each note may be for a maximum of 3 months at a time. You may issue several shorter notes within this window. |
| After the condition has lasted 6 months | You may issue for any clinically appropriate period, including longer than 3 months or "until further notice" for a stable, long-term condition — avoids needless reissues. |
| Recommended in practice | Match the duration to the expected recovery, not the calendar. Short, realistic notes (e.g. 1–2 weeks for self-limiting illness) with review beat long blanket notes — they support an early, safe return to work. |
| Start date | A note can start on the day of assessment or a later date. It can also be backdated to a past date only if based on an assessment from that date. |
| Overlap / gaps | You can issue a further ("repeat") note to continue an absence. Date the statement the day you write it, regardless of the period it covers. |
✍ Who can legally issue one
- ✓Doctors (GPs and hospital doctors).
- ✓Nurses, occupational therapists, pharmacists and physiotherapists — since 1 July 2022, any of these registered professionals may certify a fit note based on an assessment.
- !The note must be issued by the professional who assessed the patient, or who has considered a written report about them.
💷 Cost, status & what it is not
- ✓Free of charge when issued for sickness absence / a benefit or Statutory Sick Pay claim.
- !Advisory only. The employer — not the GP — decides whether suggested adjustments are possible. "May be fit" still functions as "not fit" if they can't accommodate it, with no need to reissue.
- !Not a benefits decision. Capability for ESA/PIP/Universal Credit is assessed separately by the DWP, not by the fit note.
- !Can be digital or printed; since April 2022 it does not require a wet-ink signature if issued electronically from the clinical system.
🧭 Good-practice guidance DWP / DfWP
- i"Work is generally good for health." Default to enabling a safe return — use "may be fit with adjustments" wherever possible rather than blanket "not fit".
- iBe specific and employer-appropriate in the comments box: state the functional effect (e.g. "avoid lifting >5 kg", "no prolonged standing"), not just a diagnosis.
- iUse the four tick-box adjustments — phased return, amended hours, amended duties, workplace adaptations — to structure your advice.
- iConsider occupational health and the employer's role for complex or recurrent absence; the GP is not the only source of support.
- iRemember the Equality Act 2010: for a long-term condition that meets the disability definition, the employer has a duty to make reasonable adjustments — your wording can prompt this.