Can an online psychiatrist issue a prescription and L4 (sick leave)?
You may be at a point where you know you need help — depression, anxiety, insomnia, ADHD — but the thought of an in‑person visit overwhelms you.
The natural question then is: “Can an online psychiatrist issue a prescription for medication and L4, or is it just a ‘casual chat’ over a webcam?”.
The good news is that under Polish law an online psychiatrist has the same rights as in a stationary clinic — provided it is a full consultation, not a “prescription click”.
What do the regulations say: e‑prescription and e‑sick leave from an online psychiatrist
E‑prescription — also for psychotropic medications
In Poland prescriptions are issued essentially only in electronic form (e‑prescriptions), including for psychotropic medications.
Several important facts:
an online psychiatrist is a regular doctor — they can issue an e‑prescription, including for psychotropic drugs, if after the consultation they determine there are medical indications,
a prescription for psychotropic drugs must be electronic — after the visit you receive a 4‑digit SMS code and/or you can see it on your Internet Patient Account (IKP), just like after an in‑person visit,
the e‑prescription for psychotropic medications contains m.in.:
your PESEL,
the doctor’s license number,
the medication name, dose, quantity,
other required data.
Since 2023 a doctor is required to check your treatment history in the e‑health system (P1) before issuing a prescription for psychotropic medications and controlled substances — this also applies to online visits.
So: you obtain an e‑prescription from an online psychiatrist after a visit that meets the same diagnostic standards as an in‑person visit.
L4 from an online psychiatrist — how does it work?
Sick leave (L4) is also an electronic document (e‑ZLA) that is sent automatically to ZUS and the employer — regardless of whether it is issued by a doctor in a clinic or online.
Key rules:
a psychiatrist can issue L4 during a consultation online if after the interview they determine that your mental state temporarily prevents you from performing work — e.g., in a depressive episode, severe anxiety disorders, insomnia, or other mental disorders,
this also applies to the first visit — if the doctor deems your condition requires immediate relief from work duties, they may issue sick leave at that time,
L4 does not display a diagnosis — the employer only sees that you are unfit for work (without disclosure of a psychiatric diagnosis).
In practice: L4 from an online psychiatrist has the same legal force as L4 issued in a clinic.
How to get an e‑prescription from a psychiatrist online — step by step
No magic here, but some important details.
1. Booking an online psychiatric consultation
It usually looks like this:
you choose an appointment time (at a clinic, on a platform, with a specific doctor),
you provide data (name, surname, PESEL, sometimes address, phone number, e‑mail),
you accept terms/consents (GDPR, teleconsultation rules).
Regarding psychotropic medications, most reputable providers:
require a video visit (not just a form + SMS),
may request documentation: prior prescriptions, hospital discharge summaries, test results, certificates,
have safety procedures — m.in. identity verification, access to your treatment history.
2. Medical interview — online, but “serious”
During an online psychiatric consultation the doctor:
takes a history (symptoms, duration, prior treatment, comorbidities, medications, life situation),
observes your behaviour (speech, facial expression, movement, contact) — therefore the first visit should typically be by video, not just a form,
may ask for documentation, test results, and history of previous medications.
On this basis they may:
establish or preliminarily formulate a diagnosis,
propose treatment (medication, psychotherapy, other forms of help),
decide whether to issue an e‑prescription and/or L4 — if they see indications.
3. Issuing an e‑prescription for psychotropic medications
If the doctor deems medications medically justified, they can issue an e‑prescription:
the e‑prescription goes into the P1 system (e‑health),
you receive an SMS with a 4‑digit code and/or an e‑mail with information,
you can also view the e‑prescription on your Internet Patient Account (IKP).
At the pharmacy:
you give the pharmacist your PESEL + the SMS code or show the code from IKP,
you fill the prescription like any other e‑prescription — psychotropic drugs are simply more “monitored” (limits on days of therapy, transaction registration).
Does an online psychiatrist always issue a prescription and L4?
No. And that’s an important answer.
The doctor must act according to medical indications
Guidelines and regulations are clear:
a doctor (including an online psychiatrist) may not issue prescriptions “on demand” or “prophylactically because the patient asks”,
they must assess whether a particular medication is necessary, safe, and whether legal conditions are met (e.g., for psychotropics — checking treatment history),
similarly for sick leave — L4 from an online psychiatrist is issued when your condition truly limits your ability to work, not merely so you can “get away from the boss”.
There are also situations where an online doctor may determine that they cannot safely manage treatment remotely — e.g., in case of serious life risk (suicidal thoughts with a plan, acute psychotic episode). Then they may urgently refer you to a hospital, emergency department (SOR), or admissions ward — and that is also a form of care, not a “refusal to help”.
FAQ
Can an online psychiatrist issue a prescription?
Yes.
An online psychiatrist can issue an e‑prescription, including for psychotropic medications, if after the consultation they assess there are medical indications and legal requirements are met (PESEL, documentation, review of treatment history).
Can an online psychiatrist issue L4?
Yes.
An online psychiatrist can issue an electronic sick leave (e‑ZLA), which is sent to ZUS and the employer, if they determine that your mental state temporarily prevents you from performing work duties.
This also applies to a first visit if the condition is serious enough to require immediate relief.
How to get an e‑prescription from a psychiatrist online?
book an online psychiatric consultation (preferably a video visit),
prepare a list of symptoms, treatment history, medications, test results and discharge summaries if you have them,
during the visit the doctor will take a history, assess your condition and, if appropriate, issue an e‑prescription that you will receive as an SMS code and on IKP.
Does an e‑prescription for psychotropic drugs differ from a regular one?
Technically — no, you fill it at the pharmacy in the same way (code + PESEL / IKP), but:
prescriptions for psychotropic drugs must be electronic,
the amount of medication cannot exceed a specified number of days of therapy (usually up to 120 days),
transactions are recorded and the doctor is required to check your treatment history in the e‑health system before issuing such a prescription.
If you’re at the point “I know I need help but an in‑person visit overwhelms me” — an online psychiatric consultation can be a safe first step.
It may turn out you need an e‑prescription, L4 or a referral, or perhaps at this stage psychoeducation, lifestyle changes and psychotherapy without medication will suffice.
This text is informational and educational. It does not replace an individual medical consultation or diagnosis. If you have concerns about your mental state, contact a psychiatrist or another specialist directly.
Sources
Telemedi, “Psychiatrist online — prescription” — description of the possibility of issuing e‑prescriptions (including for psychotropic drugs) and e‑sick leaves during online consultations.
INZPiRO, “Psychiatrist online — remote consultations” — information about issuing e‑prescriptions and L4 during online visits, also on the first consultation if there are indications.
Kliklekarz, “Prescription for psychotropic drugs — rules, e‑prescription and pharmacy dispensing” — detailed discussion of legal requirements for e‑prescriptions for psychotropic medications.
Telemedi, “You can get sick leave from an online psychiatrist” and “Sick leave from a psychiatrist: when it applies and how to obtain it online” — rules for issuing e‑ZLA by an online psychiatrist and the course of consultation.
