Referral for examination

We kindly inform you that due to the entry into force on 1 April 2015. The Ordinance of the Minister of Health of 26 March 2015 amending the Ordinance on conducting medical examinations of employees, the scope of preventive health care over employees and medical certificates issued for the purposes provided for in the Labour Code (Journal of Laws of 2015, item 457) has changed the specimen of the referral for medical examinations (preliminary/periodical/control).
Taking the above into consideration, please issue referrals for prophylactic examinations of your employees according to the specimen constituting Appendix No. 3 to the above mentioned Ordinance of the Minister of Health.
We also encourage you to use the electronic version of the referral below.
Test referral forms