Digital referral is a referral sent to a medical specialist that is forwarded through the Health Information System. Using a digital referral is as easy and convenient for the patient as using a digital prescription.

With the transition to digital referrals, referrals have been made maximally machinable, the information exchanged via a digital referral has become more accurate, and the rules for its use have been specified.

Outpatient specialized medical care has completely switched to digital referrals.

In the coming years, it is also planned to digitize referrals for nursing care and hospital care, and then referrals for examinations and procedures, as well as referrals for the appointments of non-medical specialists.

 Why do you need a referral?

When referring a patient to a medical specialist, the referral must always be formalized, at least for all specialties where it is required by law. A referral is required both when referring a patient from a family physician to a medical specialist and from one medical specialist to another one.

The referral is issued to the patient only for a medical indication. The referral must clearly state the medical issue or hypothesis that justifies the need to refer the patient to a medical specialist. Only relevant and underpinning information from the medical history shall be added to the referral.

 The family physician can also consult a medical specialist through an e-consultation

  • If necessary, the family physician can also use the e-consultation service. In this case, the family physician sends the issue related to the patient's treatment directly to the medical specialist through the health information system. The issue will be reviewed by the medical specialist, and the family physician will be consulted on the patient's further treatment, or the patient will be invited to the medical specialist’s appointment, i.e. the patient will be taken over by the medical specialist. The family physician always informs the patient when he/she asks the medical specialist for an e-consultation and also asks for the patient's contact telephone number, which is indicated in the referral letter.
  • The medical specialist will provide feedback to the family physician through the health information system within four working days at the latest. If the medical specialist decides to invite the patient, the latter will be contacted within six working days, taking into account the urgency of their health problem, so it is important that the patient's telephone number is correct and that the patient him/herself is available by telephone during this period.

 What will change when paper referrals are replaced by digital referrals?

  • The digital referral must be available to the patient before booking an appointment with a medical specialist, as it is the basis for booking. The presence of a digital signature is checked at the time of booking.
  • The patient must be made aware that this is a digital referral and it will be sent to the health information system.
  • At the patient's request, the family physician may also provide a written reminder to remind the patient about an appointment. Printing a digital referral, including signing and stamping, should be avoided so as not to give the wrong impression that it is a paper referral.  During the transition period, it is also difficult for a hospital receptionist to understand whether it is a printout or a paper referral.
  • It must be made clear to the patient that the booking is based on a digital referral, and that neither printout nor other paper will replace the digital referral. You can only book an appointment on a basis of a digital referral.
  • If the doctor fails to prepare a digital referral / send it to the health information system at the time of appointment, he/she may, if agreed with the patient, prepare / send it the health information system later, but it must be taken into account that the patient can only book an appointment on a basis of a digital referral.
  • A paper referral is issued to a person who does not have an Estonian personal identification code. 

 What does a patient need to know about the digital referral?

  • The digital referral is sent to the health information system. Paper referrals will no longer be issued.
  • The referral will not be issued retroactively to the patient. For example, in a situation where an appointment with a medical specialist is already underway or has taken place, it is no longer possible for the family physician to issue a digital referral for that appointment. 
  • The digital referral has an expiration time. This is the time during which it is possible to book an appointment with the referral. The appointment may also take place later, after the expiration of the referral, i.e. if the patient has booked an appointment on the basis of a valid digital referral, the referral no longer needs to be valid on the day of the doctor's appointment.  The expiration time in the family physicians’ programs is six months by default, but the issuer of the referral can change this period if necessary. 
  • You can only book one time at once with a digital referral. When booking an appointment, it is checked whether a digital referral is available, and whether it is already associated with an appointment.
  • The patient can book a new appointment on the basis of the same referral, if the current appointment has been cancelled. From the patient portal, both issued and booking-related referrals are visible to the patient.
  • Even if the patient does not show up for the appointment or the doctor / service provider cancels the appointment, the referral will be released from the old booking and the patient can use it to book a new appointment if the referral has not expired.


 If the patient has attended a medical specialist’s appointment

  • If the medical specialist finds that the patient needs to attend another specialist’s appointment, a new referral will be made by the same specialist. The patient does not have to go back to their family physician to receive a referral.
  • If the medical specialist places the patient in his/her observation and the appointment schedule is open until that time when he/she calls the patient again, the medical specialist shall book a new time for the patient and shall not have to formalize a referral. In case that the patient needs to change the appointment time, he/ she will be given a contact number / e-mail address, etc.
  • If the medical specialist places the patient in his/her observation and the appointment schedule is not yet open until that time when he/she calls the patient again, the medical specialist shall formalize the patient’s referral in the usual outpatient referral form (so-called recurring referral). In this case, the patient does not have to address the family physician again for a referral, but can be sure that a new appointment time can be booked with a referral issued by the medical specialist. If, for technical reasons, the hospital is unable to formalize a recurring referral, the patient will be given a written reminder which can be used as a basis for booking a new appointment time.
  • At the end of treatment, the medical specialist must always state in the treatment summary (or epicrisis) whether to leave the patient to be monitored or refers the latter to the family physician. The family physician can use this information if necessary through the health information system.