❗ From October 1, students’ health-related absences will be excused entirely electronically, according to the Ministry of Education.

The Ministry of Education and Science, in collaboration with the Ministry of e-Government and the Ministry of Health, has initiated the introduction of electronic medical notes to ease the burden on teachers and counter the practice of excusing absences without a valid reason.

The Ministry has published the most frequently asked questions and answers to provide clear information to all stakeholders in the transition from paper to entirely electronic medical notes.

💭 Is the new e-note paid?

Like before, medical notes are not part of the basic activities covered by the National Health Insurance Fund (NHIF) budget. Each general practitioner must visibly display a price list in their office and determine the fee for services not covered by the health fund. Therefore, some may not charge, while others may ask for 1 lev, 2 levs, or 3 levs. For any paid service, a cash receipt must be issued.

💭 Can the e-note be issued with a backdated date?

The note is issued with the date of the child’s examination, but the excuse for absences can be recorded with a backdated date. For example, if a child falls ill on Friday the 15th, and the parent takes them for an examination on Monday the 18th, the note will be issued with the date of the examination, the 18th, but will excuse absences for the period of illness, such as dates 15 to 22 in the corresponding month.

💭 Can the doctor refuse to issue an e-note if there is no internet, for example?

The doctor cannot refuse to issue the e-note. If they are hindered by technical reasons, the note can be issued later when the examination is registered. It should be noted that the National Health Information System (NHIS) is adapted to work in offline mode, and all doctors are required to work in the NHIS.

💭 Can dentists issue e-notes?

Yes. Dental software is also integrated into the NHIS, allowing dentists to issue e-notes for excusing absences.

💭 Can other doctors, such as emergency doctors, issue e-notes?

E-notes can be issued by specialists in outpatient medical care, such as after consultations with a cardiologist, allergist, etc., at the discretion of the respective specialist. Emergency medical centers (EMCs), as before, are not engaged in medical treatment and will not issue medical notes for excusing absences.

💭 Are other medical notes required for school also electronic?

The digitization of students’ personal preventive cards, required at the beginning of the school year, is forthcoming.

💭 Are absences automatically excused when the doctor submits the e-note to the MOE system?

At the time of issuing the electronic medical note, the data from it enter the National Electronic Information System for Pre-school and School Education, from where they are automatically transferred to the electronic absence records for the respective student. Electronic medical notes become immediately visible to the parent in the electronic diary. The class teacher, school director, and parent do not need to take any additional actions. All electronic diaries used in the school education system allow automatic excusing of already reflected absences and respect for absences at the time of their entry into the diary with an existing medical note.

💭 How does the e-note travel from the doctor’s office to the school?

After filling out the outpatient list for the examination, the doctor creates the e-note through the software used by them (in the NHIS). To prevent possible errors, the doctor has the right, within 2 hours after registering the note, to cancel it. Only after this period, the entered data, such as the examination number, child’s information, absence period, etc., are automatically provided to the MOE system and then reach the electronic diary. All processes are automatic and do not require intervention by anyone.

💭 What will the e-note itself say about the illness for which the student is absent?

The diagnosis given by the medical professional to the student is part of the information contained in the e-note. To protect the sensitive health data of children, this information does not reach the MOE system. The information that reaches the school electronic diary is the absence period during which the student will be absent from school.

💭 Who has access to the health data in the e-note?

Only those individuals who have access to the child’s health record will be able to see the diagnosis made during the examination. Teachers will not have access to the diagnosis, thus preserving sensitive personal data.

Translation: Simona Veleva