Health certificate in Puerto Rico: requirements, cost and where to go

Our telemedicine clinic does not issue health certificates for employment (neither the health card nor the food handler certificate), and it does not order the tests needed to get one. This guide is informational: it explains what the certificate is, who issues it and how to get it from a doctor authorized by the Department of Health.

If what you need is for a doctor to evaluate you for an illness, or a doctor's note, we do that by video: see the end of this guide.

The certificado de salud is a card, on the Department of Health's model, certifying that a doctor evaluated you and that your TB and syphilis tests are current. It is required by Law 232 of August 30, 2000 (the Puerto Rico Health Certification Act) and the Health Secretary's Regulation 138.

A doctor authorized by the Department of Health issues it in person, with an original signature and the SARAFS seal (the regulation prohibits rubber-stamp signatures). You get the original, and the doctor keeps a copy in your record with the test results.

The Department of Health requires it every year for employees in industries that serve the public directly. The Department's guide lists, among others, people who work where food or drinks are handled or produced (restaurants, grocery stores, bakeries, food stands and similar) and in places that provide direct health services.

If you are new to Puerto Rico and starting a job, ask your employer whether your position requires one. Many employers can also tell you which authorized doctor their staff usually see. A medical certificate for an illness or a doctor's note does not replace the Department of Health certificate.

According to the Department of Health's guide, the Puerto Rico health certificate requires:

The TB skin test takes two visits. The authorized doctor or their designated nursing staff places it, and it is read in person 48 to 72 hours later. The reading has to happen within that window.

The TB blood test (IGRA) uses a blood sample, processed by a clinical lab the Department of Health authorizes, the same as the syphilis test. Either way, the authorized doctor interprets the results.

Only a doctor authorized by the Department of Health, and only at the authorized site ("única y exclusivamente en el lugar autorizado"): their private office or the health institution the Department approved. The Health Certificates Division (SARAFS) authorizes those doctors and inspects their offices. The authorization must be displayed where the public can see it, so look for it when you arrive.

Clinical labs process the blood tests but do not hand out the certificate: the regulation forbids delegating delivery to lab staff. That is why the health certificate cannot be issued by video. Fines under the regulation reach 5,000 dollars for a first violation and up to 10,000 dollars for a repeat within a year.

The process is the same across Puerto Rico, whether you are in San Juan, Carolina, Bayamón, Caguas, Ponce, Mayagüez or anywhere else. We found no public list of authorized doctors by town, so:

Neither the Department of Health's guide nor Regulation 138 sets what the person getting the certificate pays, and we found no official published price. Each authorized office and each lab sets its own price, and it varies, so call ahead and ask what is included (the evaluation, the TB skin test, the reading and the blood tests).

We also found no official program that gives the certificate at no cost. If someone offers you a complete certificado de salud "online", be wary and check that an authorized doctor issues it at their authorized site.

The certificate is valid for one year. The TB test must be from the 3 months before it is issued, and the syphilis test from the 6 months before; older results are not accepted and must be repeated. The issue date is the date of the first test.

Since October 21, 2022, you no longer need to show proof of COVID-19 vaccination for the certificate.

Our clinic does not issue the health certificate or any certificate to start a job. What Dr. Diana Nieves Castro, MD, a Puerto Rico-licensed general practice physician, does by video is see you in a real medical visit and, if you are sick, document what she evaluated:

• [Doctor online visit](route:service-online-visit): for a new problem or non-emergency urgent care, any time.
• [Doctor's note](route:service-sick-note): if you missed work or class because you were sick, included after your visit if the doctor considers it appropriate.
• A medical certificate for an illness the doctor evaluated: it documents what she found in the visit; it does not certify fitness for a job. Book your video visit and you choose your time when you book.

We send you a secure video link; it works on your phone, tablet or computer. You must be in Puerto Rico during the visit. If the patient is under 21, a parent with patria potestad or a legal guardian stays on the video for the whole visit and shows photo ID.

To compare every document, read medical certificates in Puerto Rico; for the driver's license form (DTOP-DIS-260), see the driver's license medical certificate guide; and for your child's "hoja verde" vaccine record, see the PVAC-3 vaccination certificate guide.