Form for the medical certificate validation process

Procedures and requirements is always aware of your needs, in this article you will learn how to complete the Form for the validation process of the EsSalud medical certificate, the steps you must follow during the process and information about the terms it offers. This article is ideal for you.

Form for the medical certificate validation process

The Form for the Validation Process of the Medical Certificate of isHealth is used to get the Certificate of Temporary Incapacity for Work (CITT).

ANDl Certificate of Temporary Incapacity for Work is the official document of isHealthwhere the type of contingency presented by the insured is stated, be it illness, accident or maternity and the duration of the disability period. Thanks to this, the insured is granted coverage that generates subsidy for temporary disability or maternity.

It is essential that the insured complete the form to the letter, filling out all the requested fields.

In the following link you can download the form in PDF format.

How to complete the form?

The form is divided into five headings, which represent the different sections that appear within the form:

  1. I- Information of the Insured Holder.
  2. II- Applicant Information.
  3. III- Contingency.
  4. IV- Period to Validate.
  5. V- Documents to Present.

To successfully complete the form you must follow the guidelines and instructions that will be shown below:

  1. The first thing you should do is download the requested form, which you can find at the link given at the beginning of the article. You need to make sure you meet all the conditions to apply for the medical certificate.
  2. The next step is to fill out the Item Iwhich is named «Information of the Insured Holder», This is divided into two boxes, in the first you must indicate the type of Identity Document that the insured has, then write the identification number, full name, contact telephone number, either landline and/or cell phone, and a valid email .
  3. In the second box, the information of the employing entity is requested, for which, you must place in RUC Number, the Company Name, and the Position or Occupation that it holds. If the insured has more than one employer entity, place them all, with their respective data.
  4. Then we will proceed to fill the Item II called “Applicant Information”. This section must be completed only when the applicant for the medical certificate is not the same insured person, otherwise leave this part blank.
  5. If you apply to fill the Item IIthen you must enter the data of the applicant, such as the type of Identification Document and its number, full name, contact number and a valid email.
  6. Finished this section, we are going to fill the Item IIIwhich is named «Contingency», In this part we only have to indicate the contingency presented by the insured holder (illness, accident, maternity). To do this, we must place, according to the Contingency Table found at the bottom of the form, the code that corresponds to the chosen option.
  7. Now we are going to fill the Item IValso called «Period to Validate»where we must record the period of incapacity for work presented by the insured owner.
  8. Almost to finish completing the form , we have the last Item , called «Documents to present», in this box we must indicate the number of attached documents. We must attach the documents assigned in the Form Table, according to the contingency and the type of care required by the insured.
  9. Finally we are presented with Legal Statementwhere we must mark with a cross in the option YES or NO, in order to authorize the sending of notifications through the email noted in the
    present Form.

You must bear in mind that you fill out the Form in legible, printed letters. Forms that have stains, erasures, or amendments are not accepted.

If you completed the form successfully, you will be able to obtain the requested medical certificate without complications.

Table of Contingencies and Documents to present

If you have doubts regarding the Table of Contingencies and the Documents that you must attach to the form then you will be interested in reading this part of the article.

The Table present in the form has the different contingency options that the insured holder can present, which is divided into two columns where the contingencies and the type of attention presented are indicated. These two columns, in turn, are subdivided by various attributes, which show us the necessary documents for each option:

  • Contingency: Code and Name.
  • Type of Attention:External Consultation, Emergency, Hospitalization.

In the first column we must choose the contingency presented by the insured holder and write the corresponding code, which appears right next to the name of the contingency.

The second column shows us the types of care that the insured can present, according to each one of them, we are shown the documents that we must attach. It may be the case that a document is necessary for all types of care, as in other cases there are documents that only apply to a certain type of care.

We must make sure to select the contingency correctly and to record all the requested requirements.

Steps to follow

To learn how to obtain the right to subsidy through the Temporary Disability Certificate working through isHealthwe are going to expose a little more about this right.

The Certificate of Temporary Incapacity for Work It has a health, labor and economic connotation, it provides for medical absenteeism, it also supports the physical rest that the insured requires and constitutes one of the essential requirements for the payment of the subsidy granted for Temporary Disability or Maternity, as long as it corresponds.

The payment of temporary work disability allowance is the economic support that it provides isHealth to the insured, in order to avoid economic losses, which can result from work incapacity.

In order to enjoy this right, it is essential that the insured holder have the right to coverage and a labor relationship with an employer at the time the disability began and during the subsidy period.


During the first 20 days of disability the employer is obliged to continue financially supporting the worker until you overcome disability. For this, the days of paid disability during each year are accumulated. These days must be sustained based on CITT or private medical certificates.

The insured holder can benefit from the right to Temporary Disability subsidy given by isHealth from 21 day of disability and until its culmination, with a maximum period of eleven months and ten consecutive days, if you do not perform paid work.


The Insured must meet the following conditions to benefit from the EsSalud subsidy:

  1. The insured owner must have youthree months shape work continuous or alternative to this, four months non-consecutively, that this dwithin the six months that must bePrior to the month in which the contingency.
  2. If it is an accident, it will only be necessary for there to be affiliation.
  3. The Agrarian Insured You must have three months where your contributions are consecutive or four months not consecutive, which must be within the 12 months prior to the month in which the insured’s disability began.
  4. In case it is a dock worker, the subsidy will be granted from the first day of disability. The worker may only enjoy this right if he has worked during the three months prior to the date on which the disability occurred.

The temporary disability subsidy process can be carried out by:

  1. The insured owner.
  2. The legal representative of the employing entity
  3. Authorized person.


  • Identification document of the insured holder.
  • Private medical certificates and/or Certificate of Disability, which provides the payment of the first 20 days by the employing entity, which must be attached.
  • Form 1010 duly filled out and signed by the insured owner.
  • In the case of port workers, they will present the original Temporary Work Incapacity Certificate.
  • In the case of a Private Medical Certificate from the 21st day of disability, it must be exchanged by the CITT.

Prescription of the Subsidy for Temporary Disability

You must remember that the term to request your EsSalud subsidy is six months from the date on which the insured’s period of disability ends, and the following situations may arise:

  • If the disability exceeds the maximum term of eleven months and ten days, the account prescribes from the date on which the maximum term of 11 months and 10 days ends.
  • Disabilities that are classified as Non-Temporary by the Disability Qualifying Medical Commission. . The account expires from the date you complete 180 days of continuous disability.
  • Workers laid off, even if the disability continues. The account prescribes from the date of termination of the worker.

Termination, loss or suspension of the subsidy

The right to subsidy for temporary disability issued by isHealth is extinguished by:

  • Declaration of Non-Temporary Disability determined by the Disability Qualifying Medical Commission.
  • Termination of the employment relationship of the insured.
  • Change employer entity during the subsidy period.
  • Recovery of health, which generates work activity.
  • Likewise, the right to temporary disability subsidy can be lost for doing paid work during the subsidy period.

You can now start your procedures for the validation of the Medical Certificate of Incapacity for Work in case you need it.

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