A referral is not required to see the following specialists:
Ophthalmologist (eye specialist),
Dermatologist / Venereologist (skin and sexually transmitted diseases specialist),
Gynaecologist,
Psychiatrist,
Pulmonologist (in cases of suspected tuberculosis),
Dentist,
Surgeon or orthopaedic specialist in cases of trauma.
DEAR PATIENT
Estonia has transitioned from paper referrals to electronic referrals (also known as digital referrals). This means that specialist referrals are no longer issued to patients on paper, but are sent electronically through the national Health Information System. To ensure a smooth transition, the Ministry of Social Affairs, the Estonian Health Insurance Fund, the Health and Welfare Information Systems Centre (TEHIK), the Estonian Society of Family Doctors, and the Estonian Hospitals Association work closely together.
When is a referral required?
A referral from your family physician is required to book an appointment with a medical specialist (except for the specialties listed above). Referrals are issued only when there is a medical indication, as determined by the family physician. If no medical indication exists, you may still attend a private specialist consultation at your own expense.
A referral must be issued before you book your appointment with the specialist. Referrals cannot be issued retrospectively.
If you attend a specialist appointment without the required referral, both the consultation and any related services will be charged to you.
Patients can view all referrals issued to them, as well as referrals linked to booked appointments, through the national patient portal, Terviseportaal.ee. Referrals for individuals under their guardianship or representation are also available there.
Your family physician can also consult a specialist through the e-Consultation service
When appropriate, your family physician may use the national e-Consultation service. In this case, the physician sends a clinical question regarding your treatment directly to a specialist through the Health Information System. The specialist reviews the case and either provides recommendations for further management by the family physician or invites the patient for a specialist appointment, thereby assuming responsibility for further care. Your family physician will always inform you before requesting an e-Consultation and will ask for your contact telephone number, which will be included with the referral.
The specialist will provide feedback to the family physician through the Health Information System within four working days. If the specialist decides that you should be seen in person, you will be contacted within six working days, depending on the urgency of your condition. It is therefore important that your telephone number is correct and that you are reachable during this period.
What changes with electronic referrals?
Your physician will always inform you when an electronic referral has been created and submitted to the Health Information System. Upon request, you may also receive a written reminder for your own records.
Neither the written reminder nor a printed copy of the electronic referral replaces the electronic referral itself. Specialist appointments can only be booked using the electronic referral. If a patient presents a printed referral to a hospital when booking an appointment, the hospital is required to verify that a valid electronic referral exists. Reception staff are not permitted to book an appointment without one.
If the physician is unable to create or submit the electronic referral during your appointment due to technical or other reasons, it may be completed later by agreement with you. However, appointments with specialists can only be booked once the electronic referral has been submitted.
Patients who do not have an Estonian personal identification code will receive a paper referral.
After your specialist appointment
At the end of your treatment, the specialist will prepare a medical summary (epicrisis). This document includes recommendations for you and, if necessary, instructions for other healthcare professionals. It will also specify whether the specialist will continue to monitor your condition or whether your follow-up care has been transferred back to your family physician. Your family physician can access this information through the Health Information System.
You can also view your medical summary in the national patient portal at Terviseportaal.ee.
If, during your specialist consultation, it becomes clear that you need to see another specialist, the current specialist will issue the new referral. You do not need to return to your family physician to obtain one.
If the specialist keeps you under their own follow-up care, they will arrange your next appointment. No new referral is required. If you later need to change the appointment, you will be given the appropriate contact details.
If the specialist intends to continue your follow-up care but future appointment schedules are not yet available, they will issue a follow-up referral. In this case, you do not need to return to your family physician for another referral. Please note that your next appointment may not necessarily be with the same specialist.
If technical reasons prevent the specialist from issuing a follow-up referral electronically, they will arrange your follow-up by another method and explain the process to you. Information regarding the follow-up must also be included in the medical summary submitted to the Health Information System.
If you are unsure whether the specialist intended to see you again, please ask before leaving the consultation room.
If the specialist has not provided a new appointment, has not issued a follow-up referral, and has not documented follow-up arrangements in the medical summary, the treatment relationship for that health problem has ended. Should your symptoms persist or worsen, you should contact your family physician for further assessment.
