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

The certificado de salud is governed by Law 232 of August 30, 2000 (the Puerto Rico Health Certification Act) and the Health Secretary's Regulation 138. 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.

According to the Department of Health's guide:

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 issues it, and only at the authorized site: their private office or the health institution the Department approved. The Department's 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. We did not find a public list of authorized doctors; if you don't know where to go, ask your employer or call the Health Certificates Division at 787-765-2929, ext. 4759 (Spanish).

In a School and work forms visit (US$35), Dr. Diana Nieves Castro, MD, a Puerto Rico-licensed general practice physician, evaluates you by video and, if appropriate, gives you the lab order for the health certificate blood tests, so you arrive at the lab with the order in hand. We do not issue the certificate itself: the authorized doctor does. Full details are on work and school medical certificate.

• Request your visit. On the booking page, choose School and work forms. Request a visit online 24/7 — we confirm your time by email or text.
• See the doctor by video. We send you a secure video link; it works on your phone, tablet or computer. You must be in Puerto Rico during the visit.
• Get your tests. Take the order to a clinical lab the Department of Health authorizes.
• Go to the authorized doctor. They do the certificate evaluation, place and read the TB skin test if you use it, and issue the certificate.

Before you get tested, confirm with the authorized doctor that they accept results from an authorized lab ordered by another doctor. If something comes up that needs a full doctor visit, the doctor explains it and, only with your consent, you pay the difference. 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.

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).

Our part is US$35: the video visit and the lab order for the blood tests. You pay by card when you request it, with no membership, and if the visit can't take place you get a full refund. You pay the lab for the tests and the authorized doctor for the evaluation and the certificate. All three of our visit prices are on pricing.

The Department of Health's guide and Regulation 138 don't mention a free certificate or a fee waiver, and we found no official program that offers one at no cost. If someone offers you a free or fully "online" certificate, check that an authorized doctor issues it at their authorized site.

The Department of Health's guide says the doctor issues the certificate "única y exclusivamente en el lugar autorizado", only and exclusively at the location the Department authorized. The issuing doctor needs a special authorization, the office is inspected, and the TB skin test is placed and read in person by the authorized doctor or their designated nursing staff.

That is why our part is the lab order: the certificate itself is not issued by video. Be wary of any website promising a complete certificado de salud "online". 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 TB test must be from the 3 months before the certificate 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, and the certificate is valid for one year.

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

These are different documents. Your employer's or school's own health form is a work and school medical certificate. A doctor's note (excusa médica) says you were sick: see doctor's note online. The DTOP-DIS-260 is the driver's license form, which needs a vision exam: see the driver's license medical certificate guide. For all of them in one place, see medical certificates in Puerto Rico.