This page is intended for software providers. It contains specific information for incapacity notifications sent by doctors to Medex through the eHbox of Medex. Incapacity notifications provide confirmation that a patient is unable to work during a period of time. These notifications are called “eMediAtt” (elektronisch medisch attest/attestation médicale électronique).

This page describes the process where eMediAtts are sent directly from the doctor’s software to the eHbox of Medex. Medex is the only destination of the eMediAtt. This process is in productions since April 2014.

For the multi-eMediAtt process, the business requirements for Medex have been adapted but haven’t changed fundamentally. The most important change is that the message must be sent to different destinations and how the different destinations must be defined. Therefor we refer to the documentation of eHealth for the multi-eMediAtt.

This page contains:


Incapacity notifications are currently submitted by “general practitioners”. This can be extended to other healthcare workers such as medical specialists in the future.

Overview of the flow of an eMediAtt

1. The doctor submits the eMediatt from the electronic medical dossier of the patient who visits him.
2. The incapacity notification is sent over the eHealth platform to the eHbox of Medex.
3. Notification process “in batch” by Medex ; notifications are processed every 5 minutes.
4. For every notification:
The system checks if the eMediAtt is valid.

a. If valid, the eMediAtt is sent to the Medex application and is processed automatically like a paper version of the incapacity notifications.
b. If not valid, the system sends the message of the eHbox to an administrative officer who will create the incapacity notification manually in the Medex application.

Presently Medex does not send back any specific return message to the doctor who sent an eMediAtt. A generic return message developed by eHealth is provided instead. The eHealth system can give the name of the recipient, the publication and reception time, as well as the read time of the recipient. In other words, this generic return message does not mean that Medex did really receive the message and process the eMediAtt.

For more information about the generic return message, see “Cookbook eHealthBox Consultation Web Service Version 3.0”:

It is important that the software vendor:

  • correctly configure the sending of our incapacity notifications to the eHbox of Medex and not to any other recipient
  • configure the software of the doctor so that he/she can consult the acknowledgement status of the messages sent by the doctor; in the same way, the doctor is informed of which recipient did receive and read the message at what time.

Medex will develop a specific return code later on so doctors can see if Medex correctly receives the messages and if Medex has processed the messages.

The system will create the incapacity notification automatically. If the incapacity notification cannot be created automatically, it will be done manually.

For the time being, an acknowledgment of receipt is sent to the employer of the patient once the absence notification is processed in the Medex system.

In the future the patient will receive an acknowledgement of receipt in his/her eBox.

 see image in PDF


Visual representation of an eMediAtt and correspondence of the fields to an eMediAtt

The software vendor is free to add a “Visual representation” of the data of an eMediAtt. This is optional and will only be used when the eMediAtt cannot be processed automatically.

The “Visual representation” is based on the existing paper certificate for Medex.

In order to help the software vendor in creating the correct XML files for the different variations of an “incapacity notification” for Medex, a correspondence document between the Dutch version of the “visual representation” of the data of an eMediAtt and the eMediAtt itself can be found here. Indications of XML tags are added in green and potential field contents are added in red.

Those documents are only a supplement to the requirements document, knowing that the requirements must be fully met.


The business requirements for Medex

In order to reduce manual interventions, software providers are asked
- to implement the business requirements requested by Medex in their software, and
- to test their software before going life.


Examples of correct XML files

Correct examples of XML files for the different incapacity reasons can be found below. The examples contain all mandatory fields. The XML files can contain more non-mandatory fields. For the Multi e-MediAtt process the incapacity reason “hospitalisation” is not admitted any more. And the incapacity reasons “accident” and “traveltofromworkaccident” are added. Medex accepts currently for compatibility reasons the old and new values. See details in the business requirements for Medex.


Test environment - Test Scenarios

Medex has a testing environment and requests that software providers test their software before going life.

The messages have to be sent to Medex’s eHBox. The destination context properties are: 
- type                = EHP

- quality           = INSTITUTION_EHP

- id                   = the eHbox ID of Medex (this ID can be requested by contacting the Medex IT service on the following address:

The following document contains the URLs necessary to reach the test environment. It contains also the different scenarios that must be executed to prove that software is compliant with the requirements for Medex.

The software provider can execute the tests independently. Software providers can send their test files to the test environment. They have to request the Medex IT service to start the processing of messages in the eHbox, as it does not start automatically. They will receive an answer from the Medex IT service by mail.

The software provider can also execute the tests during a so-called “mini-lab” organized by eHealth and Medex.

In both cases the results must be noted down in the following Excel file. The results must be sent to 

Medex will verify the test results and the processing of the eMediAtt by the Medex system.

When tests are positive, the software can be adapted to send incapacity notifications to the production environment and can be distributed to general practitioners .