Psychiatrist letter to an occupational physician (France): template

In France, a psychiatrist's letter to the occupational physician (médecin du travail) is a letter handed to the patient that describes what they can do and what would help them at work, to prepare a return or keep them in their job, without disclosing the content of psychiatric care. Only the occupational physician rules on fitness, unfitness and the adjustments to propose.

Why this is not a letter to the GP

With the patient's GP, you exchange within the care team and can share diagnosis, treatment and doses (see our French template for letters to the GP). With the occupational physician, the logic is reversed. They advise the employer and issue opinions that affect the employment contract. The French health authority (HAS) says so in its 2019 recommendation on job retention: the occupational health team and the other job retention actors « ne forment pas une équipe de soin » (do not form a care team).

Section III of article L1110-4 of the Public Health Code therefore applies: sharing information needed for a person's care between professionals who are not in the same care team « requiert son consentement préalable, recueilli par tout moyen » (requires their prior consent, obtained by any means). Section IV adds that the person can object to this sharing at any time. In practice, the patient decides whether the letter exists, what it says and whether they hand it over.

When to write to the occupational physician (2026 rules)

The 2022 reform brought the occupational physician in earlier, and a June 2026 decree changed the return-to-work visit.

• Liaison meeting (from 30 days of sick leave). It brings together the employer, the employee and the occupational health service to inform the employee about job retention measures (article L1226-1-3 and article D1226-8-1 of the Labour Code). It is not a medical examination; your letter has no place there. The patient may decline: the law states that no consequence may be drawn from that refusal.
• Pre-return visit (sick leave of more than 30 days). Workers on sick leave for more than thirty days « peuvent bénéficier d'une visite de préreprise » (may have a pre-return visit, article R4624-29). This is the best moment for your letter: the leave is ongoing, nothing is decided, and the occupational physician can recommend workstation adjustments, redeployment or training (article R4624-30). The same article provides that the employer is told the examination is taking place unless the employee objects, which is worth knowing for a patient who values discretion.
• Return-to-work visit. It is due in particular after at least sixty days of absence for non-occupational illness or accident, on the day of return and at the latest within eight days (article R4624-31). Since decree no. 2026-503 of 12 June 2026, for sick notes issued from 15 June 2026, it is no longer required if a pre-return visit took place in the 30 days before the return and the occupational physician concluded that no adjustment was needed, unless the employee, the employer or the occupational physician asks for it (official fact sheet, updated 31 August 2026). For you: if an adjustment matters to your patient, say so at the pre-return stage.
• Visit at the employee's request, outside any sick leave. The employee may request a visit when they anticipate a risk of unfitness, to start a job retention process, and the request cannot lead to any sanction (article R4624-34). Useful for a patient who wants to keep their job but is worn out.

Often overlooked: the pre-return visit is organised at the initiative of the worker, the treating physician (médecin traitant), the health insurance medical services or the occupational physician (article L4624-2-4). If you are not the patient's registered GP, you are not on that list. We suggest the patient request it from the occupational health service, or go through their GP.

For therapeutic part-time work (temps partiel thérapeutique), the French health insurance website ameli states that it is prescribed by the GP, from 20% to 80% of working time, and that the arrangements are discussed with the employer and the occupational physician. Your letter can support the proportion and the progression.

What the psychiatrist writes, and what they leave out

The occupational physician does not need the diagnosis to act. They need to know what the employee can do, what they should avoid for a while and what will make the return easier. That is also what they can pass on to the employer, since they must never base their opinions on medical information (La Revue du Praticien, 2018).

Do write

• Current capacities in task terms: concentration on long tasks, tolerance of interruptions, tight deadlines, contact with the public.
• Temporary limits, with a review date: no night work, no on-call duty, no team management for a while.
• Suggested adjustments: therapeutic part-time work and its progression, fixed hours, partial remote work, a reduced scope, a check-in after four or six weeks.
• Any effect of treatment on alertness, if it matters for safety (driving, machinery), without naming the drug.

Do not write

• The detailed diagnosis, history, hospital stays, treatment and doses. If the patient wants a general term included (for example « anxiety disorder »), note that in the file.
• The story of the conflict, the name of a manager or colleague, or any legal label such as « workplace harassment ».
• A firm link between the symptoms and work. The French Medical Council's commentary on article 76 asks doctors not to attribute the health problems they observe to the family or work conflict the patient has described. If something comes from the patient, write it as such (« Mr X reports… »).
• An opinion on fitness or unfitness. The occupational physician declares an employee unfit, after a workstation study and discussion with the employee and the employer (article L4624-4). Write instead « a return to the previous position without adjustment seems premature to me ».

Full template to copy

The letter is in French, since it goes to a French occupational physician. Replace the items in brackets and delete any section that does not serve this patient. Short English glosses are in parentheses.

Header

Dr [Prénom Nom], psychiatre. [Adresse du cabinet]. [Téléphone, messagerie sécurisée de santé]. RPPS [numéro].

À l'attention du Dr [Nom], médecin du travail, [service de prévention et de santé au travail].

[Ville], le [date].

Objet : [Prénom Nom du patient], né(e) le [date]. Préparation de la [visite de pré-reprise / visite de reprise / visite à la demande du salarié]. (Subject: patient name and date of birth, preparing the pre-return / return / on-request visit.)

Body

Cher confrère, chère consœur,

Je suis [M. / Mme X] en consultation depuis [mois, année]. Ce courrier est rédigé à sa demande, avec son accord sur son contenu, et lui est remis en main propre afin qu'il vous le transmette s'il le souhaite. (Seen since [date]; written at the patient's request, content agreed, handed to them.)

Son état de santé a justifié un arrêt de travail depuis le [date]. L'évolution est [favorable / partiellement favorable] et une reprise me paraît envisageable à partir du [date ou période], sous réserve de votre appréciation. (Sick leave since [date]; return possible from [period], subject to your assessment.)

À ce jour, je constate en consultation : [capacités conservées] ; et des difficultés persistantes pour [tâches longues sans pause, interruptions fréquentes, délais très courts, contact avec le public]. (Current capacities and persisting difficulties, in task terms.)

Pour favoriser une reprise durable, les aménagements suivants me sembleraient utiles, si l'organisation le permet : (Suggested adjustments:)

• [reprise en temps partiel thérapeutique à X %, avec progression sur Y semaines] ;
• [horaires fixes, pas de travail de nuit ni d'astreinte pendant Z mois] ;
• [périmètre de tâches réduit au début, sans management d'équipe] ;
• [un point d'étape avec vous à quatre ou six semaines].

[Si utile : le traitement en cours peut diminuer la vigilance en début de journée, ce qui mérite votre attention pour la conduite de véhicules.] (Optional: effect of treatment on alertness, if relevant for driving.)

Je reste à votre disposition pour en parler, avec l'accord de [M. / Mme X]. Bien confraternellement, Dr [Nom].

On the envelope: Confidentiel. Pour le Dr [Nom], médecin du travail. Remis au patient.

Short version, to support a pre-return visit

Cher confrère, chère consœur, je suis [M. / Mme X] depuis [date]. À sa demande, je vous signale qu'une visite de pré-reprise me paraît utile pour préparer son retour, prévu vers le [date]. Une reprise progressive, avec [aménagement principal], favoriserait à mon avis un retour durable. Ce courrier lui est remis en main propre. Je reste disponible pour échanger avec son accord. Bien confraternellement, Dr [Nom]. (A pre-return visit seems useful; a gradual return with [main adjustment] is advised; letter handed to the patient.)

Filled-in fictional example

Fictional case: Claire L., 41, project manager at a services company, on sick leave for four months after a depressive episode that followed a long period of overload. She wants to go back but dreads back-to-back meetings and constant interruptions. She agrees to the letter but not to the diagnosis being mentioned.

The letter from Dr Paul Martin (fictional) to Dr Durand, occupational physician:

• Course: seen since February, sick leave since 3 June; a return seems possible in early October, subject to the occupational physician's assessment.
• Observations: good capacity for structured tasks and small-group work; persisting difficulty sustaining attention for long periods and handling frequent interruptions. Ms L. reports marked fatigue at the end of the day in busy weeks.
• Suggested adjustments: therapeutic part-time at 50%, then 80% after one month if progress allows; two days of remote work per week during the return; a single project at first, with no team management; a check-in at six weeks.

Deliberately left out: the diagnosis, the treatment, her manager's name, and any sentence about the cause of the episode.

Common mistakes

• Copying the GP letter, with diagnosis, history and doses. These words may travel far.
• Writing « burnout caused by Mr Y's management » or « harassment ». A letter between doctors is part of the medical file; the patient can obtain it and produce it before an employment tribunal. In 2019, Le Quotidien du Médecin reported the case of a psychiatrist who, in a letter to the GP of an employee dismissed as unfit, linked work stress to blood pressure spikes. Having not observed that link himself, he faced possible disciplinary proceedings before the Medical Council.
• Stating as fact what is only probable, such as a fixed return date. The commentary on article 76 reminds doctors not to assert what is only probable. Give a period and a review point.
• Copying the employer or HR. We advise against it, even at the employee's request: translating your suggestions without medical data is the occupational physician's job.
• Keeping no trace of the patient's agreement and of the version handed over. No text requires written consent, but a note in the file will help if anything is disputed.

Checklist before handing over the letter

• The patient asked for or agreed to the letter, read it with you, and this is noted in the file.
• No diagnosis, treatment or history unless they explicitly want it.
• No blame on the employer or a colleague, and the patient's statements are attributed to the patient.
• Capacities and limits described in terms of tasks, each adjustment with a review date.
• No opinion on fitness or unfitness.
• Letter dated, signed, handed over in a sealed envelope marked confidential, copy in the file.

Why Delta suits this letter

Delta is the clinical assistant that keeps the memory of each patient: the summary of care and its progress sit in one place, so you describe current capacities from actual sessions, not from memory. It drafts the letter in your own vocabulary and structure; you review it and remove anything that should not leave your practice. Data is hosted in France by an HDS-certified host, and the patient's name is pseudonymised before the AI. See also our clinical document templates and in French our pages on software for psychiatrists and the psychiatric consultation report.

Sources

• French Public Health Code, article L1110-4, Légifrance, version in force since 4 August 2021.
• French Labour Code, articles R4624-29, R4624-30, R4624-31 and L4624-2-4, Code du travail numérique, Ministry of Labour, and the official fact sheet on medical visits after sick leave, updated 31 August 2026.
• French National Medical Council, article 76 and commentary (updated February 2024) and article 4 on professional secrecy.
• HAS, Health and job retention, recommendation published 15 February 2019.
• Touïl L., Manaouil C., Avec qui et comment le médecin du travail doit communiquer, La Revue du Praticien, April 2018.