Referral 2026: when you need one and when you DON'T

You need a bilet de trimitere (referral) for most consultations with a specialist doctor covered by CAS (national health insurance), but NOT for emergencies, for certain specialties with direct access and, increasingly, for chronic patients already on record. The document is valid for 30 days for acute and subacute conditions and up to 90 days for chronic ones. It is usually issued by the medic de familie (family doctor). Below you’ll see exactly when you need it and when you can go straight to the specialist.

What the referral is for

The referral is the document by which you are directed from the family doctor (or from a specialist) towards:

• a consultation with an outpatient specialist doctor;
• paraclinical investigations — laboratory tests and imaging (ultrasound, X-ray, MRI, CT);
• hospital admission, other than emergencies.

Its role is twofold: it ensures continuity of care (the specialist knows why you were referred) and it conditions reimbursement from the insurance fund — without a valid referral, CAS does not pay for the consultation, and you bear it in full.

Validity: 30 vs. 90 days

The rule worth remembering:

• Acute and subacute conditions → 30 days from the issue date;
• Chronic conditions → up to 90 days.

After it expires, the referral can no longer be used, even if you didn’t manage to book. If the term has passed, you ask for a new referral. The appointment date must fall within the validity period, not just your request for it.

When you DON’T need a referral

This is the point that creates the most needless queues. You don’t need a referral in the following situations:

1. Medical-surgical emergencies

You never need a referral for an emergency. You go directly to the emergency room or the Emergency Reception Unit (UPU). Conditioning an emergency on a referral would be illegal.

2. Specialties with direct access

The CNAS framework contract provides a range of services that the insured person reaches without a referral. Usually, these include:

• family planning;
• psychiatry (in certain situations provided by the rules);
• infectious diseases;
• the monitoring of some chronic diseases with a special regime (for example oncology, diabetes, HIV/AIDS, TB).

The exact list is updated periodically — you’ll find it in the framework contract and the CNAS rules published on cnas.ro.

3. Chronic patients with direct access (new)

Increasingly, patients with chronic diseases already on record benefit from direct access to the specialist doctor, without a referral, for the condition being monitored. These situations are regulated by Annex 13 to the CNAS framework contract.

The logic is simple: if you’re already on record with a cardiologist for a chronic condition, it no longer makes sense to stop by the family doctor every month just for a piece of paper. Because the list of conditions with direct access changes, check the version in force on cnas.ro before booking.

When you DO need a referral

• The first presentation to an outpatient specialist for a new condition, covered by CAS;
• Covered laboratory tests and imaging;
• Planned (non-emergency) admissions.

If you want to avoid the referral, you can always go to a specialist as a private patient, paying for the consultation — but then you give up reimbursement from the insurance fund.

Referral for a consultation vs. referral for investigations

It’s worth telling them apart, because they are two distinct documents:

• The referral for a consultation directs you to a specialist doctor.
• The referral for paraclinical investigations sends you directly to a laboratory or imaging (blood tests, ultrasound, X-ray, MRI, CT), without an intermediate consultation.

A specialist can, in turn, issue a referral for investigations within the condition for which they’re treating you. Each type of referral has its own validity and its own ceiling of covered services, so check what exactly is ticked on the document.

What to do if the referral is missing or wrong

A few common situations and how to solve them:

• The referral expired before you could book → you ask for a new referral; it cannot be “reactivated”.
• The data is wrong (personal ID number, diagnosis code, specialty) → ask for a correction before booking, otherwise the service may be rejected at reimbursement.
• You don’t have a family doctor → you can register with one; until then, you go to the specialist as a private patient or, for a genuine need, to the emergency room.
• You’re a chronic patient on record → check whether your condition appears on the direct-access list in Annex 13, so you don’t needlessly ask for a referral every month.

Who issues the referral

Most often, the referral is issued by the family doctor with whom you’re registered. But an outpatient specialist doctor can also issue it, when referring you further to another specialty or for investigations.

If you don’t yet have a family doctor or you’re looking for a specialist in town, you can use our directory to quickly find a family doctor in Cluj, a cardiologist or any of the available specialties.

Quick summary

• Validity: 30 days (acute/subacute), up to 90 days (chronic).
• You don’t need one for: emergencies, specialties with direct access, some chronic diseases on record.
• You need one for: the first covered specialist consultation, covered tests and imaging, planned admissions.
• Without a referral, you can only go to a specialist by paying in full.

Sources

• The framework contract on the conditions for providing medical assistance within the social health insurance system — CNAS — cnas.ro
• Annex 13 to the methodological rules for applying the framework contract (direct access to a specialist for chronic conditions) — cnas.ro
• Cluj Health Insurance House — casjcluj.ro
• Law 95/2006 on healthcare reform — legislatie.just.ro