Your first visit to the medico di base

Who can enrol in the SSN and get a medico di base?

Enrolment is either obligatory or voluntary, and the difference decides whether you pay. Non-EU citizens with a permit for employment or self-employment, registered job seekers, family members, asylum seekers and several other groups are enrolled free of charge, as are all minors whatever their status¹. EU citizens who live and work in Italy, with their dependants, are enrolled as a right; a short stay is covered by the EHIC card from home⁴.

If you are staying more than three months and none of that applies, for example a student, an au pair, or a retiree on an elective-residence permit, the law requires private insurance or voluntary enrolment against a yearly contribution². Tourists, and people who came to Italy on a permit for medical treatment, cannot enrol voluntarily either². The permit for treatment granted under article 19, comma 2, lettera d-bis of the immigration code is a different case: it carries obligatory enrolment, free of charge¹.

Voluntary enrolment runs on the calendar year, cannot be split, is not retroactive, is paid with the F24 form, and does not give you the European health card². The amount depends on income. ASL Roma 1 publishes the schedule: a minimum of 2,000 euro a year, up to 2,788.87 euro at the top band; 700 euro for students with no income beyond scholarships; 1,200 euro for au pairs³.

How do you enrol at the ASL and get the tessera sanitaria?

Go to the ufficio scelta e revoca of the ASL for the comune where you are resident, or, if you are not yet registered as resident, where you actually live according to your permit¹. Bring your residence permit or the post-office receipt for its renewal, a self-certification of residence or a declaration of where you live, and your codice fiscale¹. For voluntary enrolment, add the F24 receipt and an income declaration, and students their proof of enrolment³.

You choose your doctor at the same desk. Once the ASL enters you in the system, the tessera sanitaria is produced automatically and posted by the Ministry of Economy to the address held by the tax office⁶. It is free and strictly personal, and it carries your codice fiscale⁵. For foreign residents it lasts as long as the residence permit and is renewed at the ASL with it; otherwise it lasts six years⁵⁶. You need it at the doctor, at the pharmacy, and when you book a test⁶.

How do you choose or change your medico di base?

The choice is limited to doctors in your own comune who have not yet filled their list; the district desk holds the list of those available⁷. Each doctor's contract caps the list at 1,500 adult patients, and the national average is around 1,324¹⁰. A doctor can decline you, but must give the reason in writing⁷. The ASL has the names, addresses and surgery hours; ask at the desk, and ask neighbours too.

The choice renews itself every year, and you can change doctor whenever trust breaks down, as often as you need⁸. In Lazio you change at the district desk, online through the regional portal, or through someone with a signed proxy⁷; other regions have their own portal or app. Living somewhere temporarily for work or study, you can ask for a temporary doctor there for three months to a year⁷.

What does a visit to the medico di base cost?

Nothing. The Ministry lists the services of the medico di medicina generale and the pediatra di libera scelta among those with no ticket at all⁹. That covers the consultation, the prescription and the referral.

The ticket starts when the doctor sends you onward. For specialist visits, laboratory and imaging tests, you pay the tariff of each item up to a ceiling of 36.15 euro per prescription, and one prescription can carry up to eight items from the same branch, except physiotherapy⁹. A non-urgent emergency-room visit, a white code, also carries a ticket, though not under fourteen⁹. Exemptions exist for low income combined with age, chronic and rare conditions, recognised disability and pregnancy; the exemption card comes from the ASL¹⁹.

Medicines are a regional matter. Nationally the ticket on drugs was abolished in 2000, but most regions charge a fixed amount per prescription or per box, and if you ask for the brand instead of the generic you pay the difference⁹.

The doctor is also the gatekeeper: family doctors assess the real need and regulate access to everything else the SSN offers¹⁰. A specialist appointment starts here, not with a call to the hospital.

How do you book the first visit, and what will the doctor ask?

Every doctor keeps surgery hours, l'orario di ambulatorio, which the ASL publishes along with the hours reserved for appointments⁸. Some hours are walk-in, some by appointment. In Tuscany the doctor must be reachable by phone from eight to ten on weekdays⁸; elsewhere the rhythm is similar. Call then, give your name, and say it is your first visit.

In the room, lead with the symptom and how long it has lasted. The question you will hear is «Da quanto tempo?», for how long, and the answer the doctor wants is a timeline, not a diagnosis. Use Lei with the doctor.

How do you get the prescription after the visit?

Prescriptions are electronic. The national system assigns each one a number, the NRE, and the doctor hands you a paper slip, il promemoria, with the details¹¹. At the pharmacy you give the slip and your tessera sanitaria⁶; the pharmacist retrieves the prescription with the NRE and your codice fiscale printed on the slip, and it can be dispensed once, anywhere in Italy¹¹.

The old red paper prescription survives in a few cases: narcotics, home visits, and when the doctor's system is down¹¹. A referral for a specialist or a test works the same way, and you book it through the channels your region sets, which the ASL will explain¹.

What does the first visit sound like?

1. DottoressaBuongiorno, si accomodi. È la prima volta che la vedo, mi racconti.Good morning, have a seat. It's the first time I've seen you, tell me.
2. YouBuongiorno, dottoressa. Da circa tre settimane mi sento stanco e dormo male.Good morning, doctor. For about three weeks I have felt tired and slept badly.
3. DottoressaCapisco. Da quanto tempo va avanti questa stanchezza? Ha già fatto delle analisi?I see. How long has this tiredness been going on? Have you already had tests?
4. YouNo, non ancora. Vorrei capire se serve fare delle analisi o un esame.No, not yet. I would like to know whether I need tests or an examination.
5. DottoressaLe prescrivo le analisi del sangue. Le stampo il promemoria.I'll prescribe blood tests. I'll print the slip for you.
6. YouGrazie. Devo pagare il ticket?Thank you. Do I have to pay the co-payment?
7. DottoressaDipende dalla sua esenzione. Lo chieda quando prenota.It depends on your exemption. Ask when you book.
8. YouVa bene. Grazie, arrivederci.All right. Thank you, goodbye.