If you live in Italy and use the public health system, sooner or later you’ll need an Impegnativa. This document is the official medical referral that allows you to book specialist visits, diagnostic tests, or access certain treatments through the Servizio Sanitario Nazionale (SSN). Understanding what it is and how to use it saves time, stress, and money.
👉 For a broader overview, see our main article: The Italian National Health System (SSN) Explained.
What Is an Impegnativa?
The Impegnativa, also known as Ricetta medica or just Ricetta, is a doctor’s prescription form issued within the public healthcare system. It’s the paper (or digital) document that authorizes you to receive medical services either free of charge or at a reduced cost, depending on your status. It confirms that the service is medically necessary and covered under the SSN.
You’ll need an Impegnativa for most specialist appointments, laboratory exams, diagnostic imaging (like X-rays or ultrasounds), and even some rehabilitation treatments.
Who Issues an Impegnativa?
Your Medico di Base (family doctor) or, in some cases, a specialist working in the public system can issue the Impegnativa.
Family doctors use a regional electronic system that prints or transmits the referral directly to the ASL database. You can also request a paper copy if you need to carry it in person.
When the doctor fills it out, they’ll indicate:
- Your personal details and health card number (Tessera Sanitaria)
- The type of service or visit you need
- The clinical motivation (diagnosis or suspected condition)
- The priority level (urgency category)
- The doctor’s signature and regional code
What Can You Do With It?
Once you have an Impegnativa, you can book your visit or exam through the CUP (Centro Unico di Prenotazione) system — either online, by phone, or in person at the CUP counter of your local ASL.
Each region manages its own system, but generally you’ll need to provide:
- Your fiscal code or health card number
- The code written on the Impegnativa (often called the “codice impegnativa”)
- The type of exam or visit requested
- Your preferred date or location
Once the booking is complete, you’ll receive confirmation of the appointment, including date, time, and facility name.
Does It Give You Access to Free Care?
An Impegnativa gives you access to services covered by the SSN. Whether they are completely free depends on your income category and the type of exam.
Most citizens pay a ticket, a small co-payment that helps fund the healthcare system. However, some categories — such as children, the elderly, pregnant women, low-income individuals, or those with chronic illnesses — may qualify for full exemption.
If you qualify, the exemption code (for example, E01, E02, E03) will appear directly on your Impegnativa.
How to Read an Impegnativa
Though it may look confusing at first, an Impegnativa follows a standard structure. You’ll find:
- Patient information – name, birth date, and fiscal code
- Diagnosis field – brief medical justification for the request
- Requested service – description and code for the test or visit
- Exemption code – if applicable
- Priority class – labeled as U (Urgent, within 72 hours), B (Short, within 10 days), D (Deferred, within 30 days), or P (Planned, within 120 days)
Understanding these fields helps you verify that the referral is correctly filled and valid for booking.
How to Book a Visit After You Have It
You can book the visit by:
- Calling your regional CUP hotline
- Using the online portal (most regions have one)
- Visiting your local ASL counter
- Booking through pharmacies that offer CUP services
Bring your Tessera Sanitaria and the Impegnativa (paper or digital). At the appointment, you’ll usually present both documents again. If there’s a ticket to pay, you can do it at the ASL, pharmacy, or online.
After the visit, results are often sent digitally to your doctor’s system or given to you in paper format.
Key Takeaways
- The Impegnativa is a referral required for most public healthcare visits and tests in Italy.
- It’s issued by your Medico di Base or a public specialist.
- You use it to book through the CUP system.
- It grants access to subsidized or free care under the SSN.
- Learning to read and use it helps avoid delays and unnecessary costs.
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What Is an Impegnativa in Italy (2025 Guide)
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Learn what an Impegnativa is in Italy, how to get one, who issues it, and how to use it to access doctors, tests, and free or reduced-cost healthcare.
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Italian Ministry of Health