Graduated sick leave will become the norm. And when you deviate from it, it must be justified in the medical record. A small sentence in a large agreement – that lands right in your daily documentation.

In early June 2026, the state and the Medical Association some measures and a package of measures which will both strengthen the general practitioner system and contribute to reduced sickness absence. For you as a doctor issuing sick notes, there is one principle in particular that will have practical significance: Follow or explain. Graded sick leave should be the rule, and when you do write a full sick leave notification, it should be briefly justified in the patient's medical record.

This may sound undramatic. But anyone who has experienced documentation requirements grow over time knows that small additions to record-keeping rarely come alone. The question is how you arrange things so that the new requirement becomes a short, precise sentence in an already good note – not another thing that piles up.

What the agreement actually entails

The agreement from June 3rd has two main parts. The first deals with financing: the announced changes in patient-specific basic funding – removal of damping and phasing out of equalization grants – put on hold and introduced no earlier than January 1, 2027. A working group with an independent leader will examine the effects of the current model this autumn before anything is changed. For many general practitioners, this primarily means more predictability in the coming year.

The second part is the sick leave package. The principle behind it is that graded sick leave is the general rule, and deviations must be briefly justified in the patient's record. The fees have also been adjusted so that graded sick leave and alternatives to sick leave are compensated better than full sick leave. The government has described the measures in its discussion of measures to reduce sick leave, and the Minister of Health has announced a letter to all the country's general practitioners about the scheme. At the same time, it has been emphasized by both parties that the justifications should be brief and not lead to much additional work.

The intention is easy to understand: sick leave is costly to society, and research suggests that activity and partial work are often beneficial for the patient. At the same time, it is legitimate for many doctors who sign sick notes to feel that another documentation requirement is being added to an already full workday. Both can be true simultaneously – and that is precisely why it is worth setting up documentation smartly from the start.

The medical assessment is yours – the medical record shall show it

The new principle does not change who makes the decisions. The assessment of whether a patient can work part-time is, and remains, your medical assessment, made in conjunction with the patient. Follow or explain What is required is that the assessment is visible in the record when you get full sick leave: why is grading not applicable here, right now?

In practice, this is information you have already thought through during the consultation. The challenge is rarely the assessment itself – it's getting it down in the note while the reasoning remains precise. When the charting is pushed to the end of the day, details and reasoning fade, and the notes become thinner than the thought behind them. research on AI documentation One can see that the biggest gain is precisely where the follow-up work piles up. A justification written eight hours after the conversation quickly becomes a standard phrase. A justification captured while speaking with the patient actually becomes a justification.

This is how Medivox can be part of the solution

Medivox listens to the consultation and delivers a structured draft for the medical record – and what you say aloud with the patient about work, function, and grading is precisely what belongs in the justification. You can also dictate your assessment immediately after the consultation while the reasoning is fresh.

Because you build your own templates, you can include a fixed point in your sick leave notes: Assessment of grading. The structure then reminds you of the requirement, and the justification gets a fixed place in the memo – brief, precise, and retrievable if someone asks later. Privacy is protected: personal data is pseudonymized before the data is further processed, and all data processing takes place in Norwegian data centers. And as always: You own the journal and make the final assessment. Medivox documents your assessment – the tool does not participate in it.

Wondering about the guidelines for using AI in journalistic work? We've summarized them. Norwegian Directorate of Health's guidance for safe use of AI in documentation in its own post.

A breather – and an autumn of clarifications

The postponement of the base subsidy changes gives general practitioners a year with more predictable frameworks, and the working group's review this fall will show how the model is adjusted further. The sick leave package, on the other hand, takes effect now, and Follow or explain will become part of daily sick leave management going forward.

Perhaps the best way to approach it is to think like this: the requirement isn't asking you to write more – it's asking you to write more clearly. And clear documentation of your own assessments is good medicine anyway, both for the patient who needs to understand, for the colleague who takes over, and for yourself the day someone flips back through the medical record. How will you set up your notes for that?

Frequently Asked Questions

«Follow-up or explain» when on sick leave
Graded sick leave is the main rule. If you choose full sick leave, you must briefly explain in the patient record why grading is not applicable.

When are the changes to patient-specific baseline supplementation introduced?
The announced changes have been postponed and will be implemented no earlier than January 1, 2027. A working group will review the model in autumn 2026.

Does the reasoning in the journal have to be long?
No. It is emphasized that the justifications should be brief and not lead to much extra work. One precise sentence or two is the point.

Can Medivox help me assess whether a sick note should be graded?
No. The medical assessment is yours. Medivox helps you document the assessment you have made – for example, with a standard template for grading in the sick note.

Does speech-to-text work for short sick leave consultations?
Yes. Medivox is built for conversations of all lengths, and short consultations with clear assessments are well-suited for a structured draft.

Use Medivox for free – Get started completely free

Would you like a fixed bullet point for the grading assessment in your sick-leave notes? Contact us – then we'll show you how to set up templates that fit your practice.

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