Spanish Hospital Discharge Process for Expats — Informe de Alta

Leaving a Spanish hospital is not just about feeling better — it is about walking out with the right paperwork. The informe de alta is the single most important document of your stay, and it controls everything that happens next: follow-up, prescriptions, insurance claims and your records back home.

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Alta Hospitalaria: What Discharge Actually Means in Spain

Alta hospitalaria is the formal moment a Spanish hospital releases you from inpatient or Urgencias care. It is more than a doctor saying "you can go home" — it is a regulated administrative act under Ley 41/2002 de autonomía del paciente, which guarantees every patient the right to a written discharge report.

Article 15 of that law is the one to remember: it sets out exactly what the informe de alta must contain — diagnosis, treatment given, clinical evolution, and the follow-up plan. The Ministerio de Sanidad publishes national guidelines that every public and private hospital must respect, regardless of region.

For expats, the informe is also your translation bridge: it is the document your insurer back home, your travel insurer, your new GP in Spain or any private specialist will rely on. Walking out without it — or losing it on the way home — is one of the most common mistakes new arrivals make.

Art 15Ley 41/2002 — your legal right to a written informe de alta

4 sectionsDiagnosis, treatment, evolution, follow-up plan

2 copiesOne for you, one for your centro de salud

5 yearsMinimum hospital retention period for your records

What's Covered in This Guide

From the exact contents of the informe de alta to ambulance transport home and reclaiming costs across borders, here is everything an expat needs to handle Spanish discharge confidently.

Informe de Alta Contents

The four mandatory sections under Ley 41/2002 Art 15 — diagnosis, treatment, evolution and follow-up plan with prescriptions.

Translation for Insurance

How to get a sworn (jurada) translation for travel insurance claims and English-speaking medical records abroad.

UCM Transporte Sanitario

Non-urgent ambulance home after discharge — how it is authorised, who pays, and when private cover steps in.

Seguimiento at Home

Private follow-up care with Sanitas or Caser — home nursing, physiotherapy and tele-consults during recovery.

S1 Cross-Border Reclaims

EU residents with an INSS S1 form — how costs flow between Spain and your home country.

Mistakes Expats Make

From walking out without a follow-up appointment to losing the informe before the insurance deadline.

What the Informe de Alta Must Contain

Spanish law fixes the minimum content of your discharge report. The Ministerio de Sanidad directrices and Article 15 of Ley 41/2002 set out a standard structure that hospitals across all 17 autonomous regions follow.

Patient and hospital identification. Your full name, NIE or passport number, date of birth, hospital name, ward, attending physician's number (número de colegiado) and admission/discharge dates.
Reason for admission (motivo de ingreso). The presenting complaint that brought you in — chest pain, fall, fever, planned surgery. This is what your insurer reads first.
Clinical history summary (antecedentes). Your relevant past medical history, allergies, current medications and lifestyle factors recorded during the stay.
Diagnosis (juicio clínico or diagnóstico principal). The final diagnosis in plain Spanish and the ICD-10 (CIE-10) code — the international classification used worldwide, which makes translation straightforward.
Procedures and treatment given (tratamiento realizado). Surgery, medications administered, transfusions, imaging, intervention dates and names of the lead surgeons or specialists.
Clinical evolution (evolución). A narrative of how you progressed during the stay — complications, improvements, response to treatment.
Discharge condition and follow-up plan (recomendaciones al alta). What state you left in, lifestyle and medication recommendations, when and where the follow-up appointment is, and any warning signs to return for.
Prescription (receta) at discharge. New medication should be issued on the receta electrónica linked to your TSI so any pharmacy can dispense it — or as a private receta to use at any farmacia.

Always check before signing: read the diagnosis line, the medication list and the follow-up date. If anything is missing or wrong, ask the nurse to correct it before you leave the floor — reissuing later means returning to medical records in person.

Translating Your Informe de Alta for Insurance & Records Abroad

Most expat clients need an English version of the informe at some point — for a travel insurer, an employer's sick-leave policy or a GP back home. There are three routes, depending on who needs to read it.

Informal translation for personal use. Google Translate or DeepL handles most of the informe well, because the structure is standardised and the ICD-10 codes are universal. Fine for sharing with family or your GP at home for context.
Insurer translation for a travel insurance claim. Most travel insurers accept the Spanish original plus a translated summary you provide. Your insurer's claims team will often have an in-house translator — check before paying for one yourself.
Sworn translation (traducción jurada) for legal or official use. When the document needs to be filed with a court, a visa office, an embassy or a foreign social security agency, you need a traductor jurado certified by the Spanish Ministry of Foreign Affairs. Cost runs €40-€90 per page, two to five working days.
Hospital-issued bilingual reports (private only). Some private hospitals working with international patients — Sanitas Hospitales, certain Caser-network clinics — will issue an English-language version on request, especially if your stay was paid via your insurer's hospital authorisation.
Keep a digital copy. Take a clear photo of every page the moment you leave. Cloud-back it. Lost informes are the single biggest reason claims are delayed weeks.

Getting Home: UCM Transporte Sanitario & Non-Urgent Ambulance

Spain runs a parallel non-urgent ambulance service called transporte sanitario no urgente, delivered by Unidades de Atención Domiciliaria and contracted UCM (Unidades de Cuidados Mixtos) providers. It exists precisely for the moment after discharge — when you need to get home but cannot reasonably manage a taxi.

Who authorises it. The discharging doctor signs a solicitud de transporte sanitario if you cannot walk unaided, are post-surgical, have mobility loss, are on oxygen, or live more than a manageable distance from the hospital.
What it covers. Stretcher or wheelchair transport door-to-door, often with a sanitary technician on board. Crews are trained for basic monitoring but not for full pre-hospital emergency care.
Public service cost. Free for TSI-holders when authorised by the hospital, including for expats with an S1 or full SNS access. Without authorisation, you pay privately.
Private hospital discharge. Sanitas and Caser both cover medically authorised non-urgent ambulance home as part of standard hospitalisation cover. Check whether your specific policy includes it as standard or as an add-on.
Routine private transport. If your discharge does not meet the clinical criteria but you simply cannot manage public transport, a private ambulance booking runs €90-€180 within a city — sometimes worth it after a long stay.
Cross-border repatriation. If your home country needs to be the destination — for example a UK national flying home for ongoing care — that is repatriation, not transporte sanitario. It sits under travel insurance, not health insurance, and must be pre-authorised by the assistance line.

Seguimiento: Follow-Up Care at Home or in Clinic

The seguimiento — clinical follow-up — is the part of discharge that most often goes wrong for expats. The hospital books your post-op or specialist review; the centro de salud picks up day-to-day recovery; and private cover layers home care on top.

Public seguimiento. Your discharge letter names a date for the revisión en consulta externa — the outpatient review with the same specialist team. The centro de salud handles wound checks, blood pressure monitoring, prescription refills and sick-note extensions.
Sanitas follow-up. Sanitas members can usually book a private specialist post-discharge review within days rather than weeks, plus access to Sanitas's home-care service (hospitalización a domicilio on certain policies) for nursing visits, IV drug administration and physiotherapy.
Caser follow-up. Caser's hospitalisation cover includes post-discharge specialist visits, home physiotherapy sessions within the policy limits, and access to its network of private clinics for any imaging or bloods the hospital requested.
Receta electrónica continuity. If the hospital issued prescriptions electronically via your TSI, every pharmacy in your region (and via cross-region pickup) can dispense them. Check the receta is active before leaving the hospital.
Sick leave (baja laboral). If you are employed in Spain, the discharge report is the basis for your sick-leave certificate. The hospital may issue the first parte de baja; the centro de salud reissues it weekly thereafter under INSS rules.
Telemedicine top-up. Sanitas and Caser both offer 24/7 GP video consults — useful for quick "is this normal post-op?" questions without a trip back to clinic.

Reclaiming Public-Hospital Costs: S1 Holders & Cross-Border Care

If you are a pensioner or posted worker registered in Spain via the INSS S1 form, your home country reimburses Spain for your public healthcare — you generally pay nothing. But the paperwork matters, and there are scenarios where reclaiming costs becomes your job.

The S1 in practice. S1 holders get a TSI like any Spanish resident and access public hospitals on the same terms. The financial flow happens behind the scenes between the UK NHS Business Services Authority (or other national body) and Spain via Brussels.
When you get billed by mistake. If a public hospital admits you without correctly recognising your S1 status, you may receive an invoice. The fix is to take the bill, your S1 confirmation and TSI to the hospital's atención al paciente office and request the bill be voided and reprocessed.
EHIC/GHIC visitors. Tourists from EU/EEA or the UK use their EHIC or GHIC for emergency public care, including the hospital stay and the informe de alta. Follow-up care once they leave Spain is not covered — that is travel insurance territory.
Cross-border directive reimbursement. Under EU rules, you can sometimes pay privately abroad and reclaim from your home country up to the equivalent public cost. The informe de alta and itemised invoices are mandatory for the claim.
Non-EU expats. Americans, Canadians, Australians and other non-EU expats without Spanish public coverage must rely on private health insurance — or on travel insurance during the gap before residence approves. Without either, the public hospital may invoice you the full cost.
Always request an itemised invoice (factura desglosada). If you have any chance of reclaiming — from a home-country insurer, a foreign social security body or a travel policy — ask for the itemised bill before you leave. Reissuing it later from another country is painful.

Regional Discharge Protocols: How Your Region Handles It

Every autonomous region runs its own version of the discharge process — same legal framework, slightly different forms and apps.

SERMAS (Madrid). Discharge reports appear in the Tarjeta Sanitaria Virtual app within 24-48 hours. Follow-up appointments at consulta externa are booked at the time of discharge and shown in the app.
CatSalut (Catalonia). La Meva Salut stores your informe de alta digitally in both Catalan and Spanish. Home nursing follow-up (atención a domicilio) is coordinated through your assigned CAP (centro de atención primaria).
SAS (Andalucia). ClicSalud+ holds the digital informe. The SAS network has a strong continuidad asistencial programme for post-discharge follow-up of chronic conditions.
AVS (Valencia). GVA+Salut hosts the discharge documents. Valencia's hospitalización a domicilio programme is one of the most developed in Spain for early discharge with home medical support.
Other regions. Osakidetza, SERGAS, SACYL, SESCAM, SES, IB-Salut, SCS, Cantabria, Asturias, La Rioja, Murcia, Navarra and Aragón each run equivalent digital records — the legal entitlement to the informe is national, the app you read it in is regional.
Cross-regional discharge. If you were admitted in a region other than where your TSI was issued, you still get a full informe de alta. Forward the document to your home centro de salud manually — cross-regional automatic uploads are not always reliable.

9 Practical Tips for Spanish Hospital Discharge

Hard-won wisdom from expat clients who have been through it — including the things they wish someone had told them.

Do not leave the floor without the printed informe. Verbal "you can go home" means nothing. The signed, stamped paper or PDF copy is what your insurer, GP and pharmacy will demand.
Photograph every page before you leave the building. Hospital corridors have better light than your living room and you may need to share an image with your insurer that same day.
Confirm the follow-up appointment is actually booked. Ask: ¿Está ya la cita programada? — "is the appointment already scheduled?" If not, do it at the desk before leaving.
Check the receta electrónica is active. Walk past a pharmacy on the way home with your TSI and verify the system pulls up the prescription. Sorting it later means returning to the hospital.
Get a Spanish sick-note (parte de baja) if you work locally. Ask explicitly — it is not automatic. Without it, your employer cannot process your absence under INSS rules.
Ask for warning signs to return. The signos de alarma list at the end of the informe is not a formality — it tells you exactly when to come back. Read it before discharge so you can ask questions.
Use the patient advocate office (atención al paciente). Every Spanish hospital has one. They handle missing paperwork, billing errors, language issues, complaints and second copies of lost informes.
Translate the prescription label if you travel. Brand names differ across countries. The active ingredient (principio activo) is on every Spanish receta — useful for emergency dispensing abroad.
Call your insurer the same day if you have private cover. Sanitas and Caser both have 24/7 medical lines that can authorise immediate home physiotherapy, nursing visits or follow-up specialist appointments without delay.

6 Mistakes Expats Make at Spanish Hospital Discharge

The patterns we see again and again from clients new to the Spanish system.

Walking out without a follow-up appointment booked. The discharge letter may name a date but if it has not been entered into the consulta externa system, it is not real. Verify at the desk before leaving.
Losing the informe de alta. Paper copies disappear in the chaos of getting home. Without it, your travel insurance claim stalls, your home GP has no context and your sick leave cannot be extended.
Assuming the prescription transfers across borders automatically. The Spanish receta electrónica works only inside Spain. If you fly home, you need a paper printout of the active ingredient and dose to give to your foreign pharmacy.
Going home alone after surgery. Spanish hospitals expect a designated acompañante on discharge day, especially after sedation or anaesthesia. Without one, discharge can be delayed by hours.
Not asking for an itemised invoice when you are billed. A vague total invoice from a public hospital is almost useless for reclaiming under an S1, EHIC/GHIC or travel insurance. Always request factura desglosada.
Skipping the post-discharge GP visit. Even with a hospital-booked specialist review six weeks away, you should see your centro de salud doctor within a week of discharge to coordinate care, repeat prescriptions and pick up issues early.

Why Expats Trust 247 Expat Insurance for Health Cover in Spain

The right policy turns a stressful Spanish discharge into a seamless transition home, with private follow-up booked the same day. Here is why expats choose us.

DGSFP-Registered

We are a fully registered Spanish insurance brokerage under the DGSFP — the same regulator overseeing every legal insurer in Spain.

English Throughout

Every conversation, every policy document and every claim is handled in clear English by a real human, not a chatbot.

7 Days a Week

Weekend discharge, late-night follow-up question or stranded after surgery? Our team is reachable seven days a week, including bank holidays.

Sanitas & Caser

We arrange health cover with Sanitas and Caser — two of Spain's most established insurers, with deep private hospital and clinic networks nationwide.

Visa-Compliant Cover

Health policies that meet NLV, Digital Nomad and student visa requirements with full hospitalisation and no copays.

Claims Advocacy

If you ever need to claim or dispute a hospital bill, we deal with the insurer in Spanish on your behalf — one of the biggest reasons clients stay with us for years.

Frequently Asked Questions

The most common questions our clients ask us about Spanish hospital discharge and the informe de alta.

Is the hospital legally required to give me a written informe de alta?

Yes — Article 15 of Ley 41/2002 de autonomía del paciente obliges every hospital, public or private, to issue a written discharge report containing the diagnosis, treatment, evolution and follow-up plan. You also have the right to a copy of your full medical history on request.

Can I leave the hospital without signing the informe?

Yes, you can be discharged whenever you are clinically stable, but you should always read and accept the informe before leaving. If you leave against medical advice (alta voluntaria) you sign a different document acknowledging the risk — and your insurer may take that into account on any subsequent claim.

How long does it take to get an English translation for a travel insurance claim?

A sworn translation (traducción jurada) typically takes 2-5 working days and costs €40-€90 per page. Many travel insurers accept the Spanish original with a short summary you provide in English — always ask before paying for a sworn translation. Sanitas and Caser policyholders can ask the insurer's claims team for help.

Will the public hospital arrange transport home after discharge?

Only if you medically qualify for non-urgent transporte sanitario — for example, you cannot walk unaided, are on oxygen or are immediately post-surgical. The discharging doctor signs the authorisation. Otherwise you arrange your own transport, or use the home transport benefit included in many Sanitas and Caser hospitalisation policies.

What if I lose my informe de alta?

Visit the hospital's atención al paciente (patient services) office in person with your ID and TSI. They will reissue a stamped copy — usually the same day for recent discharges, longer for older records. Many regions also store the informe permanently in the regional health app (Tarjeta Sanitaria Virtual, La Meva Salut, ClicSalud+, GVA+Salut).

Does my Sanitas or Caser policy cover follow-up after a public hospital discharge?

Yes — private health insurance is fully usable for follow-up even when the original admission was in a public hospital. Most expats use the public system for the acute stay and switch to Sanitas or Caser for fast specialist review, home physiotherapy, imaging or surgery follow-up. Your insurer will need the public hospital's informe de alta to set up the case.

I have an S1 from the UK. Should I ever be billed by a Spanish hospital?

No — once your S1 is registered with the INSS and you hold a TSI, you are treated as a fully covered Spanish resident for public healthcare. If you do receive a bill, take it with your S1 confirmation and TSI to the hospital's patient services office to have it voided. Mistakes happen most often in the first few months after registering.

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