Sick Leave & Doctor's-Note Rules in San Francisco

San Francisco passed the first paid sick leave law in the United States: voters approved it in 2006 and it took effect in February 2007. The Paid Sick Leave Ordinance (PSLO) still governs sick time for people who work in the city, and it sets clear limits on when an employer can demand a doctor’s note. This guide explains the 2026 rules, when documentation can actually be required, and how a note from a licensed physician fits in. It’s general information, not legal advice.

What the PSLO gives you

The ordinance covers essentially everyone who works in San Francisco, including part-time and temporary employees. You accrue one hour of paid sick leave for every 30 hours worked, starting on your first day (you can begin using it on your 90th day). Rather than an annual grant, the law caps the balance you can bank at one time:

• 10 or more employees: up to 72 hours.
• Fewer than 10 employees: up to 40 hours.

Unused hours roll over from year to year. Once you use some and drop below the cap, you keep accruing back up to it. There’s no separate limit on how many hours you can use in a year, as long as you have the balance.

When can a San Francisco employer require a doctor’s note?

The rule is firm. Under the city’s official PSLO rules, requiring a doctor’s note or other documentation for three or fewer consecutive workdays is deemed unreasonable, meaning your employer can’t do it. Documentation can only be required for an absence of more than three consecutive workdays.

There are two narrow exceptions where a note may be requested even for a shorter absence: a documented pattern or clear instance of abuse of sick leave, and time used to attend a scheduled appointment. Outside those, short absences need no note.

Just as important is what the note can say. San Francisco’s rules state that a verification measure is not reasonable if the employer requires more information than is necessary to confirm the absence was a proper use of sick leave. The city’s own example: a note saying an employee “will be unavailable for work for one week due to a medical operation” is legally sufficient, and the employer may not require any further detail about the type or purpose of the operation. Employers also have to follow federal and state medical-privacy laws. So an employer can confirm your absence qualified, but cannot compel you to disclose your diagnosis.

Who enforces it, and how state law interacts

The PSLO is enforced by the San Francisco Office of Labor Standards Enforcement (OLSE), which investigates complaints, can order restitution and penalties, and protects workers from retaliation. Employees can also pursue a private lawsuit.

San Francisco workers are also covered by California’s statewide paid sick leave law (the Healthy Workplaces, Healthy Families Act), which since 2024 lets employees use at least 40 hours, or 5 days, per year. When local and state rules both apply, the employer must provide whichever benefit is more generous to the employee. The PSLO’s documentation limit, more than three consecutive workdays, continues to govern within the city. For the wider state context, see our overview of California doctor’s-note laws.

How an online doctor’s note fits in

Because a San Francisco employer can only ask for documentation after more than three consecutive sick days, most short absences require no note at all. When a longer absence does trigger a request, what your employer is entitled to is narrow: confirmation that the time off was a covered use of sick leave, not your diagnosis or medical details.

A note from a physician licensed in California can meet that need whether the evaluation happened in person or through a legitimate telehealth review. What makes a note valid is that a real, licensed clinician genuinely assessed your situation, not whether it was issued online or on paper. A document that simply states you were seen and that time off was appropriate gives your employer everything the PSLO allows it to ask for.

A few practical pointers for San Francisco workers:

• For three consecutive workdays or fewer, you generally don’t owe a note; the city deems requiring one unreasonable.
• Keep any note minimal. You’re not required to disclose what was wrong with you, and the ordinance backs you up.
• If your employer’s policy seems to overreach (for example, demanding a diagnosis), the OLSE is the place to raise it.

Common misunderstandings

A frequent mistake is assuming an employer can ask for a doctor’s note any time you call in sick. In San Francisco it generally cannot: requiring documentation for three or fewer consecutive workdays is deemed unreasonable, so most short absences need nothing at all. Another is believing the note has to spell out your condition. The city’s own example makes clear it doesn’t. A note saying you’ll be out for a medical reason for a set period is sufficient, and your employer may not press for the type or purpose of the treatment.

It’s also worth separating the PSLO from other kinds of leave. Paid sick leave under the ordinance is distinct from federal family or medical leave, state disability insurance, and workers’ compensation, each of which has its own forms and eligibility rules. CuroNote’s guides, and any note a licensed physician might issue, are about routine sick-time documentation for work or school, not those programs. If your situation involves a serious or extended condition, that’s a matter for your own physician and, where appropriate, an employment attorney.

What to do if you’re asked for a note

If your employer requests documentation after a qualifying absence of more than three consecutive workdays, you can respond without oversharing. Provide a note that confirms only what’s needed, that you were seen and that time off was appropriate, and decline requests for medical specifics, which the ordinance does not permit. If you believe your employer is requiring notes for short absences, demanding a diagnosis, or otherwise overstepping, you can contact the OLSE, which investigates complaints and protects workers from retaliation. Keeping a copy of what you submit, along with the relevant dates, is good practice should a dispute arise later.

CuroNote is preparing to launch online doctor’s-note services and is not yet issuing notes. This page exists to help you understand your rights under San Francisco law in the meantime. For related reading, see do you actually need a doctor’s note?, can employers verify a note?, and are online doctor’s notes legal?.