The first physician consulted by a victim of a criminal offence, or by a rescuer, completes this medical certificate for IVAC. It records the diagnosis, the expected consolidation, whether the person can carry on their usual activities, and the planned follow-up and referral. It opens the medical side of an IVAC file, which continues with the Rapport médical (228) and ends with the Rapport final (229).
The first physician the victim or rescuer consults completes the whole form; IVAC says specialized nurse practitioners (IPS) also complete its medical forms. The victim's own application is the separate Demande de qualification (F_255 or F_254).
Download the current version from the source each time; forms change without notice.
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The first physician consulted by the victim of a criminal offence or the rescuer; IVAC says specialized nurse practitioners (IPS) also complete its medical forms. The certificate gives the diagnosis, the expected consolidation, whether the person can carry on usual activities, and the follow-up and referral planned.
Through RAMQ, using code 15795 printed on the form; physicians who do not participate in RAMQ tick the box provided. To be paid directly by IVAC, the physician must be registered as an IVAC supplier. The Rapport médical (228) and Rapport final (229) carry their own codes, 15796 and 15797.
The physician gives the copies to the victim or rescuer: one is for the Direction générale de l'IVAC (DGIVAC), one for the claimant and one marked Autre, and the physician keeps a copy for the file. IVAC also accepts documents from providers online, by fax or by mail.