CNESST uses this post-consolidation report to calculate the percentage of permanent impairment to physical or psychological integrity, and the functional limitations you describe let it determine the worker's capacity to work. It follows a Rapport final that answered Oui to impairment or limitations and covers 12 points, from diagnosis and examination to a Bilan des séquelles coded under the Règlement sur le barème des dommages corporels.
The health professional who has charge of the worker completes it first; if they will not, they refer the worker, with the worker's agreement, to another professional whose REM then counts as the treating professional's. CNESST lists assessing permanent impairment among the IPS's roles, and IVAC uses this same CNESST form for crime victims.
Complete every box: surname as on the birth certificate, first name, address, telephone, health insurance number, date of birth and CNESST file number (N° de dossier). For the Date de l'événement, enter the accident date or, for an occupational disease, the date of the consultation where it was first diagnosed. For a recurrence, relapse or aggravation, also enter the date it appeared.
Enter your name, first name, address, city, province, postal code, telephone and licence number (N° de permis). The instructions single out the Date de l'examen: record the date you examined the worker for this evaluation. It is a separate field from the date you sign the report in section D.
Point 1: the diagnosis or diagnoses of the injury accepted by CNESST. Point 2: a summary of the event and its course, current symptoms, what aggravates or relieves them, and restrictions in daily and domestic activities (AVQ, AVD) and at work. Point 3: any prior condition at or near the injured site, and any condition that may influence the injury. Point 4: treatments received, including surgery, and any still under way.
A complete, precise examination is what allows permanent impairment to be determined; for a limb injury, comparison with the opposite side is essential. Special cases: for hearing, give each ear's dB thresholds used for the average hearing threshold and the auditory rest time before the test, and attach the audiogram. For vision, give each eye's field, motility and acuity values with the calculations, and attach results such as the Goldmann visual field. For skin, give each element's value for every affected segment.
Point 6: summarize the investigations relevant to the injury. Point 7: complete only if the worker already had an injury at the same site. Point 8: complete if the worker has an impairment of both upper limbs, both lower limbs or the thorax, whatever its origin, excluding aesthetic damage. CNESST's bilateral rules add that the other limb's impairment must predate the event and be assessed for the whole limb, not one joint.
Describe limitations according to the injury, not the job: what the worker can no longer do, or must no longer do, because of the work injury. Separate actions possible with restrictions from those to avoid completely, and quantify them: joint and amplitude, maximum load, frequency or duration not to exceed. For psychological injuries, link each limitation to the diagnosed injury or to medication side effects, describing difficulties in daily activities, social functioning and work tasks.
Point 10: complete it only if you believe an evaluation should be done in another specialty or by another health professional, for an impairment in another body system. Point 11: summarize the whole file. Like every section of the report, each is limited to 500 characters, with the Annexe available for anything longer.
Using the Règlement annoté sur le barème des dommages corporels, enter for each sequela its code (Codes de séquelles), a description and the percentage. a) Current sequelae: every sequela at the site of the work injury. b) Prior sequelae: only those at the injured site, whatever their origin. c) Other bilateral deficits: impairments of the same limb, the opposite limb or the thorax not already listed, so CNESST can calculate the bilateral percentage.
Sign and date the report. RAMQ code 09944 is preprinted. Enter a Code de complexité only if the CNESST médecin-conseil authorized it in advance; for those codes, the guide refers general practitioners to tab B of the RAMQ general practitioners' manual and specialists to Annexe 24 of the specialists' manual. Keep a copy and send one to CNESST.
Each section of the report is limited to 500 characters. When you need more room, continue on the Annexe page and state the number and name of every section you are adding information to, for example point 5, Examen physique ou mental. Attach the audiograms, visual field results and other test reports the guide asks for.
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The treating professional should, where possible, refer the worker, with the worker's agreement, to another health professional, and that professional's REM is treated as the treating professional's. If no referral is made, the worker chooses the evaluator, books the appointment and notifies CNESST right away, and CNESST sends the worker's file to that professional.
From the Règlement sur le barème des dommages corporels. CNESST publishes an annotated version, the Règlement annoté sur le barème des dommages corporels, available free online or in print, and the médecin-conseil at your regional CNESST office can answer questions on applying it. For each sequela, enter the code, a description and the percentage you set.
Under RAMQ code 09944, printed in section D. A complexity code can be added only if the CNESST médecin-conseil authorized it in advance. For the applicable codes, CNESST's guide points general practitioners and specialists to the sections on medico-administrative services under the LATMP in their respective RAMQ fee-for-service manuals.
According to the injury, not the job: state what the worker can no longer do, or must no longer do, because of the work injury. The guide asks you to separate actions possible with restrictions from those to avoid completely, quantifying amplitude, load, frequency or duration, and offers checklists for musculoskeletal and psychological injuries.