One form carries two reports from the treating professional on a work injury. Tick “Sommaire de prise en charge” once per event when you expect consolidation more than 14 days after the worker became unable to work, and send it within 6 days of your first exam; tick “D'évolution” whenever the injury's course significantly changes the nature or duration of care. Once the injury is consolidated, a Rapport final is required instead.
The health professional who has charge of the worker (professionnel de la santé qui a charge), usually the physician or IPS, completes the whole form, and any professional who later takes charge must send their own summary report. The worker and employer complete nothing on it.
Tick only one box. Choose Sommaire de prise en charge as soon as you expect consolidation more than 14 days after the worker became unable to work; it is sent once per event, within 6 days of your first exam. Choose D'évolution each time the injury's course significantly changes the nature or duration of care, and send it without delay. The box you tick also determines the RAMQ code.
For a Québec beneficiary, copy the health insurance card details; for any other beneficiary, enter name, first name, date of birth and sex. Add your name and licence number. The original event date is the accident date or, for an occupational disease, the date of the consultation where it was diagnosed. Add a recurrence, relapse or aggravation date only when one applies, and the date of this examination.
Enter the diagnosis of the work injury as precisely as possible, and list every diagnosis when there is more than one. Describe how the injury or disease is evolving. The guide insists that a symptom is not a diagnosis, and that harassment is not a diagnosis either: record the physical or psychological diagnosis that results from the workplace event.
List the investigations ordered since the last visit. For treatment, tick Physiothérapie, Ergothérapie or Autre(s), and specify any other treatment. Under Chirurgie prévue, tick Oui or Non; if surgery is planned, give the date the request was signed (date de signature de la requête), the type of procedure (Type d'intervention) and the name of the facility or professional who will perform it.
Say whether you will see the worker again and give the planned date. If you referred the worker to another health professional, tick Oui, enter the date of the request and that professional's name, then answer J'assurerai le suivi malgré cette demande (Oui or Non) to state whether you will continue the worker's medical follow-up despite the referral.
Enter either the number of days (Nombre de jour(s)) or the number of weeks (Nombre de semaine(s)) until expected consolidation, counted from the date of this examination (à compter de la visite). Consolidation is the healing or stabilization of the injury after which no further improvement in the worker's health is foreseeable. Each report carries its own estimate, made at that visit.
Compared with the last visit, tick État amélioré, Stable or Détérioré, and add details in the comments space. Under Séquelles permanentes à prévoir, tick Oui or Non according to whether you believe the worker will keep a permanent impairment to physical or psychological integrity or functional limitations. If your answer is uncertain, the guide asks you to leave it blank.
Enter the clinic or establishment name, address, telephone and fax numbers of the place where you examined the worker. Sign and date the report, and tick the box only if you are a non-participating RAMQ professional. The back of the form warns that incomplete, missing or non-compliant information must be supplied at no extra fee when CNESST asks for it.
Download the current version from the source each time; forms change without notice.
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
Sources for this guide
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
As soon as you foresee that the work injury will be consolidated more than 14 days after the worker became unable to work. You complete only one summary report per event and must send it to CNESST within 6 days of your first examination. Any professional who takes charge of the worker later must also send one.
Not automatically. The rapport d'évolution is completed each time you observe a significant change in the nature or duration of the care or treatment given, and it must be sent to CNESST without delay. The sommaire de prise en charge is sent once per event, and at consolidation a Rapport final is required.
Nothing. CNESST's guide asks you to tick Oui or Non under Séquelles permanentes à prévoir according to whether you believe the worker will keep a permanent impairment to physical or psychological integrity or functional limitations, and to leave the question blank if your answer is uncertain.
Under “Avez-vous effectué une demande de consultation auprès d'un autre professionnel de la santé?”, tick Oui, enter the date of the request and the name of the professional, then answer “J'assurerai le suivi malgré cette demande” to say whether you will keep following the worker. A professional who then takes charge must send their own summary report.