Under RAMQ's hearing aids program, an otolaryngologist uses this French certificate to document the type of hearing loss in each ear, whether the impairment is permanent, and any medical contraindication to a hearing aid. The specialist also states, ear by ear, whether wearing a hearing aid is necessary. The certificate supports coverage of a hearing aid or an assistive listening device.
The otolaryngologist completes the whole certificate and signs it with their professional number and the date; the only patient details are name and health insurance number. An audiologist completes separate documents, such as the 3485 recommendation for assistive listening devices.
Download the current version from the source each time; forms change without notice.
Certificat médical – Programme d'aides auditives
Medical Certificate – Hearing Aids Program
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An otolaryngologist (oto-rhino-laryngologiste). The certificate records the type of deafness in the right and left ears, whether the impairment is permanent, any medical contraindication to a hearing aid or assistive listening device, and whether a hearing aid is necessary for each ear, followed by the specialist's signature and professional number.
Adults 19 and over need an average loss of at least 35 decibels in the better ear at the required frequencies, while people 12 to 18, and adults who are studying, need at least 25 decibels in one ear. Children 11 and under qualify with a loss likely to compromise speech and language development.
No. RAMQ publishes the Certificat médical, Programme d'aides auditives in French only, version 3486 285 15/01. The patient's name and health insurance number appear at the top, and the rest is completed and signed by the otolaryngologist.