Québec prescribers use this one-page French prescription for devices covered by RAMQ's program for devices that compensate for a physical deficiency: orthoses, prostheses, orthopaedic devices, mobility aids and posture aids. It records the device type, the diagnosis and the period of incapacity, in months or for life. RAMQ requires a prescription only in certain situations, such as an expired orthosis prescription.
A general practitioner, specialist or specialized nurse practitioner (IPS) completes and signs the whole form with a professional number. A power wheelchair needed for severe cardiovascular or cardiorespiratory insufficiency must be prescribed by a cardiologist, respirologist, internist or an IPS in cardiology or respirology.
Download the current version from the source each time; forms change without notice.
Ordonnance médicale – Orthèses, prothèses, aides à la locomotion, aides à la posture
Medical Prescription – Orthoses, Prostheses, Mobility Aids, Posture Aids
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Only in some situations: a mobility or walking aid when no permanent physical deficiency diagnosis is on file at the authorized establishment, an orthosis whose prescribed duration of use has expired, a prosthesis when the file lacks a physician or IPS report or a therapist's plan, or when a professional orthotics and prosthetics technologist provides the service.
RAMQ says it must describe the physical deficiency and the resulting incapacity, state the need for a device and include recommendations for use. Form 3497 captures this through the device type, the diagnosis, the medically required period of incapacity in months or for life and, for orthoses, whether daily wear is needed.
No. RAMQ's program covers walking aids such as crutches, canes, walkers and paediatric ambulators only if they must be used daily for at least one year. Mobility aids such as wheelchairs, positioning bases and adapted strollers have their own conditions and come through authorized public rehabilitation establishments.