Physicians complete this French certificate when an illness or impairment makes it impossible for an insured person to have their photo taken, to sign, or both, for the Québec health insurance card, which normally carries both for people aged 14 to 74. The patient attaches the certificate to their card form so the card can be issued without the photo, the signature or both.
The physician completes Sections 2 to 5: the nature of the illness or impairment, whether the incapacity is permanent or temporary (with an approximate duration), the exemption requested, and their name, professional number, signature, date and the establishment's stamp if any. Section 1 identifies the insured person.
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Certificat médical pour l'exemption de photo ou de signature
Medical Certificate for Exemption from Photo or Signature – Health Insurance Card
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A physician. RAMQ's photo and signature page tells the person to have a physician complete the Certificat médical pour l'exemption de photo ou de signature, giving the physician's name, professional number, signature and date, along with the nature of the illness and the duration of the incapacity.
It depends on the physician's answer in Section 3, which classes the incapacity as permanent or temporary, with an approximate duration for temporary cases. Section 4 then sets the scope of the exemption: photo and signature, signature only, or photo only.