Québec physicians use this five-page French form to ask RAMQ to authorize, before the patient leaves, coverage of medical and hospital services outside Québec. Authorization requires that the service be medically required, not experimental, of established effectiveness and unavailable in Québec, or unavailable anywhere in Canada for care abroad. Two requesting physicians with expertise in the patient's disease must complete and sign it.
Two requesting Québec physicians with expertise in the patient's disease complete Sections 1 to 7 (patient, physicians, recommended physician and facility outside Québec, medical summary, treatment plan, follow-up care) and both sign. The patient, if 14 or older, or a legal representative may sign the optional Section 8 consent.
Download the current version from the source each time; forms change without notice.
Demande d'autorisation préalable pour l'obtention de services médicaux hors du Québec
Request for Prior Authorization to Obtain Medical Services Outside Québec
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Two. The instructions say every section must be completed legibly and the form signed by two requesting physicians with expertise in the disease for which authorization is sought. RAMQ reviews the form and all attached documents and may ask for more information.
Not automatically. The authorization excludes follow-up after the treatment unless that follow-up was itself authorized, so services needed outside Québec afterwards must be described and justified in Section 5. Section 6 names the Québec physician and establishment that will provide follow-up.
Section 8 is optional, but RAMQ invites the patient to complete it to speed up processing. It lets RAMQ collect information from health professionals and establishments that treated the patient in the past five years. Patients 14 or older sign themselves, and representatives must attach proof of their authority.