All 96 verified Quebec forms, more than half of them in French only, from CNESST and IVAC reports to SAAQ, RAMQ, Retraite Québec and Revenu Québec, with who completes each.
Quebec has 96 verified forms in this library, and 58 of them are listed in French only. Workers' compensation runs through the CNESST: the Attestation médicale (1936) at the first visit, the Rapport médical (1937), the Rapport final (1938) at consolidation and the Rapport d'évaluation médicale (2064). Road accident victims claim through the SAAQ, starting with the Rapport initial et facture (4065 30). Public drug plan requests go to the RAMQ, such as the exception drug payment request (form 3633).
The CNESST pays for physician reports, which you bill to the RAMQ under the code printed on each form, and certified EMRs can send them directly. The SAAQ reserves its English versions for professionals without a Quebec address. QPP disability uses Retraite Québec's Rapport médical (B-076). Last-resort assistance needs the MESS Rapport d'évaluation médicale ou psychosociale (SR-2100), and students use the AFE medical certificate (1015). Federal forms such as the T2201 and EI medical certificates also apply in Quebec and are on the federal hub.
Medical Certificate
First medical certificate, completed at the first visit for a work accident, a suspected occupational disease, or a recurrence/relapse/aggravation. It records the precise diagnosis, the injury site(s), the expected consolidation (14 days or less, or more than 14 days) and the care given.
1937Medical Report (initial-care summary or progress report)
Report from the treating professional on an employment injury. Tick 'Sommaire de prise en charge' when consolidation is expected more than 14 days after incapacity began (one per event, sent within 6 days of the first exam). Tick 'D'évolution' at any visit where the nature or duration of care changes significantly.
1166Certificate for Reassignment or Preventive Withdrawal of a Pregnant or Breastfeeding Worker
Pour une maternité sans danger program (LSST s.40/46). Certifies that the worker's working conditions pose physical dangers to the unborn or breastfed child, or to the worker because of her pregnancy, and opens her right to reassignment or preventive withdrawal.
Evaluation Report – Psychosocial Intervention in Rehabilitation
Psychosocial needs assessment report for services CNESST requests under a professional-services contract. It addresses personal difficulties from the injury that hinder social or occupational rehabilitation.
Progress Report or Final Report – Psychosocial Intervention in Rehabilitation
Progress or end-of-plan report for psychosocial rehabilitation services provided at CNESST's request.
1938Final Report
Report at consolidation. It gives the final diagnosis and the consolidation date, states whether there is a permanent impairment to physical or psychological integrity and/or functional limitations, and says whether the professional will produce the Rapport d'évaluation médicale or refer the worker to another professional.
Temporary Work Assignment
The employer proposes one or two temporary assignments. The treating professional states the temporary functional limitations and answers the three LATMP s.179 questions: the worker can reasonably do the work, it is safe, and it favours rehabilitation.
Medical Evaluation Report
Post-consolidation assessment (REM) covering 12 points: diagnosis, complaints, history, treatment, physical or mental exam, tests, aggravation, bilaterality, permanent functional limitations, other systems, conclusion and sequelae. Sequelae are given as codes and percentages under the Règlement sur le barème des dommages corporels.
Written Supplementary Medical Information
Written request (IMCE) from a CNESST médecin-conseil asking the treating professional to clarify the file. Typical topics: causal relationship, diagnosis-treatment link, consolidation period, functional limitations, permanent impairment, or a pre-existing condition.
Request for Treatment Authorization – Physiotherapy/Occupational Therapy
The clinic asks CNESST to authorize physiotherapy or OT for a worker with a recurrence, relapse or aggravation of an employment injury.
Supplementary Report
Lets the treating professional support their conclusions when the employer's or CNESST's designated professional disagrees on diagnosis, consolidation, care, permanent impairment or functional limitations, before the file goes to the Bureau d'évaluation médicale (BEM).
Psychological, Psychotherapeutic or Neuropsychological Evaluation Report
Initial evaluation report after assessing a worker referred by the treating professional's prescription, once CNESST's 'Demande de soins' has been received. It covers history, factors affecting function and return to work, the worker's perception, and the treatment plan.
Progress Report – Psychological, Psychotherapeutic or Neuropsychological Intervention
Progress report during psychological, psychotherapeutic or neuropsychological treatment of an injured worker.
Final Report – Psychological, Psychotherapeutic or Neuropsychological Intervention
End-of-intervention report for psychological, psychotherapeutic or neuropsychological treatment of an injured worker.
Physiotherapy Report
Physiotherapy report requested by CNESST for a worker treated on the treating professional's prescription. It covers health status during treatment, problems found and the treatment plan.
Occupational Therapy Report
Occupational therapy report requested by CNESST for a worker treated after an employment injury. It covers health status, problems found and the treatment plan, including return-to-work arrangements.
Request for Authorization to Implement a Rehabilitation Measure Before Consolidation of the Employment Injury
CNESST asks the treating professional to approve rehabilitation measures before consolidation, such as a gradual return to job tasks, functional capacity evaluation or development, psychosocial services, workstation or vehicle adaptation, or retraining.
TP-752.0.14Attestation de déficience
Certifies that a person 18 or over has a severe and prolonged impairment in mental or physical functions: for Québec's disability amount (line 376), higher childcare or children's-activities credits, or the caregiver tax credit.
Frais pour soins médicaux non dispensés dans votre région
Tax credit claim (line 378) for travel, lodging or moving costs to get medical care in Québec that was not available within 200 km; the treating clinician certifies that equivalent care wasn't available locally.
TP-1029.8.66.2MAttestation relative au traitement de l'infertilité
Treating physician's certificate supporting the Québec refundable tax credit, or its advance payment, for infertility treatment (e.g. whether equivalent treatment is offered within 200 km, ability to travel alone).
TP-1029.AN.AAttestation d'assistance soutenue
For the caregiver tax credit when the caregiver has no family tie with the care recipient (18+, severe and prolonged impairment): a professional certifies that the caregiver gives ongoing help with a basic activity of daily living.
TPZ-1029.MD.AAttestation – Statut de personne non autonome – Crédit d'impôt pour maintien à domicile des aînés
Physician or IPS certifies that a senior claiming the home-support tax credit is a dependent (non-autonomous) person: permanently dependent on others for most personal care, or needing constant supervision because of a severe mental disorder.
Rapport médical – Régime de rentes du Québec
Physician's report on the health of a person applying for QPP disability benefits, or being medically re-assessed.
Rapport médical pour une prestation de maladie en phase terminale d'un régime de retraite du secteur public
Medical report supporting a terminal-illness benefit claim under a Québec public-sector pension plan.
Rapport médical pour une prestation d'invalidité d'un régime de retraite du secteur public
Medical report supporting a disability-benefit claim under a Québec public-sector pension plan (RREGOP, PPMP, etc.) administered by Retraite Québec.
Medical Certificate – Student with an Impairment Causing a Significant and Persistent Disability (Major Functional Deficiencies)
Certifies a student's impairment and its significant, persistent effects, for Loans and Bursaries Program accommodations (all-bursary aid, aid between study periods, part-time eligibility) and for the Allowance for Special Needs Program.
Rapports de réévaluation des différentes conditions médicales pour l'admissibilité au SEH
Condition-specific reports used to re-assess a child's continued eligibility for the SEH: physical impairments; food allergies; hearing; mental function disabilities including language disorders.
Demande de supplément pour enfant handicapé – Partie de la professionnelle ou du professionnel
Health professional's assessment of a child under 18 whose impairment or mental-function disorder significantly limits daily activities for at least a year, for the Supplement for Handicapped Children (SEH) paid with the Family Allowance.
SR-0040Medical Certificate
For last-resort assistance recipients: certifies pregnancy and the need for medical transport (prenatal/postnatal), and requests medically justified special benefits (e.g. prostheses/orthoses, orthopedic shoes, home hemodialysis, medical transport, other medical needs).
Medical or Psychosocial Assessment Report
Documents a person's diagnosis and functional limitations (temporary, prolonged or permanent) so the ministry can recognize health-related employment constraints for last-resort assistance (Social Assistance or Social Solidarity Program).
Rapport initial et facture
First medical report after a road accident, completed at the first consultation following the accident so the victim can claim SAAQ compensation; includes the clinician's invoice.
Initial Assessment Summary – Psychological Treatment
Completed after the initial psychological evaluation of a road-accident victim, to get the evaluation reimbursed and treatment hours authorized (balise 1).
Follow-up and Progress Summary – Psychological Treatment
Required when the maximum authorized psychology reimbursements will be exceeded: at the 12th treatment hour (balise 2) or the 27th hour (balise 3).
Final Assessment Summary – Psychological Treatment
End-of-treatment summary of psychological treatment for a road-accident victim.
Physiotherapy Progress Report and Invoice
Required when a road-accident victim's private-practice physiotherapy will exceed the reimbursable number of treatments: at the 15th treatment or 9th week (balise 2) and at the 35th treatment (balise 3).
Rapport d'évaluation et reçu ou facture
Report on a road-accident victim's overall health status, completed when the SAAQ asks for it (the SAAQ may send a pre-identified form).
Rapport d'évolution et reçu ou facture
Progress report on a road-accident victim, sent when the SAAQ requests it, e.g. when recovery differs from what was expected.
Rapport sur les séquelles et reçu ou facture
Assesses whether a road-accident victim has permanent after-effects (sequelae) from the accident injuries, when the SAAQ requests it.
Dentist's Report
Describes dental damage caused by a road accident, for the victim's SAAQ claim.
Request for Reimbursement of Physiotherapy Costs
Claim used by private-practice physiotherapy clinics to bill the SAAQ for a road-accident victim's treatments.
Request for Reimbursement of Psychology Fees
Claim used by private-practice psychologists/psychotherapists to bill the SAAQ for a road-accident victim's treatments.
Personal Assistance – Grid for Occupational Therapists
OT assessment of a road-accident victim's personal-assistance needs, used by the SAAQ to set the personal-assistance indemnity.
Information médicale complémentaire – Incapacité
Additional medical information the SAAQ may request to assess a road-accident victim's functional limitations/restrictions and ability to work.
Rapport sur l'état de santé – Permis de conduire
General medical report the SAAQ requests to assess a licence holder's or applicant's fitness to drive (vision, hearing, neurological, epilepsy, cardiovascular, respiratory and other conditions).
Déclaration d'inaptitude à conduire un véhicule routier
Used by a health professional to report to the SAAQ a patient they judge unfit to drive.
Rapport d'évaluation fonctionnelle sur l'aptitude physique et mentale à conduire un véhicule routier
Functional driving assessment (including a road test) of a driver's physical and mental fitness, requested by the SAAQ.
Rapport du test routier effectué par un ergothérapeute
Report of an on-road driving test carried out by an occupational therapist for the SAAQ.
5903Rapport d'évaluation médicale sur l'aptitude à la conduite sécuritaire d'un véhicule routier en présence d'un diabète
Medical evaluation of a driver with diabetes (e.g. hypoglycemia risk) requested by the SAAQ.
Rapport d'examen visuel en ophtalmologie ou en optométrie – Santé visuelle – Aptitude à conduire
Eye exam report (acuity, visual field, etc.) requested by the SAAQ to determine whether a driver meets vision standards.
Rapport d'examen médical cardiovasculaire – Permis de conduire
Cardiovascular exam report requested by the SAAQ to assess fitness to drive.
Rapport d'examen médical psychiatrique
Psychiatric exam report requested by the SAAQ to assess fitness to drive.
Rapport d'examen médical neurologique
Neurological exam report requested by the SAAQ to assess fitness to drive (e.g. seizures, stroke, neurodegenerative disease).
Rapport d'examen médical oto-rhino-laryngologique – Permis de conduire
ENT exam report (hearing, vestibular) requested by the SAAQ to assess fitness to drive.
Mental-health-specific attending physician questionnaire for a disability claim.
Attending physician statement for a short-term disability claim under Blue Cross (Canassurance) disability insurance.
Supplementary attending physician report confirming an ongoing long-term disability.
Supplementary attending physician report for an ongoing disability claim due to a physical illness.
Supplementary attending physician report for an ongoing disability claim due to a psychological illness.
Critical illness claim package with claimant's statement, attending physician's statement and medical certificate.
Maladies graves – Déclaration du médecin
Family of condition-specific physician statements for Humania critical illness claims.
Physician's statement for a Humania life insurance (death) claim.
Request for Payment Authorization – Exception Drug
Prescriber's request for public drug-plan coverage of an exception drug (Liste des médicaments, Annex IV) when the drug isn't codified or no code fits the patient.
Request for Payment Authorization – Exceptional Patient Measure
Prescriber's request for public-plan coverage of a drug not on the Liste des médicaments, or of an exception drug for an indication not on the List, under the exceptional patient measure.
Request for Payment Authorization (Outside Québec) – Exception Drug
Same request as form 3633, for prescribers outside Québec who have not joined Québec's health insurance plan.
Request for Payment Authorization (Outside Québec) – Exceptional Patient Measure
Same request as form 3996, for prescribers outside Québec who have not joined Québec's health insurance plan.
Request for Exceptional Reimbursement of the Cost of an Innovator Drug
Prescriber asks RAMQ to reimburse the innovator (brand-name) drug when the insured person must take it for particular medical reasons; the form documents the clinical consequences (e.g. hospitalization, emergency intervention, persistent disability).
Request for Exemption from the Maximum Payable Price (MPP) – Nexium (esomeprazole), Prevacid FasTab (lansoprazole)
Prescriber requests an exemption from the maximum payable price so the public plan covers Nexium or Prevacid FasTab for the patient.
Drug claim assessment for Quebec members under the RAMQ exception patient program.
Drug claim assessment for Quebec members prescribed a drug on the RAMQ exceptional medications list.
Recommendation – Assistive Listening Device
Audiologist recommends assistive listening/alerting devices (text transmission, sound transmission, environmental alerting) for an eligible person under RAMQ's hearing aids program.
Medical Certificate – Hearing Aids Program
Otolaryngologist certifies the type of hearing loss in each ear, whether it is permanent, any contraindications, and the need for a hearing aid or assistive listening device under RAMQ's hearing aids program.
Medical Prescription – Orthoses, Prostheses, Mobility Aids, Posture Aids
Prescription for devices covered by RAMQ's program for devices that compensate for a physical deficiency (orthoses, prostheses, orthopedic devices, mobility and posture aids): diagnosis, incapacity and medically required duration.
Certification of Need for a Mobility or Posture Aid
Functional evaluation and justification for a manual or power wheelchair, positioning base, stroller or posture aid (initial, additional or replacement) supplied through a rehabilitation establishment's technical-aids service.
Medical Certificate for Exemption from Photo or Signature – Health Insurance Card
Physician certifies that an illness or impairment prevents the insured person from having a photo taken and/or signing, so the Québec health insurance card can be issued without them.
Request for Authorization – Plastic Surgery
Surgeon's request for RAMQ authorization so plastic surgery (e.g. scar correction, breast surgery, lipectomy) is covered as an insured service.
Request for Prior Authorization to Obtain Medical Services Outside Québec
Physicians ask RAMQ to authorize in advance the coverage of medical (and hospital) services a patient will receive outside Québec (regulation under the Health Insurance Act, ss. 23.1–23.2; Hospital Insurance Act regulation, s. 15).
Medical Certificate (IVAC)
First medical certificate for a victim of a criminal offence or a rescuer (sauveteur). It covers diagnosis, expected consolidation, whether the person could carry on usual activities, follow-up and referral.
Medical Report (IVAC)
Follow-up medical report by the physician following a crime victim or rescuer, produced whenever the nature or duration of care changes significantly.
Final Report (IVAC)
Report at consolidation of a crime victim's or rescuer's injury. It states the consolidation date and whether permanent sequelae or functional limitations exist, which then calls for a REM.
Progress Report – Psychotherapeutic or Psychosocial Rehabilitation (IVAC)
Progress report on psychotherapeutic or psychosocial rehabilitation, with recommendations on continuing treatment, which IVAC uses to justify ongoing funding.
Initial Evaluation Report – Psychotherapeutic or Psychosocial Rehabilitation (IVAC)
Initial evaluation report giving IVAC an overall picture of the victim's or rescuer's situation in relation to the recognized offence or rescue, after the first sessions.
Final Report – Psychotherapeutic or Psychosocial Rehabilitation (IVAC)
End-of-follow-up report: conclusions, the person's own perception, results against objectives and reasons for ending. It can support a lump-sum claim for permanent sequelae or temporary impairment when no significant improvement remains possible.
Attestation by a Support Worker or Professional (IVAC)
Supporting document attesting that the victim disclosed the criminal offence (description, date and place). It is one of the accepted ways to provide the mandatory document that accompanies an IVAC request.
Admission application for the RTC's paratransit service (STAC) in Québec City; a health, education or social-service professional attests to the applicant's limitations.
Demande de vignette de stationnement pour personnes handicapées
Application for a disability parking permit; when an evaluation is required, a health professional documents diagnoses, impairments, functional class, type and duration of incapacity, and loss of mobility outdoors.
Admission application for paratransit (transport adapté) in Montréal using Quebec's provincial admission form; a professional attests to the applicant's disabilities and mobility limitations.
Avis ou rapport de l'évaluateur ou de l'évaluatrice – réévaluation d'une tutelle (maintien; modification du délai; modification ou fin)
Short evaluator notices at the periodic reassessment of an adult tutorship: concluding it should be maintained, changing only the reassessment deadline, or recommending that it be modified or ended.
Évaluation médicale – Représentation temporaire
Medical assessment supporting a court request for temporary representation of an inapt adult by a relative or a designated professional.
Évaluation médicale dans le cadre de l'ouverture d'une tutelle au majeur ou de l'homologation d'un mandat de protection
Physician's assessment of an adult's faculties, filed with the court to open a tutorship or homologate (activate) a protection mandate; form provided under the regulation of the Public Curator Act.
Réévaluation médicale dans le cadre d'une tutelle
Physician's reassessment when recommending a change in the nature or modulations of an adult tutorship, or its termination.
Évaluation psychosociale (tutelle; homologation d'un mandat; représentation temporaire) et Réévaluation psychosociale dans le cadre d'une tutelle
Psychosocial assessment that accompanies the medical assessment when opening or reassessing a protective measure.
025-DGSP-2019-01Demande de consentement à un soin (aussi : à un niveau de soin ou objectif de soins; à des mesures de contrôle)
The clinician proposing care asks the Curateur public, as legal representative, to consent to care, a level of care/goals of care, or control measures for a represented person who is inapt to consent.
Statement of Account for Psychotherapeutic or Psychosocial Intervention Services (IVAC)
Invoice for psychotherapeutic or psychosocial rehabilitation sessions with a crime victim or rescuer: session dates, initial evaluation, intervention and totals.
Transmittal Slip – Prophylactic Medication Costs (IVAC)
Fax cover sheet a pharmacy uses to claim reimbursement from IVAC for prophylactic medication dispensed to a crime victim.
Statement of Account for Psychology or Psychotherapy Care or Services
Invoice for psychology, psychotherapy or neuropsychology care given to an injured worker. Its 'Informations communes aux rapports' page must be attached to each evaluation, progress and final report.
Statement of Account for Physiotherapy or Occupational Therapy Care and Treatment
Billing statement and attendance record for physiotherapy or OT care given to an injured worker. It is sent after the initial evaluation and at the end of treatment, with the end date entered.
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.
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No. Every CNESST form in the library is French only, and the CNESST's pages for health professionals are in French under section 16 of the Charter of the French language. That includes the Attestation médicale (1936), Rapport médical (1937) and Rapport final (1938). Fill the PDF on screen and send it through the CNESST's Envoi de document service, or use a CNESST-certified EMR.
At the first consultation after the accident, the physician or IPS completes the Rapport initial et facture (4065 30) so the victim can claim compensation. The SAAQ pays for it even when it did not request it. Later reports, such as the Rapport d'évolution (4067 30) and Rapport sur les séquelles (4068 30), are done when the SAAQ asks. Quebec-based clinicians use the French versions.
Yes, with two exceptions. The federal T2201 may be filed instead of the Attestation de déficience (TP-752.0.14), except when the impairment rests on life-sustaining therapy or when the caregiver tax credit is claimed; those cases require the Quebec form. A physician, IPS, optometrist, audiologist, speech-language pathologist, OT, psychologist or physiotherapist can complete it within their field, and Revenu Québec accepts an electronic signature.
The physician, after the applicant fills sections 1 and 2. The same form covers new QPP disability applications and medical re-assessments. Send it online through Retraite Québec's document service or by mail; an electronic signature is accepted. The exam is insured by the RAMQ, while any fee for writing the report is billed to the applicant.