Psychologists and psychotherapists send this progress summary when a road-accident victim's treatment will run past the hours the SAAQ has authorized. It is due at the 12th treatment hour to request balise 2, up to 15 more hours, and at the 27th hour to request balise 3, an exceptional measure for severe and complex disorders. The SAAQ uses it to judge whether continuing treatment is warranted.
The treating psychologist or psychotherapist completes Sections 1 to 4, notes whether the summary was discussed with the accident victim, and signs it. They also complete the receipt or the invoice on the attached receipt or invoice page (4059 30).
Download the current version from the source each time; forms change without notice.
Suivi et résumé d'évolution – Traitement de psychologie
Follow-up and Progress Summary – Psychological Treatment
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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When you expect to exceed the treatment hours the SAAQ authorized: at the 12th treatment hour to request balise 2, which can add up to 15 hours (16 to 30 in total), and at the 27th hour to request balise 3, beyond 30 hours. The SAAQ asks for it at these points to confirm that continuing treatment is relevant.
Three things, according to its guide: a demonstration that significant progress has been made or is expected, comorbidity or recognized psychosocial factors that contribute to and prolong the psychological incapacity, and goals judged achievable within a reasonable time. If the information is vague or incomplete, the decision is delayed and the SAAQ may phone you.
Through the receipt or invoice page (4059 30) that comes with the form. The SAAQ pays up to one hour of work for the Suivi et résumé d'évolution. Use Section 4, the invoice, to be paid directly, or Section 3, the receipt, if the accident victim paid you. Session hours go on the monthly reimbursement request (5696 30).