Physiotherapy for a road-accident victim is reimbursed in steps called balises, and this report asks the SAAQ to fund treatment beyond the step already authorized. Balise 1 covers the initial assessment and up to 20 treatments within 12 weeks; the report requests balise 2 (21 to 40 treatments) or balise 3 (over 40). The SAAQ decides on evidence of objective progress, including functional gains, achieved or expected.
A physiotherapist or physiotherapy technologist completes all four sections, signs with their permit number and the clinic's details, and fills the attached invoice (4055 30). The invoice can be made out to the professional or to the supplier, using its SAAQ supplier number.
Download the current version from the source each time; forms change without notice.
Rapport d'évolution en physiothérapie et facture
Physiotherapy Progress Report and Invoice
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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At the 15th treatment, or at the 9th week whatever the number of treatments, to request balise 2, and at the 35th treatment to request balise 3, or as agreed with the SAAQ. The SAAQ's guide says it will not pay for additional treatments if the report was not produced and sent within these timelines.
A physiotherapist or a physiotherapy technologist, who ticks their title in Section 4 and gives their permit number with the clinic's name, address and phone number. The invoice for the report can be paid to the professional or to the supplier, such as the clinic, which then enters its SAAQ supplier number.
Yes. The SAAQ reimburses the report through the invoice that comes with the form, and its guide says the rate also covers a follow-up call from the SAAQ if one is needed. The SAAQ can refuse to pay for a report that is imprecise, incomplete or not required, and a report does not guarantee more treatments.