The SAAQ requests this progress report when a road-accident victim's recovery is not following the expected course. The physician or specialized nurse practitioner (IPS) updates symptoms, tests, diagnosis and treatment, then gives a prognosis: when functional impairments should end, whether they are stable or worsening, and whether an event unrelated to the accident has changed the picture. A receipt or invoice page follows the two-page report.
The victim's physician or IPS completes Sections 2 and 3 and signs without using a stamp. They then fill either the receipt, if the victim paid them, or the invoice, if the SAAQ is to pay them, on the last page.
Download the current version from the source each time; forms change without notice.
Progress Report and Receipt or Invoice for a Report
Rapport d'évolution et reçu ou facture
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When the evolution of a road-accident victim's health does not match what was expected. The SAAQ then sends the physician or IPS a pre-identified Rapport d'évolution (4067) with the matching receipt. Its page for physicians says reports should be produced only at the right time, and it does not reimburse a progress report it did not request.
Use the receipt or invoice page for a medical report (4063 30) attached to the report. Fill Section 4, the invoice, with your name, licence number and amount if you want the SAAQ to pay you, or Section 3, the receipt, if the victim already paid you and will claim reimbursement. Payment is capped at the SAAQ's authorized maximum.
Yes. The SAAQ publishes the Progress Report as 4067A 30 for health professionals who do not have an address in Quebec. It notes that the original document is in French and follows the same sections as 4067 30, and it goes to the SAAQ the same way: online document service, fax or mail.