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SAAQ 4068: Rapport sur les séquelles (After-Effects)

The SAAQ asks for this report to learn whether a road-accident victim has permanent after-effects once their injuries have stabilized. The answers let the SAAQ decide whether the impairments are simple, in which case it sets the degree of diminished quality of life, or complex, in which case it requires a medico-legal assessment. Scars and changes in skin sensitivity have their own description tables.

Who completes it

The victim's physician or specialized nurse practitioner (IPS) examines the patient, completes Section 2 and the specific descriptions, and signs without using a stamp. They then fill the receipt or the invoice on the last page.

Submitting and payment

How to submit it
Send a copy to the SAAQ through its online document service for external providers, by fax or by mail, and give the original to the accident victim. Filling the PDF on screen carries the victim's details onto the receipt or invoice.
Who pays
The SAAQ pays only for an after-effects report it requested, either directly to you through the invoice or by reimbursing a victim who paid you, up to its authorized maximum.

Good to know

  • Section 2.1 separates stabilized injuries without impairment from those with impairment; mental injuries use the DSM multiaxial system with current and usual pre-accident GAF scores.
  • For injuries with impairment, list persistent symptoms, clinical signs, long-term treatment, permanent needs such as walking aids or orthotics, and permanent functional limitations or restrictions.
  • Esthetic impairment counts as permanent when clearly visible at 50 cm, even if usually hidden by clothing or hair; record each scar's location, length, width and aspect.
  • Table B records impaired skin sensitivity, such as hypoesthesia or hyperesthesia, as an area in square centimetres or a percentage of the limb or region.

Get the official form

Download the current version from the source each time; forms change without notice.

After-Effects Report and Receipt or Invoice for a Report

Rapport sur les séquelles et reçu ou facture

Official pagePDFVersion française

Fill it with Vero

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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How this list is checked

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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Frequently asked questions

What does the SAAQ do with the after-effects report?

It uses the report to decide whether the accident victim's permanent impairments are simple or complex. For simple impairments, the SAAQ determines the degree of diminished quality of life; for complex ones, it requires a medico-legal assessment. The SAAQ requests the report, and it reimburses the fee only when it asked for it.

How do I describe scars on the SAAQ after-effects report?

Use Table A in the Specific Descriptions section. For each scar, give the location, the length and width in centimetres, an aspect from 1 to 4 (flat scar, faulty scar, or skin colour slightly or very different) and any change to form and contours, graded from very slight to unsightly.

Is there an English version of the SAAQ after-effects report?

Yes, the After-Effects Report (4068A 30, revised 2024-11), but the SAAQ reserves it for health professionals without a Quebec address. Physicians and IPS based in Quebec use the French Rapport sur les séquelles (4068 30). Both end with the same receipt or invoice page for a medical report.