The SAAQ sends this three-page report to a licence holder with diabetes when it needs a medical assessment of their fitness to drive, and the person has it completed by a health care professional. The examiner documents the diagnosis, HbA1c results, glucose monitoring, medication, hypoglycemic episodes in the past six months and diabetes-related complications, then comments on compliance with medical recommendations.
The examinee signs an authorization letting the SAAQ discuss their medical information with the signing professional; the examining health care professional completes sections 1 to 5 and gives their profession, licence number and how long the patient has been in their care.
Download the current version from the source each time; forms change without notice.
Medical Examination Report on a Diabetic Person's Fitness to Safely Operate a Motor Vehicle (90)
Rapport d'évaluation médicale sur l'aptitude à la conduite sécuritaire d'un véhicule routier en présence d'un diabète
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The person being examined. The form states that any fees charged for completing it must be paid by the examinee and do not qualify for reimbursement by the SAAQ. The SAAQ sends the form to the licence holder, who then has it completed by a health care professional.
The background section asks for glycated hemoglobin (HbA1c) test dates and results for the past 12 months, with the laboratory's normal value. At least one test must have been done every 6 months over those 12 months, and the form also asks how many times a day blood glucose is measured on average.
Yes. The SAAQ posts an English version, 5903A (revision 2025-09), alongside the French original on its health professionals' forms page. The English form notes that the original document is in French and can be returned the same two ways, through SAAQclic or by mail.