The SAAQ sends this two-page report to a licence holder when their cardiovascular health must be assessed for driving, and the person has it completed by a health care professional. The examiner records aortic aneurysm size and surgery, arrhythmia and implanted devices, coronary disease, heart failure with ejection fraction, syncope in the last 12 months and other cardiac conditions, and assigns an NYHA functional class.
The examinee signs an authorization for the SAAQ to discuss their medical information with the signing professional; the examining health care professional completes sections 1 to 3 and states their profession, licence number and how long they have followed the patient.
Download the current version from the source each time; forms change without notice.
Medical Cardiovascular Examination Report (11)
Rapport d'examen médical cardiovasculaire – Permis de conduire
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The examinee. The form states that any fees charged for completing it must be paid by the person examined and do not qualify for reimbursement by the SAAQ. The SAAQ sends the form to the licence holder when it needs the information, and the person then has it completed.
The form is addressed to the health care professional and does not name a specialty. The examiner gives their profession and licence number, the date the patient came into their care and the number of visits per year, and may enclose any document they consider relevant, such as test results.
The current version (6211A, 2025-09) can be submitted through the person's SAAQclic account or mailed to the SAAQ's Direction de l'accompagnement et de l'expertise santé. The SAAQ says answer spaces cannot be enlarged, so a separate sheet can be attached when more room is needed.