A-3.001, r. 1 - Regulation respecting medical aid

Schedule Disposition versions

2023-06-29

SCHEDULE IV

(s. 17.3)

CONTENT OF PSYCHOLOGY, PSYCHOTHERAPY AND NEUROPSYCHOLOGY REPORTS

(1) An evaluation report, a progress report and a final treatment report must contain

(1) the worker’s name, health insurance number, telephone number and address, and the Commission’s record number;

(2) the psychologist’s name and permit number, the telephone number and services supplier number or, where applicable, the group number;

(3) the signature of the psychologist who administered the care and the date of the signature;

(4) the name of the health professional in charge of the worker and the number of the health professional's permit to practise;

(5) the date of the employment injury and, where applicable, the date of any relapse, reoccurrence or aggravation; and

(6) the diagnosis by the health professional in charge of the worker giving rise to the referral or, where applicable, the reason for the referral.

(2) An evaluation report must also contain

(1) the dates of the evaluation meetings;

(2) the history of the case and the relevant antecedents that may have an impact on the treatment plan;

(3) the factors intrinsic and extrinsic to the employment injury that could have an impact on the worker’s psychological and social functioning and his or her return to work;

(4) the worker’s perception of his or her situation in relation to the employment injury and his or her capacity to return to work;

(5) the problems associated with the employment injury and their impact on the return to work;

(6) the nature, dates and frequency of the activities carried out, including, where applicable, the tests carried out;

(7) an analysis of all the data and observations and, where applicable, of the tests carried out;

(8) the findings of the evaluation and the recommendations;

(9) in the case of a neuropsychological evaluation,

(i) the observations on the worker’s behaviour during the meetings and when taking the tests, and the evaluation of the worker’s behaviour in the following areas: cognitive, motor, somesthetic, affective, personality and perception;

ii. the identification and results of the validity scales used to corroborate the results of the tests taken;

iii. the correlation between the results of the tests referred to in subparagraph i and those of the validity scales;

(10) in the case of treatment, an individualized treatment plan containing, among others things,

(i) the clinical approach and the therapeutic methods being considered;

ii. the objectives sought by the treatment;

iii. the therapeutic activities to be implemented in relation to the objectives sought;

iv. the participation expected from the worker with respect to the means and activities for attaining the objectives;

v. the means and progress indicators used to measure progress made under the individualized treatment plan for each of the objectives sought;

vi. the prognosis regarding the attainment of results;

vii. the date set for the beginning of treatment;

viii. the number and frequency of the meetings scheduled.

(3) A progress report must contain, in addition to the information required by section 1,

(1) the dates of the meetings for each period of treatment;

(2) a reminder of the objectives sought by the treatment;

(3) the therapeutic activities implemented in relation to the objectives sought;

(4) the evaluation of the worker’s progress in relation to each of the objectives sought taking into account progress indicators;

(5) the worker’s perception of his or her progress in relation to each of the objectives sought;

(6) where applicable, the changes to be made to the individualized treatment plan and the recommendations; and

(7) the number and frequency of the meetings scheduled.

(4) A final treatment report must contain, in addition to the information required by section 1,

(1) the dates of the meetings since the previous report;

(2) the problems associated with the employment injury identified in the initial evaluation;

(3) the therapeutic activities implemented in relation to the objectives sought;

(4) the worker’s perception in relation to the attainment of each of the objectives;

(5) an analysis and an evaluation of the results in relation to each of the objectives sought taking into account progress indicators and including the intrinsic and extrinsic factors having contributed to or hindered the attainment of the objectives; and

(6) the grounds for terminating treatment.

(5) Subject to the acts a psychotherapist is authorized to perform under his or her permit, sections 1 to 4 apply, with the necessary modifications, to the holder of a psychotherapist’s permit.

O.C. 757-2011, s. 5; O.C. 185-2017, s. 7; O.C. 506-2019, s. 8; I.N. 2023-07-01.

2021-01-25

SCHEDULE IV

(s. 17.3)

CONTENT OF PSYCHOLOGY, PSYCHOTHERAPY AND NEUROPSYCHOLOGY REPORTS

(1) An evaluation report, a progress report and a final treatment report must contain

(1) the worker’s name, health insurance number, telephone number and address, and the Commission’s record number;

(2) the psychologist’s name and permit number, the telephone number and services supplier number or, where applicable, the group number;

(3) the signature of the psychologist who administered the care and the date of the signature;

(4) the name of the health professional in charge of the worker and the number of the health professional's permit to practise;

(5) the date of the employment injury and, where applicable, the date of any relapse, reoccurrence or aggravation; and

(6) the diagnosis by the health professional in charge of the worker giving rise to the referral or, where applicable, the reason for the referral.

(2) An evaluation report must also contain

(1) the dates of the evaluation meetings;

(2) the history of the case and the relevant antecedents that may have an impact on the treatment plan;

(3) the factors intrinsic and extrinsic to the employment injury that could have an impact on the worker’s psychological and social functioning and his or her return to work;

(4) the worker’s perception of his or her situation in relation to the employment injury and his or her capacity to return to work;

(5) the problems associated with the employment injury and their impact on the return to work;

(6) the nature, dates and frequency of the activities carried out, including, where applicable, the tests carried out;

(7) an analysis of all the data and observations and, where applicable, of the tests carried out;

(8) the findings of the evaluation and the recommendations;

(9) in the case of a neuropsychological evaluation,

(i) the observations on the worker’s behaviour during the meetings and when taking the tests, and the evaluation of the worker’s behaviour in the following areas: cognitive, motor, somesthetic, affective, personality and perception;

ii. the identification and results of the validity scales used to corroborate the results of the tests taken;

iii. the correlation between the results of the tests referred to in subparagraph i and those of the validity scales;

(10) in the case of treatment, an individualized treatment plan containing, among others things,

(i) the clinical approach and the therapeutic methods being considered;

ii. the objectives sought by the treatment;

iii. the therapeutic activities to be implemented in relation to the objectives sought;

iv. the participation expected from the worker with respect to the means and activities for attaining the objectives;

v. the means and progress indicators used to measure progress made under the individualized treatment plan for each of the objectives sought;

vi. the prognosis regarding the attainment of results;

vii. the date set for the beginning of treatment;

viii. the number and frequency of the meetings scheduled.

(3) A progress report must contain, in addition to the information required by section 1,

(1) the dates of the meetings for each 10-hour period of treatment;

(2) a reminder of the objectives sought by the treatment;

(3) the therapeutic activities implemented in relation to the objectives sought;

(4) the evaluation of the worker’s progress in relation to each of the objectives sought taking into account progress indicators;

(5) the worker’s perception of his or her progress in relation to each of the objectives sought;

(6) where applicable, the changes to be made to the individualized treatment plan and the recommendations; and

(7) the number and frequency of the meetings scheduled.

(4) A final treatment report must contain, in addition to the information required by section 1,

(1) the dates of the meetings since the previous report;

(2) the problems associated with the employment injury identified in the initial evaluation;

(3) the therapeutic activities implemented in relation to the objectives sought;

(4) the worker’s perception in relation to the attainment of each of the objectives;

(5) an analysis and an evaluation of the results in relation to each of the objectives sought taking into account progress indicators and including the intrinsic and extrinsic factors having contributed to or hindered the attainment of the objectives; and

(6) the grounds for terminating treatment.

(5) Subject to the acts a psychotherapist is authorized to perform under his or her permit, sections 1 to 4 apply, with the necessary modifications, to the holder of a psychotherapist’s permit.

O.C. 757-2011, s. 5; O.C. 185-2017, s. 7; O.C. 506-2019, s. 8.

2019-06-13

SCHEDULE IV

(s. 17.3)

CONTENT OF PSYCHOLOGY, PSYCHOTHERAPY AND NEUROPSYCHOLOGY REPORTS

(1) An evaluation report, a progress report and a final treatment report must contain

(1) the worker’s name, health insurance number, telephone number and address, and the Commission’s record number;

(2) the psychologist’s name and permit number, the telephone number and services supplier number or, where applicable, the group number;

(3) the signature of the psychologist who administered the care and the date of the signature;

(4) the name of the physician in charge of the worker and the number of the physician’s permit to practise;

(5) the date of the employment injury and, where applicable, the date of any relapse, reoccurrence or aggravation; and

(6) the diagnosis by the physician in charge of the worker giving rise to the referral or, where applicable, the reason for the referral.

(2) An evaluation report must also contain

(1) the dates of the evaluation meetings;

(2) the history of the case and the relevant antecedents that may have an impact on the treatment plan;

(3) the factors intrinsic and extrinsic to the employment injury that could have an impact on the worker’s psychological and social functioning and his or her return to work;

(4) the worker’s perception of his or her situation in relation to the employment injury and his or her capacity to return to work;

(5) the problems associated with the employment injury and their impact on the return to work;

(6) the nature, dates and frequency of the activities carried out, including, where applicable, the tests carried out;

(7) an analysis of all the data and observations and, where applicable, of the tests carried out;

(8) the findings of the evaluation and the recommendations;

(9) in the case of a neuropsychological evaluation,

(i) the observations on the worker’s behaviour during the meetings and when taking the tests, and the evaluation of the worker’s behaviour in the following areas: cognitive, motor, somesthetic, affective, personality and perception;

ii. the identification and results of the validity scales used to corroborate the results of the tests taken;

iii. the correlation between the results of the tests referred to in subparagraph i and those of the validity scales;

(10) in the case of treatment, an individualized treatment plan containing, among others things,

(i) the clinical approach and the therapeutic methods being considered;

ii. the objectives sought by the treatment;

iii. the therapeutic activities to be implemented in relation to the objectives sought;

iv. the participation expected from the worker with respect to the means and activities for attaining the objectives;

v. the means and progress indicators used to measure progress made under the individualized treatment plan for each of the objectives sought;

vi. the prognosis regarding the attainment of results;

vii. the date set for the beginning of treatment;

viii. the number and frequency of the meetings scheduled.

(3) A progress report must contain, in addition to the information required by section 1,

(1) the dates of the meetings for each 10-hour period of treatment;

(2) a reminder of the objectives sought by the treatment;

(3) the therapeutic activities implemented in relation to the objectives sought;

(4) the evaluation of the worker’s progress in relation to each of the objectives sought taking into account progress indicators;

(5) the worker’s perception of his or her progress in relation to each of the objectives sought;

(6) where applicable, the changes to be made to the individualized treatment plan and the recommendations; and

(7) the number and frequency of the meetings scheduled.

(4) A final treatment report must contain, in addition to the information required by section 1,

(1) the dates of the meetings since the previous report;

(2) the problems associated with the employment injury identified in the initial evaluation;

(3) the therapeutic activities implemented in relation to the objectives sought;

(4) the worker’s perception in relation to the attainment of each of the objectives;

(5) an analysis and an evaluation of the results in relation to each of the objectives sought taking into account progress indicators and including the intrinsic and extrinsic factors having contributed to or hindered the attainment of the objectives; and

(6) the grounds for terminating treatment.

(5) Subject to the acts a psychotherapist is authorized to perform under his or her permit, sections 1 to 4 apply, with the necessary modifications, to the holder of a psychotherapist’s permit.

O.C. 757-2011, s. 5; O.C. 185-2017, s. 7; O.C. 506-2019, s. 8.

2017-04-13

SCHEDULE IV

(s. 17.3)

CONTENT OF PSYCHOLOGY, PSYCHOTHERAPY AND NEUROPSYCHOLOGY REPORTS

(1) An evaluation report, a progress report and a final treatment report must contain

(1) the worker’s name, health insurance number, telephone number and address, and the Commission’s record number;

(2) the psychologist’s name and permit number, the telephone number and services supplier number or, where applicable, the group number;

(3) the signature of the psychologist who administered the care and the date of the signature;

(4) the name of the physician in charge of the worker and the number of the physician’s permit to practise;

(5) the date of the employment injury and, where applicable, the date of any relapse, reoccurrence or aggravation; and

(6) the diagnosis by the physician in charge of the worker giving rise to the referral or, where applicable, the reason for the referral.

(2) An evaluation report must also contain

(1) the dates of the evaluation meetings;

(2) the history of the case and the relevant antecedents that may have an impact on the treatment plan;

(3) the factors intrinsic and extrinsic to the employment injury that could have an impact on the worker’s psychological and social functioning and his or her return to work;

(4) the worker’s perception of his or her situation in relation to the employment injury and his or her capacity to return to work;

(5) the problems associated with the employment injury and their impact on the return to work;

(6) the nature, dates and frequency of the activities carried out, including, where applicable, the tests carried out;

(7) an analysis of all the data and observations and, where applicable, of the tests carried out;

(8) the findings of the evaluation and the recommendations;

(9) in the case of a neuropsychological evaluation, the observations on the worker’s behaviour during the meetings and when taking the tests, and the evaluation of the worker’s behaviour in the following areas: cognitive, motor, somesthetic, affective, personality and perception; and

(10) in the case of treatment, an individualized treatment plan containing, among others things,

(i) the clinical approach and the therapeutic methods being considered;

ii. the objectives sought by the treatment;

iii. the therapeutic activities to be implemented;

iv. the participation expected from the worker;

v. the means used to measure the progress made under the individualized treatment plan;

vi. the prognosis regarding the attainment of results;

vii. the date set for the beginning of treatment;

viii. the number and frequency of the meetings scheduled.

(3) A progress report must contain, in addition to the information required by section 1,

(1) the dates of the meetings for each 10-hour period of treatment;

(2) a reminder of the objectives sought by the treatment;

(3) the therapeutic activities implemented in relation to the objectives sought;

(4) the evaluation of the worker’s progress in relation to the objectives sought;

(5) the worker’s perception of his or her progress in relation to the objectives sought;

(6) where applicable, the changes to be made to the individualized treatment plan and the recommendations; and

(7) the number and frequency of the meetings scheduled.

(4) A final treatment report must contain, in addition to the information required by section 1,

(1) the dates of the meetings since the previous report;

(2) the problems associated with the employment injury identified in the initial evaluation;

(3) the therapeutic activities implemented in relation to the objectives sought;

(4) the worker’s perception in relation to the attainment of the objectives;

(5) an analysis and an evaluation of the results in relation to the objectives sought, including the intrinsic and extrinsic factors having contributed to or hindered the attainment of the objectives; and

(6) the grounds for terminating treatment.

(5) Subject to the acts a psychotherapist is authorized to perform under his or her permit, sections 1 to 4 apply, with the necessary modifications, to the holder of a psychotherapist’s permit.

O.C. 757-2011, s. 5; O.C. 185-2017, s. 7.

2012-09-01

SCHEDULE IV

(s. 17.3)

CONTENT OF PSYCHOLOGY AND NEUROPSYCHOLOGY REPORTS

(1) An evaluation report, a progress report and a final treatment report must contain

(1) the worker’s name, health insurance number, telephone number and address, and the Commission’s record number;

(2) the psychologist’s name and permit number, the telephone number and services supplier number or, where applicable, the group number;

(3) the signature of the psychologist who administered the care and the date of the signature;

(4) the name of the physician in charge of the worker and the number of the physician’s permit to practise;

(5) the date of the employment injury and, where applicable, the date of any relapse, reoccurrence or aggravation; and

(6) the diagnosis by the physician in charge of the worker giving rise to the referral or, where applicable, the reason for the referral.

(2) An evaluation report must also contain

(1) the dates of the evaluation meetings;

(2) the history of the case and the relevant antecedents that may have an impact on the treatment plan;

(3) the factors intrinsic and extrinsic to the employment injury that could have an impact on the worker’s psychological and social functioning and his or her return to work;

(4) the worker’s perception of his or her situation in relation to the employment injury and his or her capacity to return to work;

(5) the problems associated with the employment injury and their impact on the return to work;

(6) the nature, dates and frequency of the activities carried out, including, where applicable, the tests carried out;

(7) an analysis of all the data and observations and, where applicable, of the tests carried out;

(8) the findings of the evaluation and the recommendations;

(9) in the case of a neuropsychological evaluation, the observations on the worker’s behaviour during the meetings and when taking the tests, and the evaluation of the worker’s behaviour in the following areas: cognitive, motor, somesthetic, affective, personality and perception; and

(10) in the case of treatment, an individualized treatment plan containing, among others things,

(i) the clinical approach and the therapeutic methods being considered;

ii. the objectives sought by the treatment;

iii. the therapeutic activities to be implemented;

iv. the participation expected from the worker;

v. the means used to measure the progress made under the individualized treatment plan;

vi. the prognosis regarding the attainment of results;

vii. the date set for the beginning of treatment;

viii. the number and frequency of the meetings scheduled.

(3) A progress report must contain, in addition to the information required by section 1,

(1) the dates of the meetings for each 10-hour period of treatment;

(2) a reminder of the objectives sought by the treatment;

(3) the therapeutic activities implemented in relation to the objectives sought;

(4) the evaluation of the worker’s progress in relation to the objectives sought;

(5) the worker’s perception of his or her progress in relation to the objectives sought;

(6) where applicable, the changes to be made to the individualized treatment plan and the recommendations; and

(7) the number and frequency of the meetings scheduled.

(4) A final treatment report must contain, in addition to the information required by section 1,

(1) the dates of the meetings since the previous report;

(2) the problems associated with the employment injury identified in the initial evaluation;

(3) the therapeutic activities implemented in relation to the objectives sought;

(4) the worker’s perception in relation to the attainment of the objectives;

(5) an analysis and an evaluation of the results in relation to the objectives sought, including the intrinsic and extrinsic factors having contributed to or hindered the attainment of the objectives; and

(6) the grounds for terminating treatment.

O.C. 757-2011, s. 5.