23.1. The Board shall assume or reimburse the payment of an amount for insured medical services given to an insured person in a facility maintained by the institution which operates the hospital centre and situated outside Québec but in Canada where those services are received when a hospital service is provided and where they were authorized beforehand by the Board upon written request signed by 2 physicians specialized in the field related to the illness of the person for whom the authorization is requested.
The request shall be accompanied by a summary of the case history of that person and shall contain the following items:
(1) a description of the specialized services required;
(2) a certificate attesting that the specialized services required are not available in Québec;
(3) the name of the physician whose services are required and the address of the facility maintained by the institution which operates the hospital centre in which he practises.
O.C. 499-92, s. 2; O.C. 1179-95, s. 3.