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Identity of Representative and Authorization to Release Information

Updated on

 14 December 2023

This form is used to designate the representative of an accommodated adult (public facility or intermediary resource) and authorize the exchange of information between RAMQ and the spouse, Revenu Québec or the facility in question.

Form 3906

Protection of your personal information
In order to offer you certain services, we need to collect, use, and sometimes disclose your personal information. To find out more about our privacy practices on our website, please refer to our Privacy policy webpage.