You’ve had a fall, you’re worried about a fracture, the ER wait time seems endless, and your family doctor is unavailable? Good news: since May 2020, certain physiotherapists in Quebec have been authorized to prescribe X-rays in specific circumstances. This advancement marks a significant step forward in improving access to care.
Physiotherapists are frontline professionals in the field of musculoskeletal health. They are trained to assess injuries and identify potential signs of fracture. When they hold the required certification, they can issue an X-ray referral without needing a physician’s approval, helping reduce wait times and streamline patient care.
Which physiotherapists can prescribe X-rays?
Not all physiotherapists are authorized to prescribe X-rays. To do so, they must:
When can physiotherapists prescribe X-rays?
Physiotherapists can prescribe X-rays only under very specific conditions:
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The injury must be a traumatic musculoskeletal condition (e.g., a fall, a direct blow);
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The injury must be recent, occurring within the past 72 hours;
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The physiotherapist must be the first healthcare professional consulted for the injury.
Note: If a physician has already assessed the injury and decided not to order an X-ray, the physiotherapist cannot prescribe one, even if they hold certification.
How does the prescription process work?
Before issuing an X-ray referral, the physiotherapist must conduct a thorough evaluation of your condition, which includes:
In some cases, this evaluation may be done through telerehabilitation (video consultation). However, a proper visual assessment must be possible in order to meet ACR standards.
Are there additional fees?
No. The evaluation for an X-ray referral is billed the same as a standard physiotherapy assessment. There are no extra charges for writing the referral.
Since July 2022, X-rays prescribed by a physiotherapist are covered by the RAMQ, just like those prescribed by a doctor.
Where can I go for the X-ray?
Your physiotherapist’s referral is valid at all medical imaging centers across Quebec. You may choose the facility that suits you best, whether public or private.
Note: Some private imaging clinics may charge additional fees. We recommend checking in advance.
A collaborative approach: physiotherapists and physicians
Although physiotherapists can prescribe X-rays, they cannot:
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Perform the X-ray exam themselves;
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Interpret the X-ray images;
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Make a medical diagnosis based on the images;
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Prescribe additional imaging tests.
This is why a collaborative care pathway is essential. The physiotherapist will ensure appropriate medical follow-up by contacting:
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Your family doctor, if you have one;
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A physician involved in a tripartite agreement;
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An emergency physician, if necessary.
What happens after the X-ray?
Once the results are available:
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Both your physiotherapist and your doctor (if applicable) will be informed;
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If a fracture is detected, your doctor will take over treatment. If you don’t have a doctor, your physiotherapist will assist you in finding a physician for timely medical follow-up;
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If the result is negative, the physiotherapist can continue your rehabilitation as needed.
Faster care, at the right time
This new competency allows physiotherapists to act more quickly in cases of recent musculoskeletal trauma. It leads to more efficient care, eases pressure on emergency services, and ensures patients receive the right care, from the right professional, at the right time.
Book an appointment at a clinic near you today.
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Article written by Catherine Mireault-Germain, physiotherapist and community practice lead.
Article published on May 16, 2025.
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