According to the Order of the Minister of Health no. 50/2004 - regarding the methodology for referring certain categories of patients for treatment abroad, with subsequent amendments and completions, the initiation by the County Public Health Directorates of the procedure for obtaining approval for performing treatment abroad is done only after the patient has gone through and exhausted all levels of medical care in the country and there is a recommendation from the last level specialist doctor that the patient needs treatment which cannot be performed in Romania.

Referral for treatment abroad is made for patients registered with a family doctor, who have gone through all levels of medical care, namely primary and specialized medical care, and who have been hospitalized in medical units offering high professional and technical quality medical services, but whose health has not been restored. An exception is made for infants aged 0 - 1 year for whom the dossier can be drawn up immediately after the diagnosis of the condition in a medical unit within a university center, without the need to go through all of these steps.

The person requesting referral for treatment abroad or his/her legal representative or next of kin (spouse, relative up to the fourth degree) shall submit the patient's medical documents (hospital discharge note, medical letter, medical investigation results, the attending physician's recommendation for treatment abroad, etc.) together with a request from the patient to the public health directorate in whose territorial area the patient, the legal representative or the next of kin resides, accompanied by copies of their identity documents.