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 its subsequent amendments and completions, the initiation by the County Public Health Directorates of the procedure for obtaining approval to carry out treatment abroad is done only after the patient has undergone and exhausted all levels of medical care in the country and there is a recommendation from the highest-level specialist physician that the patient needs a treatment that 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 provision, namely specialized primary medical care, and who have been hospitalized in healthcare facilities that provide high professional and technical quality medical services, but whose health has not been restored. Exceptions are infants aged 0 - 1 year for whom the file can be prepared immediately after diagnosing the condition in a healthcare facility within a university center, without it being necessary to go through all these stages.

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