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 additions, the initiation by the County Public Health Directorates of the procedure for obtaining approval for 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 stating that the patient needs a treatment that cannot be performed in Romania.

Referral for treatment abroad is made for patients registered on the list of a family doctor, who have gone through all levels of medical care, respectively primary and specialized medical care, and who have been hospitalized in medical units that offer services of high professional and technical quality, but whose health has not been restored. Exceptions are infants aged 0 - 1 year for whom the file can be prepared immediately after diagnosis in a medical unit within a university center, without the need to go through all these stages.

The person requesting referral for treatment abroad or his/her legal representative or next of kin (spouse, relative up to the fourth degree) will submit the patient's medical documents (hospital discharge ticket, medical letter, medical investigation results, recommendation from the attending physician regarding 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 next of kin resides, accompanied by copies of their identification documents.