Forms: Health care providers

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Categories:

• Report a patient's work-related physical injury or illness
• Update us on your patient's recovery and return to work
• Bill us for your services
• Treatment and programs
  • Programs of care
  • Non-surgical fracture episode of care
  • Community mental health program
• Request additional health information
• Request a hearing-related device
• Request treatment extension
• Order forms

Report a patient's work-related physical injury or illness

• Health professional's report – Form 8
  (0008A)
• Health professional's report for occupational mental stress (Form CMS8)
  (0010A)
• ENT consultation report
  (1787A)
• Dental report
  (0278A)
• Physiotherapy assessment report
  (0856C)

Update us on your patient's recovery and return to work

• Functional abilities form for early and safe return to work
  (2647A)
  • Guide to Completing the Functional Abilities Form

Fee schedule for the updated FAF fee.

• Health professional's progress report (Form 26) view only
  (0896A)
• Health professional continuity report (Form REO8)
  (2234A)

For more information refer to the commonly used forms webpage.

Bill us for your services

Register and bill us easily through TELUS Health.

• Provider payment request
  (3947A)
• Provider payment request for equipment/supplies
  (3941A)

Treatment and programs

Programs of care

• Instructions for delivering programs of care
  (0916A)
• Musculoskeletal program of care: initial assessment report
  (2345A)
• Care and outcomes summary (discharge form)
  (2339A)
• Program of care NIHL hearing aid outcome report
  (0037A2)
• Shoulder program of care initial assessment
  (2522A)
• Shoulder program of care – care and outcomes summary
  (2524A)
• Program of care for low back injuries: initial assessment report
  (3238A)
• Program of care for low back injuries: care and outcomes summary
  (3239A)
• Revised program of care for mild traumatic brain injuries Initial assessment report
  (10391A)
• Revised program of care for mild traumatic brain injuries Mid-point report
  (10392A)
• Revised program of care for mild traumatic brain injuries Care outcomes summary
  (10393A)
• Mild traumatic brain injury program of care supplementary report
  (when additional treatment is approved)

Non-surgical fracture episode of care

• Initial assessment report
  (2610A)
• Summary report
  (2611A)

Community mental health program

• Community Mental Health Program assessment form
  (0201A)
• Community Mental Health Program Progress Form
  (0203A)
• Community Mental Health Program RTW Recommendations
  (0204A)

Request additional health information

• Request for hospital medical information
  (1801A)
• Request for hospital medical Information: occupational disease
  (1823A view only)
• Request for health information
  (2012A – view only)

Request a hearing-related device

• Hearing assistive technologies (HAT) request form
  (10584A)
• Hearing aid replacement and/or clinical exception form
  (10585A)

   

Request a treatment extension

Note: Do not submit treatment extension requests for anyone being treated in a Program of Care or Episode of Care. Health care providers should call the Clinical Expert Line for case-specific clinical concerns. Read more in the Q&A document for the relevant Program of Care.

• Chiropractor's treatment extension request
  (0148A)
• Physiotherapist's treatment extension request
  (0153A)

Order forms

• Order form for health professionals' forms
  (1904C)