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Psychology Progress Report-Only Form pdf
Use this version of the form if you are sending it by secure message attachment
PDF
forms
health care service providers
Primary and Emergency Care Report pdf
This form is completed by physicians or nurse practitioners to report injury details, treatment, and return-to-work status for workers receiving primary or emergency care. Fax completed form to 902-491-8001.
PDF
forms
health care service providers
Eye Injury Report pdf
The form is required in order to assess the level of eye impairment, if any, with respect to the worker’s traumatic eye(s) injury(s).
PDF
forms
health care service providers
CTS - Physician Hand/Wrist Report pdf
This form is required in order to assess the worker’s claim regarding hand/wrist symptoms being causally related to the workplace.
PDF
forms
health care service providers
Service Provider – Assistive Devices Request Form pdf
Form to be completed by service provider for request of assisted devices.
PDF
forms
health care service providers
Physician – Assistive Devices Request Form pdf
Form to be completed by physicians for the request of an assistive device.
PDF
forms
health care service providers
Audiometric Report pdf
Audiometric report to be completed by service provider.
PDF
forms
health care service providers
Hearing Loss Exception to Benefits Form pdf
Complete this form when seeking approval of devices or services that are different from those outlined in the WCB Hearing Health Services Guide.
PDF
forms
health care service providers
Dental Claim Form pdf
Complete this form when seeking approval of dental claims.
PDF
forms
health care service providers