Physician – Assistive Devices Request Form
Form to be completed by physicians for the request of an assistive device.
Document
Assistive_Devices_Form_Physician.pdf
(32.88 KB)
Service Provider – Assistive Devices Request Form
Form to be completed by service provider for request of assisted devices.
Document
Assistive_Devices_Form_ServiceProvider.pdf
(35.08 KB)
CTS - Physician Hand/Wrist Report
This form is required in order to assess the worker’s claim regarding hand/wrist symptoms being causally related to the workplace.
Document
Eye Injury Report
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).
Document
Eye Injury Report Aug2105 Final.pdf
(78.97 KB)
Primary and Emergency Care Report
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.
Document
WCB-Primary-and-Emergency-Care-Report.pdf
(149.36 KB)
Psychology Progress Report-Only Form
Use this version of the form if you are sending it by secure message attachment
Document
Psychology Progress Invoice and Report Form
Use this version of the form if you are sending it by fax
Document
Psychology Assessment Report-only Form
Use this version of the form if you are sending it by secure message attachment
Document
Psychology Assessment Report-only Form.pdf
(675.99 KB)