Description of reports
This section provides a list of reports that may be requested by the WSIB, and a brief description of each report.
Cannabis initial assessment form (Form 0210A)
A cannabis initial assessment form is requested by the WSIB when clinical information is required regarding the initial request for coverage of medical cannabis.
Follow-up cannabis assessment form (Form 0211A)
A follow-up cannabis assessment form is requested by the WSIB when clinical information is required regarding the continued coverage of medical cannabis.
Complex report
A Complex Report is requested when a worker has been treated for a substantial period of time with different treatment modalities (including several surgical procedures) without resolution. WSIB staff will pose, in writing, a number of detailed questions for you to respond in narrative form and submit on your letterhead.
Consultation report
Only bill for a Consultation Report in conjunction with a consultation visit as defined in the General Preamble of the Ministry of Health and Long Term Care Schedule of Benefits for Physician Services. Consultation reports will be requested by the WSIB, or submitted in situations where you believe the injury/illness is work-related. These reports may be written in narrative form and submitted on your letterhead.
Health professional's report (Form 8)
In all cases, complete and submit a Form 8 following the initial visit where a worker has been treated for a workplace injury/illness. Submit only one Form 8 for each worker. This report must not be used as a progress report.
Note Form 8:
- The Form 8 can also be completed when the worker reports a recurrence of a previous work-related injury/illness.
- Provide a copy of page 2 only to the worker to give to the employer.
Health professional's report for occupational mental stress (Form CMS8)
For occupational mental stress conditions (e.g., chronic mental stress) complete and submit a Form CMS8 following the initial visit. Submit only one Form CMS8 for each worker. This report must not be used as a progress report.
Hospital emergency department consultation report
Only bill for a hospital emergency department consultation report, in conjunction with an emergency room physician consultation visit. This is defined in the General Preamble of the Ministry of Health and Long Term Care Schedule of Benefits. Complete and submit a report covering the details of an emergency room physician consultation done in the Hospital Emergency Department if the injury/illness is considered to be work-related. Include in the consultation report only information pertaining to the work-related injury/illness.
Operative report
An operative report will be specifically requested by the WSIB, or may be submitted whenever the surgeon believes that the surgical procedure was performed for a work- related injury or illness.
Physician's drug utilization report
A drug utilization report is requested by the WSIB when information is required about a worker’s medication, including dosage, strength and duration. The prescribing physician should provide the medical information in narrative form.
Physician's complex drug utilization report
A complex drug utilization report is requested when information concerning medical indications for a prescription drug and therapeutic benefit is required. The prescribing physician should provide the medical information in narrative form.
Opioid assessment form
An Opioid Assessment Form is requested by WSIB when information is required regarding the medical indications and the therapeutic benefit associated with prescription opioid drug(s).
Physician's orthotic report
The WSIB may request information on the continued use of an orthotic device. The prescribing physician should provide medical information regarding the ongoing need, therapeutic benefit, and appropriate use of the device. An orthotic report may be written in narrative form and submitted on a physician’s letterhead.
Progress report (Form 26)
The WSIB sends this form to the worker when a progress report is required. When a worker provides this form, complete it and submit it to the WSIB.
Narrative report
A progress report may be submitted on letterhead when you become aware of new or significant clinical information relevant to a workplace injury/illness.
Physician's report - home oxygen therapy (Form 0389A)
The WSIB sends this form to the worker when home oxygen therapy is prescribed. Complete the Form 0389A and return it to the WSIB. This form is required to determine the initial and ongoing entitlement to home oxygen therapy.
Physician's report on occupational disease - 8D (Form 0307A)
The WSIB sends this form to the worker when the worker reports a work-related occupational illness. Complete this form and return it to the WSIB.
Physician's report on occupational chest disease - 8S (Form 0407A)
The WSIB sends this form to the worker when the worker reports a work-related occupational chest illness. Complete this form and return it to the WSIB.
Report of death
The WSIB will request a report of death when the worker has died as a result of a work- related injury/illness.
Note:
1. A previously completed Progress Report (Form 26) must not be altered or reused as a new report.
2. If you fax your report to the WSIB, DO NOT SEND THE ORIGINAL REPORT.
Physician's report on skin disease - 8D2 (Form 0353A)
The WSIB sends this form to the worker when the worker reports a work-related skin condition. Complete this form and return it to the WSIB.
Review of medical records/medical literature
WSIB staff may request a review of medical records/medical literature. This request will involve the review of a worker’s records and preparation of a response to specific questions. The request may involve a review of medical literature relevant to the worker’s case. This review will usually only be requested where there is no concurrent clinical assessment of the worker.
Physician's special report (Form 0043A)
The WSIB sends this form to the worker when the worker is to be rated for a permanent dis- ability, and his/her accident precedes January 1, 1990. Complete this form and return it to the WSIB.
Physician’s report vibration induced white finger disease – 8w (form 0425a)
The WSIB sends this form to the worker when the worker reports a work-related vibration induced white finger illness. Complete this form and return it to the WSIB.
X-ray report
An x-ray report covering several radiological examinations is considered by the WSIB to be one report. X-ray reports should only be submitted when specifically requested by the WSIB.
Photocopies
A fee may be billed when the WSIB specifically requests copies of a worker’s medical records. A fee may also be billed when the WSIB asks for additional copies of reports that have already been submitted. Only submit copies of your own medical records.
The WSIB will request the necessary reports from other physician(s) involved in the case.
In-office interview
A WSIB representative may request an appointment with you to discuss a worker’s work- related injury/illness.
The following report may be requested by the worker’s employer or the worker:
Functional abilities form for planning early and safe return to work (Form 2647A)
The Functional Abilities Form for Planning Early and Safe Return to Work may help workers and employers achieve early and safe return to work by highlighting what a worker can do after a workplace injury/illness and the limitations that would apply. Complete this form when requested to do so by the employer or worker; you cannot initiate completion of this form. Do not include medical or diagnostic information.
Acupuncture guidelines
The WSIB may allow a trial period of acupuncture for up to 6 treatments. Requests for an extension of treatment must be made in advance, in writing, and pre-approved by the WSIB.
Note:
On the worker’s initial visit, ONLY the Form 8 will be paid. A Functional Abilities Form (FAF) will not be paid if completed on the same date.
| Services included | Service code | Fee |
|---|---|---|
| Health Professional’s Report (paper submission) | 8M | $65.00 |
| Health Professional’s Report (electronic submission) | 8ME | $85.00 |
| Health Professional’s Report for Occupational Mental Stress (paper submission) | CMS8 | $85.00 |
| Health Professional’s Progress Report (paper submission) | 26M | $45.00 |
| Health Professional’s Progress Report (electronic submission) | 26ME | $60.00 |
| Narrative Progress Report | 26 | $23.54 |
| Cannabis Initial Assessment Form | M630 | $85.00 |
| Follow-up Cannabis Assessment Form | M631 | $65.00 |
| Opioid Assessment Form | M639 | $65.00 |
| Hospital Emergency Department Consultation Report | M641 | $47.09 |
| X-ray report | M642 | $23.54 |
| Operative Report | M644 | $23.54 |
| In-office interview with WSIB representative | M645 | $29.15 |
| Consultation Report | M647 | $47.09 |
| Medical Clearance for Functional Abilities Evaluation (FAE) (Form 0298A) | M648 | $23.54 |
| Complex Report | M649 | $112.10 |
| Photocopies of Medical Report (1 to 5 pages) | M650 | $23.54 |
| Photocopies of Medical Report (after 5 pages, each additional page) | M650 | $1.12 |
| Review of medical records/medical literature (per 15 minute unit) – or major part there of | M651 | $56.05 |
| Physician’s Report of Death | M652 | $23.54 |
| Physician’s Special Report | M653 | $23.54 |
| Physician’s Report on Occupational Disease 8D | M654 | $23.54 |
| Physician’s Report on Skin Disease 8D | M655 | $23.54 |
| Physician’s Report - Occupational Chest Disease 8S | M656 | $23.54 |
| Physician’s Report - Vibration Induced White Finger Disease 8W | M657 | $23.54 |
| Physician’s Drug Utilization Report | M658 | $23.54 |
| Physician’s Report - Home Oxygen Therapy | M659 | $39.53 |
| Physician's Complex Drug Utilization Report | M758 | $56.05 |
| Physician's Orthotic Report | M890 | $23.54 |
| Functional Abilities Form for Planning Early and Safe Return to Work (FAF) |
FAF |
$45.00 |
Additional Notes:
- New Service Code for FAF
- A bill is not required for telephone consultations
| Services included | Service code | Fee |
|---|---|---|
| A telephone consultation fee is paid automatically when the call is initiated by WSIB staff and/or treating health care partners (e.g. Regional Evaluation Centres, Medical Consultants, and Low Back Expert Examiners) | WSIB use only | $75.00 |
| Services included | Service code | Fee |
|---|---|---|
| Acupuncture (per treatment) | 5130 | $49.98 |
Cancelled/missed appointments
The WSIB does not pay for cancelled or missed appointments.