Documents mental health treatment outcomes and recommended next steps at the end of treatment.
- Completed by
- Health care practitioner (mental health)
- Issued by
- Alberta Treasury Board and Finance (Care-First)
- Language
- English
Care-First Combined Program of Care Assessment and CTR
Some people injured in Alberta collisions have both injuries that fit the Care-First Program of Care and injuries that need customized treatment. For those claims, the health care practitioner uses this combined form, which pairs the Program of Care Initial Assessment with a Care and Treatment Request for the customized treatment, and sends it to the insurer.
Who completes it
The health care practitioner who assesses the injured person completes the whole combined form.
Submitting and payment
- How to submit it
- Send the completed form to the injured person's auto insurer; its Care and Treatment Request asks the insurer to approve the customized treatment.
Good to know
- Alberta also lists a standalone Program of Care Initial Assessment, which documents functional status, injury impacts, diagnosis, treatment needs and Program of Care eligibility.
- Program of Care treatment is then reported on the Phase 1 Report after six weeks and on the Phase 2 / Concluding Report at the end.
- Alberta's customized treatment guide and Program of Care Guideline 04-2026 describe the two treatment paths that this form brings together.
- The Program of Care takes effect January 1, 2027, when Alberta's Care-First auto insurance system begins.
Get the official form
Download the current version from the source each time; forms change without notice.
Combined Program of Care Initial Assessment and Care and Treatment Request
Get the note ready with Vero
This form isn’t published as a fillable PDF. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.
How this list is checked
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Frequently asked questions
When is the combined Care-First initial assessment used?
When a claim has both injuries eligible for the Program of Care and injuries that need a Care and Treatment Request for customized treatment. Alberta also lists a standalone Program of Care Initial Assessment and separate initial assessment and request forms for physical and mental health treatment.
Where is the Care-First Program of Care explained?
Superintendent of Insurance Guideline 04-2026 covers eligibility, treatment and administration within the Program of Care, and Alberta's Program of Care Eligibility resource sets out entry requirements. Guideline 08-2026 adds care pathways for weeks 13 through 24 for Program of Care-eligible injuries.