CNESST asks the treating physiotherapist for this four-page, French-only report on a worker receiving physiotherapy for an employment injury on the treating professional's prescription. It compares the worker's initial and current condition, covering pain ratings, objective findings, functional tolerances and return-to-work obstacles, then sets out the treatment plan and whether treatment should end. The report also serves as the invoice.
A member of the Ordre professionnel de la physiothérapie du Québec completes and signs the whole report, with their member number and the clinic's CNESST supplier number. The treating health professional's prescription date and diagnosis are recorded on it, and that professional receives a copy.
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The report must reach CNESST no later than 15 days after the request date printed in section 1. After that, CNESST suspends payment for the worker's treatments until it receives the report. The suspension does not apply to public health establishments. Clinics can send it through certified software, the Guichet SST, the online document-sending service, fax or mail.
Section 3 records the worker's pain intensity at rest, in movement and on palpation, each out of 10, where 1 is the lowest level and 10 the highest. The same section asks which positions or movements are affected, whether daily and work activities are affected, and how the worker sees their return to the pre-injury job.
No. The form's notes cite section 194 of the Act respecting industrial accidents and occupational diseases: the provider cannot claim any amount from the worker. CNESST pays the report under its tariff, and the report itself serves as the invoice, provided it is on CNESST's form or one produced by CNESST-certified software.