Family physician's first report after the initial assessment when injuries did not cause missed work/school or significant impairment of daily living.
- Completed by
- Family physician
- Issued by
- ICBC
- Format
- Fillable PDF
- Language
- English
ICBC asks a treating physiotherapist for this report when a patient is not recovering as expected or new barriers to recovery appear. It compares initial and current findings for work, daily activities, symptoms and objective measures, then sets out barriers, a SMART treatment goal and prognosis. ICBC has no physiotherapy initial report for crashes on or after May 1, 2021: the first appointment is billed as an Initial Visit.
The treating physiotherapist completes the whole form and certifies that a treating therapist completed it. The patient's part is consent to share it with ICBC; without consent, ICBC sends a request letter (CL491) citing the Insurance (Vehicle) Act.
Enter the claim number, date of accident and date of report (dd/mmm/yyyy), your ICBC vendor number, an invoice or reference number, and the payee name and address. Start from the current CL489F on ICBC's partners site: ICBC updates its templates, requires the most recent version and discourages saving personal copies of the template.
Give the client's name, date of birth and Personal Health Number, then your name and practitioner number. The assessment block asks for the date of this assessment, the number of treatment sessions to date, the date of the previous assessment and the date of first visit, which frame the initial and current findings compared later in the report.
Say whether you know of prior injuries or medical conditions at the time of the accident, choosing up to three from the list (such as chronic pain, concussion, depression or prior surgery) with details on possible impact on recovery. Then list crash-related investigations or specialist referrals, such as MRI, CT scan or orthopedic surgeon, with dates and findings if known. ICBC expects all clinically relevant information, including intervening events or new injuries.
Tick what the patient was doing on the date of the accident (full time, part time, self-employed, seasonal, training, student, retired, unemployed), give job titles, and pick current work, training and school status from the lists. ICBC's help text asks you to give reasons for any absence, confirm modified duties or hours on a graduated return, and say whether a patient with no job to return to is able to return.
Fill this in only if the patient has not returned or is on a graduated return. List the main work-related functional limitations against job demands, with initial and current findings and whether demands are met, and say whether the information is self-reported or from objective testing against employer-confirmed job demands. State whether you support a graduated return to work (GRTW) now, its earliest start date and duration, and any safety concerns or restrictions; if you support it, ICBC's recovery specialist will contact you.
Indicate whether the patient can perform the self-care, homemaking, caregiving, sport and leisure tasks they did before the accident. ICBC's help text limits homemaking to essential tasks (not landscaping, gardening, pool maintenance or pet care) and caregiving to unpaid pre-accident care of dependents under 16 or unable to hold regular employment. For tasks the patient cannot do, record ADL demands, initial and current findings, and whether demands are met.
Record subjective findings related to the accident, including symptom location, frequency, duration and intensity, with optional outcome measures, and objective findings such as observation, range of motion, strength, neurological signs, special tests and palpation. Both have initial and current columns, so show what has changed since the first assessment rather than repeating the initial picture.
Identify the primary diagnosis, the most serious or significant injury, and up to three other diagnoses caused by or related to the accident. Each row uses pick lists for nature of injury (for example sprain or strain grades, WAD I to IV, concussion or disc injury), body part and orientation, plus a comments box for detail.
List up to three primary barriers to recovery (functional, physical, psychosocial, employer, medical or compliance) and the primary treatment goal, written to be Specific, Measurable, Achievable, Relevant and Time-bound. ICBC's built-in example: improve neck range of motion to the full pre-accident range within 4 to 6 weeks to support return to work as a truck driver.
Choose whether you expect a return to pre-accident function with continued physiotherapy, from options such as a discharge date, a functional plateau, or unable to determine with the reason. Say whether active rehabilitation would help now; ICBC does not accept passive stretching, relaxation or other passive treatment as active rehabilitation. Add the next reassessment date if applicable, certify, and select consent or an ICBC request under section 28 or 28.1.
Download the current version from the source each time; forms change without notice.
Physiotherapy Progress Report
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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.
Sources for this guide
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Not for crashes on or after May 1, 2021. The first appointment is billed as an Initial Visit, which includes the initial assessment and a standard treatment and is billed once per patient unless ICBC approves otherwise. The legacy Physiotherapy Initial Report (CL489E) relates to older claims, and ICBC announced in April 2025 that initial visits for pre-May 2021 crashes no longer include a reporting requirement.
Only when an ICBC claims contact asks for it. ICBC may request a progress report when a patient is not recovering as expected or additional barriers to recovery have been identified. ICBC will not fund a progress report that was completed and invoiced without a request from the claim representative.
Possibly. The form notes that a Treatment Plan must be submitted when treatment is requested outside the Enhanced Care early access period, the first 12 weeks after the crash, or when more sessions are recommended beyond the current approval. A Treatment Plan (CL751 for physical treatment) may therefore be due at the same time as a requested progress report.
Recovery Network firms invoice ICBC through HCPIR or HCPP using the Progress Report service type, at the rate in ICBC's Fee Schedule for Health Care Providers, within 45 calendar days of the service. ICBC pays only for requested, fully completed reports on the current template; an incomplete report must be completed and resubmitted before it qualifies.