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 CL489R: Nurse Practitioner Report
Nurse practitioners caring for a patient injured in a BC crash complete this three-page report only when ICBC requests it. It records subjective and objective findings, relevant pre-accident history, diagnoses with ICD-9 codes, work status, a recommended treatment plan with an anticipated recovery date, and the patient education provided. ICBC accepts it only once it is completed in its entirety.
Who completes it
The nurse practitioner completes the whole report; the form says it should be completed by the patient's primary care provider whenever possible and asks whether you are the patient's regular practitioner.
Submitting and payment
- How to submit it
- Send the report with an invoice to ICBC by fax or mail, using the CL392 health service provider invoice or your own invoice format. Share it only with patient consent or when ICBC requests it under section 28 or 28.1 of the Insurance (Vehicle) Act.
- Who pays
- ICBC pays a set fee per report, listed on its nurse practitioners page, and cannot process payment if the invoice lacks the claim number, date of accident or patient name.
Good to know
- Diagnoses are entered with an ICD-9 code, side, and a degree or grade for WAD, sprain or strain, with room for up to four additional injuries.
- A checklist confirms education on early return to activity, expected symptom duration, the usual course of recovery, factors behind symptoms, and self-management and pain management strategies.
- The form asks whether medication has been prescribed for the injury and whether you expect a return to normal function with the recommended treatment.
Get the official form
Download the current version from the source each time; forms change without notice.
Nurse Practitioner Report
Fill it with Vero
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.
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.
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Frequently asked questions
Can a nurse practitioner send ICBC a CL489R without a request?
No. ICBC's nurse practitioner page says reports must only be completed upon ICBC's request, using the template ICBC provides, and must be completed in their entirety before submission. Reports should be shared only with patient consent or when requested under the Insurance (Vehicle) Act.
What invoice goes with the CL489R?
ICBC accepts either its CL392 health service provider invoice or your own invoice format. The invoice must show the ICBC claim number, date of accident and patient name, and ICBC says it cannot process payment if any of these are missing.