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Manitoba MPI Chiropractic Report: Form 18-019-416

Manitoba chiropractors use this two-page report to update Manitoba Public Insurance (MPI) on a PIPP injury claimant's complaints, findings, diagnosis, treatment plan and work capacity. MPI's chiropractic guide says no report is needed in Category 1 unless MPI asks for one, the patient will be off work more than 7 days, or the chiropractor is requesting Category 2 or 3.

Who completes it

The treating chiropractor completes both pages, including the MPI registered account number, and signs the report. The patient or guardian signs the line authorizing release of the report to MPI in support of the claim.

Submitting and payment

How to submit it
MPI accepts the report by mail, by fax or by email to its reports inbox, with only the claim number in the email body to ensure timely processing.
Who pays
MPI pays chiropractors under its chiropractic service agreement and the rate card for January 1, 2026 to March 31, 2030, with invoices showing the claim number, claimant name, service and MPI Registered Account Number.

Good to know

  • Self-assessment tools such as Roland Morris, NDI, Oswestry, LEFS and DASH are reported as raw scores with the two most recent results; scores are required for Category 3.
  • All claimants start in Category 1; the report gives the rationale for Category 2, Category 3 or a lapse in care, and MPI must approve any move.
  • MPI's 2026 chiropractic FAQ defines the 90-day lapse as 90 days after the last treatment or 90 days after the collision.
  • Page 2 rates the job from sedentary to very heavy using printed Work Capacity Guidelines and asks whether the patient can safely operate a vehicle.

Get the official form

Download the current version from the source each time; forms change without notice.

Chiropractic Report

Official pagePDF

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.

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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

When does MPI need a Chiropractic Report?

MPI's Guide for Chiropractic Treatment says no report is required in Category 1 unless MPI requests one, for example on personal care only or caregiver weekly indemnity claims, the patient will be off work more than 7 days, or you are asking MPI to move the claim to Category 2 or 3.

How do I confirm a patient's PIPP coverage for chiropractic care?

MPI says all claims for coverage of a compensable loss require its approval. Chiropractors can confirm coverage by email to MPI's chiropractic approvals inbox or by phone, giving only the claimant's initial and claim number, and MPI replies to emails within three business days.

What qualifies a patient for Category 2 chiropractic care?

MPI's guide lists factors such as WAD II with a visual analog scale above 5.5, comorbidities, a previous MPI claim or WCB-elected motor vehicle injury in a related area within 5 years, multiple injury areas, prior injury in the area within 2 years, age over 55, and WAD III.