Physiotherapist or athletic therapist's follow-up report on treatment response and status for a PIPP claimant.
- Completed by
- Physiotherapist or athletic therapist
- Issued by
- MPI
- Format
- Fillable PDF
- Language
- English and French
Manitoba MPI Initial Therapy Report (Physio, AT)
Physiotherapists and athletic therapists treating a Manitoba Public Insurance (MPI) PIPP claimant use this one-page report after the initial assessment. It records collision-related symptoms, physical and neurologic signs, five-year pre-collision history, at least two outcome measures, clinical diagnoses, injury category, work status and a management plan with in-clinic frequency for the next six weeks.
Who completes it
The treating physiotherapist or athletic therapist completes and signs the report, ticking PT or AT and adding the MPI registered account number. The patient or guardian signs the authorization releasing the report to MPI in support of the claim.
Submitting and payment
- How to submit it
- Send it to MPI by mail, fax or email to its reports inbox, putting only the claimant's initial and claim number in the email subject. The patient must also file a claim with MPI before a compensation file can be opened.
- Who pays
- MPI pays physiotherapists and athletic therapists at its service-agreement rates, set out in the rate schedules on its provider pages, and invoices need the claim number, claimant name, specific service and MPI Registered Account Number.
Good to know
- MPI's physiotherapy guidelines expect at least two outcome measures, selected within five working days of the assessment, from tools such as Roland Morris, Neck Disability Index, LEFS and DASH.
- The form flags Category 3 or complex claims and asks for the diagnoses that justify Category 3; MPI's physiotherapy guidelines commit to a decision on complex requests within ten working days.
- Five yes or no questions cover the five years before the collision: time off work over four weeks, regular medication, significant health problems, prior chiropractic or physiotherapy, and anxiety, depression or substance abuse.
- MPI's physiotherapy provider page links a French version of the Initial Therapy Report as a Word document.
Get the official form
Download the current version from the source each time; forms change without notice.
Initial Therapy 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
How many visits does MPI allow for physiotherapy?
MPI's physiotherapy guidelines set a framework of 18 to 25 in-clinic visits for primary care treatment and 36 to 43 for extended treatment such as fractures, dislocations or WAD III, with no extensions beyond 25 or 43 visits unless MPI approves. Complex cases are managed case by case.
How do I confirm PIPP coverage before treating a patient?
MPI states that all claims for coverage of a compensable loss require its approval. Physiotherapists and athletic therapists can email MPI's approvals inbox for their profession or call, giving only the claimant's initial and claim number, and MPI replies to emails within three business days.