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Manitoba MPI Therapy Discharge Report (Physio, AT)

Physiotherapists and athletic therapists complete this one-page report when PIPP-funded treatment with Manitoba Public Insurance (MPI) ends. Besides remaining symptoms, signs, outcome scores, diagnoses and work status, its discharge plan records the total number of sessions, the patient's status at discharge, the reason for discharge and the treatments provided.

Who completes it

The treating physiotherapist or athletic therapist completes and signs it with the MPI registered account number, and the patient or guardian signs the authorization releasing it to MPI.

Submitting and payment

How to submit it
Send it to MPI by mail, fax or email to its reports inbox, with only the claimant's initial and claim number in the email subject.
Who pays
MPI pays at its physiotherapy and athletic therapy service-agreement rates, invoice questions go to its BI Payment Unit, and invoices must show the claim number, claimant name, specific service and MPI Registered Account Number.

Good to know

  • Status at discharge is one of five options: condition resolved, much improved, slightly improved, unchanged or worse.
  • Reasons for discharge include resolution, insufficient improvement with treatment, reaching the maximum number of allotted sessions, patient-initiated discharge and referral to another practitioner.
  • Treatment provided is broken into exercise instruction, education, manual therapy, modalities and other, each with space for details.
  • MPI's physiotherapy guidelines cap primary care treatment at 25 visits and extended treatment at 43 visits unless MPI approves an extension.

Get the official form

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

Therapy Discharge 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.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Is there a French version of the MPI Therapy Discharge Report?

No French version is listed. MPI's physiotherapy provider page offers French Word versions of the initial and subsequent therapy reports, but the discharge report only as an English PDF. The form has PT and AT boxes, so physiotherapists and athletic therapists use the same report.

What outcome measures go on the MPI discharge report?

Check and score at least two of the seven listed tools: Numeric Pain Rating Scale, Roland Morris Back Pain Questionnaire, Neck Disability Index, Yellow Flags Questionnaire, LEFS, DASH and SF-12. MPI's physiotherapy guidelines also expect at least two outcome measures to track progress.