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WCB Alberta C1399: DTC Orthopaedic Referral Form

Physicians use this referral to request a Diagnostic and Treatment Consultation (DTC) for a worker on a WCB-Alberta claim: a one-time orthopaedic opinion on diagnosis and management to support maximal recovery. The specialist does not follow the worker afterwards, so the referring physician stays responsible for acting on the recommendations and books a follow-up visit to discuss them.

Who completes it

The referring physician completes the whole form: their contact details, patient demographics and WCB claim number, chief complaint and relevant history, clinical findings, investigations and interventions, treatment and management plan, other physicians consulted and the follow-up date.

Submitting and payment

How to submit it
Fax the completed referral to the DTC fax line printed on the form; questions about a referral go to WCB-Alberta's Physician Help Line, which connects you with a clinical consultant.
Who pays
The form lists no referral fee, but a resulting physician-to-physician telephone consultation can be billed to WCB-Alberta on the C568 invoice under referring-physician codes 03.01LG to 03.01LI, depending on the time of day.

Good to know

  • Tick whether you prefer a call: if yes, the consulting specialist phones on the day of the appointment; if no, you receive the report only.
  • The consultation is one-time only, with no further follow-up by the specialist; implementing the recommendations is the treating physician's responsibility.
  • The form asks for the date of a follow-up appointment with the patient, booked specifically to discuss the recommendations of the referral.
  • The current version is C1399 REV AUG 2025, a three-page PDF listed under Physicians, Diagnostic on WCB-Alberta's forms and guides page.

Get the official form

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

Diagnostic and Treatment Consultant referral form – C1399

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it 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

What is a WCB Alberta Diagnostic and Treatment Consultation?

It is a one-time orthopaedic consultation arranged through WCB-Alberta that gives the treating physician an opinion on diagnosis and management to support the worker's maximal recovery. The specialist does not provide follow-up care, so the referring physician implements the recommendations and sees the patient afterwards to discuss them.

Will the DTC specialist call me about my patient?

Only if you ask. The referral has a 'Prefer a call?' choice: yes means the specialist calls on the day of the appointment, and no means you receive the report only. When a call happens, both physicians should document it in their records, as WCB-Alberta's Physician's Reference Guide requires for billing.