Non-specialist physician's combined first report and invoice for every first visit on a work injury.
- Completed by
- Physician (general practitioner / non-specialist)
- Issued by
- WCB-Alberta
- Format
- Online portal or EMR
- Language
- English
WCB Alberta C914N: NP Medication Management Report
Nurse practitioners who prescribe opioids for a worker on a WCB-Alberta claim use this one-page report, which WCB's forms page lists as required when opioids are prescribed. It records the diagnosis being treated, current medications and doses, clinical and patient-rated scores for function and pain, the treatment plan and any request for WCB resources.
Who completes it
The prescribing nurse practitioner completes and signs the whole report, entering their WCB practitioner number and the patient's own estimate of average pain severity over the last week.
Submitting and payment
- How to submit it
- Fax or mail it to WCB-Alberta using the details printed on the form; under WCB's opioid policy, long-term opioid therapy needs a progress report within four weeks and every three months after.
Good to know
- Unlike the physician version (C914), C914N has no billing code fields and no work capability section; it ends with the next follow-up visit date and the NP's signature.
- Function is rated 0 to 10, from severe impact at home and work to return to pre-injury level, and the patient rates average pain from 0 to 10.
- NPs apply as WCB providers with application HC982 and report first and progress visits online as C050 and C151 reports in Electronic Injury Reporting.
- WCB policy expects prescribers to avoid benzodiazepines, hypnotics or sedatives alongside opioids and to continue opioids only with measurable improvement in function and pain.
Get the official form
Download the current version from the source each time; forms change without notice.
Nurse practitioner medication management report (C914N)
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.
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 must a nurse practitioner complete C914N?
When opioids are prescribed for a worker on a WCB-Alberta claim, according to WCB's forms page. WCB's opioid policy also requires a written treatment agreement on file before long-term opioid therapy, and progress reporting within four weeks of starting it and every three months afterwards.
How is C914N different from C914?
Both track opioid use, function and pain with the same 0 to 10 scales and the same requests for WCB resources. The physician version, C914, adds health service and diagnostic code fields for billing and a work capability section; the nurse practitioner version, revised June 2020, uses a WCB practitioner number instead.