WCB Manitoba Doctor First Report: How to Complete

Physicians use this one-page fax form to give WCB Manitoba the first medical account of a workplace injury: findings, ICD diagnosis, treatment plan and whether the worker can do alternate or modified work. The WCB uses these details to manage the claim, and the restrictions you report help the employer identify safe and suitable work. The initial report fee is guaranteed, even if the claim is later disallowed.

Who completes it

The examining physician completes every section and signs the form; WCB Manitoba's service code manual also lists the Doctor's first report among optometrist services. The worker and the employer report the injury to the WCB separately.

How to fill it in

Claim Number and Worker Information

Enter the WCB claim number if the worker has one. Then give the worker's last and first name, address, city, province, postal code, phone, date of birth (dd/mm/yyyy), gender, weight, height, job title and PHIN. The WCB needs the claim number, name, date of birth, PHIN and contact details on invoices too, and says missing information means follow-up that may delay payment.

Employer Information

Give the employer's name and address, including the branch where applicable, with city, province and postal code. WCB Manitoba expects providers to communicate the worker's abilities to both the worker and the employer, and the restriction details you give help the employer identify safe and suitable work.

Injury Details

Record the date of incident, the area of injury and the worker's own description of the incident or injury. The date of incident and area of injury are also required on WCB invoices, so use the same values when you bill. Keep the worker's account here and put your findings in the next section.

Examination Findings and Diagnosis

Enter the date of examination, the ICD code and a written diagnosis, then subjective complaints and objective findings; the form asks specifically for range of motion, muscle testing and neurological status. Describe any pre-existing condition that may affect recovery. List tests performed, such as X-ray, CT scan or MRI, with location and date, and attach the results. WCB Manitoba asks that recommendations be medically indicated and as objective and specific as possible.

Treatment Plan

Describe the treatment plan and give the date of the next visit. The WCB must pre-approve physiotherapy, chiropractic treatment, pain management injections, surgery and optometry services before they are billed. If you prescribe opioids, the WCB publishes separate opioid management reports and an opioid treatment agreement on its resources and forms page.

Work Capabilities

Answer whether the worker will be disabled from work beyond the date of incident and whether they can do alternate or modified work. If yes, outline restrictions, their duration in weeks, and when the worker can return to regular duties, or tick unknown at time of examination. WCB Manitoba asks providers to focus on functional abilities and limitations, give specific modifications (for example lifting limits, a reduced starting shift, a sit/stand stool or limited chemical exposure), and set the earliest safe date for modified duties and a potential date for full duties.

Physician Information

Print your name, address, city, province, postal code, phone and fax, then sign and date the form. To be paid you need a WCB provider account; invoices must show the account number and name, the treating provider's name and registration number, the service code and the date of service. Providers working from more than one location need a separate WCB account for each.

Common mistakes

Answering yes to alternate or modified work without outlining restrictions, their duration in weeks, or a date for return to regular duties.
Listing tests without attaching the results, which the form asks you to attach; copies sent with the report can be billed as photocopy charges.
Leaving off the claim number, PHIN or date of birth; missing details mean follow-up by the WCB that can delay payment.
Describing restrictions in general terms; the WCB wants functional abilities and limitations that are medically indicated and as objective and specific as possible.
Billing the chart-note preparation fee (0017) with the report; it cannot be combined with an initial, progress or discharge report.
Resending an unpaid invoice too soon: wait at least 45 days after submitting it, then mark the copy 're-submission'.

Submitting and payment

How to submit it: Fax the completed form to the WCB using the numbers printed at its foot, including the worker's claim number if there is one. WCB Manitoba asks for reports promptly, and invoices for reports must reach it within 12 months.
Who pays: WCB Manitoba pays the initial report fee under service code 3024 as a guaranteed fee, payable whether the claim is unadjudicated, accepted or disallowed; bill it on your invoice or the WCB's general billing form.

Good to know

Code 3024 is payable for a completed report, an incomplete report with that visit's chart notes attached, or an outpatient summary sheet from a healthcare facility.
Attach test results and imaging reports; photocopy charges 0015 and 0016 can be billed with the report when copies go with it, but chart-note preparation (0017) cannot.
If you start opioids, WCB Manitoba has a separate Initial Opioid Management Report, which carries its own initial report fee (8114).
WCB Manitoba's eHealth Portal is described for physiotherapists and athletic therapists; physicians fax this form, and the WCB issues provider payments twice a month.

Get the official form

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

Doctor First Report

Premier rapport du médecin

Official page PDF

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.

See how Vero Documents works

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.

Sources for this guide

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

Frequently asked questions

Is the Doctor First Report available in French?

WCB Manitoba's French resources page lists the form as 'Premier rapport du médecin', but its link opens the same English PDF as the English page. The French page says all resources are available in other formats on request through the WCB's contact form.

Can I submit the Doctor First Report online?

The form is built for fax: the WCB's Winnipeg and toll-free fax numbers are printed at the bottom, and its billing guide says all claim-related reports, correspondence and billing forms can be faxed. WCB Manitoba's eHealth Portal is described for physiotherapists and athletic therapists. Include the worker's claim number if one exists.

Will WCB Manitoba pay for the report if the claim is denied?

Yes. The service code manual calls the initial report fee (3024) a guaranteed expense, paid whether the claim is unadjudicated, accepted or disallowed. If a claim is denied, the WCB writes to say it no longer needs medical reports, and it may recover other payments, such as costs Manitoba Health covers, but not reporting fees.

When do I send a Doctor Progress Report instead?

Progress or discharge reports (service code 3025) are not required after every follow-up visit. Send one when the WCB asks or when there is a notable change in the worker's recovery. The progress form asks whether the diagnosis has changed, whether recovery is satisfactory and whether you referred to a consultant. Follow-up visits without a report earn an administrative fee (5562).