When a worker with a WCB Manitoba claim is prescribed opioids, the physician or nurse practitioner sends this two-page initial report. It captures the diagnosis that accounts for the pain, average pain over the past week on a 0 to 10 scale, five function ratings, the Opioid Risk Tool score, whether a treatment agreement is in place, current medications and work capabilities.
The prescribing physician or nurse practitioner completes and signs the report. The worker's part is the separate Opioid Treatment Agreement, which the worker and prescriber both sign and which goes to the WCB with this form.
Download the current version from the source each time; forms change without notice.
Initial - Opioid Management Report
Formulaire de rapport initial de gestion des opioïdes
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.
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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No. The report asks whether the Opioid Risk Tool was completed and for the score, but it says not to forward the completed ORT questionnaire. It does ask you to send a copy of the Opioid Treatment Agreement to the WCB with the report.
Physicians and nurse practitioners. WCB Manitoba's fee schedules include an opioid management initial report fee for both: service code 8114 for physicians and 0020 for nurse practitioners, each billable when a completed initial report is submitted and paid even if the claim is later disallowed.
WCB Manitoba's French resources page lists it as Formulaire de rapport initial de gestion des opioïdes, but it links to the same English PDF. Complete the English fillable form, which has OMIR printed beside the claim number box.