Rapport sur l’évolution/la fin de la prise en charge du patient en physiothérapie
Physiotherapist's progress or discharge assessment report.
- Completed by
- Physiotherapist
- Issued by
- WCB Manitoba
- Format
- Fillable PDF
- Language
- English
WCB Manitoba Physiotherapy Additional Treatment Request
On an approved WCB Manitoba claim, physiotherapists can provide up to 18 follow-up and acupuncture treatments before an extension is needed, and this one-page application is how they ask for more. It sets out current complaints, at least two self-assessment scores, objective findings, whether recovery is satisfactory and what is impeding it, the dates attended, and the planned frequency and duration with a rationale.
Who completes it
The treating physiotherapist completes and signs the application, naming the attending or referring physician and noting any cancellations or no-shows. The worker does not sign; their description of the incident is recorded by the therapist.
Submitting and payment
- How to submit it
- Submit it through the WCB eHealth Portal, which accepts requests for additional treatment from clinics below the 53rd parallel, or fax the fillable PDF to the number printed on the form.
- Who pays
- WCB Manitoba pays the request under service code 8116, which cannot be combined with the progress/discharge report fee.
Good to know
- Use at least two self-assessment tools, such as the Numeric Pain Rating Scale, Roland Morris, Neck Disability Index, LEFS, DASH or a health status disability measure, and give scores.
- Mark each date attended on the monthly calendar and list cancellations and no-shows; the WCB is not responsible for missed-appointment fees.
- Tick the box if you want to discuss the case with a WCB physiotherapy consultant; the eHealth Portal also accepts these consultation requests.
- State whether your diagnosis has changed from the initial report and, if recovery is not satisfactory, the complications or other factors impeding progress.
Get the official form
Download the current version from the source each time; forms change without notice.
Physiotherapy application for additional treatment
Demande de traitement additionnel – Physiothérapeute
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.
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
How many physiotherapy treatments does WCB Manitoba allow before an extension?
Up to 18 follow-up and/or acupuncture treatments can be provided on an approved claim before an extension is required. To continue, submit the Physiotherapist Application for Additional Treatment with the anticipated treatments per week, the number of weeks and the rationale for further treatment.
Can I bill a progress report and an additional treatment request together?
No. WCB Manitoba's service code manual says the request for additional treatment fee (8116) is not to be combined with the progress/discharge report fee (0203). The application itself carries the clinical update the WCB needs, including current findings, attendance and the treatment plan.
Is the additional treatment application available in French?
WCB Manitoba's French resources page lists it as Demande de traitement additionnel (Physiothérapeute), but it links to the same English PDF. The printed title on the English form is Physiotherapist Application for Additional Treatment.