Demande de traitement additionnel – Physiothérapeute
Physiotherapist's request for treatment beyond the authorized period.
- Completed by
- Physiotherapist
- Issued by
- WCB Manitoba
- Format
- Fillable PDF
- Language
- English
WCB Manitoba Physiotherapy Initial Report (PRI)
A Manitoba physiotherapist sends this one-page report after the initial assessment of a worker with a WCB claim. It records the worker's description of the incident, current complaints, at least two self-assessment scores, mobility, strength and other impairments, the therapist's diagnosis, the anticipated treatment frequency and duration, any home program and the worker's work capabilities.
Who completes it
The physiotherapist completes and signs the report and names the attending or referring physician. The worker does not sign, but the form asks whether findings and recommendations were discussed with them.
Submitting and payment
- How to submit it
- Clinics below the 53rd parallel submit it through the WCB eHealth Portal, which bills the report fee automatically on submission; otherwise fax the fillable PDF. If no claim number exists yet, the initial report and invoice can go on paper.
- Who pays
- WCB Manitoba pays the initial report fee under service code 3029, a guaranteed expense paid whether the claim ends up unadjudicated, accepted or disallowed.
Good to know
- A multisite request, if approved, means scheduling double the normal treatment time, and multi-site visits need WCB pre-approval.
- Up to 18 follow-up and/or acupuncture treatments can be given on an approved claim before an extension is needed.
- If the worker's condition isn't on the WCB's hand therapy list but may benefit from hand therapy, say so on the initial report for consideration.
- Specify strength out of 5 with the muscle groups involved, and note any ligamentous, stability, edema, gait or neurological findings.
Get the official form
Download the current version from the source each time; forms change without notice.
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
Is the WCB physiotherapy initial report paid if the claim is denied?
Yes. WCB Manitoba's service code manual lists the physiotherapy initial report fee (3029) as a guaranteed expense, paid whether the claim is unadjudicated, accepted or disallowed. By contrast, follow-up treatment billed after a claim is disallowed cannot be paid.
Do physiotherapists have to use the eHealth Portal?
The portal is open to physiotherapists and athletic therapists below the 53rd parallel and offers faster payment and automatic billing when reports are submitted. Clinics moving to it are asked to transition fully rather than mix paper and portal submissions. Therapists submit their own reports, and submission replaces a signature.
Which self-assessment tools does the WCB accept?
The report asks you to check at least two tools and record the scores: the Numeric Pain Rating Scale, the Roland Morris Back Pain Questionnaire for back injuries, the Neck Disability Index for neck injuries, the Lower Extremity Activity Profile (LEFS), the DASH questionnaire, or a health status disability measure.