The physician and NP Primary and Emergency Care Report, specialist and drug coverage forms, and the reports out-of-province providers send to WCB Nova Scotia.
WCB Nova Scotia is the province's workers' compensation board. Physicians and nurse practitioners report on the Primary and Emergency Care Report, completed at the first visit and updated at later visits. It covers the incident, diagnosis, treatment and barriers to return to work. Other physician forms include the CTS Physician Hand/Wrist Report for carpal tunnel claims and the Eye Injury Report, which an ophthalmologist must complete. Prescribers use special authorization forms for opioid and non-opioid drugs, and request forms for medical cannabis.
Fax the Primary and Emergency Care Report to WCB, and bill through MSI billing software with WCB as the payee, within 6 months of service. Drug and cannabis requests go to Medavie Blue Cross, not WCB. WCB lists Forms B, C and E and the psychology forms for out-of-province providers. In Nova Scotia, care for sprains, strains, concussion and psychological injury runs through the Work-Connected Recovery (WCR) network. All forms here are in English.
Physician/NP report to WCB on a work-related physical or psychological injury: incident, diagnosis, clinical notes, treatment and return-to-work barriers. Completed at the first visit and updated at later visits.
Physician's carpal tunnel syndrome assessment for a hand/wrist claim: history, current medications, height/weight, lab results and electrodiagnostic tests.
Authorizer's request to extend WCB coverage of medical cannabis (5 pages).
Ophthalmologist's report used to assess impairment from a traumatic work-related eye injury.
Authorizer's initial request for WCB coverage of medical cannabis (7 pages).
Physician's request or prescription for an assistive device for a worker.
Physician referral of a worker to WCB's Centralized Surgical Services Program for non-urgent surgical assessment, with diagnosis and mechanism of injury.
Health care provider's request for an assistive device (type, cost, warranty), with an orthotics/footwear section.
Initial assessment report for a worker with a physical or psychological injury treated by an out-of-province provider.
Psychologist's initial assessment report for a worker with a psychological injury (out-of-province providers).
Psychologist's treatment progress report, including response to treatment (out-of-province providers).
Dentist's claim for dental procedures (codes, teeth, fees, lab charges) on a WCB claim.
Audiologist's current audiometric results and hearing-loss findings for a WCB hearing loss claim.
Request WCB approval for hearing devices or services that differ from standard hearing loss benefits.
Prescriber's request for an exemption from WCB's mandatory generic drug policy.
Prescriber's special authorization request for a non-opioid medication not covered by default.
Prescriber's special authorization request for opioid pain medication on a WCB claim.
Prescriber's substance-use risk assessment, required before WCB considers later opioid special authorization requests.
Supplementary information sheet that accompanies tiered-services provider reports.
Form ATreating provider's intake report (worker, family physician, employer and job information) at the start of WCB tiered services.
Treatment progress report from an out-of-province provider.
Detailed physical and functional abilities report for return-to-work planning.
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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The Primary and Emergency Care Report. Physicians and nurse practitioners complete it at the first visit for a work-related physical or psychological injury and update it at later visits. It covers the incident, diagnosis, clinical notes, treatment and return-to-work barriers, and you can ask WCB to call you back. Fax it to WCB; physicians bill through MSI with the billing code printed on the form.
Complete the Pain Medication (OPIOID) Special Authorization Request Form and return it to Medavie Blue Cross. Before WCB considers later opioid requests, the prescriber also completes the Substance Abuse Assessment Form. Keep its page 2 scoring worksheet in the office and transfer the total score to page one. For other drugs, use the NON-OPIOID Special Authorization Request Form instead.
The authorizing physician or nurse practitioner completes the INITIAL REQUEST FORM for Medical Cannabis, a 7-page form, and later the 5-page EXTENSION REQUEST FORM to continue coverage. Both go to Medavie Blue Cross by fax or mail, not to WCB. Each form has its own MSI fee code for physicians.
WCB lists Form B (initial assessment), Form C (progress report) and Form E (physical abilities report) for treating providers outside Nova Scotia. The psychology assessment and progress forms and the assistive devices request forms are also listed for them. Fax them with the worker's claim number on every page. Inside Nova Scotia, care for sprains, strains, concussion and psychological injury goes through the Work-Connected Recovery network.