Authorizers use this five-page form to ask WCB Nova Scotia to extend coverage of medical cannabis for a worker already approved, or to adjust the approved dosage. It records the latest assessment, weekly function and pain scores, whether either has improved since starting cannabis, side effects and risk concerns, new conditions or medication changes, and revised functional goals. Every request is evaluated against WCB's medical cannabis coverage criteria.
The authorizing practitioner who manages the worker's cannabis treatment completes the whole form and signs it with their licence number; a fax number is mandatory.
Download the current version from the source each time; forms change without notice.
EXTENSION REQUEST FORM for Medical Cannabis
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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When a worker already has WCB-approved medical cannabis and you are asking to continue coverage or adjust the approved dosage. For a first request, use the Initial Request Form for Medical Cannabis. Either way, the request is evaluated against WCB's medical cannabis coverage criteria, which call for reassessment at least every 12 weeks.
Grams per day and duration, the mode of administration (vaporized or oil), and for each product the strain or name, THC and CBD percentages, and the daily THC dose in mg. For dried cannabis the form gives the formula: daily quantity in mg multiplied by THC percentage as a decimal. Oils need concentrations and daily volume.
Where vaporizing is the approved route, WCB's medical cannabis guidelines say it will cover up to a reasonable cost of a vaporizer, with replacements limited to once every two years. Other devices and paraphernalia are not covered, and smoking is never a covered mode of administration.