Prescriber's request for an exemption from WCB's mandatory generic drug policy.
- Completed by
- Prescriber
- Issued by
- WCB Nova Scotia
- Format
- Fillable PDF
- Language
- English
WCB Nova Scotia Additional Information Form (Tiered)
WCB Nova Scotia's tiered services reports have a one-page continuation sheet for findings that do not fit on the main form. The provider ticks whether it is page 2 of Form A, B, C or E, repeats the claim number, health card number and worker details, then adds subjective findings, objective findings and additional comments. It goes to WCB with the report it continues, carrying the claim number like every other page.
Who completes it
The treating health care provider who completed the main tiered services form fills in the whole sheet, including the provider name and ID number and the individual practitioner's name, phone and fax. The worker and employer do not complete any part of it.
Submitting and payment
- How to submit it
- Send it with the main form: providers with WCB Online access upload the completed PDF as a secure-message attachment, and others fax it, with the claim number on every page. Work-Connected Recovery network providers do not submit forms through WCB Online and work through Lifemark instead.
- Who pays
- WCB guarantees payment only for services it has pre-authorized, invoiced separately for each worker with the claim number, the worker's health card number and the service dates.
Good to know
- The tick boxes at the top read 'Page 2 of' Form A, Form B, Form C or Form E: the Intake Report, Initial Assessment, Progress Report or Physical Abilities Report.
- WCB now lists Forms B, C and E for out-of-province providers, because care for musculoskeletal and psychological injuries in Nova Scotia goes through the Work-Connected Recovery network.
- Dates on the sheet are written day, month, year, and the footer shows a 5/2014 revision; WCB's resource library lists it as the Tiered Services Additional Information Form.
- For services before January 1, 2026, WCB wants invoices within six months of the service date; from that date network providers invoice Lifemark on the ACMS platform.
Get the official form
Download the current version from the source each time; forms change without notice.
Tiered Services - Additional Information Form
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.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Frequently asked questions
When do I use the WCB Nova Scotia Additional Information form?
Use it when your findings for a tiered services report do not fit on Form A, B, C or E. Tick which form the sheet continues, repeat the WCB claim number, health card number, worker's name, date of birth and date of injury, then add subjective findings, objective findings and any additional comments.
How do I send the Additional Information form to WCB Nova Scotia?
Send it with the report it continues. Providers with WCB Online access upload the completed PDF as a secure-message attachment, and providers without access fax it. Out-of-province providers complete, print, sign and fax their forms. Put the worker's claim number on every page. Work-Connected Recovery network providers go through Lifemark rather than WCB Online.