Physician's report to WCB PEI for a work-related injury: accident description, clinical findings, diagnosis, work capacity and fee codes.
- Completed by
- Physician
- Format
- Fillable PDF
- Language
- English
WCB PEI forms for Prince Edward Island clinicians
The six report forms Prince Edward Island clinicians send to WCB PEI, from the physician's Form 8 to functional assessments and counselling reports.
WCB PEI is the workers' compensation board for Prince Edward Island. Physicians complete the Physician's Report (Form 8) for a work-related injury, covering the accident, clinical findings, diagnosis, work capacity and fee codes. Chiropractors and physiotherapists each have a multipurpose report for the initial assessment, progress, discharge or amended billing. Clinics assessing return to work use the Functional Scan (CL-53) and the Fit For Work Assessment (CL-54), and counsellors send the Counselling Report (CL-66).
Form 8 is a fillable PDF. Print and fax it, or submit it electronically through WCB PEI Online Services for health care providers, which needs a sign-up; do not email sensitive information. The chiropractor and physiotherapist reports are print-only PDFs, and WCB PEI takes them online too. Fee codes go on the forms, but WCB PEI does not publish its fee schedule on its site. All six forms are in English. Vero Documents fills the fillable PDFs from the visit note and the chart.
Physicians and nurse practitioners
Clinic assessment comparing the worker's functional tolerances with the reported job demands (history, MSK exam, functional abilities).
- Completed by
- Clinic-based assessor (regulated health professional named on the form)
- Format
- Fillable PDF
- Language
- English
Physiotherapy
Physiotherapist's multipurpose report (initial assessment, progress, discharge or amended billing): diagnosis, findings, treatment and recommended work status.
- Completed by
- Physiotherapist
- Format
- Language
- English
Chiropractic
Chiropractor's multipurpose report (initial assessment, progress, discharge or amended billing): diagnosis, findings, treatment and recommended work status.
- Completed by
- Chiropractor
- Format
- Language
- English
Psychology and mental health
CL-66Counselling Report
Counsellor's periodic report: in-person and virtual treatment dates, symptoms, modalities, response, engagement and psychosocial measures.
- Completed by
- Counsellor or psychologist (mental health provider)
- Format
- Fillable PDF
- Language
- English
Other providers
CL-53Functional Scan
Serial functional scan (up to four) comparing the worker's maximum ability levels with pre-injury job demands.
- Completed by
- Treating clinic clinician (named on the form)
- Format
- Fillable PDF
- Language
- English
More Canadian forms
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
Where do I get the WCB PEI Physician's Report (Form 8)?
WCB PEI posts Form 8 as a fillable PDF, listed on its forms page as 'Physician's Report: Fillable', next to a Submit Online option. Complete the accident description, findings, diagnosis, work capacity and fee codes. Then print and fax it, or send it through WCB PEI Online Services after signing up. Do not email it, because it holds sensitive information.
What is the WCB PEI Functional Scan (CL-53)?
A serial functional scan, repeated up to four times, that compares the worker's maximum ability levels with the demands of their pre-injury job. A clinician at the treating clinic completes it and faxes it to WCB PEI, with a fee code or 'Report Only' marked on the form. The Fit For Work Assessment (CL-54) compares functional tolerances with the reported job demands, using history, an MSK exam and functional abilities.
Which report do chiropractors and physiotherapists send to WCB PEI?
Each has one multipurpose report, the Chiropractor Report or the Physiotherapist Report, used for the initial assessment, progress, discharge or amended billing. It records diagnosis, findings, treatment and recommended work status. The PDFs have no fillable fields, so print and fax them or submit electronically through WCB PEI Online Services.
Who completes the WCB PEI Counselling Report (CL-66)?
A counsellor or psychologist treating the worker. It is a periodic report on in-person and virtual treatment dates, symptoms, modalities, response, engagement and psychosocial measures, with fields for the fee code and HST. Fax it to WCB PEI using the number printed on the form.