Physician's report to WCB PEI for a work-related injury: accident description, clinical findings, diagnosis, work capacity and fee codes.
- Completed by
- Physician
- Issued by
- WCB PEI
- Format
- Fillable PDF
- Language
- English
WCB PEI Chiropractor Report Form
Chiropractors treating a worker with a Workers Compensation Board of PEI claim use this one-page report at the initial assessment, for progress updates, at discharge and to amend billing. It records treatment dates and missed appointments, initial and present diagnosis, objective findings, goals and treatment plan, recommended work status and an expected return-to-work date.
Who completes it
The treating chiropractor completes and signs the whole report. The worker and employer report the injury separately on the Worker's Report (Form 6) and the Employer's Report (Form 7).
Submitting and payment
- How to submit it
- Fax the completed report to WCB PEI, or submit it electronically through WCB PEI Online Services for health care providers after signing up through its self-registration page.
- Who pays
- Billing goes to WCB PEI through the form's Fee Code field, with a Report Only box and an Amended Billing option; the WCB's forms page does not post a fee schedule.
Good to know
- Tick one report type at the top: Initial Assessment, Progress Report, Discharge Report or Amended Billing; the injury history box is completed for the initial assessment only.
- Recommended work status options are full duties, not able, ease back or modified duties, and the form ends with an expected return-to-work date.
- Record the total number of treatments, any missed appointments with the reason, and conflicting circumstances such as compliance issues, with an explanation.
- The current version is dated November 2015, and the PDF is a print form without fillable fields, so online submission is the electronic option.
Get the official form
Download the current version from the source each time; forms change without notice.
Chiropractor Report
Fill it with Vero
If your copy of the form is a fillable PDF, upload it 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
How do chiropractors submit reports to WCB PEI?
By fax, or electronically through WCB PEI Online Services for health care providers, which lets providers submit an electronic Physiotherapist or Chiropractor Report and a Physician Report (Form 8). Providers sign up through the WCB's online self-registration. The PDF version is a print form without fillable fields.
Is the WCB PEI chiropractor report used at discharge?
Yes. The same form serves as an initial assessment, a progress report, a discharge report or an amended billing, chosen with a checkbox at the top. At discharge, update the present diagnosis, current objective findings, recommended work status and expected return-to-work date, along with the total number of treatments.
What work status can a chiropractor recommend on the form?
Four options: full duties, not able, ease back or modified duties. The form also asks for an expected return-to-work date and lets you flag conflicting circumstances, such as compliance, with an explanation. Goals, the treatment plan and time frames sit just above the work status section.