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 Counselling Report (CL-66)
Counsellors and psychologists treating a worker with a Workers Compensation Board of PEI claim use this four-page fillable report for each reporting period. It lists in-person and virtual treatment dates, symptoms, modalities and response to treatment, engagement and psychosocial measures, the treatment plan, risk of harm, barriers to return to work and a recommended work status.
Who completes it
The treating counsellor or psychologist completes the whole report, including the claim number, diagnosis, fee code and HST fields.
Submitting and payment
- How to submit it
- Fax the completed report to WCB PEI at the number printed on the form.
- Who pays
- Billing goes to WCB PEI through the form's Fee Code field, with Add HST (Y/N) and HST number fields; the WCB does not post the fee schedule on its forms page.
Good to know
- Rate imminent risk of harm to self or others as no risk, low, medium or high, and describe the safety plan.
- Barriers to return to work include employment concerns, psychosocial factors, emotional reaction to a physical injury, fear of re-injury, pain, and other or non-compensable conditions.
- Recommended work status is full duties, transitional duties or not able; transitional options include modified or alternate duties, workspace changes, modified hours, easing back, rehabilitation, gradual exposure and training.
- The return-to-work goal is recorded as pre-injury employment, an alternative job with the pre-injury employer, or an alternative job with a different employer.
Get the official form
Download the current version from the source each time; forms change without notice.
Counselling Report
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.
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Frequently asked questions
Can virtual counselling sessions be reported on CL-66?
Yes. The January 2024 version has separate fields for in-person and virtual treatment dates in the reporting period, plus the total number of treatments to date and any missed appointments with the reason. Current symptoms, treatment modalities being used and response to treatment follow on the first page.
What does the treatment plan section of CL-66 ask?
It asks for the treatment plan, continuing modalities with the expected timeframe and outcome, and any changes to the plan with an explanation, expected timeframe and expected outcome. Further fields cover recommendations, current abilities and limitations, homework and participation, and the worker's personal goals.
Why does WCB PEI collect the information on this form?
The form states that the information is required to administer workers compensation claims under sections 18(9) and 59(2) of the Workers Compensation Act, and that the WCB is authorized to collect it under section 31 of the Freedom of Information and Protection of Privacy Act.