Prince Edward Island physicians file this one-page report after the initial assessment of any work-related injury or illness, whether or not the worker loses time from work, and again at follow-up visits. It records the injury, clinical findings, best working diagnosis, treatment, return-to-work plan and barriers to recovery. WCB PEI reviews it with the worker's and employer's information to decide entitlement to benefits and plan the return to work.
The treating physician completes and signs the whole form, including Provider # and fee code(s). The worker reports on the Worker's Report (Form 6) and the employer on the Employer's Report (Form 7).
Enter the claim number if known, the worker's PHN, date of birth, name and address, then your clinic name and address, physician name, Provider # and Fee Code(s). Add the date of accident and visit date (day, month, year) and tick the Time from Injury band: 0-4, 4-6, 6-8, 8-12 or more than 12 weeks. WCB PEI pays fees to registered service providers, so the provider number and fee codes are needed for payment.
Tick New Injury at the first visit and provide a description of the accident or injury plus clinical findings. Tick Follow-up at later visits and provide clinical findings. WCB PEI asks that follow-up medical visits also be documented on the Physician's Report, so each follow-up visit gets its own Form 8 with the Follow-up box ticked.
For soft tissue injuries, tick acute strain/sprain or repetitive strain injury, the body part (head, neck, shoulder, forearm, wrist, upper back, low back, hip/thigh, knee, ankle/foot) and side. Answer whether there is clinical evidence of internal derangement or nerve impingement, ticking MRI ordered where applicable. For head injuries, record the GCS out of 15 and tick mild head injury, mTBI or TBI. Use Other for injuries such as burns or psychological or occupational conditions.
Describe how the accident or injury happened at the first visit only, and record clinical findings at every visit. When WCB PEI reviews a claim, it considers whether the medical information is evidence-based and consistent with medical literature and whether there is a documented need for time off work, so record the objective findings that support your diagnosis and any time off.
For fractures, tick closed or compound, name the bone(s) and, if you referred the worker to orthopaedics or plastics, give the surgeon's name and copy WCB. Enter your best working diagnosis in the adjacent box, whatever the injury type. WCB PEI may contact the treating provider if it needs clarification or additional medical information.
Tick a pain rating from 1 to 10 and whether progress is improved, unchanged or regressed. Tick diagnostics ordered: X-ray, MRI, EMG or other. Under Treatment, tick NSAID/analgesics, physio/chiro, injection or specialist referral, naming the specialist and copying WCB, and record medications on the Rx line as new, discontinued (D/C) or changed.
Tick the option that fits: confined to home/bedridden; OT/physio to plan the return to work or ease back with the employer and/or complete a functional assessment; I have completed employer's RTW Planning Form (please copy to WCB); or able to remain at work at full duties. WCB PEI uses physicians' functional abilities and recovery timelines to build return-to-work plans, which can include modified or alternate work, an ease-back program or work conditioning.
Tick every category that applies: injury related (for example injury severity or a pre-existing condition), pain related (fear avoidance, catastrophizing), work related (not job attached, fear that work is harmful) or other (mental health, substance dependence or abuse, psychosocial). WCB PEI asks health care providers for objective information on the worker's functional or psychological abilities and expected recovery time, and these boxes show what may stand in the way.
Sign and date the report and enter the next visit date (day, month, year). Then print and fax it, or submit it through Online Services. The footer states that the information is required to administer claims under sections 18(9) and 59(2) of the Workers Compensation Act and is collected under section 31 of the Freedom of Information and Protection of Privacy Act.
Download the current version from the source each time; forms change without notice.
Physician's Report - Form 8
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.
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Sources for this guide
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After the initial assessment of any work-related injury or illness, regardless of whether it results in time off work, with New Injury ticked. Follow-up visits are also documented on Form 8 with the Follow-up box ticked. Payment requests must reach WCB PEI within six months of the date of service, or within timeframes set in a service provider agreement.
Yes. WCB PEI's Online Services let health care providers submit an electronic Physician Report (Form 8) and apply for or change direct deposit details. Sign up through the health care provider registration link on the Online Services page. Otherwise, use the fillable PDF, print it, sign it and fax it; the form says not to email sensitive information.
Yes. WCB PEI requires the Physician's Report after the initial assessment whether or not the injury or illness results in time off work. In the return to work plan, tick 'Able to remain at work at full duties' when that applies, and use the barriers section to flag anything that could slow recovery.
One return-to-work option reads 'I have completed employer's RTW Planning Form (please copy to WCB)', so if you complete an employer's planning form, send WCB a copy. The other options are confined to home or bedridden, OT or physio to plan the return or ease back with the employer and/or complete a functional assessment, and able to remain at full duties.