Record of a functional examination of a worker.
- Completed by
- Treating practitioner
- Issued by
- WCB Saskatchewan
- Format
- Language
- English
WCB Saskatchewan MCARETX: Treatment Program Intake
Secondary, tertiary and mental health treatment centres use this one-page WCB Saskatchewan form to notify the WCB that an injured worker has been taken into a program. It names the centre and its clinic number, the treatment level, who referred the worker, the program start date and the referral date. It also sets out the anticipated daily schedule for the first two weeks.
Who completes it
The treatment centre completes and signs it. The worker and the referring provider complete no part of it, although the form records who made the referral and the referral date from the WCB or primary care provider.
Submitting and payment
- How to submit it
- Fax it to the WCB at the numbers printed on the form, with the worker's name and WCB claim number.
Good to know
- Enter the treatment clinic number in the format the form shows, such as PHY or HSP, and tick one level: secondary, tertiary or mental health.
- The schedule grid covers Monday to Friday for two weeks, with a date and start and end times for each treatment day.
- The WCB's support package for physicians says treatment centres contact the worker to arrange intake within one week of the referral date.
- Most secondary programs involve three to five hours of treatment a day and tertiary programs four to six hours, according to the same WCB support package.
Get the official form
Download the current version from the source each time; forms change without notice.
Notification of Intake for Secondary or Tertiary Treatment Program
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
What is the difference between secondary and tertiary treatment at WCB Saskatchewan?
Secondary programs are for workers who have not recovered in a timely way but are expected to return to their pre-injury duties without permanent disability. Tertiary programs add a wider range of treatment, conditioning, education and return-to-work planning, plus management of psychosocial and pain issues. Both are delivered by multidisciplinary teams.
When should a treatment centre arrange intake?
The WCB's support package for physicians says that when a referral is made, the treatment centre contacts the worker to arrange intake within one week of the referral date and explains the daily time commitment. The MCARETX then records the referral date, the program start date and the first two weeks' schedule.
Who can refer a worker to a secondary or tertiary program?
The form records a referral date from the WCB or the primary care provider. The support package says a physician or nurse practitioner who agrees with a recommendation for secondary or tertiary treatment can refer the worker directly to a WCB-approved clinic, or ask the WCB to make the referral.