Form MD, chiropractic, physiotherapy, dental, counselling, hearing and occupational rehabilitation reports for WorkplaceNL claims, with how each one is sent.
WorkplaceNL is the workers' compensation board for Newfoundland and Labrador. Physicians use the Physician's Report (Form MD) for new work-related injuries, recurrences, and progress when the worker's condition, treatment or return-to-work status changes significantly. Chiropractors use the Chiropractor's Report (Form 8/10C) and physiotherapists the Physiotherapist's Report (Form PR), each a multipurpose initial, progress and discharge report. Counsellors send the Initial Counselling Report and Counselling Progress Report, and treating providers complete the Hand Injury form (Form 53).
Form MD is a paper triplicate: fax it, or submit it online through WorkplaceNL's connect, which pays a higher reporting fee. Because it is a triplicate, stamps are not allowed, and the employer's copy reaches the employer through the worker. Incomplete or illegible reports are not paid. All WorkplaceNL forms in this library are in English. Vero Documents fills fillable PDFs, such as the counselling reports, from the visit note and the chart.
Physician's report for new work-related injuries, recurrences, and progress when the worker's condition, treatment or return-to-work status changes significantly. The employer's copy goes to the employer through the worker.
Physician's medical fitness certificate for a commercial diver, required under NL Occupational Health and Safety Regulations.
Physiotherapist's multipurpose initial, progress and discharge report to WorkplaceNL.
Chiropractor's multipurpose initial, progress, extension and discharge report to WorkplaceNL.
Counsellor's progress report: treatment modalities, functioning, and the worker's confidence and readiness to return to or stay at work.
Counsellor's initial report: presenting problem, clinical assessment, treatment plan and return-to-work factors.
Dentist's report after examining a worker with a work-related dental injury.
Audiologist's assessment report for an occupational hearing loss claim.
Vendor's purchase order requisition for hearing aid products or services on a claim.
Fitting report: audiological profile, tympanometry, device fitted and orientation checklist, signed by the client.
Request for repair of a worker's hearing aid(s), with the reason for repair.
Request to replace a worker's hearing aid(s), with the current device, reason and proposed solution.
Initial, progress or discharge report for clinic-based occupational rehabilitation (CBOR) of a worker.
Prescription for health care devices or supplies (model, sizing, rationale related to the compensable injury) for a worker.
Treating health care provider's report on a worker's hand injury, including expected time to maximum recovery.
Cover/information sheet sent with occupational rehabilitation service reports (e.g., JSA, WSR, FA, adjustment assessment, WSOR).
Physician's account (invoice) to WorkplaceNL for services on a claim.
Dentist's final or recurrence report and account to WorkplaceNL.
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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Fax the paper triplicate, or submit it online through WorkplaceNL connect, which pays a higher reporting fee. Section B uses codes from the code sheet for body parts, findings, diagnoses and treatments. Stamps are not permitted on the triplicate, and incomplete or illegible reports are not paid. Physicians bill on the physicians' invoice (Form 92).
Chiropractors use the Chiropractor's Report (Form 8/10C) and physiotherapists the Physiotherapist's Report (Form PR). Each is one multipurpose form for initial, progress and discharge reports, and the chiropractor's form also covers extension requests. Form 8/10C goes by fax only. For Form PR, the physiotherapists page says to submit through connect, while the PDF header says fax only.
An Audiologist's Report (AR) must accompany every occupational hearing loss application, and it goes by fax only. Hearing aid vendors then use HA-01 to request a purchase order, HA-02 for the fitting report, HA-04 for repairs and HA-05 for replacements, sent by fax or mail.
Counsellors with a WorkplaceNL vendor number, such as psychologists and social workers, send an Initial Counselling Report covering the presenting problem, clinical assessment, treatment plan and return-to-work factors. Counselling Progress Reports follow, covering modalities, functioning and the worker's readiness to return to or stay at work. Both are fillable PDFs, revised in April 2026, and go by fax.