Contracted mental health clinician's treatment report under WorkSafeBC's Comprehensive Mental Health Program.
- Completed by
- Contracted registered psychologist, clinical counsellor or clinical social worker
- Issued by
- WorkSafeBC
- Language
- English
WorkSafeBC Form 10D5: Psychology Assessment Report
Contracted psychologists use this report for assessments done under WorkSafeBC's Psychology and Neuropsychology Assessments program. The first page records the report type and fee code, how the assessment was delivered, the omnibus measure used, validity, and whether a DSM diagnosis was given; the clinical report then covers claim background, interviews, psychometric testing, functional evaluation and recommendations.
Who completes it
The contracted registered psychologist who conducted the assessment completes the report, naming who carried out the interview, test analysis and report.
Submitting and payment
- How to submit it
- Submit the report through WorkSafeBC's Provider Portal within 10 business days of the appointment for psychology assessments and supplemental reports, or 15 business days for neuropsychology assessments.
- Who pays
- WorkSafeBC pays the fee code ticked on the form when the report meets its timeline: 19768 (psychology), 19772 (neuropsychology), 19770 and 19774 (PFI versions), or 1265664 and 1265665 for supplemental reports.
Good to know
- Audio-only assessments are not permitted; for telehealth, use audio and video and give a rationale, and for in-person assessments give the city.
- Indicate whether the MMPI, PAI or another omnibus measure was used and whether validity scales were within limits; an opinion on validity must appear in the report body.
- A DSM diagnosis should be based on integrating the medical history, the worker interview, and valid and objective findings.
- For supplemental services, skip the service information section and go straight to the provider information, which includes your WorkSafeBC payee number.
Get the official form
Download the current version from the source each time; forms change without notice.
Psychology Assessment Report
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Frequently asked questions
What is the deadline for a WorkSafeBC psychology assessment report?
The fee codes are tied to timelines: psychology assessments and supplemental reports within 10 business days of the appointment, and neuropsychology assessments within 15 business days. The form, revised March 2025, says to bill the listed code when the report is submitted within that timeline.
Can a WorkSafeBC psychology assessment be done by telehealth?
Yes, but only by audio and video. The form states that audio-only assessments are not permissible, and a telehealth assessment needs a written rationale. Related WorkSafeBC reports include the Brief Diagnostic Psychology Assessment Report (10D114) and the Mental Health Treatment Recovery and RTW Standard Tx Progress Report (10D106).