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WorkSafeBC Form 11RC: Chiropractor's X-ray Report

WorkSafeBC requires an X-ray report only if X-rays are performed and the results are clinically relevant to the compensable injury, and this two-page form is the chiropractor's version. It records who took the X-rays, the area examined and information wanted, the films and exposures, any previous X-ray, the report of findings and the chiropractor's impressions and recommendations.

Who completes it

The chiropractor completes the form, and it must be personally signed by a professional member of the firm. Worker and employer details are entered by the clinic; the worker does not sign.

Submitting and payment

How to submit it
The form directs paper practitioner reports to WorkSafeBC by fax. WorkSafeBC asks contracted chiropractors to use My Provider Services for claim and billing information whenever possible, with only Form 8C billed through Teleplan.
Who pays
WorkSafeBC pays contracted chiropractors under the Chiropractic Services Agreement and its fee schedule, and asks that invoices use the correct fee codes.

Good to know

  • Record the number of films taken, film size, direction of exposures and X-ray number, plus the date and location of any previous X-ray.
  • The area of findings is designated on a chart on the reverse side of the report, with separate boxes for impressions and comments or recommendations.
  • Since January 1, 2026, chiropractors need an individual WorkSafeBC contract to treat injured workers, even if they worked under the former agreement.
  • The current PDF is revision R11/07, published November 2007, and has payee and practitioner number fields for the chiropractor or group.

Get the official form

Download the current version from the source each time; forms change without notice.

Chiropractor's X-ray Report (Form 11RC)

Official page

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Frequently asked questions

When does a chiropractor need to send Form 11RC?

Only when X-rays are performed and the results are clinically relevant to the compensable injury, according to WorkSafeBC's form page. Separately, the Chiropractor's Report (Form 8C/11C) asks you to mention X-rays used in investigations in its clinical information section, alongside symptoms, examination and treatment.

Who can sign the chiropractor's X-ray report?

The form states that the report must be personally signed by a professional member of the firm. The chiropractor information block takes the stamped or typed name of the chiropractor or group, the address, and the payee name and number and practitioner name and number used for payment.