Physiotherapists contracted with WorkSafeBC for musculoskeletal care use this four-page report for two purposes: a treatment plan request (83D219) to extend care, or a discharge report (83D222) after the last visit. It covers return-to-work status and next steps, changes in subjective and objective findings, functional abilities, goals, outcome measures, and a request summary with visits and hydrotherapy.
The treating physical therapist completes the whole report and confirms whether the findings and treatment goals were discussed with the worker.
Download the current version from the source each time; forms change without notice.
Physiotherapy Treatment Report (Form 83D665)
This form isn’t published as a fillable PDF. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.
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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Complete the Physiotherapy Treatment Report as a treatment plan request (83D219). The request summary gives the initial assessment date, visits to date, number of visits requested and requested end date, with treatment goals for the extension, two outcome measures, and the PDI or Örebro questionnaire.
No. The discharge report (83D222) is a report type on form 83D665; tick it and use the date of the last visit as the date of service. If the worker has returned to work and needs no further treatment, enter the discharge date in the return-to-work section.