Medical and chiropractic Form 8-10 plus mental health, physiotherapy, hearing, dental and opioid forms for WorkSafeNB claims, each in English and French.
WorkSafeNB is New Brunswick's workers' compensation board. Physicians and nurse practitioners use one form, Medical Form 8-10, for both the first medical report and progress visits. Page 2 sets out functional abilities for return to work and goes to the employer through the patient. Chiropractors have their own Chiropractic Form 8-10. Mental health providers use the Initial Psychology Assessment Report and the Mental Health Provider Report, and physiotherapists send the Physiotherapy Progress Report.
Form 8-10 is due within 72 hours of the appointment. Send it through MyServices secure email, by fax or by mail, but if you fax it, don't mail it too. Physicians are paid under the New Brunswick Medical Society agreement with WorkSafeNB. Every WorkSafeNB form in this library has English and French versions. Opioid coverage outside standard criteria needs the Opioid Review Process, completed by the prescriber and pharmacist. Vero Documents fills Medical Form 8-10 and the other PDFs from the visit note and the chart.
Formulaire médical 8-10
Single physician/NP report for both the First Medical Report of Accident or Occupational Disease and progress visits. Page 2 (functional abilities for return to work) is given to the patient for the employer.
Examen de la thérapie par la kétamine
Pre-approval request and periodic treatment review documentation for ketamine/esketamine treatment on a WorkSafeNB claim.
Client adressé pour une admission au Centre de rééducation professionnelle
Refer a claimant to the WorkSafeNB Rehabilitation Centre for services, or request supplies, with the reason for referral.
Processus d'examen de la thérapie par les opiacés – Travail sécuritaire NB
Handbook (Appendix A to Policy 25-012) that the prescriber and pharmacist complete for opioid coverage outside standard criteria and for ongoing opioid approval.
Formulaire de consultation par téléphone et de conférence de cas de Travail sécuritaire NB
Document and bill a telephone consultation or case conference that WorkSafeNB initiated or requested.
Rapport d'évolution en physiothérapie
Physiotherapist's progress report (subjective, objective and neurological findings, ROM, treatment and goals) to the WorkSafeNB case manager.
Formulaire 8-10 – Rapport du chiropraticien
Chiropractor's First Chiropractic Report of Accident or Occupational Disease and Chiropractic Progress Report to WorkSafeNB.
Service psychologique – Rapport d'évaluation initiale
Mental health provider's initial psychological assessment of a worker. Do not start treatment until WorkSafeNB approves it.
Rapport d'évolution en psychologie santé mentale
Combined mental health treatment report: Initial (within 5 business days of the first session), Progress (after each 8-week block) and Discharge (within 5 business days of the final appointment).
Service psychologique – Résumé de dossier
Psychologist's discharge report: treatments, missed appointments, rehabilitation goal and discharge disposition.
Résumé de dossier RÉUSSIR
Mental health provider's discharge report for a worker treated in the SUCCEED program: treatment dates, work status and outcomes.
Coût estimatif des services dentaires requis
Dentist or denturist's tooth charting and cost estimate for dental services needed after a work-related dental injury.
Rapport audiometrique
Audiogram and audiometric findings for an occupational hearing loss claim.
Formulaire HA-01 – Rapport sur l'ajustement et le service relatifs à un appareil auditif
Audiologist's report of a hearing aid fitting (standing-offer or exception device), supplies and service for a claimant. Also used to confirm the visit for worker mileage.
Formulaire HA-02 – Rapport d'exception
Audiologist's request or justification for a replacement or non-standard hearing aid outside the standing-offer device list.
Formulaire 33 – Détails de l'ordonnance
Pharmacy statement of prescriptions (DIN/PIN, drug, quantity, charges) dispensed for a claim, for direct payment or claimant reimbursement.
Formulaire de facturation pour l'anesthésie à l'intention des travailleurs blessés de Travail sécuritaire NB
Anaesthesiologist's billing form for anaesthesia on a WorkSafeNB claimant, including after-hours and BMI modifiers.
Compte du médecin pour consultations et actes médicaux
Physician invoice to WorkSafeNB for consultations and procedures on a claim.
Formulaire de facturation pour la chirurgie à l'intention des travailleurs blessés de Travail sécuritaire NB
Surgeon's billing form for surgery (primary surgeon, GP or specialist surgical assistant, collaborative surgery) on a WorkSafeNB claimant.
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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A physician or nurse practitioner, for both the first medical report of an accident or occupational disease and later progress visits. Page 1 goes to WorkSafeNB. Page 2 rates the patient as able or unable for each listed activity and goes to the patient for the employer. You need your WorkSafeNB payee number and office service code, and WorkSafeNB says the form is not compatible with Firefox.
Within 72 hours of the appointment, for both Medical Form 8-10 and Chiropractic Form 8-10. Send it through MyServices secure email once you have registered, by fax, by mail or in person. If you fax it, do not also mail the original. Chiropractors use their form for both the first report and progress reports.
Psychologists, social workers and counselling therapists send the Initial Psychology Assessment Report within 5 business days of the assessment, and do not start treatment until WorkSafeNB approves it. After that, the Mental Health Provider Report covers the initial report (within 5 business days of the first session), progress reports after each 8-week block, and the discharge report. Both are Word templates sent through MyServices.
Yes. Every WorkSafeNB form listed here has a French version, such as the Formulaire médical 8-10 and the Rapport d'évolution en physiothérapie. If a link on the French health care forms page fails, the French forms list has the working file for the hearing aid forms and the Rehabilitation Centre referral.