This two-page report closes a course of psychological treatment on a WorkSafeNB claim. It records total treatments and missed appointments, the rehabilitation goal, the discharge disposition, a summary of treatment with psychometric test and re-test results, final progress toward treatment objectives, and the worker's return-to-work status with the clinician's recommendations.
The treating psychologist or therapist completes and signs it, naming the case manager. The worker does not complete any part.
Download the current version from the source each time; forms change without notice.
Psychology Discharge Report
Service psychologique – Résumé de dossier
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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It remains in WorkSafeNB's general forms list, dated March 20, 2016, but is not on the current health care forms page. That page lists the Mental Health Provider Report, which includes a discharge option due within 5 business days of the final appointment, and the SUCCEED Discharge Report.
The form states that the report is due within 14 days of discharge. It asks for the date of the final appointment and the report date, and it should be forwarded to WorkSafeNB by fax or mail with the claim number on both pages.