Physiotherapists and occupational therapists treating WSCC claimants in the Northwest Territories or Nunavut close out a course of therapy with this one-page report. It logs treatment dates week by week, the type of treatment given, goals achieved in percentage or degrees, goals not met and why, and whether the worker has returned to work. A discharge summary and final assessment findings complete the record for the claim.
The treating physiotherapist or occupational therapist completes and signs the whole report, with the clinic name and WSCC claim number. The worker and employer do not complete any part.
Download the current version from the source each time; forms change without notice.
Physiotherapy/Occupational Therapy – Discharge Report
Physiothérapie / Ergothérapie Rapport de congé
If your copy of the form is a fillable PDF, upload it 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.
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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Send it when you discharge a WSCC claimant from physiotherapy or occupational therapy. The Acts excerpt printed on the form says a health care provider's report must reach the Commission within three days after the examination or treatment, so send it promptly after the final visit to the NWT or Nunavut claims department.
Record goals achieved, as a percentage or in degrees, goals not met and the reason they were not met at discharge. Then answer whether the worker is missing time from work, has returned to work, and is working modified or part-time, before writing the discharge summary and final assessment findings.
Yes. WSCC publishes it in English and in French as Physiothérapie / Ergothérapie Rapport de congé, and the English form notes that a French version is available. Both are print-and-complete PDFs, and the same form serves workers in the Northwest Territories and Nunavut.