Registered massage therapists treating a WSCC claimant in the Northwest Territories or Nunavut record a course of treatment on this one-page form. It lists the number of treatments and their dates on a six-week calendar grid, the referring physician, the part of the body treated, and a description of the worker's response to therapy. The WSCC receives it as the therapist's report on the claim.
The treating massage therapist completes and signs the whole form, adding the claim number, client name and their own name and phone number. The worker and employer do not complete any part.
Download the current version from the source each time; forms change without notice.
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The treating massage therapist, who signs the form and prints their name and phone number. The form states that treating massage therapists must be registered with the Massage Therapists' Association in the province or territory where they practise, and it also records the name of the physician who referred the worker.
The claim number, the client's name, the number of treatments, each treatment date marked on a weekly calendar grid, the referring physician's name, the part of the body treated, and a description of the worker's response to therapy. It is a single page, completed and signed by the treating therapist.
No. WSCC asks providers to separate reports from invoices: the treatment form goes to the NWT or Nunavut claims department, and the invoice goes to Financial Services on the WSCC Medical Invoice form. Medical reports may be required as part of a complete invoice, and invoices must arrive within one year of the service.