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WSIB CMHP Return to Work Recommendations (0204A)

When a return-to-work opportunity is identified for a worker in the WSIB's Community Mental Health Program, the psychologist summarizes recommendations on this two-page form. Unlike the clinical reports, it is written to be shared with the worker and their employer. The psychologist indicates return with full abilities or with restrictions, limitations or accommodations, lists up to five of them, and gives their expected duration.

Who completes it

The worker signs section A, authorizing the WSIB to give the employer this form about their functional abilities. The program psychologist completes section B and the recommendations, and signs on page 2.

Submitting and payment

How to submit it
Submit it online through WSIB online services at wsib.ca/submit, with any supporting documents, or by fax.
Who pays
The form carries its own billing fields: your WSIB provider ID, invoice number, date of visit and service code MHPRTW, plus HST registration and the ONHST code if HST applies.

Good to know

  • The form has no diagnosis or clinical history fields: it asks only for return-to-work recommendations, restrictions, limitations or accommodations, and how long they are expected to last.
  • Both the worker and the psychologist can sign electronically by ticking a box, which the form treats as a signature once the name and date are filled in.
  • The progress form (0203A) also asks for restrictions and accommodations, but this form is the version written to be shared with the worker and employer.
  • The WSIB says its mental health program of care, delivered from April 27, 2026, replaces the Community Mental Health Program; confirm which form applies first.

Get the official form

Download the current version from the source each time; forms change without notice.

Community Mental Health Program Return to Work Recommendations

Recommandations concernant le retour au travail

Official pagePDFVersion française

Fill it with Vero

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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How this list is checked

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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Frequently asked questions

Does the employer see the CMHP Return to Work Recommendations?

Yes, with the worker's consent. Section A has the worker sign to authorize the WSIB to provide their employer with this form about their functional abilities, and the form asks for a summary of recommendations that can be shared with the injured or ill person and their employer.

When should a psychologist complete WSIB Form 0204A?

The form says the psychologist should fill it out when the opportunity for return to work is identified. Choose return with full abilities or with restrictions, limitations or accommodations, list up to five recommendations, and state how long they are expected to last, then sign and submit it to the WSIB.

Is WSIB Form 0204A available in French?

Yes. The WSIB publishes a French version, Recommandations concernant le retour au travail (0204B), and the English form notes that it is available in French. The current PDF carries revision 0204A (04/19) and directs providers to wsib.ca/submit for the form and supporting documents.