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WSIB Form 0298A: Medical Clearance for an FAE

Before a patient undergoes a WSIB functional abilities evaluation, the WSIB needs a physician's medical clearance, and this is the form it uses to get it. The form is not among the downloadable provider forms: the WSIB supplies it, you complete it and return it, and the WSIB pays a set report fee under code M648.

Who completes it

A physician completes the whole form, giving the medical clearance the WSIB needs before the functional abilities evaluation goes ahead.

Submitting and payment

How to submit it
Complete the copy the WSIB supplies and return it to the WSIB; the physician fee schedule notes that if you fax a report, you should not also send the original.
Who pays
Bill the WSIB directly under fee code M648, which the WSIB physician fee schedule lists in its physician reports table as medical clearance for a functional abilities evaluation.

Good to know

  • It is not the Functional Abilities Form (FAF, 2647A): the FAF is requested by the worker or employer, cannot be initiated by you, and is billed under its own code, FAF.
  • The physician reports section of the fee schedule notes that on a patient's initial visit only the Form 8 is paid, so a clearance completed that day is not paid separately.
  • Accounts the WSIB receives more than six months after the date of service may be reduced, although late billing penalties may be waived when a good reason for the delay is given.

Get the official form

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

Medical clearance for functional abilities evaluation (FAE)

Official page

Fill it with Vero

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.

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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

Where can I get WSIB form 0298A?

The WSIB does not post it with its downloadable health care provider forms. It supplies the form when it needs a physician's medical clearance before a functional abilities evaluation, and the form's name and number appear in the physician fee schedule under code M648. Complete the copy you receive and return it to the WSIB.

Do I need the patient's consent to return form 0298A?

The WSIB's reporting requirements page says section 37(1) of the Workplace Safety and Insurance Act requires health care practitioners to share the information the WSIB needs, and section 43(1)(h) of the Personal Health Information Protection Act allows a health information custodian to disclose health information to the WSIB without consent.

Is form 0298A the same as the WSIB Functional Abilities Form?

No. Form 0298A is the physician's medical clearance for a functional abilities evaluation and is billed under M648. The Functional Abilities Form (FAF, 2647A) is a separate form for planning an early and safe return to work; only the worker or employer can request it, and it is billed under code FAF.