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WSIB Initial Bundle Outcome Report (10702A)

At the end of the 30 to 90-day trial in a patient's first year of WSIB hearing services, this four-page report confirms the final hearing aid selected and the services delivered. It also holds the patient's 15-item questionnaire on using the aids. The WSIB allows the initial bundle only once it receives this report, which is not valid if completed before the trial ends.

Who completes it

The hearing health care provider who did the initial assessment completes it with the patient, covering barriers to use, services provided and the final device. The patient completes Section F on how they use the aids and the Section G questionnaire, and signs the Section I declaration in person.

Submitting and payment

How to submit it
Log in at wsib.ca/submit and submit the report after the 30 to 90-day trial period ends; a report completed too early is not considered valid.
Who pays
Bill the report under BSHORCOS with the trial end date as the service date, and the initial bundle (BSHAINIL/BSHAINIR for audiologists, BSHHINIL/BSHHINIR for hearing instrument specialists) with the trial start date as the service date.

Good to know

  • Section D lists services to tick, from audiometric testing (if not done in the past six months) and cerumen management to verification by real ear measurements, a copy of which you keep on file.
  • Record barriers to hearing aid use (health, social, cognitive or other), and give the date if the patient did not return or self-discharged from the program.
  • The WSIB processes payment only after it receives both the completed report and the associated bill, and supporting documents include the manufacturer's invoice after dispensing.
  • Bills go through the TELUS Health Provider Portal within five business days of the service, and the same provider who did the initial assessment must complete this report.

Get the official form

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

Hearing services initial bundle outcome report

Forfait de services auditifs initiaux – Rapport des résultats

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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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

When is the WSIB initial bundle outcome report due?

After the hearing aid trial ends, which is a minimum of 30 and a maximum of 90 days after fitting. The fee schedule says a report completed too early is not valid, and the initial bundle is allowed only once the WSIB receives this report, so submit it once the patient has made a final selection.

Which service dates do I use when billing the initial bundle?

The form's billing note says to bill the initial bundle with the date the patient started the hearing aid trial as the service date, and to bill the outcome report (BSHORCOS) with the date the trial ended. The initial bundle is paid when the trial is complete and the report has been received.

What does the patient complete on Form 10702A?

Section F covers where they wear their aids, which phones they connect to, hearing protection devices and who supports them. Section G is a 15-item questionnaire scored from 5 (strongly agree) to 1 (strongly disagree). The patient then signs Section I in person, confirming they received the services and are satisfied.