Chiropractor's progress report.
- Completed by
- Chiropractor
- Issued by
- Yukon Workers' Safety and Compensation Board
- Format
- Language
- English
Yukon WSCB Chiropractor's First Report (F-0093)
Yukon chiropractors complete this report after first assessing a worker with a work-related injury, and it doubles as the request for treatment approval. It records the worker's account, objective data, diagnosis, any similar past injury, return-to-work factors and the recommended treatment, duration and frequency. WSCB returns it with its authorization: approved, not approved, claim denied or call to discuss.
Who completes it
The treating chiropractor completes and signs the assessment, return-to-work and treatment plan sections, attaching Appendix 1 if there are barriers to return to work. WSCB's claim owner completes the Chiropractic Treatment Authorization box.
Submitting and payment
- How to submit it
- Fax or mail it to WSCB using the contact details on the form within two days of first attending the worker, the reporting deadline section 113 of the Act sets for health care providers.
- Who pays
- WSCB may pay for the initial assessment, which may include the first treatment, before the claim is accepted, and approves later treatments and billing under the chiropractor's service agreement.
Good to know
- Workers can see a chiropractor without a referral, because WSCB policy 3.11 recognizes chiropractors as primary health care providers.
- Appendix 1 groups barriers as injury, pain, work or WSCB related, such as fear avoidance, catastrophizing, heavy job demands or a lack of suitable modified work.
- Ready-made devices such as shoe inserts may be reimbursed when within your scope of practice, but custom-made devices need WSCB's written authorization before purchase.
- Treatment beyond the initial approved set needs a written extension request with rationale; the Chiropractor progress report (F-0149) has a section for it.
Get the official form
Download the current version from the source each time; forms change without notice.
Chiropractor's first report and assessment
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.
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.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Frequently asked questions
Does a Yukon worker need a referral to see a chiropractor on a WSCB claim?
No. Policy 3.11 recognizes chiropractors as primary health care providers, so workers may seek chiropractic treatment without a referral from another medical practitioner. WSCB may pay for the initial assessment, which may include the first treatment, before the claim is accepted, when the chiropractor has a service agreement with the board.
What happens after I send the chiropractor's first report?
WSCB's claim owner completes the Chiropractic Treatment Authorization box on page 2, entering a proposed treatment end date and marking the plan approved, not approved, claim denied or call to discuss. Progress and extension requests then go on the Chiropractor progress report (F-0149), and the Chiropractor discharge report (F-0150) closes treatment.
When should I attach Appendix 1?
Whenever you answer yes to barriers to return to work. Appendix 1 groups them as injury related, such as advice of extended rest or deconditioning; pain related, such as fear avoidance or high medication intake; work related, such as heavy job demands; and WSCB related, such as poor attendance or compliance.