F-0043Doctor's first report
Physician's first report: subjective/objective findings, diagnosis, treatment plan and follow-up.
- Completed by
- Physician
- Issued by
- Yukon Workers' Safety and Compensation Board
- Format
- Fillable PDF
- Language
- English
Yukon WSCB Massage Therapy Report (F-0125)
Massage therapists treating a Yukon worker with a work-related injury use this one-page report for the initial assessment and to request a treatment extension. It records the worker's complaints, objective findings, clinical impression, treatment goals and recommended duration and frequency. WSCB's claim owner completes the authorization box, approving or declining the plan, denying the claim or asking you to call.
Who completes it
The massage therapist completes and signs the assessment and treatment plan. WSCB's claim owner completes the Massage Treatment Authorization box, including a proposed treatment end date.
Submitting and payment
- How to submit it
- Fax or mail it to WSCB using the contact details on the form after assessing a referred worker, and again in writing when you request more treatment.
- Who pays
- WSCB covers therapeutic massage only from therapists who have signed an Agreement for Therapeutic Massage Services with it, up to the maximum number of treatments set in that agreement.
Good to know
- WSCB covers massage only on a referral from a medical practitioner, chiropractor or physiotherapist, and alongside other care such as physiotherapy.
- An extension needs a written request with rationale; WSCB may approve it when the referring provider's progress report or treatment plan identifies it as necessary.
- WSCB may end coverage when there is no evidence of improved function, guidelines such as the Medical Disability Advisor show no benefit, or no further improvement is expected.
- The form asks providers who have not signed a service agreement to contact WSCB before providing care.
Get the official form
Download the current version from the source each time; forms change without notice.
Massage Therapy Report
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.
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Frequently asked questions
Does massage therapy for a Yukon work injury need a referral?
Yes. Under policy 3.12, WSCB covers therapeutic massage when it follows a referral from a medical practitioner, chiropractor or physiotherapist, is provided alongside other care such as physiotherapy, and is delivered by a therapist who has signed a service agreement with WSCB or works for a signatory.
How many massage treatments does WSCB cover?
The maximum number is set in the therapist's service agreement, not on the form. For more, submit a written extension request with rationale, using the 'rationale for extension request' field on this report. WSCB may authorize it when the referring provider's progress report or treatment plan identifies it as necessary.
What does WSCB look for in massage treatment?
Policy 3.12 says WSCB may authorize massage that addresses acute injury-related needs, is provided in concert with other care, supports timely recovery and return of function, focuses on musculoskeletal function and helps the worker stay at or return to work. The report's treatment goals and recommended duration and frequency show this.