Chiropractor's first report and assessment.
- Completed by
- Chiropractor
- Issued by
- Yukon Workers' Safety and Compensation Board
- Format
- Language
- English
Yukon WSCB Chiropractor Progress Report (F-0149)
Yukon chiropractors use this two-page report to update WSCB on a worker's progress and to request treatment beyond what was approved. It covers treatment dates, goals and progress, then the worker's critical job demands, the estimated percentage of current function at each and the accommodations that would keep them at work. WSCB answers in the authorization box with a proposed treatment end date.
Who completes it
The treating chiropractor completes and signs the report, attaching a Functional Abilities Form if function has changed significantly and Appendix 1 if there are barriers to return to work. WSCB's claim owner completes the treatment authorization box.
Submitting and payment
- How to submit it
- Fax or mail it to WSCB using the contact details on the form when you report progress or need treatment beyond the initial approved set.
- Who pays
- WSCB approves and pays chiropractic treatments as set out in the chiropractor's service agreement, and extensions beyond the initial approved set need its written approval.
Good to know
- An extension request needs your rationale, treatment frequency and focus, expected results and an end date, because policy 3.11 requires a written request with rationale.
- If function has improved and the extension ends within one month of the request, WSCB doesn't need to refer the worker to a medical practitioner before approving it.
- WSCB may end authorization when there is no objective evidence of improved function, guidelines show chiropractic care isn't useful, or no further improvement is reasonably expected.
- Attach a Functional Abilities Form (FAF) when the worker's functioning has changed significantly since the last report.
Get the official form
Download the current version from the source each time; forms change without notice.
Chiropractor progress 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
How do I ask Yukon WSCB for more chiropractic treatments?
Complete the further-treatment section of this progress report with your rationale, frequency, focus of treatment, expected results and end date. Policy 3.11 requires a written request with rationale for any extension beyond the initial approved treatments, and WSCB may consult the worker's physician, a specialist or its medical consultant before deciding.
What return-to-work information does F-0149 ask for?
Page 2 asks whether you have educated the worker about recovering while at work, the worker's current occupation, their critical job demands with an estimated percentage of current function at each task, and the modifications or accommodations that would let them remain at work. Barriers to return to work go on Appendix 1.
When does WSCB stop paying for chiropractic care?
Under policy 3.11, WSCB ends authorization when there is no objective evidence of improved functional abilities, evidence-based guidelines such as the Medical Disability Advisor show chiropractic care isn't useful, the focus has moved away from regaining function, no further improvement is reasonably expected, or the worker isn't mitigating their loss.