Chiropractor's first report and assessment.
- Completed by
- Chiropractor
- Issued by
- Yukon Workers' Safety and Compensation Board
- Format
- Language
- English
Yukon WSCB Chiropractor Discharge Report (F-0150)
Yukon chiropractors complete this two-page report when they discharge a worker from treatment for a work-related injury. It records the worker's critical job demands and estimated percentage of function at each, recommended accommodations and any exercise or maintenance program. Discharge recommendations cover whether modified duties are possible, estimated work capacity from sedentary to very heavy, and remaining restrictions with their expected duration.
Who completes it
The treating chiropractor completes and signs the whole report, attaching a Functional Abilities Form if the worker's functioning has changed significantly and Appendix 1 if barriers to return to work remain.
Submitting and payment
- How to submit it
- Fax or mail it to WSCB using the contact details printed on the form when chiropractic treatment ends.
- Who pays
- WSCB pays chiropractors on the terms and fees in the service agreement each must sign with the board before treating injured workers.
Good to know
- Work capacity is rated by maximum lift: sedentary up to 10 lb, light 20 lb, medium 50 lb, heavy 100 lb, and very heavy over 100 lb.
- Describe any exercise or maintenance program you recommend at discharge; policy 3.11 counts a self-directed exercise plan, including stretching, as part of appropriate treatment.
- Unlike the first report (F-0093) and the progress report (F-0149), the discharge report has no WSCB treatment authorization box.
- WSCB also expects health care providers to report when an injured worker is able to return to work.
Get the official form
Download the current version from the source each time; forms change without notice.
Chiropractor discharge 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
When do I send the Yukon chiropractor discharge report?
When you discharge the worker from chiropractic treatment. It closes the episode of care that began with the Chiropractor's first report and assessment (F-0093) and continued through any progress reports (F-0149). Yukon WSCB also expects health care providers to report when a worker is able to return to work.
How is work capacity rated on F-0150?
Tick one estimated work capacity: sedentary (maximum 10 lb), light (maximum 20 lb), medium (maximum 50 lb), heavy (maximum 100 lb) or very heavy (over 100 lb). The form also asks whether modified duties can be performed, what work restrictions apply, and how long those restrictions are expected to last.
Do I need a functional abilities form at discharge?
Only if the worker's functioning has changed significantly since your last report; in that case attach a Functional Abilities Form (FAF). If barriers to returning to work remain, complete and attach Appendix 1, which groups them as injury, pain, work or WSCB related.