Physiotherapist's initial assessment, treatment plan and goals.
- Completed by
- Physiotherapist
- Issued by
- Yukon Workers' Safety and Compensation Board
- Format
- Fillable PDF
- Language
- English
Yukon WSCB Physiotherapy Extension/Discharge (F-0203)
Yukon physiotherapists use this five-page report either to request more treatment for an injured worker or to report discharge. It tracks objective findings from the initial assessment through each extension request to discharge, alongside treatment dates, missed appointments and overall functional progress. Extension requests add goals, rationale, visits per week, duration and an estimated discharge date, and WSCB answers on the last page.
Who completes it
The treating physiotherapist completes and signs pages 1 to 4, ticking extension request or discharge report at the top. WSCB's case manager completes page 5, the extension authorization, and returns it to the provider.
Submitting and payment
- How to submit it
- Fax or mail it to WSCB using the contact details on the form when you need treatment beyond what was approved, or at discharge; WSCB's reply on page 5 sets the next reporting date.
- Who pays
- WSCB pays physiotherapy under the Physiotherapy Services Agreement and funds treatment beyond the initial approval only once it authorizes the extension.
Good to know
- For a discharge report, skip the treatment plan section and go straight to return to work, then record discharge instructions such as a home exercise program.
- With every extension request, explain any delay in recovery and give an estimated discharge date.
- If function has improved and the extension has a defined end date within one month, policy 3.10 says WSCB needn't refer the worker to a physician first.
- WSCB may stop funding when an independent exercise program would suffice and the worker can safely do it alone, or when no further improvement is expected.
Get the official form
Download the current version from the source each time; forms change without notice.
Physiotherapy Extension and Discharge Report
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.
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 request more physiotherapy from Yukon WSCB?
Tick 'Extension request' and complete the treatment plan: goals and methodology, progress toward each goal, the rationale for further treatment, visits per week and duration, any delay in recovery and an estimated discharge date. Policy 3.10 requires a written request with rationale, and WSCB answers on page 5 with its authorization and next reporting date.
Is there a separate Yukon physiotherapy discharge report?
This report covers both purposes. Tick 'Discharge report' at the top, skip the treatment plan, and complete the return-to-work section and discharge instructions, such as a home exercise program. The objective findings table has a discharge-date column, so results can be compared with the initial assessment and earlier extension requests.
What return-to-work details does F-0203 ask for?
List up to four critical job demands with the worker's estimated percentage of current function at each, then any ongoing accommodation: workstation analysis, modified hours, modified duties, gradual return to work or other. Tick any barriers, such as hesitancy to return, fear of movement, lack of modified work or the worker not engaging in treatment.