Forms and guides

General/other

• Billing guide: reconciliation
  A guide to help contracted physiotherapists, chiropractors, psychologists, hospitals and their billing staff reconcile cheques and direct deposits.
• Contact list
  This guide summarizes WCB contacts—psychology, RSW and MSW providers.
  
• Direct deposit form - C894
  Please use this form to have payments for your services directly deposited into your bank account.
• Inpatient hospital account - C094
  For hospitals when invoicing WCB for in-patient services provided to an Alberta injured worker.
  
• Interpreter no show web form
  If a WCB-contracted interpreter does not attend a scheduled appointment, please submit this web form.
  
• Invoice correction - C845
  Use this form to request corrections on invoices where payments have been issued.
• Online administrator guide for myWCB online services
  Learn how to use WCB online services for online administrators.
• On-site health centre report - C709
  To be completed by on-site health care providers (except medical doctors) in the event of a work-related injury.
• Quote for medical equipment or services - C1051
  Complete this form to request WCB approval for an injured worker's medical equipment or services.

Acupuncturists

• Acupuncture reporting guide
  This guide summarizes treatment and reporting guidelines for acupuncture providers.
  
• Acupuncture first report - M007
  This assessment report summarizes the worker’s current functioning, limitations, barriers, acupuncture treatment regimen, and prognosis.
  
• Acupuncture progress/discharge report - M007A
  Use this report to summarize your worker’s progress or final findings when your worker is discharged from treatment.
  
• Acupuncture invoice - M007B
  Submit this invoice to bill for all authorized treatment completed to date.
  
• Become an authorized acupuncture provider
  Complete this form and provide the listed documents to become an authorized acupuncture provider.
  

Chiropractors

Authorized provider

• Chiropractor joining an authorized clinic
  Outlines the procedure for obtaining a WCB billing number for a new chiropractor joining an authorized clinic.
  
• Relocating a WCB-authorized chiropractic clinic
  This outlines the procedure and required documents for an authorized chiropractic clinic that is moving to a new location.
• Transfer in ownership of an authorized chiropractic clinic
  This guide outlines the procedure and required documents for a chiropractic clinic that is changing ownership and wishes to continue to provide service under the existing WCB contract.
  
• Treatment authorization (electronic injury reporting)
  This document discusses electronic treatment authorization for initial assessments.
  
• Chiropractic Fees & Sundry List
  Here's a list of chiropractic fees and sundry items found in the chiropractic contract. This list contains all fees and service codes.
  

Non-authorized provider

• Become an authorized chiropractor provider
  This guide provides the details and mandatory documents required to become an authorized chiropractic provider.
  
• Chiro first report - C056
  This assessment report summarizes your worker's current functioning, limitations, barriers, acupuncture treatment regimen, and prognosis.
  
• Chiro progress/discharge report - C352
  Use this report to summarize your worker’s progress or final findings when your worker is discharged from treatment.
  
• Chiro additional treatment invoice - C552
  Please submit this invoice to bill WCB for authorized treatment and sundry items provided to date.
  
• Chiro invoice correction - C570H
  Use this form to modify an invoice previously submitted with incorrect services, and/or fees.
• 1-2-3 poster for chiropractors
  Steps to reporting a workplace injury to WCB.
  

Dentists

Note: WCB-Alberta has adopted the current Alberta Blue Cross (ABC) dental fee guide for generalists and specialists. Please contact ABC for a copy of it.

WCB-Alberta reimburses dental rates according to this schedule, which outlines rates for different disciplines within the dental industry. When specialist rates are applied, they’re paid at the maximum rate indicated by the ABC fee guide.

• 2022 Blue Cross dental fee guide
  Fee guide used by dental practitioners for treatment authorization and billing purposes.
• 2021 Blue Cross dental fee guide
  Previous year's fee guide for comparison purposes.
  
• Dental report - C055/C887
  Use this report to summarize your worker’s injury, proposed treatment regimen and prognosis. It can also be used to summarize final findings when your worker is discharged from treatment.
  
• Dental guide - C616
  Summarizes treatment authorization and reporting guidelines for dental providers.
  
• TMJ bundled services
  Summarizes the 14799 billing code for TMJ bunded services.
  

Denturists

Note: WCB pays denturist fees at 90 per cent of the rates set out by the Denturist Association of Alberta (DAA). For information on these rates, please contact DAA.

• Denturist guide - C617
  Summarizes treatment authorization and reporting guidelines for denturist providers.
  
• Denturist report - C884
  Use this report to summarize your worker’s injury, proposed treatment regimen and prognosis. It can also be used to summarize final findings when your worker is discharged from treatment.
  

ESL (English as a second language) providers

• ESL student attendance report - C1153
  Use this report to document your worker's attendance.
• ESL bi-monthly progress update - C1154
  Provide an update on your worker's progress using this report.
• ESL six-month point formal assessment - C1155
  After six months, use this form to document a formal assessment on your worker's progress.

Hearing aid practitioners/audiologists

• Hearing aid purchase agreement - C1042
  This is a consent form to ensure your worker is aware of the hearing aid purchase agreement.
  
• Hearing loss assessment - C662
  Assessment for pure tone & speech audiometry, background information, results and recommendations.
  
• Hearing loss authorization - C972
  Use this form when your clinic needs to request further treatment or sundry items.
  
• Hearing loss invoice correction - C1266
  Use this form to correct any billing errors for one specific date of service. Please submit a separate form for each date of service being corrected.
  
• Hearing loss - hearing aid replacement information - C1265
  This form is completed for a hearing aid replacement if the hearing aid is less than five years old.
  
• Hearing loss - hearing aid replacement information - C1265B
  Please use this form for hearing aid replacement if the hearing aid is more than five years old.
  
• Hearing aid invoice - C659
  Submit this form to invoice hearing devices and other incidentals provided with the hearing aid. This form can also be submitted for cost sharing purposes if your worker wants a more expensive device and will pay the difference.
  
• Hearing aid repairs invoice - C659B
  Submit this form to invoice for any repairs, maintenance, incidental items as well as batteries.
  
• Travel reimbursement - C660
  If your worker has to pick up hearing devices from out of town, this form can be submitted to reimburse for the mileage travelled.
  

Home health care providers

• Home health care authorization - C727
  Form to request authorization from WCB to provide home health services.
• Home health assessment report - C642
  Submit this assessment report to WCB outlining your patient's home health care needs.
  
• Home health supply form - C726
  Submit this form to be reimbursed for the purchase of home health care supplies.
• Home health monthly status report - C643 and C643E
  Use this report to provide a monthly update of your patient's status. This report can also be used to indicate more services are needed.
• Home health homemaking plan - C728
  This form will help you determine the homemaking support services your patient's needs.
  
• Home health personal care plan - C729
  This form will help you determine the personal care plan for your patient.
• Home health invoice - C641
  Invoice for billing services to WCB.
• Home health monthly summary - C1304
  This form needs to be attached to your invoice (C641) with travel time details and hours of service.
  
• Home health invoice correction - C1303
  Use this form to correct any billing errors for one specific date of service. Please submit a separate for for each date of service being corrected.
  
• Home health incident report - C921
  Report any safety incidents with your patient's using this form.
• Home health consent form
  For your WCB client to provide consent for home health services.
• Home health responsibilities form
  Use this form for each initial client assessment, when issue(s) arise and annually.
• Home health non-authorized provider invoice cover sheet - C776
  This cover sheet is for non-contracted providers to include when submitting your invoice.

Master level social workers

• Consent form for psychological counselling - HC-862
  For your WCB client to provide consent for psychological counselling treatment.
• Master level social worker counselling services invoice - C1388
  Use this form to bill WCB for psychology counselling services performed by a master level social worker.
• Psychology worker satisfaction survey - HC-428
  This survey is for WCB clients to provide feedback to help improve WCB services.

Nurse practitioners

• Nurse Practitioners Fee Guide
  This is an overview of WCB's fee guide for nurse practitioners.
• Nurse practitioner medication management report - C914N
  In cases where opioid medication is prescribed, this form must be completed each time a nurse practitioner has an appointment with an injured worker.

Occupational Injury Service (OIS)

Our OIS resources page has all the forms and materials you need for your OIS clinic.

Occupational therapists

Accident profiles

• Pre- and post-accident profile contract reference guide - HC-397
  This guide provides information to help you complete the forms below.
• Pre- and post-accident profile report - C977
  Following a brain injury, this form is used to investigate and compare any differences in your worker's behaviour and functioning before and after the accident.
• Pre- and post-accident profile consent - HC-693
  Consent form for a worker to provide permission for relevant background research needed for WCB to make decisions on a claim involving an accident.

Ergonomics

• Ergonomic assessment contract reference guide - HC-773
  This guide provides information to help you complete the reports below.
• OT Ergonomic Assessment - C1162
  Assessment of a position or work station to identify possible improvements to minimize the risk of injury.

Exposure therapy and cognitive therapy

• Cognitive therapy master form contract reference guide - HC777
  This guide provides information to help you complete the reports below.
• Cognitive therapy initial, progress, and discharge assessment master form - C1417,C1418,C1419
  This master form will help you outline your cognitive therapy treatment plan, provide an update on how therapy is progressing, or summarize the final treatment results.
• Exposure therapy contract reference guide - HC-774
  This guide gives you the information you need to complete the below forms.
• OT exposure therapy master form - C1164/1165/1166
  This master form will help you outline your exposure treatment plan, provide an update on how exposure therapy is progressing, or summarize the final treatment results.

General assessments

• OT general assessment report - C1260
  Use this report if you have been requested to complete a special occupational therapy assessment which is not one of the outlined assessments in this contract.
• Occupational therapy assessment contract reference guide - HC-404
  This reference guide summarizes guidelines for an occupational therapy assessment.
• Occupational therapy re-assessment contract reference guide - HC-861
  This reference guide summarizes guidelines for re-assessments.
• Occupational therapy re-assessment form - C1313
  General occupational therapy reassessment form that can be used to complete assessments that don't have a designed report.

Hand therapy

• Hand therapy contract reference guide - HC-775
  This guide provides information to help you complete the forms below.
• Hand therapy initial assessment report - C1167
  Initial form to determine subjective and objective findings for your worker, and to create goals and timeframes for treatment.
• Hand therapy mid-term report - C1168
  Mid-point treatment report to identify any changes to the findings and goals.
• Hand therapy discharge report - C1169
  When discharging your worker, use this form to summarize final findings.
• Hospital hand clinic assessment report - C829
  Use this assessment report for the initial consultation. This report includes measures and recommendations.
• Hospital hand clinic progress/discharge status report - C830/831
  Use this report to add any new measures and recommendations.

Home maintenance, home modification & housekeeping

• OT HKA, HMA and HKA/HMA contract reference guide - HC-825
  This is a contract reference guide for the OT house keeping allowance, home maintenance allowance, and combined house keeping allowance with home maintenance allowance master form.
• OT home maintenance allowance initial assessment, housekeeping allowance initial assessment, housekeeping and home maintenance initial assessment master form -C1174,C1172,C1259
  Use this master form to determine the worker’s independence level for housekeeping and home maintenance. Clearly outline which activities they are independent in and those in which they are dependent on others.
• OT home modifications assessment contract reference guide - HC-780
  Use this guide to help you complete the OT home modifications assessment.
• OT home modifications assessment - C1178
  Use this assessment if there are potential barriers to your worker's independence resulting from the work-related injury and identify any recommendations.

Hospitals

• Hospital occupational therapy assessment/discharge/progress report - C826/827/828
  Use this report as follows by checking of the appropriate box: for the initial consultation (C826), to add any new measure or recommendations (C827), or report progress or discharge (C828).
• Outpatient hospital account - C012
  This form would be used by hospitals, auxiliary hospitals, out-of-province hospitals when invoicing WCB for outpatient services that they have provided to our injured workers of Alberta.
  

Incident report

• OT incident report - C1444
  Use this form to report an incident with the worker.

Invoices

• OT invoice contract reference guide - HC-782
  This guide provides information to help you complete the invoice form below.
• OT invoice with legend - C950
  Use this form to bill WCB for your services.

Personal care & home equipment

• OT PCA, HEA and PCA/HEA contract reference guide - HC-403
  This is a contract reference guide for the OT personal care allowance, home equipment assessment, and personal care allowance/home equipment assessment master form.
• OT personal care initial assessment, home equipment initial assessment, personal care and home equipment initial assessment master form - C589,C1176,C1258
  Use this form only when the referral is for a personal care and/or home equipment assessment. This assessment helps to determine your worker’s functional ability, personal care and adaptive-equipment needs relative to his or her injury.

Seating/pressure assessments

• OT seating/pressure mapping assessment contract reference guide - HC-781
  This guide provides information to help you complete the seating and pressure mapping assessment report.
• OT seating/pressure mapping assessment - C1180
  Use this assessment to determine your worker's seating needs, which may include the need for pressure relief and/or positioning.

Splinting

• Splinting assessment contract reference guide - HC-776
  Find information on how to complete the forms below.
• Splinting initial assessment report - C1170
  If splinting is recommended, use this form to report.

Vehicle modifications

• OT new vehicle modification assessment contract reference guide - HC-172
  This guide provides information to help you complete the form below.
  
• OT new vehicle modification initial assessment - C822
  Use this from to assess any vehicle modifications needed for your worker to travel independently.
  

Wheelchairs

• OT mobility aid assessment reference guide - HC-109
  Use this guide to help you complete the forms below.
• OT mobility aid initial assessment - C960
  This report is used to determine your worker’s manual or power wheelchair needs.

Pharmacists

• Opioid alert
  Notification to all Alberta pharmacies outlining WCB’s position on opioid analgesics/narcotics.
  
• Pharmacy prescription invoice - C774
  Use this form to bill WCB for work injury-related prescriptions.

Physicians

• Disclosing personal health info to WCB-Alberta
  The Workers' Compensation Act authorizes the Workers' Compensation Board to collect an injured worker’s personal health information.
• Physician’s billing guide: reconciliation
  A guide to help physicians and their billing staff reconcile cheques and direct deposits.
• Physicians guide to authorizing cannabinoids for medical purposes
  Refer to the guide when considering prescribing pharmaceutical cannabinoids or authorizing medical cannabis to injured workers.
• Physician's reference guide
  Detailed information on injury reporting, the claims process, and a complete fee schedule for medical services.
• WCB full-time emergency physician practice confirmation - HC-417
  For physicians who spend over 80 per cent of their clinical time practicing or working on site in an emergency department.
  
• WCB requested supplementary reports billing guide
  Guide for completing the C568 Medical Care Invoice (available in Electronic Injury Reporting).
• WCB billing number - C724
  For physicians, nurse practitioners or clinics who are newly treating injured workers and require a billing number.
  

Diagnostic

• Diagnostic and Treatment Consultation referral form - DTC
  To help with the diagnosis of a work-related injury; patient referral form for expedited orthopedic consultation.
• Diagnostic providers
  Contact information for diagnostic providers.
• Authorized WCB referral source/agents
  Reference guide of authorized referral sources for diagnostic testing.

Opioid management

• Opioid (narcotics) treatment agreement - C913
  This form is required to consider payment for opioids beyond 12 weeks post injury/surgery.
• Opioid risk assessment checklist - C942
  This form is used to assess the patient's risk for opioid misuse or addiction. It must be completed by the physician if they are prescribing opioids to a WCB injured worker.
• Medication management report - C914
  This paper report should only be completed by out-of-province physicians and Alberta specialists when seeing a WCB-AB injured worker for whom they have prescribed opioids for treatment of non-cancer pain.
• Messages for patients taking opioids
  Information about opioid use and its effects.
• Canadian opioid guideline
  Link to the National Pain Centre for the Canadian guideline.
  
• Opioid (narcotics) policy
  WCB's policy on prescribing opioids (Policy 04-06).
• MD scope article
  Article covering OxyNeo replacing generic OxyContin.
  

Physiotherapists

Authorized provider

• 1-2-3 poster for physiotherapists
  Steps to reporting a workplace injury to WCB.
• Hospital hand clinic assessment report - C829
  Use this assessment report for the initial consultation. This report includes measures and recommendations.
• Hospital hand clinic progress/discharge status report - C830/831
  Use this report to add any new measures and recommendations.
• Hospital physiotherapy assessment report - C823
  A report used when a physiotherapy assessment is completed in a hospital setting.
• Hospital physiotherapy status/discharge report - C824/825
  A report used when physiotherapy treatment is completed in a hospital setting.
• On-site physiotherapy decision tree
  Use this guide to help determine when an injury should be reported to WCB.
• Outpatient hospital account - C012
  This form would be used by hospitals, auxiliary hospitals, out-of-province hospitals when invoicing WCB for outpatient services that they have provided to our injured workers of Alberta.
  
• Physiotherapy invoice reference guide
  Use this guide if you have billing questions regarding physiotherapy services.
• Physiotherapy sundry list with service codes
  A list of all contracted sundry items, including their service codes and prices.
• Physiotherapy sundry item request - HC948
  Use this form to request unlisted sundry items.
• Reference guide to understanding your contract
  This guide outlines WCB's expectations of physiotherapy providers.
  
• Transfer in ownership of an authorized physiotherapy clinic
  If your clinic changes ownership, this guide outlines the necessary steps to follow.
  
• Treatment authorization (electronic injury reporting)
  This document discusses electronic treatment authorization for initial assessments.
  
• Relocating a WCB-authorized physiotherapy clinic
  This outlines the procedure and required documents for an authorized physiotherapy clinic that is moving to a new location.
  

Non-authorized provider

• Become an authorized physiotherapy provider
  This guide provides the details and mandatory documents required to become an authorized physiotherapy provider.
• Disclosure of medical information to WCB-Alberta
  This guide will assist with understanding your requirements when reporting to WCB.
• Information package for non-contracted provider
  Use this information on treating injured Alberta workers.
• Physiotherapy services first report - C533
  Outline details of the initial physiotherapy treatment using this form.
• Physiotherapy services abbreviated progress report - C534
  A report for progress and discharge.
• Physiotherapy services comprehensive progress/discharge report - C534
  Use this report to provide a treatment update or to provide a summary when treatment has ended.
• Physiotherapy services invoice – C019
  Bill WCB for your services with this invoice.
  
• Physiotherapy services invoice correction - C570T
  Modify previous bills submitted to the WCB using this invoice.

Prosthetic and orthotic providers

• Prosthetic and orthotic authorized providers
  A list of all current WCB authorized providers.
• Prosthetic and orthotic fee guide
  The fee schedule for authorized prosthetic and orthotic items and services.
  
• Prosthetic and orthotic - fee guide addition/deletion form - HC-302
  Use this form to request additions and/or deletions to the authorized list of prosthetic and orthotic items.
• Prosthetic and orthotic service info and/or authorization request - C998
  Use this form to request authorization or provide service information for prosthetic and orthotic services.
• Prosthetic and orthotic services invoice - C537
  Use this invoice to bill WCB for your services.
• Prosthetic and orthotic services invoice correction - C1270
  Use this form to correct any billing errors for one specific date of service. Please submit a separate form for each date of service being corrected.
  
• Prosthetic and orthotic services status/follow-up report - C999
  Use this report to outline the details of a prosthetic and orthotic visit.
• Prosthetic and orthotic services unlisted device/service calculations worksheet - C537A
  Use this form to calculate and request payment for an unspecified price item (e.g. unlisted device).
• Prosthetist assessment – microprocessor knee or upper extremity myoelectric device - C989
  Use this form to assess the need for a microprocessor knee prosthetist.
• Prosthetist fitting summary – microprocessor or myoelectric device - C991
  Outline the details of a microprocessor knee prosthetist fitting using this form.
• Client notice – foot orthotics
  This guide outlines mold-retention requirements for foot orthosis.
  

Psychologists and social workers

Electronic reporting is now available for WCB-contracted psychology providers.

• Sign up for your myWCB online account.
• See the psychology electronic injury reporting guide if you already have an account but need help submitting your online psychology reports.
• Use the billing guide: reconciliation if you need help with invoices, cheques and direct deposits.

Interested in becoming a WCB-contracted provider? Email hcs.psychology@wcb.ab.ca for assistance.

• Psychology initial counselling contract reference guide - C851CRG
  Use this guide to help you fill in the psychological counselling initial report (C851).
• Psychology progress counselling contract reference guide - C852CRG
  Use this guide to help you fill in the psychological counselling progress report (C852).
• Psychology discharge counselling contract reference guide - C853CRG
  Use this guide to help you fill in the psychological counselling discharge report (C853).
• HC-965 Psychology services
  This is a family member counselling authorization and consent form.
• Consent form for psychological assessment
  For your WCB client to provide consent for psychological or neuropsychological assessment services.
• Consent form for psychological counselling
  For your WCB client to provide consent for psychological counselling treatment.
• Psychology initial counselling report - C851
  Provide background and information that may be relevant to the WCB client's psychological adjustment.
• Psychology progress counselling report - C852
  Report on the status of treatment goals and note any barriers to attaining these goals.
• Psychology discharge counselling report - C853
  Provide a treatment summary and comment on the status of treatment goals and any presenting problems.
• Psychology Services Assessment Report Coversheet
  Use this form as a cover sheet to submit your psychology assessment reports.
• Psychology assessment invoice - C1228
  Use this form to bill WCB for a psychological assessment.
• Neuropsychology Services Assessment Report Coversheet
  Use this form as a cover sheet to submit your neuropsychology assessment reports.
• Neuropsychology assessment invoice - C1226
  Use this form to bill WCB for a neuropsychological assessment.
• Psychology counselling services invoice - C1227
  Use this form to bill WCB for psychology counselling services.
• Psychology invoice correction - C1229
  Use this form to make a correction on a psychology invoice .
• Psychology Services TPI Screen Report - C1017B
  Report results of Traumatic Psychological Injury (TPI) screen.
• Psychology worker satisfaction survey - HC428
  This survey is for WCB clients to provide feedback to help improve WCB services.
• Psychology treatment extension request - C1147
  To be completed each time further treatment is needed.
• Mental Health First Report - C1392
  This report outlines the information needed when a worker reports a work-related mental health condition.
• Guide to the Mental Health First Report
  This guide outlines your responsibilities when reporting mental health injuries.
• Psychology electronic injury reporting (PEIR) FAQ
  Learn about the benefits of using electronic reporting with frequently asked questions.
• Psychology electronic injury reporting (PEIR) guide
  Use this guide to help you fill out online psychological injury forms.

Family or joint counselling

• Worker/Joint family counselling report - C1415
  Please use this form for initial, progress and discharge updates for counselling attended with the worker and family member together.
  
• Family joint counselling services extension request - C1416
  Please use this form to request treatment extensions for worker joint and individual family member counselling. Please review the report form for submission guidance.

Return-to-work providers

• 2021-2025 return-to-work contract information.
  - All services
  - Assessment services
  - Brain injury
  - Complex services
  - Fees and sundry - Return to work
  - Fees and sundry - Re-employment services
  - Provider-site based, work-site based, hybrid programs
  - Traumatic psychological injury program
  - Cumulative psychological injury program
  - Re-employment services
  - Post-COVID rehabilitation program
  

Translators and interpreters

• Interpretation & translation services summary - C780
  Use this form to document the total number of hours used for your services and extra costs associated with mileage, meals, and parking.
• Interpretation & translation services invoice - C778
  Use this form to bill WCB for your services and expense reimbursement (for costs associated with mileage, meals, parking).
• Interpretation & translation services invoice correction - C1282
  Use this form to correct any billing errors for one specific date of service. Please submit a separate form for each date of service being corrected.
• Interpretation & translation services printed material translation - C1206
  Use this form to submit translated text to WCB.