Health care forms

 Timely and complete reports help workers receive appropriate medical care when they need it. This is a legislative requirement and also a standard outlined in the agreements with the New Brunswick Medical Society (NBMS), New Brunswick Chiropractors Association (NBCA) and New Brunswick Private Practitioners of Physiotherapy (NBPPP). Physician, nurse practitioner and chiropractor reports are due within 72 hours of the injured worker’s appointment. 

 

Forms

Physicians and nurse practitioners     

Medical Form 8-10
Doctor's Account for Consultations and Procedures
Surgery Billing Form for WorkSafeNB Claimants
Anaesthesia Billing Form for WorkSafeNB Claimants
Referral Service Form WRC

Chiropractors Form 8C – Chiropractor’s First Report of Accident
Form 10C – Chiropractor’s Progress Report
Audiologists

Form HA-01 – Hearing Aid Fitting and Service Report
Form HA-02 – Exception Report
Audiometric Report

Physiotherapists Physiotherapy Progress Report
Psychologists

Psychology Initial Assessment Report
Psychology Progress Report
Psychology Discharge Report

Dentists

Estimate of Required Dental Services

Pharmacists

Form 33 – Claiment Prescription Information


 
New! Medical Form 8-10 

WorkSafeNB has recently combined its medical forms 8 and 10. The new form, developed in collaboration with NBMS, requires clarity on worker abilities. Evidence shows workplace connection is good for mental, physical and emotional health. Employers have a duty to accommodate reasonable restrictions and limitations. Even if a worker is able to work one hour per week, there are positive benefits. Use Medical Form 8-10 for both initial and progress visits.

See detailed instruction on completing Medical Form 8-10.

Please ensure forms are complete before submission. If you fax a form, do not mail it as well.

How to submit reports:

  • MyServices: Register for MyServices to access secure email.
  • Fax (toll-free): 1 888 629-4722 (If a report is faxed, please do not mail it as well.)
  • In person: You may deliver it to one of our five locations.
  • Mail: WorkSafeNB, 1 Portland St., P.O. Box 160, Saint John, N.B.  E2L 3X9

 

Physician inquiry line: 1 877 647-0777
Use this dedicated phone line for questions on medical forms and claims.

WorkSafeNB adheres to the Right to Information and Protection of Privacy Act and the Personal Health Information Privacy and Access Act. Learn more about our privacy and confidentiality requirements.

 

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