Get Wsib Extension Request

The Wsib Extension Request form is essential for users seeking to extend their physiotherapy treatment coverage beyond the initial twelve weeks. This guide provides a step-by-step instruction to accurately complete the form online, ensuring all necessary information is submitted efficiently.

Follow the steps to complete the Wsib Extension Request form online.

1. Press the ‘Get Form’ button to access the Wsib Extension Request form and open it in your preferred digital editor.
2. Carefully enter the patient’s information, including their last name, first name, address, city, postal code, and telephone number. Ensure that all details are accurate.
3. Provide the date of birth in the specified format (dd/mmm/yyyy) along with the date of the worker's first treatment.
4. Indicate the patient’s sex by marking 'M' for male or 'F' for female.
5. In the assessment section, input the date on which the report is based.
6. Fill in the working diagnosis and specify if there has been any change from the initial diagnosis. If there is a new diagnosis, detail it in the designated area.
7. Summarize the treatment provided to date in the case summary section, and note if the worker has lost time due to the accident.
8. Indicate whether the worker has returned to regular or modified work, and include their present status.
9. Outline the expected outcomes with additional treatments and current symptoms based on examination findings.
10. Document any current functional limitations, expected improvements, and factors that may be delaying recovery.
11. Specify the duration of treatment required by entering the start and end date along with the estimated frequency of further treatment.
12. Indicate whether a multi-disciplinary health care assessment would be beneficial for the worker.
13. Fill in the physiotherapist's information, including their name, clinic name, address, and telephone number. Sign and date the form either digitally or print it out for signing.
14. Once you have completed all sections of the form, review the information for accuracy, and then save your changes, download, print, or share the completed form as necessary.

Complete your Wsib Extension Request online for a smoother submission process.