Follow the steps to complete the online form effortlessly.

1. Click ‘Get Form’ button to access the form and open it for editing.
2. Enter the date of service in the format yyyy-mm-dd, ensuring it matches the date on the invoice.
3. Complete the extension request summary by providing the initial assessment date, total number of treatment visits, duration of the extension request, average visits per week, number of visits requested, and the end date of the extension.
4. Indicate whether hydrotherapy services are being provided and if you are requesting a hydrotherapy extension; if yes, state the number of hydrotherapy visits requested.
5. Fill in the worker and claim information, including the worker's last name, first name, middle initial, WorkSafeBC claim number, areas of injury accepted on the claim, date of injury, and whether the worker is currently employed.
6. Provide detailed treatment information, including descriptions of treatments provided to date and whether the worker's condition has improved.
7. Explain significant subjective and clinical findings, along with recovery and return-to-work factors relevant to the worker's condition.
8. State the rationale for the extension request, including specifics for hydrotherapy if requested.
9. Document the status of critical job demands and assess the current functional ability in relation to those demands, providing relevant job match details.
10. Outline treatment goals and propose a treatment plan detailing type and progressions of treatment.
11. Indicate if the worker can perform regular or modified duties concurrently with physiotherapy treatment, and provide a date for any changes to duties.
12. Comment on available modified hours or duties, as well as expected treatment outcomes.
13. Complete provider information by entering the physical therapist’s name, clinic’s contact details, and other relevant information.
14. Save your changes, download a copy of the form, print it if needed, and ensure you upload or submit it as required.

Complete your Canada WorkSafeBC 83D219 form online today for a smoother processing experience.